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Prevalence and Risk Factors of Attempted Suicide in Adult War-Affected Population of Eastern Uganda

Published Online:https://doi.org/10.1027/0227-5910/a000196

Background: There is conflicting evidence on the relationship between war trauma and suicidal behavior. Some studies point to an increased risk of suicidal behavior while others do not, with a paucity of such data from sub-Saharan Africa. Aims: To investigate the prevalence and risk factors of attempted suicide in war-affected Eastern Uganda. Method: A cross-sectional survey was carried out in two districts of Eastern Uganda where 1,560 respondents (15 years and older) were interviewed. Multivariable logistic regression was used to assess risk factors of attempted suicide in this population. Results: Lifetime attempted suicide was 9.2% (n = 142; 95% CI, 7.8%–10.8%), and 12-month attempted suicide was 2.6% (n = 41; 95% CI, 1.9–3.5%). Lifetime attempted suicide was significantly higher among females 101 (11.1%) than among males 43 (6.5%; OR = 1.80, 95% CI 1.21–2.65). Factors independently associated with lifetime rate of attempted suicide among females were subcounty, being a victim of intimate partner violence, having reproductive health complaints, and having major depressive disorder. Among males these were belonging to a war-vulnerable group, having a surgical complaint, and having a major depressive disorder. Conclusions: In both sexes, the lifetime rate of attempted suicide was not independently directly related to experiences of war trauma. It was, however, indirectly related to war trauma through its association with psychological, somatic, and psychosocial sequelae of war.

References

  • American College of Obstetrics and Gynecology . (2006). Violence against women: Screening tools. Retrieved from www.acog.org/departments/dept_notice.cfm?recno=17&bulletin=585 First citation in articleGoogle Scholar

  • Barak, Y. , Aizenberg, D. , Szor, H. , Swartz, M. , Maor, R. , Knobler, H. Y. (2005). Increased risk of attempted suicide among aging holocaust survivors. American Journal of Geriatric Psychiatry, 13, 701–704. First citation in articleCrossref MedlineGoogle Scholar

  • Beyeza, T. , Naddumba, E. K. , Kakande, B. (2001). Orthopaedic/surgical war-related complications of women and men. In R. Ojiambo-Ochieng, J. Were-Oguttu, E. Kinyanda, (Eds.), Medical intervention study of war-affected Gulu District, Uganda (pp. 53–60). Kampala, Uganda: An Isis-WICCE Research Report. First citation in articleGoogle Scholar

  • Burrows, S. , Laflamme, L. (2005). Living circumstances of suicide mortality in a South Africa city: An ecological study of differences across race groups and sexes. Suicide and Life-Threatening Behavior, 35, 592–603. First citation in articleCrossref MedlineGoogle Scholar

  • Burrows, S. , Schlebusch, L. , Musisi, S. , Kinyanda, E. , Kizza, R. (2010). Self-directed violence. In WHO (Ed.), Violence and health in the WHO African region (pp. 119–161). Libreville, Gabon: WHO Regional Office for Africa Publication. First citation in articleGoogle Scholar

  • Clerke, D. E. , Colantonio, A. , Heslegrave, R. , Rhodes, A. , Links, P. , Conn, D. (2004). Holocaust experience and suicidal ideation in high-risk older adults. American Journal of Geriatric Psychiatry, 12, 65–74. First citation in articleCrossref MedlineGoogle Scholar

  • Cochran, W. G. (1963). Sampling techniques. New York, NY: Wiley. First citation in articleGoogle Scholar

  • Congdon, P. (1996). Suicide and parasuicide in London: A small-area study. Urban Studies, 33, 137–158. First citation in articleCrossrefGoogle Scholar

  • Corcoran, P. , Arensman, E. , Perry, I. J. (2007). The area-level association between hospital-treated deliberate self-harm, deprivation, and social fragmentation in Ireland. Journal of Epidemiology and Community Health, 61, 1050–1055. First citation in articleCrossref MedlineGoogle Scholar

