Global mental health: transformative capacity building in Nicaragua.

BACKGROUND: Mental health is increasingly recognised as integral to good public health, but this area continues to lack sufficient planning, resources, and global strategy. It is a pressing concern in Latin America, where social determinants of health aggravate existing inequities in access to health services. Nicaragua faces serious mental health needs and challenges. One key strategy for addressing gaps in mental health services is building capacity at the primary healthcare and system levels. OBJECTIVE: Using the framework of best practice literature, this article analyses the four-year collaborative process between the National Autonomous University of Nicaragua in León (UNAN-León) and the Centre for Addiction and Mental Health (CAMH) in Canada, which is aimed at improving mental healthcare in Nicaragua. DESIGN: Based on a critical analysis of evaluation reports, key documents, and discussion among partners, the central steps of the collaboration are analysed and main successes and challenges identified. RESULTS: A participatory needs assessment identified local strengths and weaknesses, expected outcomes regarding competencies, and possible methodologies and recommendations for the development of a comprehensive capacity-building programme. The partners delivered two international workshops on mental health and addiction with an emphasis on primary healthcare. More recently, an innovative Diploma and Master programme was launched to foster interprofessional leadership and effective action to address mental health and addiction needs. Collaborative activities have taken place in Nicaragua and Canada. DISCUSSION: To date, international collaboration between Nicaragua and CAMH has been successful in achieving the jointly defined goals. The process has led to mutual knowledge sharing, strong networking, and extensive educational opportunities. Evidence of effective and respectful global health capacity building is provided. Lessons learned and implications for global health action are identified and discussed.

Suicide intent among parasuicide patients in Nicaragua: a surveillance and follow-up study.

This study examines suicide intent among parasuicide patients in a low-income country, Nicaragua, with special reference to gender patterns and future suicidal behavior. Using the Suicide Intent Scale (SIS), suicide intent was assessed in 204 persons presenting to hospital after parasuicide. Repetition was checked after a mean follow-up period of three years. The total SIS scores did not differ between women and men. However, a higher SIS score among women was significantly associated with older age, having children and use of pesticide as the parasuicide method. The overall method of suicide intent was low in Nicaragua compared to other countries, as was the nonfatal repetition rate (4.8% after three years). Subsequent suicides were found only in three men. Factor structures within the SIS disclosed supported the cross-cultural validity of the instrument. The level of suicide intent at the index attempt did not show any association with future suicidal behavior.

Suicidal expressions among young people in Nicaragua: a community-based study.

BACKGROUND: Suicidal behaviour is a major public health problem among adolescents. In Nicaragua as well as in most other countries, young people aged 15-24 have the highest rate of attempted suicide according to hospital records. The aims of this study were to investigate self-reported life-weariness, death wishes, suicidal ideation, suicidal plans and suicide attempts (i.e. suicidal expressions) among young men and women in the community and to identify factors associated with suicidal expressions. METHODS: The sample was derived from an established study base in the city of León, Nicaragua. From 352 randomly selected subjects aged 15-24 years, 278 individuals (145 males and 133 females) were interviewed using the Attitudes Towards Suicide (ATTS) questionnaire, including questions on suicidal expressions. RESULTS: The overall 1-year prevalence of any suicidal expression was 44.8% among males and 47.4% among females. A suicide attempt in the past year was reported by 2.1% of males and 1.5% of females. There was no significant gender difference in reporting of the separate types of suicidal expressions, except for death wishes, where females reported higher prevalence (33.8% vs. 20.7%). Exposure to suicidal expressions among significant others was significantly associated with own serious suicidal expressions. The study failed to identify any association between suicidal expressions and sociodemographic factors such as poverty or educational level. CONCLUSIONS: The present study highlights that suicidal behaviour is a significant public health problem among young people in Nicaragua. The finding that suicidal behaviour among significant others appears to have a contagious effect on adolescents, needs to be addressed in the prevention of suicidal behaviour.

Parasuicide in a low-income country: results from three-year hospital surveillance in Nicaragua.

AIMS: A study was undertaken to assess the incidence of parasuicide in Nicaragua, to identify groups at risk, and to describe the characteristics of parasuicides, such as methods used and seasonal and diurnal patterns. METHOD: All hospital-admitted parasuicide cases in the area of Leon, Nicaragua, were assessed over a three-year period using standardized instruments. RESULTS: Two hundred and thirty-three parasuicide cases were identified in the catchment area giving a parasuicide rate of 66.3/100,000 inhabitants per year based on the population 10 years and older. Corresponding figure for 15 years and older was 71.3. A majority were females (68.8%), who were significantly younger than the males (mean 20.8 years vs. mean 24.6 years). The highest rates were found in the age group 15-19 years with a female rate three times higher than the male rate (302.9 vs. 98.9). Pesticides, a highly lethal substance, were used as method in 19.1% of the attempts. Consistent seasonal variation with peaks in May-June and September-October were found over the years. Among parasuicide cases, 46.5% had been in contact with the healthcare system within 6 months before attempting suicide. CONCLUSIONS: Parasuicides represent a significant health problem among young people in Nicaragua. Preventive efforts should be directed especially towards the life situation for young girls, limitation of availability of suicide means, increased awareness in schools concerning suicidal problems, as well as improved management of patients with mental health problems within primary healthcare.

Trastornos mentales en Nicaragua: perspectiva familiar / Mental disorders in Nicaragua: family perspective

En los últimos años la perspectiva familiar en psiquiatria ha adquirido mayor importancia, particularmente en el Tercer Mundo. El objetivo de este esutio ha sido el de examinar la estructura de familias con individuos aquejados de trastornos mentales, en Léon, Nicaragua. Se comparan con familias sanas de la misma muestra. Se presenta también el uso del genograma en un estudio epidemiológico. 201 familias fueron seleccionadas al azar y sus miembros entrevistados en dos etapas: una fase de filtro o screening y otra de diagnóstico. El "mapa de familia" o genograma fue analizado en cada familia con relación a variables como: casos de niños y adultos, cantidad de generaciones en cada grupo doméstico familiar, cantidad de individuos o tamaño de la familia y otras variables demográficas de interés (AU)

Trastornos mentales en Nicaragua: perspectiva familiar / Mental disorders in Nicaragua: family perspective

En los últimos años la perspectiva familiar en psiquiatria ha adquirido mayor importancia, particularmente en el Tercer Mundo. El objetivo de este esutio ha sido el de examinar la estructura de familias con individuos aquejados de trastornos mentales, en Léon, Nicaragua. Se comparan con familias sanas de la misma muestra. Se presenta también el uso del genograma en un estudio epidemiológico. 201 familias fueron seleccionadas al azar y sus miembros entrevistados en dos etapas: una fase de filtro o screening y otra de diagnóstico. El "mapa de familia" o genograma fue analizado en cada familia con relación a variables como: casos de niños y adultos, cantidad de generaciones en cada grupo doméstico familiar, cantidad de individuos o tamaño de la familia y otras variables demográficas de interés