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Citation
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Lazzarini T, Rohrbaugh RM, Croda J, Gonçalves C, Ko A, Benites W, Silva LD. Ann. Glob. Health 2015; 81(1): e114. |
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Abstract
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Background
Suicide is a major global public health problem, and the burden of suicide is unevenly distributed across societies and ethnic groups; high rates of suicide among indigenous populations and especially among indigenous young adults have been documented in many different societies. Previous studies have demonstrated a very high burden of adolescent suicide among the Guarani-Kaiowá in Mato Grosso do Sul Brazil. The purpose of this study was to establish the current suicide epidemiology, perform in-depth stratified analysis, and to conduct focus group interviews with different segments of the Guarani-Kaiowá community to learn more about possible risk and protective factors.
Methods
The study was conducted in indigenous reservations in Dourados and Itaporã, Mato Grosso do Sul. Two different approaches were taken to further investigate this phenomenon: (1) an epidemiological study of suicide rates in the local indigenous healthcare office catchment area that consisted of village and household-level risk stratification in this population for the first time and (2) a community-based qualitative study consisting of 15 focus group interviews with community health workers, community leaders, and young adults (aged 16-22) designed to develop an understanding of community perceptions of suicide as well as to identify possible risk and protective factors. Community participants were volunteers who fit the following criteria: (1) were Identified as a community leader by the village chief; (2) work as a community health agent or health worker; or (3) is a Guarani-Kaiowá adolescent aged 16-22 years. The primary outcome for the epidemiological study was suicide mortality, and stratified analysis was performed based on important demographic variables including age, sex and village of residence. This study was approved by the Yale University IRB, the ethical review board at Universidade Federal da Grande Dourados, and the village chiefs. All participants signed a written consent form and for participants under 18, guardian consent as well as participant assent was required.
Findings
This study confirmed a high rate of overall and adolescent suicide among the Guarani-Kaiowá, and also provided new insight into differential suicide mortality rates among different neighboring villages, differential age of peak risk between men and women, and a dramatically heightened risk among those living in households with a previous suicide case. Additionally, in the qualitative component, familial dysfunction, marginalization, lack of access to educational and employment opportunities, and alcohol use were identified as possible risk factors, whereas attending school and an intact family structure were identified as possible protective factors.
Interpretation
The results of the study have important public health implications and will be utilized by the local indigenous health care office (DSEI - Polo Base Dourados) to develop and improve targetted suicide intervention and prevention strategies.
Language: en |