The determinants of attempted suicide in a general hospital setting in Fiji Islands: a gender-specific study.

The objective of the study was to examine the sociodemographic and clinical factors influencing gender-specific attempted suicide. Suicide attempters, 40 males and 88 females, seen on a consultation-liaison psychiatric service over a period of 42 months (from January 1, 1999 to June 30, 2002) were compared on sociodemographic and clinical variables. The female attempters [22.99 years (SD 8.1)] were younger than their male counterparts [25.15 years (SD 9.5)] [P = 0.0002]. A higher proportion of the male attempters were engaged in outside occupations, compared with their female counterparts who were mainly full-time housewives or engaged in domestic duties [P = 0.003]. Alcohol misuse was more associated with male suicide attempts [P = 0.001]. Ninety percent of male attempters and 54.6% of the female attempters had the intention to die [P = 0.001]. Although depressive episode was the most common psychiatric disorder in male attempters, followed by neurotic and stress-related disorders, while neurotic and stress-related disorders ranked first in female attempters followed closely by depressive episode, the difference was not significant. However, significantly more male attempters required pharmacotherapy and psychological intervention than their female counterparts [P = 0.002]. More females had marital difficulties, although comparing the two groups on social difficulties did not yield a significant difference. Method used, personality disorders, previous attempt, repeat attempt, race, religion, and marital status were not significant distinguishing factors. Younger age, lack of employment outside home, marital problems, and nondeath motives were more influential in female attempted suicide, while alcohol misuse and severe psychiatric morbidity were more frequently associated with male attempted suicide. The findings support gender-specific preventive and interventional strategies.

Attitude toward and knowledge about mental illness in Fiji islands.

BACKGROUND: There is a dearth of information on the extent of knowledge about mental illness and attitudes toward the mentally ill in Fiji. AIMS: This study aimed to explore these aspects, and also to determine the factors influencing them. METHOD: Market vendors, peri-urban dwellers, white-collar and health workers from Greater Suva were interviewed. The interview schedule used elicited socio-demographic characteristics, knowledge of, and attitudes toward, mental illness. RESULTS: A majority of the subjects attributed the cause of mental illness to substance abuse, believed in the diversity of mental illness, considered hospital as an important source of help and acknowledged the effectiveness of medication. Less than one-fifth of the subjects were willing to marry or employ mentally ill persons. About 42% of the sample would be deterred by embarrassment from seeking help. Educational attainment was correlated with knowledge about mental illness, except with knowledge about early mental symptoms (p < 0.01). Prestigious occupation, single marital status, female gender, younger age and urban dwelling were associated with positive disposition toward the mentally ill (p < 0.01). Race was not significantly influential on almost all attitudinal variables. CONCLUSION: Health education is capable of positively influencing knowledge about, and attitudes toward, mental illness in Fiji.

Tumor necrosis factor haplotype analysis amongst schizophrenia probands from four distinct populations in the Asia-Pacific region.

A single nucleotide polymorphism (TNF(-308A)) within the promoter region of the gene encoding tumor necrosis factor (TNF), has been significantly associated with schizophrenia in a study of Italian patients and control subjects Boin et al. [2001: Mol Psychiatry 6:79-82]. We have applied case-control analyses to examine TNF promoter haplotypes (containing TNF(-308) and two additional promoter variants: TNF(-376) and TNF(-238)) in four schizophrenia cohorts drawn from Australian, Indian Fijian, Indigenous Fijian, and Brahmin populations. In addition, we have applied the sibling transmission disequilibrium (STD) test to promoter haplotypes within 81 trios drawn from Australian Caucasian pedigrees with multiple schizophrenia cases, and 86 trios drawn from the Brahmin population of Tamil Nadu province in Southern India. Within each of these cohorts, we found no evidence of recombination between these tightly linked promoter variants, supporting previous studies which demonstrated that only a subset of the eight possible haplotypes exist. Of the four observed haplotypes, we and others have observed only one carries the TNF(-308A) variant allele. We report no significant differences in TNF promoter haplotype frequencies between the patient and control groups within each population, although the Indian Fijian cohort showed a trend towards reduced TNF(-308A) alleles amongst schizophrenia cases (P = 0.07). We found no evidence of bias in TNF promoter haplotype transmission to schizophrenia probands. Very similar results were obtained when only the TNF(-308) polymorphism was considered. Taken together, these data provide no support for the involvement of TNF promoter variants TNF(-308), TNF(-376), and TNF(-238) in schizophrenia susceptibility within four ethnically distinct cohorts.

