Suicide, Stigma and COVID-19: A Call for Action From Low and Middle Income Countries

Shoib, Sheikh; Chandradasa, Miyuru; Saeed, Fahimeh; Armiya’u, Aishatu Yusha’u; Roza, Thiago Henrique; Őri, Dorottya; Jakhar, Jitender Kumar; Rodrigues-Silva, Nuno; Banerjee, Debanjan

doi:10.3389/fpsyt.2022.894524

Cited by 14 publications

(13 citation statements)

References 43 publications

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“…Healthcare professionals stigmatizing behaviors and beliefs may be subtle and denied because of how they are perceived ( 23 ) thus, it is important to implement interventions focusing on awareness, internal policies, procedures and protocols. It’s also relevant to implement educational approaches, as the one included in this protocol, as adequate information and contact between the public and the stigmatized individuals would lead to diminish stigma ( 110 ) in PHC settings.…”

Section: Discussionmentioning

confidence: 99%

Reducing stigma toward mental illness and substance use issues in primary health care in Chile: Protocol of a cluster controlled trial study

et al. 2022

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BackgroundChile is implementing a Community Mental Health Model with a strong role of primary health care (PHC). PHC has great potential to early detection and provision of accessible and coordinated services to people who present mental illness and/or substance use issues (MISUI). However, stigma toward people with MISUI among PHC professionals is a significant barrier to accessing good quality of care. A wealth of literature supports the importance of reducing stigma for this population. The main goal of this research project is to determine the effectiveness of a comprehensive anti-stigma intervention in reducing stigmatizing attitudes and behaviors among PHC providers toward individuals with MISUI in the Chilean context, using Centros de Salud Familiar (CESFAMs) as the point of intervention.MethodsThe intervention is based on an initiative that was previously developed in Canada and then also pilot-tested in Lima, Peru, with the Center for Addiction and Mental Health (Ontario, Canada). The model will be culturally adapted with CESFAM PHC provider and user inputs to be relevant and valid to Chile. The 18-month intervention includes five (5) components that are simultaneously implemented in CESFAMs: (1) Develop a Team of Local Champions in each intervention CESFAM, comprising PHC providers and users; (2) Analysis of Internal CESFAM Policies, Procedures, and Protocols to determine areas of improvement in service delivery for individuals with MISUI; (3) Raising Awareness of stigma toward MISUI using various forms of media within the CESFAM; (4) Innovative Contact-Based Education workshops on anti-stigma and recovery principles, co-lead by academic/clinical trainers and a person with lived experience of MISUI; and (5) Recovery-Based Arts, a multi-week arts workshop for PHC providers and users to produce artwork related to MISUI and recovery, culminating in an exhibition to showcase artwork for the CESFAM providers, users, and community. The expected intervention outcomes are the following: Participation in the experimental group will result in a significant decrease in stigmatizing attitudes among PHC providers toward individuals with MISUI compared with the control group as measured by the Chilean version of the Opening Minds Scale for Health Care Providers Scale (OMS-HC); Participation in the experimental group will result in a significant decrease of PHC users experiences of stigma conveyed by PHC providers compared with the control group as measured by the Internalized Stigma of Mental Illness (ISMI) scale, validated for the Chilean population. The changes in attitudes and behaviors within the experimental group will be sustained over time as measured at 6 months-follow-up. To evaluate the effectiveness of this 18-month intervention, a 4-year, two-arm, cluster-randomized controlled trial is proposed, with CESFAMs being the unit of randomization (or “cluster”). Implementation Science approach will be taken to measure relevant implementation outcomes for each component of the intervention, and through qualitative data collection with CESFAM providers and authorities. Data analysis will be carried out using SAS 9.4 (specifically, using POC MIXED and PROC GENMOD) and R 3.5. Mixed-effect modeling will used for both PHC provider and user data, which will include individuals and CESFAMs as random effects and group (intervention/control) as fixed effects.DiscussionThis study represents a new stage of relevant and innovative research in mental health and stigma in Chile that will contribute to improving access and quality of care for people with MISUI. Evaluating the impact of the intervention model and its implementation will provide the necessary tools to scale the intervention up to other CESFAMs across Chile.Clinical trial registration[www.ClinicalTrials.gov], identifier [NCT05578066].

