A systematic review of the risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents in sub-Saharan Africa between 1986 and 2018: protocol for a systematic review of observational studies
Abstract and Figures
Background
Suicide is one of the leading causes of death among children and adolescents. Most studies about the burden and risk factors for suicide have been conducted in high-income countries. However, there is a dearth in the literature about the burden and risk factors for suicide among children and adolescents in low- and middle-income countries including within Sub-Saharan Africa (SSA). There is need to summarise the available literature about the burden and risk factors for suicide among children and adolescents in SSA. In this review, we will (a) determine the overall prevalence of suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA; (b) describe the methods (such as hanging, firearms, overdose, poisoning, drowning and burning) used for suicidal attempt, and completed suicide among children and adolescents in SSA; and (c) document the risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA.
Methods
The review will be conducted and reported in accordance to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. We will include journal articles that have documented the prevalence and risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents aged 5–19 years in SSA. We will also include accessible grey literature about the topic. Qualitative studies will be excluded from the study since they are limited in estimating prevalence. We will search different search engines including PUBMED, EMBASE, Psych-INFO, Cochrane Library, Africa wide-information and global health using suicide, adolescents and children, SSA as the keywords. We will use a meta-analysis, should we find that there is no heterogeneity between included studies.
Discussion
This protocol describes a systematic review of observational studies reporting completed suicide, suicidal ideation and suicidal attempt among children and adolescents in sub-Saharan Africa. We anticipate that once this review is complete and published, our findings will be of interest to adolescents with suicidal behaviour, their families and caregivers, clinicians and other healthcare professionals, scientists and policy makers.
Systematic review registration
PROSPERO International prospective register of systematic reviews: CRD42016048610.
Electronic supplementary material
The online version of this article (10.1186/s13643-018-0901-8) contains supplementary material, which is available to authorized users.
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P R O T O C O L Open Access
A systematic review of the risk factors for
suicidal ideation, suicidal attempt and
completed suicide among children and
adolescents in sub-Saharan Africa between
1986 and 2018: protocol for a systematic
review of observational studies
Godfrey Zari Rukundo
1*
, Elizabeth Kemigisha
2
, Moses Ocan
3
, Wilson Adriko
4
and Dickens Howard Akena
5
Abstract
Background: Suicide is one of the leading causes of death among children and adolescents. Most studies about
the burden and risk factors for suicide have been conducted in high-income countries. However, there is a dearth in
the literature about the burden and risk factors for suicide among children and adolescents in low- and middle-income
countries including within Sub-Saharan Africa (SSA). There is need to summarise the available literature about the
burden and risk factors for suicide among children and adolescents in SSA. In this review, we will (a) determine the
overall prevalence of suicidal ideation, suicidal attempt and completed suicide among children and adolescents in SSA;
(b) describe the methods (such as hanging, firearms, overdose, poisoning, drowning and burning) used for suicidal
attempt, and completed suicide among children and adolescents in SSA; and (c) document the risk factors for suicidal
ideation, suicidal attempt and completed suicide among children and adolescents in SSA.
Methods: The review will be conducted and reported in accordance to the preferred reporting items for systematic
reviews and meta-analysis (PRISMA) statement. We will include journal articles that have documented the prevalence
and risk factors for suicidal ideation, suicidal attempt and completed suicide among children and adolescents aged
5–19 years in SSA. We will also include accessible grey literature about the topic. Qualitative studies will be excluded
from the study since they are limited in estimating prevalence. We will search different search engines including
PUBMED, EMBASE, Psych-INFO, Cochrane Library, Africa wide-information and global health using suicide, adolescents
and children, SSA as the keywords. We will use a meta-analysis, should we find that there is no heterogeneity between
included studies.
Discussion: This protocol describes a systematic review of observational studies reporting completed suicide, suicidal
ideation and suicidal attempt among children and adolescents in sub-Saharan Africa. We anticipate that once this
review is complete and published, our findings will be of interest to adolescents with suicidal behaviour, their families
and caregivers, clinicians and other healthcare professionals, scientists and policy makers.
Systematic review registration: PROSPERO International prospective register of systematic reviews: CRD42016048610.
Keywords: Suicide, Suicidal attempt, Suicidal ideation, Suicidal behaviour, Adolescents
* Correspondence: grukundo@must.ac.ug
1
Department of Psychiatry, Mbarara University of Science and Technology
and African Centre for Suicide Research, Mbarara, Uganda
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Rukundo et al. Systematic Reviews (2018) 7:230
https://doi.org/10.1186/s13643-018-0901-8
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Background
Globally, suicide is a public health concern and one of the
leading causes of death among children and adolescents [1].
Most studies about the burden and risk factors for suicide
have been conducted in high-income countries (HIC).
However, there is a dearth in the literature about the
burden and risk factors for suicide among children and
adolescents in low- and middle-income countries (LMIC)
including within Sub-Saharan Africa (SSA); the majority of
studies about the risk factors for suicide having been con-
ducted among adults and in specific sub-populations [2–5].
A recent literature review by Mars et al. (2014) docu-
mented the prevalence of suicide and its risk factors on
the African continent, but fell short of studying children
and adolescents [6,7]. The African annual prevalence of
suicide was found to be 34,000 with incidence of 3.2 per
100,000.
