• Aucun résultat trouvé

Assessment of suicidality in a Moroccan metropolitan area


Academic year: 2021

Partager "Assessment of suicidality in a Moroccan metropolitan area"

En savoir plus ( Page)

Texte intégral


Brief report

Assessment of suicidality in a Moroccan metropolitan area

Mohamed Agoub *, Driss Moussaoui, Nadia Kadri

Ibn Rushd University Psychiatric Centre, Department of Psychiatry, Rue Tarik Ibn Ziad, Casablanca 20000, Morocco Received 13 July 2005; received in revised form 8 September 2005; accepted 29 September 2005

Available online 13 December 2005


Background: The aim of the study was to evaluate the prevalence of suicidal ideations and suicide attempts in a representative sample of the general population of the urban area of Casablanca, Morocco.

Methods: The survey was conducted based on face-to-face household interviews. The Mini International Neuropsychiatric Interview (M.I.N.I.) was used to assess axis I diagnoses according to DSM-IV criteria and the M.I.N.I. suicidality module to rate the severity of active suicidality.

Results: The 1-month prevalence of suicidal ideation was 6.3%. Seventeen subjects (2.1%) reported at least one suicide attempt during their lifetime. Some variables were positively associated to suicidal ideation: the non-married status, subjects with a history of psychiatric disorders, and subjects without children. At least one mental disorder was present among 88.2% of subjects with suicidal ideation. Major depressive disorder was the most prevalent one (23.5%).

Limitations: The sample was small and the prevalence was not determined longitudinally.

Conclusion: Suicidal ideation being relatively frequent in the general population, there is a need to develop programs of prevention of suicide.

D2005 Elsevier B.V. All rights reserved.

Keywords:Suicidality; Epidemiology; Comorbidity

1. Introduction

Suicidality spans a spectrum that ranges from suicid- al thoughts (thoughts about wanting to be dead) to suicidal acts (self-destructive behaviours with at least some intent to end one’s life) (Ahrens et al., 2000).

Approximately 10–18% of population across diverse countries report suicidal ideation and 3–5% have made a suicide attempt at some point in their life (Weissman et al., 1999). In the Arab culture, suicidal behaviour is stigmatised and an expressed hostility to the suicidal patient is the usual reaction (Suleiman et al., 1986). The

prevalence of suicidal ideation in Arab general popula- tions has been rarely explored (Weissman et al., 1999).

Some studies have attempted to evaluate the extent of the phenomenon in non-representative population sam- ples by recruiting in the health care services (Suleiman et al., 1986; Hamdi et al., 1991) or in specific popula- tions (Daradkeh and Al-Zayer, 1988).

Suicide is usually most accurately viewed as a multi- determined act. Risk factors include psychiatric disor- ders, social, psychological, biological and physical factors (Hawton and Van Heeringen, 2000; Van Heer- ingen, 2001). Regarding mental disorders, it has been shown that depressive disorders and alcohol and/or substance dependence or abuse are the most prevalent ones accompanying suicidal ideation and behaviour.

However, a number of factors unrelated to psychopa-

0165-0327/$ - see front matterD2005 Elsevier B.V. All rights reserved.


* Corresponding author. Tel.: +212 63 67 99 36; fax: +212 22 20 68 67.

E-mail address:magoub@fmpc.ac.ma (M. Agoub).

Journal of Affective Disorders 90 (2006) 223 – 226



thology, such as socio-demographic factors (Lewis and Sloggett, 1998), serious medical illness (Druss and Pincus, 2000) or traumatic events (Goldney et al., 2000), have been shown to be independently associated with suicidal ideation and/or suicide attempt.

The main aim of the current study is to assess the prevalence of suicidal ideations and suicide attempts in a representative sample of a general population in the metropolitan area of Casablanca, Morocco. The secondary aim is to identify risk factors associated with suicidality, especially the comorbidity with psychiatric disorders.

2. Methods

2.1. Subjects and diagnostic procedures

The survey was conducted based on face-to-face interviews by trained interviewers who were medical doctors and clinical psychologists. A stratified random general population sample was drawn from the adult population of Casablanca, Morocco, aged 15 years and above. Only 2.6% were 60 years old or more. Informed consent was obtained from all respondents.

The Mini International Neuropsychiatric Interview (M.I.N.I.) (Sheehan et al., 1998) in its Moroccan Col- loquial Arabic version (Kadri et al., 2005) was used to assess axis I diagnoses according to the DSM-IV crite- ria (APA, 1994).

