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Minja L, Knettel BA, Pan W, Madundo K, Amiri I, Joel L, Knippler E, Relf MV, Vissoci JRN, Staton CA, Msoka EF, Tarimo CS, Katiti V, Mmbaga BT, Goldston DB. Validation of a culturally sensitive, Swahili-translated instrument to assess suicide risk among adults living with HIV in Tanzania. Glob Ment Health (Camb) 2023; 10:e67. [PMID: 38024799 PMCID: PMC10643229 DOI: 10.1017/gmh.2023.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/05/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
In Tanzania, there are high rates of suicidal thoughts and behavior among people living with HIV (PLWH), yet few instruments exist for effective screening and referral. To address this gap, we developed and validated Swahili translations of the Columbia Suicide Severity Rating Scale (C-SSRS) Screen Version and two accompanying scales assessing self-efficacy to avoid suicidal action and reasons for living. We administered a structured survey to 80 PLWH attending two HIV clinics in Moshi, Tanzania. Factor analysis of the items revealed four subscales: suicide intensity, self-efficacy to avoid suicide, fear and social concern about suicide, and family and spirituality deterrents to suicide. The area under the receiver operating curve showed only suicide intensity, and fear and social concern met the prespecified cutoff of ≥0.7 in accurately identifying patients with a plan and intent to act on suicidal thoughts. This study provides early evidence that brief screening of intensity of suicidality in the past month, assessed by the C-SSRS Screen Version, is a strong, resource-efficient strategy for identifying suicide risk in the Tanzanian setting. Patients who report little fear of dying and low concern about social perceptions of suicide may also be at increased risk.
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Affiliation(s)
- Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Brandon A. Knettel
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Wei Pan
- Duke University School of Nursing, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ismail Amiri
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Louise Joel
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Elizabeth Knippler
- Duke University School of Nursing, Durham, NC, USA
- Duke Center for AIDS Research, Duke University, Durham, NC, USA
| | - Michael V. Relf
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Joao Ricardo N. Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Department of Emergency Medicine, Durham, NC, USA
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Department of Emergency Medicine, Durham, NC, USA
| | - Elizabeth F. Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Victor Katiti
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
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Olfati L, Safari-Faramani R, Najafi F, Nazar MM, Shakiba E. Population size estimation of female sex workers using network scale-up method in Kermanshah city. BMC Public Health 2023; 23:268. [PMID: 36750800 PMCID: PMC9906867 DOI: 10.1186/s12889-023-15141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Appropriate estimate of size of the female sex workers as well as the other hard-to-reach-populations plays a crucial role in reaching them with effective preventive measures. This study aimed to estimate the population size of female sex workers in Kermanshah City using the network scale-up method. METHOD In this cross-sectional study, of the 1000 pedestrians aged between 18 and 65 years, selected from the population of Kermanshah City via a multistage sampling, were recruited in the study. Face-to-face interview using a questionnaire including the number of FSWs in the social network of the respondent was used to collect the data. RESULTS The overall estimated number of female sex workers in the general population was 4848(UI 95%: 4597, 5074). Accordingly, the prevalence of FSWs among women 18 years and older in Kermanshah in 2018 was about 11.92 (UI 95%: 11.30, 12.47) in one thousand. More than half of the female sex workers in the respondent's social network were unmarried and were in the age range of 18 to 29, and had a high school or university degree. Among high-risk behaviors, a history of alcohol consumption accounted for the highest percentage. CONCLUSION The number of female sex workers estimated in this study is considerable, which highlights the importance of planning harm reduction interventions in order to alleviate the burden of HIV infection in the population.