Suicide is the third leading cause of death among ad-
olescents and young adults [8–10]. A number of factors
including high levels of poverty, growing unemploy-
ment, disruptions in traditional family life and the un-
recognised and poorly treated depressive illness,
political instabilities and high disease burdens including
HIV/AIDS disproportionately affect children and ado-
lescents in SSA [6,11], and places them at a much
higher risk of suicide, especially in those who fail to
cope with these upheavals [12]. Moreover, SSA is home
to the highest population of children and adolescents,
with 20% of the world’s children and adolescents living
in SSA. In South Africa, suicidality has been reported
at suicide attempt 3.2%, suicide planning 5.8% and sui-
cidal ideation 7.2% [11]. The few studies that have docu-
mented the burden and risk factors of suicide among
children and adolescents in SSA have reported conflicting
results, perhaps as a result of differences in the methods
of assessment [13].
There is an urgent need to summarise the available
literature about the burden and risk factors for suicide
among children and adolescents in SSA. Findings from
the synthesis of this data will be useful in developing
specific evidence-based prevention and treatment
strategies. Findings from this review will also be used
in enlightening parents, children, adolescents and
members of the community at large about the burden
of suicide and the factors that predispose individuals to
commit suicide.
For this review, we will (a) determine the overall preva-
lence of suicidal ideation, suicidal attempt and completed
suicide among children and adolescents in SSA; (b)
describe the methods used for suicidal attempt and com-
pleted suicide among children and adolescents in SSA;
and (c) document the risk factors for suicidal ideation,
suicidal attempt and completed suicide among children
and adolescents in SSA.
Methods
The review will be conducted and reported in accordance
to the preferred reporting items for systematic reviews
and meta-analysis (PRISMA) statement (Additional file 1)
[14,15]. This systematic review protocol title has been
registered with the International Prospective Register of
Systematic Reviews (PROSPERO) database (registration
number: CRD42016048610).
Eligibility criteria
We will include articles that have documented the
prevalence and risk factors for suicidal ideation, suicidal
attempt and completed suicide among children and ado-
lescents aged 5–19 years in SSA. The review will include
articles from studies done following cross-sectional, longi-
tudinal, cohort and case control study designs. Sub-group
analysis will be performed on the included studies to cater
for the variations in the study designs.
Unpublished but accessible studies will be included in
the review. Studies on non-suicidal deliberate self-harm
will be excluded. Articles with only abstracts available
(with no full articles) will be excluded as they may be
difficult to compare with full articles.
The selection criteria of the articles for inclusion will
be strictly applied and no double reporting of the same
outcome will be included in the review. We will report
the study as a single one, but in the event that there
were separate outcomes, we will report them as such.
Each publication will have the name of the author, year
and labelled a, b, c, d.
Study design
We will conduct a systematic review of observational
studies (cross-sectional,cohort,longitudinal and case con-
trol studies) that documented the prevalence of completed
suicide, suicide attempt or suicidal ideation among children
and adolescents living in SSA irrespective of how the
studies report the main outcome. We will also review
suicide methods used and associated risk factors for
suicide.
Setting
The systematic review will only include studies conducted
in sub-Saharan Africa.
Participants
The participants in this systematic review will be children
and adolescents aged 5–19 years living in SSA.
Comparisons
The comparison groups will be children and adolescents
without suicidal ideation, suicidal attempt and completed
suicide.
Rukundo et al. Systematic Reviews (2018) 7:230 Page 2 of 6
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Outcomes
The outcomes of interest in this systematic review will
be [1] prevalence, [2], suicidal methods used and [3] risk
factors for suicidal ideation, attempts and completion
among children and adolescents in Sub-Saharan Africa.
Search methods
The search strategy will be carried out by the research
team using the following electronic databases and search
engines, from inception, using the same search strategy
with alterations as appropriate for each database: the
Cochrane Library, PsychINFO, PubMed, EMBASE, Africa
wide-information and global health. We will hand search
the references of the included studies. We will develop a
Medline search strategy and use a combination of mesh
terms, text words and combine them with appropriate
Boolen operators in order to identify as many studies as
possible. Grey literature will also been included. We will
identify the relevant grey literature using web searching,
web-based catalogues as well as using bibliographic
databases.
Search string
We will search using various terms as shown in Appendix.
Data extraction
The summary of the variables from which data will be
extracted from reviewed articles include citation of the
study, country/region where the study was done, year
when data collection was carried out, study design, sample
size, response rate, method of data collection, study popu-
lation, age of study participants, selection criteria of the
study participants, gender, religion, ethnicity, prevalence
of suicidal ideation, prevalence of attempted suicide,
prevalence of completed suicide, method of data analysis
and sampling criteria used in participant selection. Quality
of the study will be assessed through risk of bias assess-
ment tool which will be done using a checklist developed
from the strobe statement [16].
The data collected will also include the authors’names,
the title of the article and the year the study was con-
ducted. This data will be extracted by two content experts
on the research team. For articles with missing infor-
mation, the primary authors will be contacted by the
principle investigator to provide the missing or additional
data. For any discrepancies, the principle investigator will
make the final decision.
