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Jidong DE, Ike TJ, Murshed M, Nyam PP, Husain N, Jidong JE, Pwajok JY, Francis C, Mwankon SB, Okoli E. Interventions for Self-Harm and Suicidal Ideation in Africa: A Systematic Review. Arch Suicide Res 2024:1-25. [PMID: 38506246 DOI: 10.1080/13811118.2024.2316168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Self-harm and suicidal ideation are increasing public health concerns globally and are paramount in Africa. Therefore, a review of suicidal ideation and self-harm interventions would be beneficial in identifying culturally appropriate interventions for the African context. METHOD The Population, phenomenon of Interest and Context (PICo) model was adopted to formulate the review strategy. Thus, the Population (Africans), phenomenon of Interest (intervention) and Context (self-harm and suicidal ideation). We used this PICo strategy which is a modified version of PICO for qualitative studies. Framework with Boolean operators (AND/OR/NOT) was further used to ensure rigor through search terms such as ("Suicide" OR "suicidal ideation") AND ("Intervention" OR "Treatment" OR "Therapy" OR "Psychological" OR "Psychosocial" OR "Culturally adapted") AND "Africa" OR "African countries." Six databases were searched (Embase, PsycINFO, ProQuest Central, Cochrane Controlled Trials Register, Medline, and Web of Science) for published articles between 2000 and March 2023. N = 12 studies met the inclusion criteria, and the relevant data extracted were synthesized and thematically analyzed. The review protocol was pre-registered on the PROSPERO Registry (no. CRD42021283795). RESULTS N = 12 studies met the inclusion criteria, and the following themes emerged from the synthesized literature and analyses of current African approaches to curbing self-harm and suicidal ideation: (a) Western medical and compassion-focused intervention (b) the helpful role of traditional healing and healers (c) psychoeducation and self-help techniques (d) use of technology and a nation-wide approach. CONCLUSION Self-harm and suicidal ideation are global health concerns. To address this health concern in Africa, the authors recommend culturally adapted psychological interventions to be tested via randomized control trials.
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Knippler ET, Martinez AJ, Amiri I, Madundo K, Mmbaga BT, Goldston DB, Relf MV, Knettel BA. Challenges and opportunities for improving mental health care and preventing suicide among people living with HIV: Perspectives of mental health professionals in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002762. [PMID: 38363789 PMCID: PMC10871509 DOI: 10.1371/journal.pgph.0002762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/17/2024] [Indexed: 02/18/2024]
Abstract
People living with HIV (PLWH) experience unique stressors that contribute to emotional distress, and PLWH are more than twice as likely to die by suicide when compared to the general population. In countries like Tanzania, there is a relatively high burden of HIV but few resources to support mental health needs. To gain a better understanding of mental health challenges experienced by PLWH in northern Tanzania and identify opportunities for intervention, we interviewed 12 mental health professionals working in the Kilimanjaro region. Thematic analysis was used to explore drivers and impacts of emotional distress, community influences on mental health, and gaps and barriers to existing mental health care. Perspectives from mental health workers highlight the compounding effects of stress related to HIV status, family conflict, finances, and other social challenges, which can lead to poor HIV treatment outcomes and suicidal ideation. Cultural beliefs and stigma surrounding both mental health and HIV limit care-seeking behavior for mental health issues. Those who do seek care often encounter barriers related to poor mental health infrastructure, including a lack of providers, limited financial resources, and little integration into other health services. There is a clear need for investment in the mental health care system, as well as interventions to improve knowledge and perceptions of mental health and comprehensively address stressors. We describe feedback on a proposed telehealth counseling intervention integrated into routine HIV services, which shows strong potential to mitigate barriers to mental health treatment, reduce suicidal ideation, and support the wellbeing of PLWH.
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Affiliation(s)
- Elizabeth T. Knippler
- Duke Center for AIDS Research, Durham, North Carolina, United States of America
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Alyssa J. Martinez
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Ismail Amiri
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - Michael V. Relf
- Duke University School of Nursing, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Brandon A. Knettel
- Duke University School of Nursing, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
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Lew B, Lester D, Mustapha FI, Yip P, Chen YY, Panirselvam RR, Hassan AS, In S, Chan LF, Ibrahim N, Chan CMH, Siau CS. Decriminalizing suicide attempt in the 21st century: an examination of suicide rates in countries that penalize suicide, a critical review. BMC Psychiatry 2022; 22:424. [PMID: 35739483 PMCID: PMC9219191 DOI: 10.1186/s12888-022-04060-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/07/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Decriminalizing suicide may decrease overall suicide rates because then individuals who are at risk of suicide would be more willing to seek help from the community and from mental health professionals, therefore enabling early interventions for preventing suicidality. We aimed to examine the suicide trends over the last 20 years in 20 countries that still criminalize attempted suicide, and to compare the suicide rates of these 20 countries against the global average suicide rate and to a comparison sample of 20 countries that do not criminalize suicide, matched according to region and majority religion. METHODS Age-standardized suicide rates were extracted from the WHO Global Health Estimates, available for the period 2000-2019. Population data were extracted from the World Bank. We analyzed only countries which criminalize attempted suicide under its criminal justice system. Countries were further categorized according to their membership in the Commonwealth of Nations and countries in Africa. Countries from the same region and with the same majority religion were chosen as a matching group. Joinpoint analysis was used to compare the trends of the two groups with the global average. RESULTS Based on the 2019 WHO Global Health Estimates data, there is a large range in the suicide rates of the countries that criminalize attempted suicide, from 2.5 (Brunei) to 40.9 (Guyana) per 100,000 population. The mean suicide rate was 8.3 (Standard Deviation = 10.6). Out of the 20 countries, seven have suicide rates higher than the global average, covering a total population of about 387.3 million. Of these seven countries, five are in the African region. The other thirteen countries have suicide rates between 2.5 to 8.2. Mean scores of the countries which criminalized attempted suicide was lower than the global average and 20 comparison countries over the 20 years, but average annual percentage in the decrease of suicide was greater for countries in which attempted suicide was not criminalized. CONCLUSIONS Based on our review, there was no substantial evidence here to indicate that countries which criminalized attempted suicide had consistently lower suicide rates compared to the global average. There is a need to acknowledge that the currently available evidence is inadequate to definitively claim that criminalizing suicide is beneficial or harmful for the reduction of suicide rate for the entire populations. Future studies should continue to evaluate the unique effects of decriminalizing attempted suicide while controlling for other key associated factors.
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Affiliation(s)
- Bob Lew
- grid.1022.10000 0004 0437 5432Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland Australia
| | - David Lester
- grid.262550.60000 0001 2231 9854Department of Psychology, Stockton University, Galloway, NJ USA
| | - Feisul Idzwan Mustapha
- grid.415759.b0000 0001 0690 5255Non-Communicable Diseases Section, Disease Control Division, Ministry of Health, Malaysia, Putrajaya, Malaysia
| | - Paul Yip
- grid.194645.b0000000121742757Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, SAR China ,grid.194645.b0000000121742757Center for Suicide Research and Prevention, University of Hong Kong, Hong Kong, SAR China
| | - Ying-Yeh Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | | | - Astrid Sinarti Hassan
- grid.412259.90000 0001 2161 1343Department of Medical Ethics and Law, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Selangor Malaysia
| | - Serena In
- grid.411729.80000 0000 8946 5787Department of Psychology, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Lai Fong Chan
- grid.240541.60000 0004 0627 933XDepartment of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Norhayati Ibrahim
- grid.412113.40000 0004 1937 1557Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Caryn Mei Hsien Chan
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Ching Sin Siau
- grid.412113.40000 0004 1937 1557Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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