Background Suicidal ideation is the intention or wish to die, and the mental formulations and strategies to accomplish it (Mintz 1971) Suicidal ideati

Transcription

1 Suicidal ideation among the elderly in rural Ghana: identifying the socio-demographic and equity correlates using the Kintampo Demographic and Health Surveillance Site Akpalu B 1, Victor D 1, Owusu-Agyei S 1, Weobong B 1, Sulemana Y 1, Prince M 2 1. Kintampo Health Research Centre 2. IoP, King s College, London

2 Background Suicidal ideation is the intention or wish to die, and the mental formulations and strategies to accomplish it (Mintz 1971) Suicidal ideation is the prelude to suicide: 5% of people with persistent suicidal ideation eventually commit suicide. Suicidal id lid ideation is a psychologically ll stressful condition and needs attention, whether it leads to suicide or not. The literature reports interesting gender correlates between suicidal ideation and suicide WHO ranks suicide among the 10 highest causes of death in the world (16 people per 100,000). Suicide kills one million people each year, more than deaths from road traffic accidents. Elderly people (65years+) commit suicide more than any other age group (Mintz 1971, WHO 2001).

3 Theoretical underpinnings Aggression turned inward Retaliation: inducing guilt in others or punishing others Efforts to make amends for perceived wrong The desire to escape from stress, deformity, pain or emotional vacuum Psychiatric disorders: About 90% of people whose suicidal ideation escalate into suicide have a psychiatric i condition i at the time of suicide id The psychiatric conditions implicated are depression, alcohol-induced psychosis, sexual dysfunction, schizophrenia, personality disorders and anxiety disorders Some physical conditions implicated are mainly chronic ones: diabetes, cancer, non-congenital deformity (eg due to an accident), stroke, HIV/AIDS.

4 The suicide process 1. I couldn t do anything useful in life (reflective) 2. If I don t wake up tomorrow, I ll be happy (passive) 3. I m tired of life, why is God not calling me? (passive) 4. Carelessness with life (active, subconscious) 5. Let me kill myself (suicidal plan-- --active) 6. Preparation 1: Poison, rope, firearms, sleeping tablets 7. Preparation 2: Making vital ld documents available vrs destroying them-- will, bank accounts, insurance 8. Last-minute hints, or efforts to seek help 9. The quiet day-- --minimises ii i social ili interactions, i exhibits flat affect (mental rehearsal) 10. D-day?!?!?!

5 Study objectives To conduct an exploratory survey of suicidal ideation among the general population in the central belt of rural Ghana To investigate the socio-demographic correlates of suicide in the study population To find out what risk factors as well as protective factors exist in relation to suicidal ideation in the study population

6 Study design and methodology We used a cross-sectional sectional analytic design for this study. Sampling frame was the dataset of elderly yp people p 65 years and above from the Kintampo Health and Demographic Surveillance System (KHDSS) The KHDSS has active surveillance over a population of about 127,000, and basic demographics of the population are captured at six-monthly intervals The listing i of the subjects was segregated into four ethno-geographic clusters, with 100 subjects from each cluster Sample size of 400 subjects (179 males and 221 females). 388 valid responses were analysed (175 males and 213 females)

7 The study tools 1. Beck Hopelessness Scale (BHS) It was developed to predict suicidal ideation in both clinical and non-clinical samples. The scale has apriori cutoff guidelines, although the author recommends that empirical cut-off scores should be based upon clinical decisions. 2. The other tool was the Community Screening Instrument for Dementia (CSI-D) Provided iddth the detailed dtild socio-demographic data of the subjects.

8 Data collection and analysis Trained fieldworkers piloted the tools in an adjacent non-study area and slight adjustments made Data collection lasted four months, supervised by a research assistant and the principal investigator. The data was cleaned, and double entered into FoxPro Data analysis was done using STATA Bivariate and multivariate analyses were used to find correlations and divergent variables Proportions were also calculated

9 Main findings We found suicidal thoughts to be significantly more prevalent among females, even when adjusted for age and socioeconomic variables. (Compare with studies on completed suicide) Depressive symptoms correlated highly with suicidal ideation Being a younger elderly l (65 to 70 years) also correlated with higher suicidal ideation Tiredness with life was common The death wish was also common, but did not go beyond the passive stage Suicidal iidl attempts were surprisingly ii less reported

10 Main findings (contd) A rich social network was a protective factor against suicidal ideation (married, religious affiliation, closeness to children and relatives, having good neighbours) Healthy status also provided a protective factor (the absence of a chronic disease or disability) Socio-economic status was a protective factor only when it conferred a rich social network The empty nest phenomenon was also found to be a risk factor

11 Discussion The higher rates of suicidal thoughts among females may be due to the fact that they bear the brunt of housekeeping responsibilities in a typical home in rural Ghana The finding that the younger elderly are more suicidal is both interesting and surprising and may be due to the fact that this category of the elderly have just entered the difficult era of the elderly and would be more depressive Low rates of suicidal attempts was a surprise finding, given the relatively high scores on the BHS, and the dire personal circumstances of many of the subjects Possible explanations could include the stigma of suicide that exits in the Ghanaian pre-burial cultural practices for the suicide victim Or the impact of religion which frowns on suicide

12 Conclusion Suicidal ideation is common among the elderly in the middle belt of rural Ghana Interesting gg gender and socio-demographic correlates were identified Risk and protective factors were also identified Suicide attempts were rare, (maybe under-reported) reported) as a result of the stigma attached to suicide This is an area that needs further, more focused research

13 Acknowledgement Respondents and their family members The Ghanaian-Dutch Collaboration for Health Research and Development (funded the study) Kintampo Health Research Centre The INDEPTH Network

14 Asante sana Thank you