Mental disorders and attempted suicide in Vietnam

Background: Millions of people die from suicide globally every year. Suicide is strongly associated with mental disorders. More than 90% of those who die by suicide have at least one diagnosable mental disorder at the time of their death. Attempted suicide is also a major public health concern since it is an important predictor of subsequent completed suicide and an indicator of mental health problems. Aims: There are four aims which correspond to four papers. First, we validated the Vietnamese version of SRQ-20 as a tool to detect mental disorders in Vietnam. Second, we analyzed the prevalence and types of mental disorders among people who have attempted suicide. Third, we assessed the incidence, methods used and characteristics of people attempting suicide. Fourth, we followed-up people who had attempted suicide with respect to repeated attempt and completed suicide. Methods: Three studies with different designs were performed. In study I, the Vietnamese version of SRQ-20 was tested and evaluated in 52 people in a district hospital sample and 485 people from the general population. In study II, we investigated patients admitted to a central referral hospital in Hanoi following attempted suicide by poisoning, from July 2007 to February 2008. In study III, we identified all those who attempted suicide during 2003-2007 in a district outside Hanoi. Subjects were retrospectively interviewed by trained medical staff to investigate, socio-demographic and other characteristics, methods used and to estimate incidence. Subjects were followed until the end of June 2009 with respect to repeated suicide attempt and completed suicide. Statistical significance for differences between groups was assessed using chi-square and Fisher’s exact tests where appropriate. Results: In paper I, we found that the optimal cut-off points of SRQ-20 in hospital and community settings were 5/6 and 6/7, respectively. In paper II, the most common methods were poisoning by pharmaceutical drugs in urban areas and by pesticides in rural areas. ICD-10 diagnostic criteria confirmed mental disorders were present in 68% of the cases and 73% were rated positive on SRQ-20. Most patients (92%) had not been in contact with psychiatric care. In paper III and IV, we showed that the yearly incidence of attempted suicide was 10.2 per 100000 person-years. 12.5% repeated suicide attempts and 5.8% completed suicide during the followup period. 99% of cases attempted suicide by poisoning, 62.6% by pesticides and 36.3% by pharmaceutical drugs. Methods used were mainly drugs (8 cases) and pesticides (5 cases) for repeated suicide attempt, and pesticides, hanging and drowning for completed suicide. 34.3% reported having been in contact with physical health care and 13.2% had received mental health care. Conclusions: We confirmed the validity of the SRQ-20 for use in developing countries, specifically Vietnam, and that it can be used to collect and report data on mental disorder in epidemiological surveys and public health reports. The majority of suicide attempts are undertaken with pesticides and pharmaceutical drugs. The risk of re-attempted and completed suicide is increased among patients who have attempted suicide and most of those who attempt suicide have a psychiatric illness while the large majority has no support from psychiatric care. Thus, suicide prevention strategies should include components for limiting access to pesticides and for the stronger regulation of accessibility of pharmaceutical drugs. Mental health services should focus efforts on safeguard against suicide among high risk groups by developing the care and follow-up of people with mental health problems and those who have previously attempted suicide. Better access to mental health care should be prioritized for this group, possibly by integration of mental health care into primary health care. LIST OF PUBLICATIONS This thesis is based on the following four publications. I. Kim Bao Giang, Peter Allebeck, Gunnar Kullgren, Nguyen Van Tuan. The Vietnamese version of the self reporting questionnaire 20 (SRQ-20) in detecting mental disorders in Rural Vietnam: A validation study. Int J Soc Psychiatry 2006;52:175-184. II. Nguyen Van Tuan, Christina Dalman, Nguyen Viet Thiem, Tran Viet Nghi, Peter Allebeck. Suicide attempts by poisoning in Hanoi, Vietnam: Methods used, mental problems and history of mental health care. Arch Suicide Res 2009;13:1-10. III. Nguyen Van Tuan, Christina Dalman, Le Cong Thiem, Nguyen Viet Thiem, Tran Viet Nghi, Peter Allebeck. Suicide attempt in a rural area of Vietnam: Incidence, methods used and access to mental health care. Int J Mental Health Systems 2010;4:3. IV. Nguyen Van Tuan, Christina Dalman, Nguyen Viet Thiem, Tran Viet Nghi, Peter Allebeck. Suicide attempt in rural area of Vietnam: follow-up with regard to repeated attempt and completed suicide. Manuscript.