Community suicide rates and related factors within a surveillance platform in Western Kenya

Linnet Ongeri,Rachel Jenkins,Peter Sifuna,James Lyon,Bernhards Ogutu,David A Larsen,Symon Kariuki,Brenda Penninx,Charles R Newton,Andrea Shaw,Hannah Connolly

doi:10.1186/s12888-021-03649-6

Abstract

BackgroundSuicide is an important contributor to the burden of mental health disorders, but community-based suicide data are scarce in many low- and middle-income countries (LMIC) including Kenya. Available data on suicide underestimates the true burden due to underreporting related to stigma and legal restrictions, and under-representation of those not utilizing health facilities.MethodsWe estimated the cumulative incidence of suicide via verbal autopsies from the Health and Demographic Surveillance System (HDSS) in Kisumu County, Kenya. We then used content analysis of open history forms among deaths coded as accidents to identify those who likely died by suicide but were not coded as suicide deaths. We finally conducted a case-control study of suicides (both verbal autopsy confirmed and likely suicides) compared to accident-caused deaths to assess factors associated with suicide in this HDSS.ResultsA total of 33 out of 4306 verbal autopsies confirmed suicide as the cause of death. Content analysis of a further 228 deaths originally attributed to accidents identified 39 additional likely suicides. The best estimate of suicide-specific mortality rate was 14.7 per 100,000 population per year (credibility window = 11.3 – 18.0). The most common reported method of death was self-poisoning (54%). From the case-control study interpersonal difficulties and stressful life events were associated with increased odds of suicide in both confirmed suicides and confirmed combined with suspected suicides. Other pertinent factors such as age and being male differed depending upon which outcome was used.ConclusionSuicide is common in this area, and interventions are needed to address drivers. The twofold increase in the suicide-specific mortality rate following incorporation of misattributed suicide deaths exemplify underreporting and misclassification of suicide cases at community level. Further, verbal autopsies may underreport suicide specifically among older and female populations.

Highlights

Suicide is an important contributor to the burden of mental health disorders, but community-based suicide data are scarce in many low- and middle-income countries (LMIC) including Kenya
From 2011-2017 7,915 deaths were recorded in the Health and Demographic Surveillance System (HDSS) of which 4,306 (54%) had a verbal autopsy
Suicide‐specific mortality rate Thirty-three verbal autopsies were confirmed as suicides, giving a cumulative incidence of 3.6 per 100,000 population per year (95% confidence interval [CI] = 2.5 – 5.0 per 100,000)

Summary

Introduction

Suicide is an important contributor to the burden of mental health disorders, but community-based suicide data are scarce in many low- and middle-income countries (LMIC) including Kenya. An estimated 700,000 persons die from suicide related deaths annually, representing an annual global mortality rate of approximately 9.0 per 100,000 populations with majority (77%) of these deaths in low- and middle-income countries (LMIC) [2]. Like many African countries, suicide data are scarce [4] and most estimates are based on audits from hospitals, may not be representative of the situation in the general population [5, 6]. Data on suicide rates when available, frequently underestimate the true occurence of suicide in a population [7,8,9]. Data on intent is not routinely captured in medical certification of death resulting in high misclassification of suicide cases

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Discussion

Conclusion