Impact of the Tunisian Revolution on homicide and suicide rates in Tunisia

Khelil, Mehdi Ben; Gharbaoui, Meriem; Farhani, Fethia; Zaafrane, Malek; Harzallah, Hana; Allouche, Mohamed; Zhioua, M.; Hamdoun, Moncef

doi:10.1007/s00038-016-0834-8

Cited by 31 publications

(18 citation statements)

References 37 publications

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“…However, our study showed a rise in self-harm and interpersonal violence during the same time period that was much faster than in other parts of the world. Clearly the unrest and conflicts are causing deaths due to collective violence and legal interventions, but they are also correlated with increased burden from self-harm and other diseases (Murray et al 2002 ; Ben Khelil et al 2016 ). All countries with the highest mortality rates of self-harm and interpersonal violence (Afghanistan, Somalia, Djibouti, and Iraq) have been affected by multiple episodes of civil or inter-state wars and social unrest, as well as terrorism during 1990–2015.…”

Section: Discussionmentioning

confidence: 99%

“…The Eastern Mediterranean Region (EMR) has had several conflicts and unrests in the past years; such events have huge impact on all types of intentional injuries. A study in Tunisia showed an increase by 1.7 times in self-harm and 1.3 times in homicide after the Tunisian Revolution in 2011 (Ben Khelil et al 2016 ). The effect of conflicts and social unrest on collective violence and legal intervention is obvious.…”

Section: Introductionmentioning

confidence: 99%

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Intentional injuries in the Eastern Mediterranean Region, 1990–2015: findings from the Global Burden of Disease 2015 study

Mokdad¹,

Moradi‐Lakeh²,

Charara³

et al. 2017

Int J Public Health

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ObjectivesWe used GBD 2015 findings to measure the burden of intentional injuries in the Eastern Mediterranean Region (EMR) between 1990 and 2015.MethodsThe Global Burden of Disease (GBD) study defines intentional injuries as a combination of self-harm (including suicide), interpersonal violence, collective violence (war), and legal intervention. We estimated number of deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for each type of intentional injuries.ResultsIn 2015, 28,695 individuals (95% UI: 25,474–37,832) died from self-harm, 35,626 (95% UI: 20,947–41,857) from interpersonal violence, and 143,858 (95% UI: 63,554–223,092) from collective violence and legal interventions. In 2015, collective violence and legal intervention was the fifth-leading cause of DALYs in the EMR and the leading cause in Syria, Yemen, Iraq, Afghanistan, and Libya; they account for 49.7% of total DALYs in Syria.ConclusionsOur findings call for increased efforts to stabilize the region and assist in rebuilding the health systems, as well as increasing transparency and employing preventive strategies to reduce self-harm and interpersonal injuries.Electronic supplementary materialThe online version of this article (doi:10.1007/s00038-017-1005-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intentional injuries in the Eastern Mediterranean Region, 1990–2015: findings from the Global Burden of Disease 2015 study

Mokdad¹,

Moradi‐Lakeh²,

Charara³

et al. 2017

Int J Public Health

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“…Tunisia, a lower-middle-income country located in North Africa [ 53 ], is among the many countries concerned with the provision of effective mental health care to target the growing mental health treatment gap [ 23 ]. This gap is on the rise given widespread untreated mental health symptoms, especially since the 2010–2011 Revolution [ 23 , 54 – 57 ]. Lack of treatment is caused, in part, by human resource challenges [ 23 , 39 , 58 ].…”