2.2. Suicidality assessment

THE M.I.N.I. suicidality module was used to rate the severity of active suicidality. It included the following items:

bIn the past month did you:

1. think you would be better off dead or wish you were dead? (1 point),

2. want to harm your self? (2 points), 3. think about suicide? (6 points), 4. have a suicide plan? (10 points), 5. attempt suicide? (10 points).

In your life:

6. did you ever make a suicide attempt? (4 points).Q A current suicide risk is present if at least one item is coded yes. The total number of points is used to classify the current suicide risk on three levels as follows: low if the total score ranges from 1 to 5 points, moderate if it ranges from 6 to 9 points and high if it is above 10 points.

2.3. Statistical analysis

The data were analysed using the 6th version of the Epi Info software. The significance of the differences between suicidal and non-suicidal groups was assessed with the aid of 95% confidence intervals (CI). Level of significance was set at 0.05 for all analyses.

3. Results

Out of 850 interviewed subjects, 800 completed the whole evaluation: 400 men and 400 women. Single people represented 58% of the population; 35.3% of them were married.

The level of unemployment was 24.1%; 41.5% had a professional activity. The remaining subjects were stu- dents (18.8%) or housewives (15.5%).

Concerning the level of education, 15.2% had no education, 16.3% had a primary school level (1–5 years), 53.1% had 6–13 years of education and 15.3%

had a university level.

During the previous 1-month period, 6.3% of sub- jects (n= 51, 95% CI, 3.7–8.9%) presented a suicidal

Table 1

Prevalence of suicidal ideation and suicide attempts

Total Men (N= 400) Women (N= 400)

N % N % N %

In the past month

Think you would be better off dead? 62 7.8 22 5.5 44 11.1

Want to harm your self? 17 2.1 9 2.2 8 2

Think about suicide? 15 1.9 8 2 7 1.8

Have a suicide plan? 8 1.0 3 0.7 5 1.3

Attempt suicide? 6 0.8 3 0.7 3 0.7

In your life

Did you ever make a suicide attempt? 17 2.1 6 1.5 11 2.7

M. Agoub et al. / Journal of Affective Disorders 90 (2006) 223–226 224


ideation. The prevalence was 10.5% in women (n= 42, 95% CI, 8.0–12.9%) and 2.25% in men (n= 9, 95% CI, 0.5–3.9%) (OR = 5.1, 95% CI, 2.33–11.5).

A total of 17 subjects (2.1%) reported at least one suicide attempt during their lifetime, 11 women (2.75%) and 6 men (1.5%). The difference was not significant (OR = 1.8, 95% CI, 0.6–5.7). Table 1 shows the detailed answers to the 6-item questions targeting suicidal ideation and behaviour by gender.

The following variables were positively associated with suicidal ideation:

– non-married status (single, widowed divorced) (OR = 5.4, 95% CI, 2.0–15.7),

– subjects with a history of psychiatric disorders (OR = 5.3, 95% CI, 2.3–11.8),

– subjects without children (OR = 2.5, 95% CI, 1.1–5).

The comorbidity with mental disorders was high in people with suicidal ideation (88.2%). In this respect only 6 subjects had no current psychiatric disorder.

Depressive disorders were the most prevalent ones followed by anxiety disorders and substance and/or alcohol related disorders (Table 2).

Twenty-one subjects had two comorbid psychiatric disorders, essentially depressive and anxiety disorders.

4. Discussion

The discrimination between suicidal thoughts and acts is present in surveys conducted across the world.

The month prevalence of suicidal ideation in a rep- resentative sample of the general population in Casa- blanca, Morocco was 6.4%, according to the M.I.N.I.

suicidality module. The risk was higher among women (10.5%) than men (2.2%). Weissman et al.

(1999) conducted an epidemiological survey using similar diagnostic assessment and criteria indepen- dently in nine countries including an Arab country:

Lebanon. The lowest lifetime prevalence rate for suicide ideation was reported in Beirut, Lebanon (2.09%), and the highest rate was found in Christch- urch, New Zealand (18.51%). On the other hand, the current prevalence of suicidal ideation on the present sample was higher than in other studies conducted in Western countries. Hintikka et al. (2001) found a 12- month prevalence of suicidal ideation in the Finnish general population of 2.4% in women and 2.3% in men. There are several methodological differences between the Finnish study and ours: the period ex- plored was 12 months versus 1 month in our studies and most interviews were conducted by phone versus face-to-face interviews in Casablanca. Waern et al.

(2002) explored suicidal ideation in women; the weighted 1-year prevalence of suicidal thoughts was 6.6%.

In the current study, we explored also the occur- rence of suicidal acts. The lifetime rate of suicide attempts was 2.1%. In the study of Weissman et al.