Data extraction will be done in two stages. Mr. Wilson
Adriko, an information scientist and Dr. Elizabeth
Kemigisha, a Paediatrician with interest in adolescent
health will screen the title and abstract of all identified
studies. We will then download the full text articles
for further screening by two independent reviewers:
Dr. Moses Ocan, a Pharmacologist with expertise in
conducting reviews and Dr. Dickens H. Akena, a
Psychiatrist and systematic review specialist. In the event
that there is disagreement about which study to include
or exclude, the PI who is a content expert will be the
arbitrator.
Quality assessment
Data will be entered in REVMAN 5.1.2 software for ana-
lysis of findings. The assessment of the methodological
quality of the articles will be done using QUIPS (Quality
in Prognostic Studies). We will assess study participa-
tion, confounding measurement and handling, outcome
measurement and statistical analysis, and presentation.
The quality of primary studies will be ensured as part
of the selection criteria of the articles prior to inclusion
into the systematic review. This will be done by ensuring
that only studies that meet the a priori selection criteria
will be included in the review [17]. Screening of articles
for inclusion into the review will be done independently
by two reviewers. Articles will only be included if the
Kappa agreement between the two reviewers in ≥70%.
In addition, risk of bias (publication bias, methodological
bias) in the included articles will be assessed using a risk
of bias assessment checklist developed from the Cochrane
risk of bias (RoB) assessment tool. We will use the
AMSTAR [18] guidelines to assess for the quality of
included studies, and GRADE [19] to assess the overall
quality of each of the outcomes.
Data synthesis
Qualitative synthesis
We will describe the important study features like date,
number of participants, age categories, prevalence,
completed suicide, attempted suicide, suicidal ideation,
country in which the study was done and the associated
risk factors. We will export the data to STATA 13.1 for
analysis.
Meta-analysis
Statistical tests for heterogeneity will be used to assess the
degree of variability in the prevalence measures between
the included studies. Specifically, we will use the I
2
statistic
to report the percentage of variation across studies that is
due to heterogeneity [20]. This is preferred because it does
not depend on the number of studies reviewed. The I
2
score of 0 (zero) will be considered no heterogeneity,
whereas a score of more than zero but less than 25% will
be taken as low heterogeneity. On the other hand, an I
2
score of more than 25% will be considered as moderate-
high heterogeneity. In case we find no statistically sig-
nificant heterogeneity (I
2
= zero), we will go ahead and
conduct meta-analysis. Otherwise, in circumstances of
statistically significant heterogeneity, we will not conduct
meta-analysis [21].
Rukundo et al. Systematic Reviews (2018) 7:230 Page 3 of 6
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Random-effects models will be employed [22]. This
model is used when the researcher thinks or knows
that the effect/main outcome varies widely in the
population. We will use random effects model, be-
cause we are not confident that all the variables we
will identify will be measured in the same way and
with the same values [23–25].
The prevalence, odds ratios and confidence intervals
of individual studies will be presented in forest plots and
we will generate a summary prevalence and confidence
levels. There will also be sensitivity and sub-group ana-
lyses to determine the influence of selected independent
variables on the effect size (suicidality). We will use fun-
nel plots to show small-study effects that will help point
towards publication bias.
In addition to the prevalence, we will also pool effect
estimates relating to risk factors. This will be achieved
through the random effects meta-analysis. Pooling of
results will be done for the prevalence of suicidal ideation,
attempt and completed suicide. This will only be done if
there is need to proceed to meta-analysis. We will conduct
the following sub-group analyses: study designs (cross
sectional studies, case control studies, clinical trials and
cohort studies), region (s) where the studies were con-
ducted, gender and participant age. This is to ensure that
only studies that report similar effect measures are com-
pared. In the event that there is too much heterogeneity,
we will summarise the studies as narrative reviews.
The included articles will report study variables of
interest to the review differently. The interconversion of
the measurements of interest will therefore depend on
how the articles have reported and available data to that
effect. However, the interconversion will be manually
done whenever there is need. The review will use odds
ratios (OR) in reporting the risk factors for suicidal idea-
tion, attempted suicide and completed suicide. Using Stata
13, we shall perform meta-regression on articles with high
heterogeneity. The subgroup and meta-regression analyses
for levels of heterogeneity will be conducted since hetero-
geneity may often be missed or undetected in the included
studies. The possible causes of variability that will need
to be considered include variation in participants from
the different settings, outcomes of the different studies
(suicidal ideation, attempt, behaviour), varying degrees
of bias in the different studies and varying power of the
different studies.
Heterogeneity will be inferred from the I
2
-statistic
(I
2
= 25% (small heterogeneity), I
2
= 50% (moderate het-
erogeneity), I
2
= 75% (large heterogeneity)) generated using
Stata 13 software [26].
Discussion
This protocol describes a systematic review of observational
studies reporting completed suicide, suicide attempt and
suicidal ideation among children adolescent in sub-Saharan
Africa. According to our knowledge, no previous systematic
review specifically addressed this topic. We will summarise
the methods used and results of observational studies
specifically looking at the prevalence and risk factors for
completed suicide and suicidal behaviour in Sub-Saharan
Africa. We anticipate facing a challenge of varying method-
ologies and use of different terms to mean the same thing.
