The Epidemiology of Suicide and Suicidal Behaviour across the Lifespan in Nigeria: A Systematic Review of the Literature.

BACKGROUND/PURPOSE: Suicidal behaviour is a global public health issue affecting all ages, gender, and regions of the world. This systematic review sought to synthesize the available evidence on the prevalence and risk factors for suicide and suicidal behaviour across the lifespan in Nigeria. DATA SOURCE: The databases of PubMed, Embase, Medline, PsychInfo, Google Scholar and African Journals OnLine (AJOL). STUDY SELECTION: Literature on suicidal behaviour and suicide from Nigeria published between 2000 and 2019. DATA EXTRACTION: Data were extracted independently by two authors using a fixed template. RESULTS: The search identified 431 articles; 23 were eligible for inclusion. The 12-month prevalence of suicide ideation among adolescents was between 6.1-22.9% and 3-12.5% for attempts; identified risk factors were sexual abuse, family dysfunction and food insecurity. For the adult population, lifetime rates of suicidal ideation, plan and attempt were 3.2%, 1.0% and 0.7% respectively; risk factors included age (peak in the third decade of life), childhood adverse experiences and the presence of mood disorders. In the elderly the rates were 4.0% for ideation, 0.7% for plan and 0.2% for attempt. Risk factors identified in the elderly were being single (separation or widowhood) and rural residence. Suicides accounted for 0.3- 1.6% of autopsies performed by the coroners and constituted the least common cause of death. Suicides were more common in males and peaked in the third decade of life. CONCLUSION: Suicide and suicidal behaviour in the Nigerian population seem to peak in young adult life suggesting that suicide prevention initiatives should target late adolescence.

CONTEXTE/BUT: Le comportement suicidaire est un problème mondial de santé publique qui touche tous les âges, tous les sexes et toutes les régions du monde. Cet examen systématique visait à synthétiser les données probantes disponibles sur la prévalence et les facteurs de risque de suicide et de comportement suicidaire tout au long de la vie au Nigéria. SOURCE DE DONNEES: Les bases de données de PubMed, Embase, Medline, PsychInfo, Google Scholar et African Journals OnLine (AJOL). SELECTION DE L'ETUDE: Publication de la littérature sur les comportements suicidaires et le suicide au Nigéria entre 2000 et 2019. EXTRACTION DE DONNEES: Les données ont été extraites indépendamment par deux auteurs à l'aide d'un modèle fixe. RESULTATS: La recherche a permis d'identifier 431 articles; 23 étaient admissibles à l'inclusion. La prévalence sur 12 mois de l'idée de suicide chez les adolescents se situe entre 6,1 et 22,9 % et 3 à 12,5 % pour les tentatives; les facteurs de risque identifiés étaient la violence sexuelle, le dysfonctionnement familial et l'insécurité alimentaire. Pour la population adulte, les taux à vie d'idées, de planifier et de tenter suicidaires étaient de 3,2 %, 1,0 % et 0,7 % respectivement; les facteurs de risque comprenaient l'âge (sommet au cours de la troisième décennie de la vie), les expériences indésirables de l'enfance et la présence de troubles de l'humeur. Chez les personnes âgées, les taux étaient de 4,0 % pour l'idée, de 0,7 % pour le régime et de 0,2 % pour les tentatives. Les facteurs de risque identifiés chez les personnes âgées étaient état matrimonial célibataire (séparation ou veuvage) et la résidence rurale. Les suicides représentaient de 0,3 à 1,6 % des autopsies effectuées par les coroners et constituaient la cause de décès la moins fréquente. Les suicides étaient plus fréquents chez les hommes et ont atteint un sommet au cours de la troisième décennie de leur vie. CONCLUSION: Le suicide et les comportements suicidaires dans la population Nigériane semblent culminer chez les jeunes adultes, ce qui suggère que les initiatives de prévention du suicide devraient cibler la fin de l'adolescence. Mots-clés: Le suicide, comportements suicidaires, Les facteurs de risque, autopsies du coroner, la vie.

The perceived effectiveness of traditional and faith healing in the treatment of mental illness: a systematic review of qualitative studies.

PURPOSE: This work complements a quantitative review by Nortje et al. (Lancet Psychiatry 3(2):154-170, 2016) by exploring the qualitative literature in regard to the perceived effectiveness of traditional and faith healing of mental disorders. METHOD: Qualitative studies focusing specifically on traditional and/or faith healing practices for mental illness were retrieved from eight databases. Data were extracted  into basic coding sheets to facilitate the assessment of the quality of eligible papers using the COREQ. RESULTS: Sixteen articles met the inclusion criteria. Despite methodological limitations, there was evidence from the papers that stakeholders perceived traditional and/or faith healing to be effective in treating mental illness, especially when used in combination with biomedical treatment. CONCLUSION: Patients will continue to seek treatment from traditional and/or faith healers for mental illness if they perceive it to be effective regardless of alternative biomedical evidence. This provides opportunities for collaboration to address resource scarcity in low to middle income countries.

