RESUMO
BACKGROUND: Suicide rates increase following periods of war; however, the mechanism through which this occurs is not known. The aim of this paper is to shed some light on the associations of war exposure, mental disorders, and subsequent suicidal behavior. METHOD: A national sample of Lebanese adults was administered the Composite International Diagnostic Interview to collect data on lifetime prevalence and age of onset of suicide ideation, plan, and attempt, and mental disorders, in addition to information about exposure to stressors associated with the 1975-1989 Lebanon war. RESULTS: The onset of suicide ideation, plan, and attempt was associated with female gender, younger age, post-war period, major depression, impulse-control disorders, and social phobia. The effect of post-war period on each type of suicide outcome was largely explained by the post-war onset of mental disorders. Finally, the conjunction of having a prior impulse-control disorder and either being a civilian in a terror region or witnessing war-related stressors was associated with especially high risk of suicide attempt. CONCLUSIONS: The association of war with increased risk of suicidality appears to be partially explained by the emergence of mental disorders in the context of war. Exposure to war may exacerbate disinhibition among those who have prior impulse-control disorders, thus magnifying the association of mental disorders with suicidality.
Assuntos
Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Guerra , Adolescente , Adulto , Distribuição por Idade , Idade de Início , Idoso , Feminino , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Entrevista Psicológica/métodos , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Ideação Suicida , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Adulto JovemRESUMO
This article reviews recent findings in the epidemiology of childhood psychiatric disorders in the developing world and the relationship of epidemiology to system development. Examples of systems developed in the Third World are discussed. The experience with attention-deficit/hyperactivity disorder and the development of a comprehensive system of care around it in Lebanon are described. Cultural factors that affect special populations in childhood mental health are examined. The article concludes with recommendations for systems development in Third World countries.