We also anticipate the challenge of stigma and underreport-
ing of suicide-related deaths or morbidity. In addition, stud-
ies may have been conducted in various study populations
like adolescents with HIV, or in war torn areas, those in
school, with few studies looking at the general population.
There may also be unpublished studies conducted on the
same subject in the region that we may not have access to,
but we shall include any available grey literature. We antici-
pate that once this review is complete and published, our
findings will be of interest to adolescents with suicidal
behaviour, their families and caregivers, clinicians and other
healthcare professionals, scientists and policy makers.
Appendix
Search string
We will search using the following terms in the order 1–3.
1. Suicide) OR Para-suicide) OR suicide awareness) OR
suicide attempt) OR attempted suicide) OR suicide
ideation) OR potential suicide) OR deliberate self--
harm) OR uncompleted suicide) OR completed sui-
cide) OR suicidality
2. Children) OR child) OR boy) OR girl) OR juvenile)
OR minors) OR paediatric) OR Adolescence) OR
Preadolescence) OR Puberty) OR Teenager) OR
Teen) OR Young) OR Youth
3. Developing countries) OR low income countries)
OR resource-limited) OR resource constrained) OR
Africa) OR Angola) OR Benin) OR Botswana) OR
Burkina Faso) OR Burundi) OR Cameroon) OR
Cape Verde) OR Central African Republic) OR
Chad) OR Comoros) OR Congo) OR Democratic
Republic of Congo) OR Djibouti) OR Equatorial
Guinea) OR Eritrea) OR Ethiopia) OR Gabon) OR
Gambia) OR Ghana) OR Guinea) OR Guinea
Bissau) OR Ivory Coast) OR Cote d’Ivoire) OR
Jamahiriya) OR Jamahiryia) OR Kenya) OR
Lesotho) OR Liberia) OR Madagascar) OR Malawi)
OR Mali) OR Mauritania) OR Mauritius) OR
Mayote) OR Mozambique) OR Mozambique) OR
Namibia) OR Niger) OR Nigeria) OR Principe) OR
Reunion) OR Rwanda) OR Sao Tome) OR Senegal)
OR Seychelles) OR Sierra Leone) OR Somalia) OR
South Africa) OR St Helena) OR Sudan) OR
Swaziland) OR Tanzania) OR Togo) OR Tunisia)
Rukundo et al. Systematic Reviews (2018) 7:230 Page 4 of 6
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OR Uganda) OR Western Sahara) OR South Suda)
OR Zambia) OR Zimbabwe 657,258
Additional file
Additional file 1: PRISMA-P 2015 Checklist. (DOCX 81 kb)
Abbreviations
SA: Suicide attempt; SI: Suicide ideation; WHO: World Health Organisation
Acknowledgements
We would like to thank Professor Celestino Obua for supporting this review
by providing training on how to conduct systematic reviews through his
grant “Mbarara”University Research Training Initiative (MURTI) Program
(Grant Number D43TW010128) funded by Fogarty International Center of the
National Institutes of Health.
Funding
There is no dedicated funding for this review.
Availability of data and materials
Not applicable.
Authors’contributions
Content expert: GZR, a Child and Adolescent Psychiatrist with a PhD in
suicidology. Search strategist: WA. Data abstraction and extraction and entry:
EK, a Paediatrician, and MO, a Pharmacologist. DHA a Psychiatrist and
systematic review specialist based at the African Centre for Systematic
Reviews. All authors read and approved the final manuscript.
Authors’information
Dr. G. Z. Rukundo is the content expert. He is a Child and Adolescent
Psychiatrist with a PhD in suicidology.
Mr. Wilson Adriko is a Librarian and search strategist.
Dr. Elizabeth Kemigisha, a Paediatrician, and Dr. Moses Ocan, a
Pharmacologist will do data abstraction, extraction and entry.
Dr. Dickens Akena, a Psychiatrist with PhD in systematic reviews and is based
at the African Centre for Systematic Reviews
Ethics approval and consent to participate
No ethical approval will be required for the performance of this systematic
review.
Consent for publication
No need for consent for publication. No raw data will be used. We will use
already published data.
Competing interests
The authors declare that they have no competing interests.
Publisher’sNote
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Author details
1
Department of Psychiatry, Mbarara University of Science and Technology
and African Centre for Suicide Research, Mbarara, Uganda.
2
Faculty of
Interdiscilinary Studies, Mbarara University of Science and Technology,
Mbarara, Uganda.
3
Department of Pharmacology & Therapeutics, Makerere
College of Health Sciences, Kampala, Uganda.
4
Library, Mbarara University of
Science and Technology, Mbarara, Uganda.
5
Department of Psychiatry,
Makerere College of Health Sciences and African Centre for Systematic,
Kampala, Uganda.
