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.

Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.

AIMS: Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioural subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment. METHODS: IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioural subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment. RESULTS: The lifetime prevalence of IED in all countries was 0.8% (s.e.: 0.0). The two subtypes involving anger attacks that harmed people ('hurt people only' and 'destroy property and hurt people'), collectively comprising 73% of those with IED, were characterised by high rates of externalising comorbid disorders. The remaining three subtypes involving anger attacks that destroyed property only, destroyed property and threatened people, and threatened people only, were characterised by higher rates of internalising than externalising comorbid disorders. Suicidal behaviour did not vary across the five behavioural subtypes but was higher among those with (v. those without) comorbid disorders, and among those who perpetrated more violent assaults. CONCLUSIONS: The most common IED behavioural subtypes in these general population samples are associated with high rates of externalising disorders. This contrasts with the findings from clinical studies of IED, which observe a preponderance of internalising disorder comorbidity. This disparity in findings across population and clinical studies, together with the marked heterogeneity that characterises the diagnostic entity of IED, suggests that it is a disorder that requires much greater research.

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.

Incidence and risk factors for late-life depression in the Ibadan Study of Ageing.

BACKGROUND: We present the incidence and risk factors for major depressive disorder (MDD) among community-dwelling elderly Nigerians. METHOD: A cohort study of persons aged ≥ 65 years residing in eight contiguous Yoruba-speaking states in south-west and north-central Nigeria was conducted between November 2003 and December 2007. Of the 2149 baseline sample, 1408 (66%) were successfully followed up after approximately 39 months. Face-to-face in-home assessments were conducted with the World Health Organization (WHO) Composite International Diagnostic Interview, version 3 (CIDI.3) and diagnosis was based on the DSM-IV. Incident MDD was determined in the group with no prior lifetime history of MDD at baseline and who were free of dementia at follow-up (n=892). RESULTS: During the follow-up period, 308 persons had developed incident MDD, representing a rate of 104.3 [95% confidence interval (CI) 93.3-116.6] per 1000 person-years. Compared to males, the age-adjusted hazard for females was 1.63 (95% CI 1.30-2.06). Lifetime or current subsyndromal symptoms of depression at baseline did not increase the risk of incident MDD. Among females, but not males, rural residence and poor social network were risk factors for incident MDD. Physical health status at baseline did not predict new onset of MDD. CONCLUSIONS: The finding of a high incidence of MDD among elderly Nigerians complements earlier reports of a high prevalence of the disorder in this understudied population. Social factors, in particular those relating to social isolation, constitute a risk for incident MDD.

Parental psychopathology and the risk of suicidal behavior in their offspring: results from the World Mental Health surveys.

Previous research suggests that parental psychopathology predicts suicidal behavior among offspring; however, the more fine-grained associations between specific parental disorders and distinct stages of the pathway to suicide are not well understood. We set out to test the hypothesis that parental disorders associated with negative mood would predict offspring suicide ideation, whereas disorders characterized by impulsive aggression (for example, antisocial personality) and anxiety/agitation (for example, panic disorder) would predict which offspring act on their suicide ideation and make a suicide attempt. Data were collected during face-to-face interviews conducted on nationally representative samples (N=55 299; age 18+) from 21 countries around the world. We tested the associations between a range of parental disorders and the onset and persistence over time (that is, time since most recent episode controlling for age of onset and time since onset) of subsequent suicidal behavior (suicide ideation, plans and attempts) among offspring. Analyses tested bivariate and multivariate associations between each parental disorder and distinct forms of suicidal behavior. Results revealed that each parental disorder examined increased the risk of suicide ideation among offspring, parental generalized anxiety and depression emerged as the only predictors of the onset and persistence (respectively) of suicide plans among offspring with ideation, whereas parental antisocial personality and anxiety disorders emerged as the only predictors of the onset and persistence of suicide attempts among ideators. A dose-response relation between parental disorders and respondent risk of suicide ideation and attempt was also found. Parental death by suicide was a particularly strong predictor of persistence of suicide attempts among offspring. These associations remained significant after controlling for comorbidity of parental disorders and for the presence of mental disorders among offspring. These findings should inform future explorations of the mechanisms of intergenerational transmission of suicidal behavior.