Specific psychiatric morbidity in liver cirrhosis in a Nigerian general hospital setting.

The purpose of this investigation was to explore the psychiatric complications of liver cirrhosis in a Nigerian general hospital setting. The mental state of 31 consecutive patients with liver cirrhosis seen in a gastroenterology unit, from July 1996 to August 1998, was assessed using the 30-item General Health Questionnaire (GHQ-30) and Present State Examination (PSE) and compared with those of 20 hypertensive patients and 20 apparently healthy controls. The socio-demographic characteristics of patients with liver cirrhosis who developed psychiatric complications were compared with those without such complications. The mental status of the cirrhosis patients in the present study was also compared with those of Chronic Obstructive Pulmonary Disease (COPD) and hemodialysis patients in earlier studies. About fifty-five percent of all the liver cirrhosis patients developed diagnosable psychiatric morbidity. This was significantly higher than that of the hypertensive patients (15%) or healthy controls (5%) (P=0.0001). The psychiatric conditions were depressive episode, generalized anxiety disorder, delirium and adjustment disorder. No socio-demographic parameter had a significant effect on the mental state of the patients with liver cirrhosis. The same proportion (55%) of hemodialysis and a lower proportion (30%) of COPD patients compared with cirrhosis patients had psychiatric morbidity. We found a high rate of psychiatric morbidity in the patients with liver cirrhosis compared with those of hypertension and normal subjects. None of the socio-demographic variables considered was found to be associated with psychiatric complications in the liver cirrhosis patients. Poor medical conditions seem to be associated with high levels of psychiatric morbidity.

Consultation-liason psychiatry in Fiji.

OBJECTIVE: To examine and report the characteristics of the patients seen on the consultation-liaison (C-L) psychiatry in the main general hospital in Fiji-Islands. METHOD: The socio-demographic and clinical indices of all the patients referred to the C-L psychiatric service between January 1999 and June 2000 were retrieved from the computerized C-L psychiatry register and analyzed. These were compared, in certain aspects, with those of the patients seen in psychiatric hospital located within the same city. RESULTS: The rate of referral to the C-L service was 0.4% of all hospital admission and outpatient referrals. A major reason for referral was psychiatric comorbidity (80.5%). Other reasons include social problems, neurological conditions such as epilepsy and migraine. About fifty-four percent of the patients were referred to the C-L psychiatric service by internists. The mean age of the patients seen on this service was 31.1 (SD 13.1) years, while those of psychiatric hospital patients were 32.6 (SD14.5) (inpatients) and 33.2 (SD13.9) years (outpatients). A majority of C-L patients were female and of Indian descent, while the psychiatric hospital patients were predominantly males with more indigenous Fijian inpatients but more Indian outpatients. The most common psychiatric disorders in the C-L service were depressive episode/recurrent depressive disorder (29.9%), and neurotic, stress-related and somatoform disorders (25.7%). The most common psychiatric disorders encountered in the psychiatric hospital were schizophrenia/delusional disorders (58.5% for inpatients and 52.7% for outpatients) and bipolar affective disorders (30.6% for inpatients and 27.9% for outpatients). CONCLUSION: The most likely person to utilize the C-L service in this population is a young adult female Indian who has been suffering from an internal medical condition, which became complicated by depression, resulting in the attending physician seeking psychiatric opinion. The C-L and psychiatric hospital patients are different in age, gender and racial distributions, and in patterns of psychiatric morbidity. The characteristics of this C-L service place it between what obtained in centres in developing countries and advanced ones.