Section: Introductionmentioning

confidence: 99%

Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia

Spagnolo¹,

Champagne²,

Leduc³

et al. 2018

Int J Ment Health Syst

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BackgroundNon-specialists’ involvement in mental health care is encouraged in the field of global mental health to address the treatment gap caused by mental illness, especially in low- and middle-income countries. While primary care physicians (PCPs) are involved in mental health care in Tunisia, a lower-middle-income country in North Africa, it is unclear to what extent they are prepared and willing to address mental health problems, substance use disorders, and suicide/self-harm. In this context, we aim (1) to report on mental health knowledge, attitudes, and self-efficacy among a sample of PCPs working in the Greater Tunis area, prior to the implementation of a mental health training program developed by the World Health Organization; and (2) to identify what characteristics are associated with these competencies.MethodsIn total, 112 PCPs completed questionnaires related to their socio-demographic and practice characteristics, as well as their mental health knowledge, attitudes, and self-efficacy. Descriptive analyses and regression models were performed.FindingsPCPs had more knowledge about depression, symptoms related to psychosis, and best practices after a suicide attempt; had favourable attitudes about distinctions between physical and mental health, learning about mental health, and the acceptance of colleagues with mental health issues; and believed most in their capabilities related to depression and anxiety. However, most PCPs had less knowledge about substance use disorders and myths about suicide attempts; had unfavorable attitudes about the dangerousness of people with mental health problems, personal disclosure of mental illness, non-specialists’ role in assessing mental health problems, and personal recovery; and believed the least in their capabilities related to substance use disorders, suicide/self-harm, and psychosis. Participation in previous mental health training, weekly hours (and weekly hours dedicated to mental health), weekly provision of psychoeducation, and certain work locations were associated with better mental health competencies, whereas mental health knowledge was negatively associated with weekly referrals to specialized services.ConclusionsFindings suggest that PCPs in our sample engage in mental health care, but with some gaps in competencies. Mental health training and increased interactions/involvement with people consulting for mental health issues may help further develop non-specialists’ mental health competencies, and integrate mental health into primary care settings.Electronic supplementary materialThe online version of this article (10.1186/s13033-018-0243-x) contains supplementary material, which is available to authorized users.

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“…Rather, we agree with Campbell and Guiao [41], who claimed that SI as a demonstrative act (carried out in front of others) can entail the intention to induce guilt and shame among close family members in particular. Additionally, lack of fear of death [25] in combination with a sort of copycat effect [11, 12, 33], along with the availability of fluid accelerants and the presence of psychiatric disorders (especially adjustment disorders) may be factors with the potential to deepen our understanding of the psychosocial and psychological conditions favorable to committing suicide by SI.…”

Section: Discussionmentioning

confidence: 99%

“…The macrolevel approach is based on the observation that suicide and suicidal behavior can increase during economic crises or as a result of extreme poverty [8-10] or political instability [11, 12]. However, evidence from Greece [13] and South Korea [8, 14, 15] has not fully supported this analysis when factors such as psychiatric disorders and the interpersonal environment are taken into account.…”

Section: Introductionmentioning

confidence: 96%

Female Gender, Marital and Family Problems, and Feelings of Guilt Are Related to Self-Immolation Suicide Attempts

Ahmadpanah¹,

Rahighi²,

Haghighi³

2017

Neuropsychobiology

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Background: Self-immolation (SI) is considered one of the most painful, dramatic, and at the same time most inexplicable methods of suicide, with a high social impact. Prevalence rates are particularly high in Iran, and in north-western Iran specifically. Here, we report sociodemographic, psychological, and psychiatric characteristics of patients attempting self-immolation (PSIs), compared to patients with accident burns (PABs). Method: Patients referred to the Burns Emergency Unit of the Besat Hospital (Hamadan, Iran) were enrolled in the present study between winter 2015 and summer 2016. After burn-related treatments and surgery, a thorough interview was undertaken covering sociodemographic characteristics, burn-related information, and psychiatric background. Results: A total of 79 patients were enrolled. Among these, 19 (31.7%) had attempted suicide via SI. Compared to the PABs, the PSIs were predominantly females; they reported family and marital problems as the main triggers for SI. The psychiatric interviews indicated that PSIs often suffered from major depressive disorders, adjustment disorders, and bipolar disorders. The prevailing feelings reported were guilt and shame. A binary logistic regression showed that feelings of guilt and marital and family problems predicted SI. Conclusions: The prevalence of SI was surprisingly high. Marital and family conflicts as a proxy for highly distressing social interactions, along with female gender and feelings of guilt and shame were strongly associated with SI. Family and couple counseling specifically tailored to difficulties experienced by women might reduce the risk of SI.

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Impact of the Tunisian Revolution on homicide and suicide rates in Tunisia

Abstract: Our results proved a short-term impact of the transition period on homicides and suicides. Urgent preventive measures are needed especially to decrease the suicide rates.

Cited by 31 publications

References 37 publications

Intentional injuries in the Eastern Mediterranean Region, 1990–2015: findings from the Global Burden of Disease 2015 study

Intentional injuries in the Eastern Mediterranean Region, 1990–2015: findings from the Global Burden of Disease 2015 study

Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia

Female Gender, Marital and Family Problems, and Feelings of Guilt Are Related to Self-Immolation Suicide Attempts

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