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Affiliation(s)
- Lida Olfati
- grid.412112.50000 0001 2012 5829Student Research Committee, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- Department of Epidemiology, School of Health Research Centre for Environmental Determinants of Health Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Farid Najafi
- grid.412112.50000 0001 2012 5829Department of Epidemiology, School of Health Research Centre for Environmental Determinants of Health Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Moradi Nazar
- grid.412112.50000 0001 2012 5829Department of Epidemiology, School of Health Research Centre for Environmental Determinants of Health Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ebrahim Shakiba
- grid.412112.50000 0001 2012 5829Department of Biochemistry, School of Medicine Social Development and Health Promotion Research Centre Research Institute for Health Kermanshah, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Shafiee M, Mahboubi M, Shanbehzadeh M, Kazemi-Arpanahi H. Design, development, and evaluation of a surveillance system for suicidal behaviors in Iran. BMC Med Inform Decis Mak 2022; 22:180. [PMID: 35818024 PMCID: PMC9275034 DOI: 10.1186/s12911-022-01925-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a serious cause of morbidity and mortality in Iran and worldwide. Although several organizations gather information on suicide and suicide attempts, there is substantial misperception regarding the description of the phenomenon. This study proposes the minimum data set (MDS) for suicidal behaviors surveillance. METHODS A literature review was first conducted to achieve a thorough overview of suicide-related items and map the existing evidence supporting the development of the MDS. The data items included in the literature review were then analyzed using a two-round Delphi technique with content validation by an expert panel. The suicidal behaviors surveillance system was then established based on the confirmed MDS, and ultimately, its performance was assessed by involving the end-users. RESULTS The panel of experts consisted of 50 experts who participated in the Delphi phase and validity content review. Of these, 46% were men, and their mean age and average work experience were (36.4, SD ± 6.4) and (12.32, SD ± 5.2) years, respectively. The final MDS platform of our study contained 108 items classified into eight main categories. A web-based system with a modular and layered architecture was developed based on the derived MDS. CONCLUSION The developed system provides a framework for recording suicidal behaviors' data. The integration of multiple suicide-related information systems at the regional and national levels makes it possible to assess the long-term outcomes and evolutions of suicide prevention interventions.
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Affiliation(s)
- Mohsen Shafiee
- Department of Nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - Mohammad Mahboubi
- Department of Public Health, Abadan University of Medical Sciences, Abadan, Iran
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran. .,Department of Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran.
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Shafiee M, Shanbehzadeh M, Kazemi-Arpanahi H. Establishing a minimum data set for suicide and attempted suicide registry system in Iran. BMC Public Health 2022; 22:857. [PMID: 35484542 PMCID: PMC9052659 DOI: 10.1186/s12889-022-13276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicidal behavior is a major cause of mortality and disability worldwide. Accurate and consistent collection of data on suicide, suicide ideation, and suicide attempts presents many challenges for public health practitioners, policymakers, and researchers. This study aimed to establish a minimum data set (MDS) for integrating data across suicide registries and other data sources. METHODS The MDS proposed in this study was developed in two-stepwise stages. First, an extensive literature review was performed in order to identify the potential data items. Then, we conducted a two-round Delphi stage to reach a consensus among experts regarding essential data items and a supplementary one-round Delphi stage for validating the content of the final MDS by calculating the individual item content validity index (CVI) and content validity ratio (CVR) and using other statistical tests. RESULTS After the literature review, 189 data items were extracted and sent to a panel of experts in the form of a questionnaire. In the Delphi stage and CVI calculation, 55 and 10 experts participated in kappa and CVR calculation, respectively. Finally, the MDS of the suicide registry was finalized with 84 data elements that were classified into four categories, including patient profile, socio-economic status, clinical and psychopathological status, and suicide circumstances. CONCLUSIONS The suicide MDS can become a standardized and consistent infrastructure for meaningful evaluations, reporting, and benchmarking of suicidal behaviors across regions and countries. We hope this MDS will facilitate epidemiological surveys and support policymakers by providing higher quality data capture to guide clinical practice and improve patient-centered outcomes.
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Affiliation(s)
- Mohsen Shafiee
- Department of Nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, Ilam University of Medical Sciences, Ilam, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran. .,Department of Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran.