  • Derogatis, L. R. , Lipman, R. S. , Rickels, K. , Uhlenhuth, E. H. , Covi, L. (1974). The Hopkins symptom checklist (HSCL): A self report symptom inventory. Behavioral Science, 19, 1–15. First citation in articleCrossref MedlineGoogle Scholar

  • Ewing, A. J. (1984). Detecting alcoholism: The CAGE questionnaire. Journal of the American Medical Association, 252, 1905–1907. First citation in articleCrossrefGoogle Scholar

  • Fontana, A. , Rosenheck, R. , Brett, E. (1992). War zone traumas and posttraumatic stress disorder symptomatology. Journal of Nervous Mental Disease, 180, 748–755. First citation in articleCrossref MedlineGoogle Scholar

  • Hendin, H. , Haas, A. P. (1991). Suicide and guilt as manifestations of PTSD in Vietnam combat veterans. American Journal of Psychiatry, 148, 586–591. First citation in articleCrossref MedlineGoogle Scholar

  • Joachim, I. (2005). Sexualised violence in war and its consequences. In M. Mondiale, (Ed.), Violence against women in war: Handbook for professionals working with traumatized women (pp. 63–110). Cologne, Germany: Prisma. First citation in articleGoogle Scholar

  • Kinyanda, E. (2007). Suicidal and homicidal ideation/behavior. In G. Bantebya, R. Ojiambo-Ochieng, J. V. Mwaka-Nakiboneka, J. Long-John, J. Were-Oguttu, H. Micah-Laila, R. Naylor, (Eds.), Women’s experiences during armed conflict in Southern Sudan, 1983–2005 (pp. 78–79). Kampala, Uganda: An Isis-WICCE Report. First citation in articleGoogle Scholar

  • Kinyanda, E. (2008). Experiences of torture during conflict in Liberia and its psychological, medical and social consequences. In R. Ojiambo-Ochieng, J. V. Mwaka-Nakiboneka, V. Gayflor, H . Liebling-Kalifani, J. Were-Oguttu, E. Kinyanda, ... H. Nabukeera-Musoke, (Eds.), A situational analysis of the women survivors of the 1989–2003 armed conflict in Liberia (pp. 69–105). Kampala, Uganda: An Isis-WICCE Report. First citation in articleGoogle Scholar

  • Kinyanda, E. , Hjelmeland, H. , Musisi, S. (2005). Negative life events associated with deliberate self-harm in an African population in Uganda. Crisis, 26, 4–11. First citation in articleLinkGoogle Scholar

  • Kinyanda, E. , Kizza, R. , Levin, J. , Ndyanabangi, S. , Abbo, C. (2011). Adolescent suicidality as seen in rural Northeastern Uganda: Prevalence and risk factors. Crisis, 32, 43–51. First citation in articleLinkGoogle Scholar

  • Kinyanda, E. , Musisi, S. , Biryabarema, C. , Ezati, I. , Oboke, H. , Ojiambo-Ochieng, R. , ... Walugembe, J. (2010). War related sexual violence and its medical and psychological consequences as seen in Kitgum, Northern Uganda: A cross-sectional study. BMC International Health and Human Rights, 10, 10. First citation in articleCrossref MedlineGoogle Scholar

  • Kinyanda, E. , Nakku, J. , Oboke, H. , Oyok, T. , Ndyanabangi, S. , Olushayo, O. (2009, October). Suicide in rural war-affected Northern Uganda. Paper presented at the XXV World Congress on Suicide Prevention of the International Association for Suicide Prevention, Montevideo, Uruguay. First citation in articleGoogle Scholar

  • Kinyanda, E. , Woodburn, P. , Tugumisirize, J. , Kagugube, J. , Ndyanabangi, S. , Patel, V. (2009). Poverty, life events and the risk for depression in Uganda. Social Psychiatry and Psychiatric Epidemiology, 46, 35–44. First citation in articleCrossref MedlineGoogle Scholar

  • Kizza, D. , Knizek, B. , Hjelmeland, H. , Kinyanda, E. (2012). Men in despair: A qualitative psychological autopsy study of suicide in Northern Uganda. Transcultural Psychiatry, 49, 696–717. First citation in articleCrossref MedlineGoogle Scholar