Received: 5 October 2017 Accepted: 28 November 2018
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Supplementary resource (1)
Data
December 2018
... Retrospective studies that asked older adolescents and adults to identify previous DSH behaviors have been helpful in identifying characteristics of early DSH (Kiekens et al., 2018). For example, the younger a child is who engages in DSH, the more likely they are to be male, to engage in repeat DSH, to have a future suicide attempt, and to use more lethal means to self-harm (Brezo et al., 2008 ;Hyman, Fisher, Mercugliano, & Cataldo, 1990;Mitchell et al., 2018;Rukundo, Kemigisha, Ocan, Adriko, & Akena, 2018;Sheftall et al., 2016). Chronis-Tuscano et al. (2010) found, while controlling for gender, age, income, maternal psychopathology and early childhood DSH, (ages 3-7) that those with early childhood DSH were four times as likely to have school aged DSH. ...
... Retrospective studies asking older adolescents and adults to identify previous selfinjury behaviors have been helpful in identifying characteristics of early self-injury (Kiekens et al., 2018). For example, the younger a child is who engages in self-injury, the more likely they are to be male, to engage in repeated self-injury, to go on to have a future suicide attempt, and to use more lethal means to self-injure (Brezo et al., 2008;Hyman et al., 1990;Mitchell et al., 2018;Curtis, & Foster, 2018;Rukundo et al., 2018Adriko, & Akena, 2018Sheftall et al., 2016). While controlling for gender, age, income, maternal psychopathology and early childhood (ages 3-7) self-injury, Chronis-Tuscano et al. (2010) found that children with early childhood self-harm behavior were four times as likely to have school-aged self-injury. ...
... Retrospective studies asking older adolescents and adults to identify previous selfinjury behaviors have been helpful in identifying characteristics of early self-injury (Kiekens et al., 2018). For example, the younger a child is who engages in self-injury, the more likely they are to be male, to engage in repeated self-injury, to go on to have a future suicide attempt, and to use more lethal means to self-injure (Brezo et al., 2008;Hyman et al., 1990;Mitchell et al., 2018;Curtis, & Foster, 2018;Rukundo et al., 2018Adriko, & Akena, 2018Sheftall et al., 2016). While controlling for gender, age, income, maternal psychopathology and early childhood (ages 3-7) self-injury, Chronis-Tuscano et al. (2010) found that children with early childhood self-harm behavior were four times as likely to have school-aged self-injury. ...
Secondary data analysis using CANS data in Indiana exploring NSSI and DSH in children younger than 10 years of age
... However, most of the review studies about the risk factors for suicide using a case-control approach have been conducted in non-Muslim countries. 10,19,[47][48][49] and the literature regarding the burden and risk factors for suicide using a case-control PA approach in Muslim countries is limited. ...
Background
Suicide and risk factors have been poorly studied in the Muslim-majority countries that hinder the formulation of prevention strategies and affect suicide prevention eventually.
Objectives
We aimed at identifying and analyzing the psychological autopsy studies assessing the risk factors for suicide conducted in Muslim-majority countries.
Methods
We did a search to trace all the available psychological autopsy studies in the Muslim countries with the search term “psychological autopsy study in Muslim countries.” We also checked the available bibliographies to identify the psychological autopsy studies in the Muslim countries so that all the possible studies could be included.
Results
Out of the Muslim countries, only eight psychological autopsy studies were identified in five countries (Bangladesh [1], Indonesia [1], Iran [1], Pakistan [2], and Turkey [3]). Six studies adopted a case-control study design, and all were carried out in urban settings. The prevalence of psychiatric disorders among case-control studies varied from 52.8% in Turkey to 96% in Pakistan. Psychiatric illness, self-harm, and stressful life events were the commonly replicated risk factors for suicide across studies.
Conclusions
Psychological autopsy studies have been conducted only in five Muslim countries revealing that the risk factor for suicide is certainly under-researched in the incumbent countries. This review identified a similar list of risk factors for suicide, namely, psychiatric disorder, past non-fatal attempts, and adverse life events compared to the Western countries even though the rate varies.
... Suicidal behavior among children and young people (up to age 18) is a significant public health issue (Bilsen, 2018;Carballo et al., 2019;Rukundo et al., 2018). Studies investigating global mortality patterns have found that suicide is among the top five leading causes of death for young people (Bilsen, 2018;Blum & Nelson-Nmari, 2004;Borowsky et al., 1999;Patton et al., 2009;Wasserman et al., 2005;Zhao & Zhang, 2014). ...
Children and young people in out-of-home care are at a higher risk of suicide than young people not involved with child protection systems. Despite this, there is a lack of evidence of effective suicide prevention interventions for this vulnerable population. We reviewed the types of suicide prevention interventions that have been used and evaluated with children and young people and staff and carers in out-of-home care/child protection systems. We conducted a systematic review of existing literature using PRISMA guidelines. Only five studies met the inclusion criteria. Two evaluated youth-focused interventions: emotional intelligence therapy; and multidimensional treatment foster care, while three evaluated adult-focused "gatekeeper training." Youth-focused interventions led to reductions in suicidal thoughts (suicidal ideation), and adult-focused interventions led to increased knowledge, skills, and behaviors such as referring youth to supports. Only one study, one of the youth-focused ones, evaluated the impact of the intervention in terms of suicide attempts but found no reduction. Large numbers of children enter into care with a high risk of suicide. With the considerable overlap between the trauma characteristics and mental health needs of young people in out-of-home care and suicide risk factors in the general population of young people, we recommend developing (and evaluating) new or adapted existing suicide prevention interventions designed specifically for the out-of-home care context. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... 3 Furthermore, it is well known that psychological, somatic, and psychosocial sequelae are the risk factors for suicidal ideation. 4 While the etiology and mechanism of MDD are unclear, it may involve dysregulation of neurotransmitters, dysfunction of the hypothalamic-pituitary-thyroid axis, and inflammatory responses. 5 Patients with long-term MDD have high levels of the peripheral inflammatory markers interleukin-6, tumor necrosis factor-alpha and C-reactive protein (CRP). ...