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Ongeri L, Larsen DA, Jenkins R, Shaw A, Connolly H, Lyon J, Kariuki S, Penninx B, Newton CR, Sifuna P, Ogutu B. Community suicide rates and related factors within a surveillance platform in Western Kenya. BMC Psychiatry 2022; 22:7. [PMID: 34983463 PMCID: PMC8729019 DOI: 10.1186/s12888-021-03649-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is an important contributor to the burden of mental health disorders, but community-based suicide data are scarce in many low- and middle-income countries (LMIC) including Kenya. Available data on suicide underestimates the true burden due to underreporting related to stigma and legal restrictions, and under-representation of those not utilizing health facilities. METHODS We estimated the cumulative incidence of suicide via verbal autopsies from the Health and Demographic Surveillance System (HDSS) in Kisumu County, Kenya. We then used content analysis of open history forms among deaths coded as accidents to identify those who likely died by suicide but were not coded as suicide deaths. We finally conducted a case-control study of suicides (both verbal autopsy confirmed and likely suicides) compared to accident-caused deaths to assess factors associated with suicide in this HDSS. RESULTS A total of 33 out of 4306 verbal autopsies confirmed suicide as the cause of death. Content analysis of a further 228 deaths originally attributed to accidents identified 39 additional likely suicides. The best estimate of suicide-specific mortality rate was 14.7 per 100,000 population per year (credibility window = 11.3 - 18.0). The most common reported method of death was self-poisoning (54%). From the case-control study interpersonal difficulties and stressful life events were associated with increased odds of suicide in both confirmed suicides and confirmed combined with suspected suicides. Other pertinent factors such as age and being male differed depending upon which outcome was used. CONCLUSION Suicide is common in this area, and interventions are needed to address drivers. The twofold increase in the suicide-specific mortality rate following incorporation of misattributed suicide deaths exemplify underreporting and misclassification of suicide cases at community level. Further, verbal autopsies may underreport suicide specifically among older and female populations.
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Affiliation(s)
- Linnet Ongeri
- Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya.
| | - David A. Larsen
- grid.264484.80000 0001 2189 1568Syracuse University Department of Public Health, Syracuse, NY USA ,grid.411023.50000 0000 9159 4457Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY USA
| | - Rachel Jenkins
- grid.13097.3c0000 0001 2322 6764Kings College London, London, UK
| | - Andrea Shaw
- grid.411023.50000 0000 9159 4457Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY USA
| | - Hannah Connolly
- grid.411023.50000 0000 9159 4457Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY USA
| | - James Lyon
- grid.411023.50000 0000 9159 4457Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY USA
| | - Symon Kariuki
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Wellcome Trust Program, Kilifi, Kenya
| | - Brenda Penninx
- grid.12380.380000 0004 1754 9227Vrije University, Amsterdam, Netherlands
| | - Charles R. Newton
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Wellcome Trust Program, Kilifi, Kenya
| | - Peter Sifuna
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya ,grid.33058.3d0000 0001 0155 5938US Army Medical Research Directorate–Kenya (USAMRD-K)/Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Bernhards Ogutu
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya ,grid.33058.3d0000 0001 0155 5938US Army Medical Research Directorate–Kenya (USAMRD-K)/Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
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Ocagli H, Azzolina D, Lorenzoni G, Gallipoli S, Martinato M, Acar AS, Berchialla P, Gregori D. Using Social Networks to Estimate the Number of COVID-19 Cases: The Incident (Hidden COVID-19 Cases Network Estimation) Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115713. [PMID: 34073448 PMCID: PMC8198250 DOI: 10.3390/ijerph18115713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022]
Abstract
Recent literature has reported a high percentage of asymptomatic or paucisymptomatic cases in subjects with COVID-19 infection. This proportion can be difficult to quantify; therefore, it constitutes a hidden population. This study aims to develop a proof-of-concept method for estimating the number of undocumented infections of COVID-19. This is the protocol for the INCIDENT (Hidden COVID-19 Cases Network Estimation) study, an online, cross-sectional survey with snowball sampling based on the network scale-up method (NSUM). The original personal network size estimation method was based on a fixed-effects maximum likelihood estimator. We propose an extension of previous Bayesian estimation methods to estimate the unknown network size using the Markov chain Monte Carlo algorithm. On 6 May 2020, 1963 questionnaires were collected, 1703 were completed except for the random questions, and 1652 were completed in all three sections. The algorithm was initialized at the first iteration and applied to the whole dataset. Knowing the number of asymptomatic COVID-19 cases is extremely important for reducing the spread of the virus. Our approach reduces the number of questions posed. This allows us to speed up the completion of the questionnaire with a subsequent reduction in the nonresponse rate.