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Section: Discussionmentioning

confidence: 99%

Reducing stigma toward mental illness and substance use issues in primary health care in Chile: Protocol of a cluster controlled trial study

et al. 2022

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“…Suicide is one of the mental health issues that is accompanied by stigma, and numerous studies have documented highly prevalent stigmatizing attitudes toward suicidal individuals especially in low- and middle-income countries like Iran ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Stigma as a barrier to suicide prevention efforts in Iran

Masoomi

Hosseinikolbadi

Saeed

et al. 2023

Front. Public Health

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Suicide and suicide attempt affect a considerable part of the general population, and in spite of their prevalence, the stigma associated with suicide remains an unsolved problem surrounding this important public health problem, especially in lower-income countries such as Iran. Evidence shows that help-seeking from formal mental health services for suicidal people is low in countries like Iran. Previous studies on Iranian survivors of suicide attempts have shown that these people experience fear of stigma due to labels such as loss of faith in God, having forms of severe mental illnesses (“madness”), and being involved in unaccepted sexual relationships. The associated stigma prevents them from seeking appropriate health and social services. Although both self-stigma and public stigma contribute to an unwillingness to seek mental health care and suicide prevention efforts in Iran, public stigma may be of greater consequence, significantly impeding an individual's likelihood of accessing care for their suicidal thoughts or attempts. In such circumstances, many people with suicidal thoughts miss out on social and formal support programs offered by social and healthcare providers. In this perspective article, focusing on the public stigma regarding suicide in Iranian society, we address the challenges and barriers to seeking suicide prevention efforts in Iran and discuss culturally appropriate strategies to improve the current situation.

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“…Suicide is a major public health concern worldwide (Shoib et al, 2022). While suicide rates have declined globally (World Health Organization, 2021), suicide remains the second leading cause of death in university students (Cecchin et al, 2022) and the prevalence of suicidal ideation is increasing in this group (Sivertsen et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Study Dropout Thoughts in Male University Students as Warning Sign for Suicidal Ideation and Mental Health Problems

Logoz¹,

Weber²,

Eggenberger³

et al. 2023

Preprint

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Background: Increasing prevalence rates for suicidal ideation among university students call for better understanding of critical risk factors. Because of traditional masculinity ideologies (TMI; socially defined sets of standards and norms how men are expected to be or behave), men are less likely to report suicidal ideation but up to four times more likely to die by suicide. Establishing low-threshold risk factors to identify suicidal ideation among male students at an early stage is paramount. Study dropout thoughts, due to a particular relationship with TMI, could be one such risk factor. The present study therefore examines the relationship between study dropout thoughts and suicidal ideation as well as gender-differences in risk patterns. Methods: A total of N = 4894 German university students (24.6% men) completed a cross-sectional online survey on mental health at the University of Cologne. A first part of the survey consisted of sociodemographic and study related questions (e.g., study dropout thoughts). In the second part psychological syndromes (any psychological syndrome, depressive syndrome, alcohol syndrome), life stressors and suicidal ideation were assessed using the Patient Health Questionnaire D (PHQ-D). Results: Male university students expressed study dropout thoughts more frequently than female students, while for both genders study dropout thoughts were associated with increased suicidal ideation. Significant gender-differences were observed for all outcomes, with financial stress and a recent bad experience being risk factors for suicidal ideation in men but not women. Relationship problems, problems at work, and current psychotherapy use were associated with increased suicidal ideation in women but not in men. Conclusions: In the University context, study dropout thoughts are expressed often, especially by male students. Given that study dropout thoughts are associated with suicidal ideation and that male-specific risk patterns for suicidal ideation have been identified, men who report thoughts of dropping out of studies or experience financial stress should be screened for suicidality and mental health problems. Future prevention measures in the University context should consider study dropout thoughts and male-specific risk-patterns to increase chances for detection of male students at risk for suicide and to improve the effectiveness of suicide prevention programs specifically targeting men.

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Suicide, Stigma and COVID-19: A Call for Action From Low and Middle Income Countries

Cited by 14 publications

References 43 publications

Reducing stigma toward mental illness and substance use issues in primary health care in Chile: Protocol of a cluster controlled trial study

Reducing stigma toward mental illness and substance use issues in primary health care in Chile: Protocol of a cluster controlled trial study

Stigma as a barrier to suicide prevention efforts in Iran

Study Dropout Thoughts in Male University Students as Warning Sign for Suicidal Ideation and Mental Health Problems

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