Background:
Elevated levels of growth differentiation factor (GDF)-15 and reduced levels of testosterone have been linked to depressive disorder, but whether they are also linked to suicidal ideation in patients with depression is unclear.
Methods:
This retrospective study involved 301 patients ≥22 years old hospitalized for depression between July 2018 and November 2020 at Renmin Hospital of Wuhan University, of whom 120 had suicidal ideation. Serum levels of GDF-15 and testosterone were compared between patients with or without suicidal ideation.
Results:
GDF-15 levels were significantly higher among patients with suicidal ideation than among those without, regardless of whether testosterone levels were above or below the median of 314 ng/dL. In multivariate logistic regression involving all patients, serum GDF-15 level was associated with low testosterone level (P=0.001). Among patients with testosterone <314 ng/dL, an increase of 1 standard deviation in serum GDF-15 level translated to a 1.3-fold increase in the risk of suicidal ideation (P=0.007). This relationship was not observed in all population or patients with testosterone levels ≥314 ng/dL.
Conclusion:
High serum GDF-15 level may be associated with an increased risk of suicidal ideation in patients with depression, and this association appears to be partly mediated by low testosterone levels.
Background
Suicide has become a severe public health issue worldwide. Body weight has been put forward as a potentially modifiable element for suicide thought and behavior. However, there are discrepancies across previous studies. Furthermore, the relationships of body weight with suicidal ideation and suicide attempt among low- and middle-income countries (LMICs) remain unclear. Therefore, we addressed this issue among 104907 adolescents of 12-15 years old in 45 LMICs.
Methods
The present study used data from the Global School-based Student Health Survey (GSHS). Suicidal ideation and suicide attempt during the last year were self-reported. Participants were classified intro underweight, normal weight, overweight and obesity according to their body mass index classification. Multivariable logistic regression and meta-analyses based on country-wise estimates were conducted.
Results
The prevalence of suicidal ideation and suicide attempt were 11.8% and 13.0%, respectively. Countrywide meta-analysis demonstrated that overweight and obesity were significantly associated with increased risks of suicidal ideation (For overweight: OR = 1.10; 95% CI = 1.01-1.20; for obesity: OR=1.17; 95%CI: 1.01-1.35) and suicide attempt (For overweight: OR = 1.12; 95% CI = 1.02-1.23; for obesity: OR=1.12; 95%CI: 1.00-1.25). Subgroup analyses showed that the associations between overweight/obesity and suicide attempt were significant for girls but not for boys.
Limitations
The cross-sectional design cannot explore causality; mental health factors were not assessed; suicidal behaviors were self-reported; significant heterogeneity across countries; only students attending school were included.
Conclusions
Overweight/obesity was significantly associated with the risk of suicidal ideation and suicide attempt among adolescents in LMICs.
Objective:
to identify the prevalence of suicidal behavior in young university students.
Method:
a systematic review with meta-analysis of cross-sectional studies based on the Joanna Briggs Institute proposal, and carried out in the PubMed, Web of Science, Scopus, PsycINFO and LILACS databases and in the Brazilian Digital Library of Theses and Dissertations, with no language or year restrictions. A total of 2,942 publications were identified. Selection, data extraction and methodological evaluation of the studies were performed by two independent researchers. The meta-analysis was performed considering the random effects model.
Results:
eleven articles were included in this review. The prevalence variation for suicidal ideation was from 9.7% to 58.3% and, for attempted suicide, it was from 0.7% to 14.7%. The meta-analysis showed a 27.1% prevalence for suicidal ideation in life, 14.1% for ideation in the last year, and 3.1% for attempted suicide in life.
Conclusion:
the high prevalence of suicidal behavior, even with the considerable heterogeneity of the studies, raises the need to implement interventions aimed at preventing suicide and promoting mental health, especially in the academic environment.
Aim: Even though male breast cancer is responsible for less than 1% of all male
cancers, its prognosis proceeds as poor. Since male breast cancer is rare, information
about the disease is limited. In this study, we aimed to present the clinical,
pathological features and clinical experiences of male breast cancer cases.
Method: Male patients who underwent surgical treatment for breast cancer in the
clinic between January 2011 and November 2020 were included in the study. Clinical
and pathological data, surgical treatment procedures and overall survival data of the
patients were analyzed retrospectively.
Results:The median mean age of a total of 16 patients included in the study was 63.6
years. Invasive ductal carcinoma (87.5%) was the most common histological type.