Recovery from DSM-IV post-traumatic stress disorder in the WHO World Mental Health surveys.

BACKGROUND: Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors. METHODS: The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD. RESULTS: 20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2-0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66-55% v. 43%) and later-recovery (75-68% v. 39%). CONCLUSIONS: We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.

Determinants of length of stay in the psychiatric wards of the University College Hospital, Ibadan, Nigeria.

BACKGROUND: Inpatient care constitutes the most expensive component of psychiatric services and pressure is increasingly being mounted on clinicians to discharge patients early. With the advent of managed care in Nigeria, psychiatrists as well as other physicians will be faced with the challenge of having to justify patient's length of hospital admission. This study was designed to examine the factors that influence the length of stay (LOS) in an acute psychiatric ward. METHODS: A list of all patients admitted to the psychiatric unit of the UCH for the twelve month period between June 1st 2006 and May 31st 2007 was compiled from the ward admission registers. Data were extracted from the patient's case notes using specially designed data record forms. RESULTS: There were a total of three hundred and seventy one (371) admissions made up of three hundred and thirty three (333) patients, out of which a total of 247 (74.5%) case notes were successfully reviewed. The most common diagnoses necessitating admission were schizophrenia and mood disorders. The mean LOS was 28.7 days and bed turnover for this period was 5.8. Factors found to be significantly associated with longer LOS include age, diagnosis, previous admissions and receiving electroconvulsive therapy with medication. These factors need to be considered in determining the period of hospitalization covered under managed care schemes.

Traumatic events and suicidal behaviour in the Nigerian Survey of Mental Health and Well-Being.

OBJECTIVE: Not much is known about the role of different traumatic events in predicting suicidal outcomes. We investigated the association of specific traumatic events with different suicidal outcomes. METHOD: Data are from the Nigerian Survey of Mental Health and Well-Being, a multistage probability household survey of persons aged 18 years and over. Information on traumatic events and suicidal behaviours (ideation, plan and attempts) was collected in face-to-face interviews using the Composite International Diagnostic Interview (CIDI.3) from a subsample of the respondents (N = 2143). RESULTS: At least one traumatic event was reported by 63% of the sample. Traumatic events were more likely to have been experienced by individuals with different suicidal outcomes, with a dose-response relationship between the number of traumatic events and suicide ideation. The risks of suicidal ideation were elevated among persons with a history of combat experience (OR 6.3 95% CI 1.8-21.8) and those with exposure to war (OR 4.2; 95% CI 1.6-10.6), while that of suicidal attempt was increased among persons with experience of interpersonal violence (OR 4.3; 95% CI 1.4-13.0). CONCLUSION: Traumatic events are common in the general population. This report highlights the role of traumatic events (especially those related to violence) in predicting suicidal behaviour.

Traumatic events and post-traumatic stress symptoms among adolescents in Ibadan.

Little empirical data exist on the rates of exposure to traumatic events and its sequelae especially in adolescents. This study was designed to determine the lifetime prevalence of exposure to traumatic events and posttraumatic stress symptoms among adolescents in Ibadan, Nigeria. A sample of 786 boys and girls from 10 senior secondary schools located within Ibadan were interviewed using an adapted version of the Schedule for Affective Disorders and Schizophrenia (KSADS) to ascertain the prevalence of exposure to traumatic events and posttraumatic stress symptoms. Irrespective of gender, more than 40% reported lifetime exposure to at least one traumatic event. Commonly reported events were: receiving news of sudden injury, death or illness in a close family member or friend, being a victim or witness to a violent crime and physical abuse. About 2.4% of the sample met diagnostic criteria for posttraumatic stress disorder (PTSD). Female sex, exposure to more than one traumatic event, and sexual abuse were associated with increased risk for PTSD. The results of this study highlights the substantial risk for experiencing serious traumatic events by adolescents within the community, and a need for professionals involved in the care of adolescents to be more vigilant in screening for trauma related distress.

Traumatic events and post-traumatic stress symptoms among adolescents in Ibadan

Little empirical data exist on the rates of exposure to traumatic events and its sequelae especially in adolescents. This study was designed to determine the lifetime prevalence of exposure to traumatic events and posttraumatic stress symptoms among adolescents in Ibadan; Nigeria. A sample of 786 boys and girls from 10 senior secondary schools located within Ibadan were interviewed using an adapted version of the Schedule for Affective Disorders and Schizophrenia (KSADS) to ascertain the prevalence of exposure to traumatic events and posttraumatic stress symptoms. Irrespective of gender; more than 40reported lifetime exposure to at least one traumatic event. Commonly reported events were: receiving news of sudden injury; death or illness in a close family member or friend; being a victim or witness to a violent crime and physical abuse. About 2.4of the sample met diagnostic criteria for posttraumatic stress disorder (PTSD). Female sex; exposure to more than one traumatic event; and sexual abuse were associated with increased risk for PTSD. The results of this study highlights the substantial risk for experiencing serious traumatic events by adolescents within the community; and a need for professionals involved in the care of adolescents to be more vigilant in screening for trauma related distress