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Affiliation(s)
- Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan, 18, 35121 Padova, Italy; (H.O.); (D.A.); (G.L.); (M.M.)
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan, 18, 35121 Padova, Italy; (H.O.); (D.A.); (G.L.); (M.M.)
- Research Support Unit, Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli, 17, 28100 Novara, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan, 18, 35121 Padova, Italy; (H.O.); (D.A.); (G.L.); (M.M.)
| | | | - Matteo Martinato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan, 18, 35121 Padova, Italy; (H.O.); (D.A.); (G.L.); (M.M.)
| | - Aslihan S. Acar
- Department of Actuarial Sciences, Hacettepe University, 06800 Ankara, Turkey;
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, 10043 Orbassano, Italy;
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Via Loredan, 18, 35121 Padova, Italy; (H.O.); (D.A.); (G.L.); (M.M.)
- Correspondence: ; Tel.: +39-049-827-5384
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Pritchard C, Iqbal W, Dray R. Undetermined and accidental mortality rates as possible sources of underreported suicides: population-based study comparing Islamic countries and traditionally religious Western countries. BJPsych Open 2020; 6:e56. [PMID: 32482190 PMCID: PMC7345585 DOI: 10.1192/bjo.2020.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Four Western countries (Greece, Ireland, Italy and Portugal) with strong Orthodox and Catholic traditions have been associated with the underreporting of death by suicide, and underreported suicides are sometimes found among deaths recorded as 'undetermined' or 'accidental'. AIMS This population-based study tests whether there are any significant difference in patterns of suicides, undetermined deaths and accidental deaths between these four Western countries and 21 predominately Islamic countries. METHOD World Health Organization age-standardised death rates per million population were used to compare suicide rates with combined undetermined death and accidental death (UnD+AccD) rates, from which odds ratios were calculated. Substantial odds ratios (OR > 2.0) were taken as indicative of likely underreporting of suicides. The Islamic countries come from four different historico-cultural regions, described as: less-traditional Islamic countries; former USSR countries; Gulf Arab states; and Middle Eastern and North African countries. χ2-tests were used to determine any significant differences between the Western comparator countries and the Islamic regions. RESULTS For the Western comparator countries, the average suicide rate was 66 per million population, the average undetermined death rate 56 per million and the average accidental death rate 58 per million, yielding a suicide:UnD+AccD odds ratio (OR) of 1.73. The average values for the other three groups were as follows. Less-traditional Islamic countries: suicide rate, 31 per million; UnD+AccD rate, 101 per million; suicide:UnD+AccD OR = 3.3. Former USSR countries: suicide rate, 61 per million; UnD+AccD rate, 221 per million; suicide:UnD+AccD OR = 3.6. Gulf Arab states: suicide rate, 10 per million; UnD+AccD rate, 76 per million; suicide:UnD+AccD OR = 8.6. Middle Eastern and North African countries: suicide rate, 6 per million; UnD+AccD rate, 151 per million; suicide:UnD+AccD OR = 25.2. The patterns of these mortalities in the Islamic countries was significantly different from Western comparator countries. CONCLUSIONS The results indicate underreporting of suicides in Islamic countries. This might inadvertently lead to reduced access to mental health preventive services in both Western and Islamic countries.
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Affiliation(s)
- Colin Pritchard
- Faculty of Health and Social Sciences, Royal London House, Bournemouth University, UK
| | - Wajid Iqbal
- Royal South Hants Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rosslyn Dray
- Faculty of Health and Social Sciences, Royal London House, Bournemouth University, UK
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