The study aimed to explore the suicidal process, suicidal communication and psychosocial situation of young suicide attempters in a rural community in Hanoi, Vietnam. Semi-structured interviews were conducted, in a community setting, with 19 suicide attempters aged 15-24 who had been consecutively hospitalized in an intensive care unit. In 12 of 19 cases, the first pressing, distinct and constant suicidal thoughts appeared less than one day before the suicide attempt in question. However, distress and mild, fleeting suicidal thoughts had been present up to six months before the suicide attempt in 16 cases. Five respondents had a suicide plan one to three days before attempting suicide. Altogether, 13 engaged in some form of suicidal communication before their attempt. This communication was, however, difficult for outsiders to interpret. Twelve of the respondents were victims of regular physical abuse and 16 had suffered psychological violence for at least one year before attempting suicide. Eighteen of the respondents used pesticides or raticides in their suicide attempts. None sought advice or consultation in the community despite long-standing psychosocial problems. The strategy of reducing the availability of suicide means (e.g., pesticides or raticides) in Asian countries should be complemented with a long-term suicide-preventive strategy that targets school dropouts and domestic violence, and promotes coping abilities and communication about psychological and social problems as well as recognition of signs of distress and suicidal communication.
Some suicide-preventive strategies used in the West for young people may be applicable in Vietnam. Reducing access to pesticides and rat poison is comparable to western efforts to make paracetamol or firearms less freely available. Skills in resolving family and other conflicts can be taught in schools according to WHO's suicide-prevention resources for teachers.
Although the highest suicide rates are currently found in Eastern Europe, the largest number of suicides take place in Asia (Bertolote 2001). Unfortunately, in Vietnam, as in many other Asian countries, national strategies for suicide prevention have not yet been developed. Suicide was among the ten leading causes of death in Vietnam during 2002, and according to the Ministry of Health, the estimated suicide rate (based on hospital records of mortality is 0.98/100,000 (Ministry of Health in Vietnam 2002). The real suicide rate in Vietnam is still unknown, because the number of deaths reported by the Ministry of Health is based only on hospital data. However, most suicides occur outside the hospital system. There is no national system to monitor causes of death, including suicide, in Vietnam.
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