Only one patient was triple negative. The most common type was luminal A (50%)
and the most common was stage 1A (31.3%). Modified radical mastectomy was performed in 8 patients (87.5%).Axillary lymph node metastasis was detected in 8 patients. The most
common pathological stage was 1A (31.3%). 4 patients received
neoadjuvant therapy and 9 patients received adjuvant therapy. Again,
9 patients had received postoperative radiotherapy. Median followup period is 54 months (min 6 - max 118 months) for 15 patients.
During the follow-up, 3 (18.8%) patients died. The 5-year survival rate
was found to be 78.6%.
Conclusion:Information about the treatment of male breast cancers is
limited. Acceptable survival times are provided with multimodal
treatment approaches. Hormonotherapies come to the fore in this
hormonally positive tumor group. Data from different centers should
be compiled and reviewed to determine a specific treatment protocol
for male breast cancer.
Examination of Oncological Results of Laparoscopic and Open Surgical Method in Rectosigmoid Tumors
Background:
Suicidal ideation and suicidal attempt are warning signs for and determine the prognosis of completed suicide. These suicidal behaviors are much more pronounced in people living with HIV/AIDS. Despite this, there is a scarcity of aggregate evidence in Africa. This study was therefore aimed to fill this gap.
Methods:
we extensively searched Psych-info, PubMed, Scopus, and EMBASE to obtain eligible studies. Further screening for a reference list of articles was also done. Meta XL package was used to extract data and the Stata-11 was also employed. Cochran's Q- and the Higgs I2 test were engaged to check heterogeneity. Sensitivity and subgroup analysis were implemented. Egger's test and funnel plots were used in detecting publication bias.
Results:
The pooled prevalence of suicidal ideation was 21.7% (95% CI 16.80, 26.63). The pooled prevalence of suicidal ideation in Ethiopia, Nigeria, Uganda, and South Africa was 22.7%, 25.3%, 9.8%, and 18.05% respectively. The pooled prevalence of suicidal ideation was larger; 27.7% in studies that used Composite International Diagnostic Interview (CIDI) than Mini-international Neuropsychiatric Interview (MINI); 16.96%. Moreover, the prevalence of suicidal ideation in studies with a sample size of < 400 was 23.42% whereas it was 18.3% in studies with a sample size ≥ of 400 participants. The pooled prevalence of suicidal attempts in this study was 11.06% (95% CI 6.21, 15.92). A suicidal attempt was higher in Ethiopia (16.97%) and Nigeria (16.20%) than Uganda (3.51%). This pooled prevalence of suicidal attempt was higher among studies that used a smaller sample (< 400 participants) (15.5%) than studies that used a larger sample size (≥ 400 participants) (8.4%). The pooled prevalence of suicidal attempt was 3.75%, and 16.97% in studies that used MINI and CIDI respectively. Our narrative synthesis revealed that advanced stages of AIDS, co-morbid depression, perceived HIV stigma, and poor social support was among the factors strongly associated with suicidal ideation and attempt.
Conclusion:
The pooled magnitude of suicidal ideation and attempt was high and factors like advanced stages of AIDS, co-morbid depression, perceived stigma, and poor social support were related to it. Clinicians should be geared towards this mental health problem of HIV patients during management.
Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
Although the impact of HIV/AIDS has changed globally, it still causes considerable morbidity and mortality, including suicidality, in countries like Uganda. This paper describes the burden and risk factors for suicidal ideation and attempt among 543 HIV-positive attending two HIV specialized clinics in Mbarara municipality, Uganda. The rate of suicidal ideation was 8.8% (
n
=
48
; 95% CI: 6.70–11.50) and suicidal attempt was 3.1% (17, 95% CI 2.00–5.00). The factors associated with increased risk for suicidal ideation and attempts were state anger (OR = 1.06, 95% CI: 1.03–1.09;
p
=
0.001
); trait anger (OR 1.10, 95% CI 1.04–1.16,
p
=
0.002
); depression (OR 1.13, 95% CI 1.07–1.20,
p
=
0.001
); hopelessness (OR 1.12, 95% CI 1.02–1.23,
p
=
0.024
); anxiety (OR 1.06, 95% CI 1.03–1.09); low social support (OR 0.19, 95% CI 0.07–0.47,
p
=
0.001
); inability to provide for others (OR 0.19, 95% CI 0.07–0.47,
p
=
0.001
); and stigma (OR 2.48, 95% CI 1.11–5.54,
p
=
0.027
). At multivariate analysis, only state anger remained statistically significant. HIV/AIDS is associated with several clinical, psychological, and social factors which increase vulnerability to suicidal ideation and attempts. Making suicide risk assessment and management an integral part of HIV care is warranted.
Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical considerations, a group of methodologists, researchers, and editors developed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations to improve the quality of reporting of observational studies. The STROBE Statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how to improve the reporting of observational studies and facilitates critical appraisal and interpretation of studies by reviewers, journal editors and readers. This explanatory and elaboration document is intended to enhance the use, understanding, and dissemination of the STROBE Statement. The meaning and rationale for each checklist item are presented. For each item, one or several published examples and, where possible, references to relevant empirical studies and methodological literature are provided. Examples of useful flow diagrams are also included. The STROBE Statement, this document, and the associated Web site (http://www.strobe-statement.org/) should be helpful resources to improve reporting of observational research.
Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
Background:
Antimicrobial self-medication is common in most low and middle income countries (LMICs). However there has been no systematic review on non-prescription antimicrobial use in these settings. This review thus intended to establish the burden, risk factors and effects of antimicrobial self-medication in Low and Middle Income Countries.
Methods:
In 2012, we registered a systematic review protocol in PROSPERO (CRD42012002508). We searched PubMed, Medline, Scopus, and Embase databases using the following terms; "self-medication", "non-prescription", 'self-treatment', "antimicrobial", "antimalarial", "antibiotic", "antibacterial" "2002-2012" and combining them using Boolean operators. We performed independent and duplicate screening and abstraction of study administrative data, prevalence, determinants, type of antimicrobial agent, source, disease conditions, inappropriate use, drug adverse events and clinical outcomes of antibiotic self-medication where possible. We performed a Random Effects Meta-analysis.
Results:
A total of thirty four (34) studies involving 31,340 participants were included in the review. The overall prevalence of antimicrobial self-medication was 38.8 % (95 % CI: 29.5-48.1). Most studies assessed non-prescription use of antibacterial (17/34: 50 %) and antimalarial (5/34: 14.7 %) agents. The common disease symptoms managed were, respiratory (50 %), fever (47 %) and gastrointestinal (45 %). The major sources of antimicrobials included, pharmacies (65.5 %), leftover drugs (50 %) and drug shops (37.5 %). Twelve (12) studies reported inappropriate drug use; not completing dose (6/12) and sharing of medicines (4/12). The main determinants of antimicrobial self-medication include, level of education, age, gender, past successful use, severity of illness and income. Reported negative outcomes of antimicrobial self-medication included, allergies (2/34: 5.9 %), lack of cure (4/34: 11.8 %) and causing death (2/34: 5.9 %). The commonly reported positive outcome was recovery from illness (4/34: 11.8 %).
Conclusion:
The prevalence of antimicrobial self-medication is high and varies in different communities as well as by social determinants of health and is frequently associated with inappropriate drug use.
The growth in comparative effectiveness research and evidence-based medicine has increased attention to systematic reviews and meta-analyses. Meta-analysis synthesizes and contrasts evidence from multiple independent studies to improve statistical efficiency and reduce bias. Assessing heterogeneity is critical for performing a meta-analysis and interpreting results. As a widely used heterogeneity measure, the I statistic quantifies the proportion of total variation across studies that is due to real differences in effect size. The presence of outlying studies can seriously exaggerate the I statistic. Two alternative heterogeneity measures, the Ir and Im, have been recently proposed to reduce the impact of outlying studies. To evaluate these measures' performance empirically, we applied them to 20,599 meta-analyses in the Cochrane Library. We found that the Ir and Im have strong agreement with the I, while they are more robust than the I when outlying studies appear.
Context: American Indians and Alaska Natives have the highest suicide rates of all ethnic groups in the United States, and suicide is the second leading cause of death for American Indian and Alaska Native youth. Objective: To identify risk and protective factors associated with suicide attempts among native male and female adolescents. Design: The 1990 National American Indian Adolescent Health Survey. Setting: Schools of reservation communities in 8 Indian Health Service areas. Participants: Eleven thousand six hundred sixty-six 7th-through 12th-grade American Indian and Alaska native youth. Main Outcome Measures: Responses were compared among adolescents with and without a self-reported history of attempted suicide. Independent variables included measures of community, family, and individual characteristics. Separate analyses were conducted for boys and girls. Results: Ever attempting suicide was reported by 21.8% of girls and 11.8% of boys. By logistic regression done on boys and girls separately, suicide attempts were associated with friends or family members attempting or completing suicide; somatic symptoms; physical or sexual abuse; health concerns; using alcohol, marijuana, or other drugs; a history of being in a special education class; treatment for emotional problems; gang involvement; and gun availability. For male and female youth, discussing problems with friends or family, emotional health, and connectedness to family were protective against suicide attempts. The estimated probability of attempting suicide increased dramatically as the number of risk factors to which an adolescent was exposed increased; however, increasing protective factors was more effective at reducing the probability of a suicide attempt than was decreasing risk factors. Conclusions: A history of attempted suicide was associated with several risk and protective factors. In addition to targeting youth at increased risk, preventive efforts should include promotion of protective factors in the lives of all youth in this population.
There is a paucity of data on the prevalence of suicidality in HIV/AIDS, and associated psychological factors in sub-Saharan Africa, shown to be high in Uganda. Yet, the region accounts for over 70% of the world HIV burden. Our study used a cross-sectional survey of 226 HIV-positive (HIV+) adults and adolescents (aged 15–17 years) in Mbarara, Uganda. The relationship between suicidality and depressed mood, anxiety symptoms, state anger, self-esteem, trait anger and hopelessness was examined; anger was the predominant factor in suicidality, suggesting that anger management could potentially lower the prevalence of suicidality.