  • Mann, J. J. , Waternaux, C. , Haas, G. , Malone, K. (1999). Toward a clinical model of suicidal behavior in psychiatric patients. American Journal of Psychiatry, 156, 181–189. First citation in articleMedlineGoogle Scholar

  • Ministry of Finance, Planning and Economic Development, Uganda . (2000). The Uganda participatory poverty assessment report. Kampala, Uganda: Author. First citation in articleGoogle Scholar

  • Mirembe, F. , Biryabarema, C. , Mutyaba, T. , Otim, T. (2001). The gynaecological effects of the armed conflict. In R. Ojiambo-Ochieng, J. Were-Oguttu, E. Kinyanda, (Eds.), Medical interventional study of war-affected Gulu District, Uganda (pp. 46–52). Kampala, Uganda: An Isis-WICCE Research Report. First citation in articleGoogle Scholar

  • Musisi, S. , Kinyanda, E. , Leibling, H. , Mayengo, K. (2000). Posttraumatic torture disorders in Uganda – a three year retrospective study of patient records as seen at a specialized torture treatment center in Kampala, Uganda. Torture, 10, 81–87. First citation in articleGoogle Scholar

  • Musisi, S. , Kinyanda, E. , Walugembe, J. , Oboke, H. (2006). Psycho-social impact of war and the mental health consequences of torture. In E. Kinyanda, C. Sauerborn, R. Ojiambo-Ochieng, J. Were-Oguttu, (Eds.), Medical interventional study of war-affected Kitgum district, Uganda (pp. 23–31). Kampala, Uganda: An Isis-WICCE Report. First citation in articleGoogle Scholar

  • Ovuga, E. B. L. , Boardman, J. , Wasserman, D. (2005). Prevalence of suicidal ideation in two districts of Uganda. Archives of Suicide Research, 9, 321–332. First citation in articleCrossref MedlineGoogle Scholar

  • Phillips, M. R. , Yang, G. , Zhang, Y. , Wang, L. , Ji, H. , & Zhou, M. (2002). Risk factors for suicide in China: A national case-control psychological autopsy study. Lancet, 360, 1728–1736. First citation in articleCrossref MedlineGoogle Scholar

  • Pietrzak, R. H. , Goldstein, M. B. , Malley, J. C. , Rivers, A. J. , Johnson, D. C. , Southwick, S. M. (2010). Risk and protective factors associated with suicidal ideation in veterans of Operation Enduring Freedom and Iraq Freedom. Journal of Affective Disorder, 123, 102–107. First citation in articleCrossref MedlineGoogle Scholar

  • Slodnjak, V. , Kos, A. , & Yule, W. (2002). Depression and parasuicide in refugee and Slovenian adolescents. Crisis, 23, 127–132. First citation in articleLinkGoogle Scholar

  • Thoresen, S. , Mehlum, L. (2008). Traumatic stress and suicidal ideation in Norwegian male peacekeepers. Journal of Nervous and Mental Disease, 196, 814–821. First citation in articleCrossref MedlineGoogle Scholar

  • Transcultural Psychosocial Organization . (2010). Psychological effects of war: A factor to high risk sexual behavior. Kampala, Uganda: Author. First citation in articleGoogle Scholar

  • Wasserman, D. (2001a). Negative life events (losses, changes, traumas and narcissistic injury) and suicide. In D. Wasserman, (Ed.), Suicide an unnecessary death (pp. 111–117). London, UK: Martin Dunitz Ltd. First citation in articleCrossrefGoogle Scholar

  • Wasserman, D. (2001b). A stress-vulnerability model and the development of the suicidal process. In D. Wasserman, (Ed.), Suicide an unnecessary death (pp. 13–27). London, UK: Martin Dunitz Ltd. First citation in articleCrossrefGoogle Scholar

  • Wojcik, B. E. , Akhtar, F. Z. , Hassell, L. H. (2009). Hospitalised admissions related to mental disorders in U. S. army soldiers in Iraq and Afghanistan. Military Medicine, 174, 1010–8. First citation in articleCrossref MedlineGoogle Scholar