(1999), the lifetime prevalence rate for suicide attempts ranged from 0.72% to 5.93% with the lowest rate in Beirut, Lebanon (0.72%). The WHO/EURO Multicentre Study on Parasuicide retrieved an average male age-standardized rate of suicide attempts ranging from 45/100,000 (Guipuzcoa, Spain) to 314/100,000 (Helsinki), and an average female age-standardized rate ranging from 69/100,000 (Guipuzcoa) to 462/

100,000 (Cergy-Pontoise, France) (Schmidtke et al., 1996).

Concerning the gender factor, females as compared to males had higher rates for suicide attempts, reaching a two- to three-fold increase in most countries (Weiss- man et al., 1999). We retrieved the same ratio (the lifetime prevalence of suicide attempts was 2.7% in women and 1.5% in men).

Since the suicidal ideation is relatively frequently reported by subjects in this representative sample of the general population, there is a need to develop programs of prevention of suicide. The exploration of suicidal ideation has to be systematically assessed in mental patients. Finally, training of general practitioners on this issue in all countries, especially developing ones is crucial.

Table 2

Comorbidity with current psychiatric disorders according to DSM IV (N= 51)

N %

No current psychiatric disorder 6 11.7

Depressive disorders

Major depressive disorder 12 23.5

Dysthymia 11 21.5

Anxiety disorders

Panic disorder 4 7.8

Agoraphobia 12 23.5

Social phobia 8 15.7

PTSD 5 9.8

OCD 10 19.6

GAD 8 19.6

Substance and/or alcohol abuse/dependence 8 15.7 PTSD: post-traumatic stress disorder, OCD: obsessive-compulsive disorder, GAD: generalised anxiety disorder.

M. Agoub et al. / Journal of Affective Disorders 90 (2006) 223–226 225



Ahrens, B., Linden, M., Zaske, H., Berzewski, H., 2000. Suicidal behavior-symptom or disorder? Compr. Psychiatry 41 (2 Suppl.

1), 116 – 121.

American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychiatric Press, Washington, DC.

Daradkeh, T.K., Al-Zayer, N., 1988. Parasuicide in an Arab industrial community: the Arabian-American Oil Company experience, Saudi Arabia. Acta Psychiatr. Scand. 77, 707 – 711.

Druss, B., Pincus, H., 2000. Suicidal ideation and suicide attempts in general medical illnesses. Arch. Intern. Med. 60, 1522 – 1526.

Goldney, R.D., Wilson, D., Dal Grande, E., Fisher, L.J., Mc Farlane, A.C., 2000. Suicidal ideation in a random community sample:

attributable risk due to depression and psychosocial and traumatic events. Aust. N. Z. J. Psychiatry 34, 98 – 106.

Hamdi, E., Amin, Y., Mattar, T., 1991. Clinical correlates of intent in attempted suicide. Acta Psychiatr. Scand. 83, 406 – 411.

Hawton, K., Van Heeringen, C., 2000. The International Handbook of Suicide and Attempted Suicide. John Wiley and Sons, Chichester.

Hintikka, J., Pesonen, T., Saarinen, P., Tanskanen, A., Lehtonen, J., Viinamaki, 2001. Suicidal ideation in the Finnish general popu- lation. A 12-month follow-up study. Soc. Psychiatry Psychiatr.

Epidemiol. 36, 590 – 594.

Kadri, N., Agoub, M., EL Gnaoui, S., Mchichi Alami, Kh., Her- gueta, T., Moussaoui, D., 2005. Moroccan Colloquial Arabic version of the Mini-International Neuropsychiatric Interview (M.I.N.I): Qualitative and Quantitative validation. Eur. Psychiatr.

20, 193 – 195.

Lewis, G., Sloggett, A., 1998. Suicide, depression and unemploy- ment: record linkage study. BMJ 317, 1283 – 1286.

Schmidtke, A., Bille-Brahe, U., DeLeo, D., Kerkhof, A., Bjerke, T., Crepet, P., Haring, C., Hawton, K., Lonnqvist, J., Michel, K., Pommereau, X., Querejeta, I., Phillipe, I., Salander-Renberg, E., Temesvary, B., Wasserman, D., Fricke, S., Weinacker, B., Sam- paio-Faria, J.G., 1996. Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989–1992. Results of the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatr. Scand. 93, 327 – 338.

Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., Dunbar, G.C., 1998. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the de- velopment and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J. Clin. Psychiatry 59 (Suppl. 20), 22 – 33.

Suleiman, M.A., Nashef, A.A., Moussa, M.A., El-Islam, M.F., 1986.

Psychosocial profile of the parasuicidal patient in Kuwait. Int. J.

Soc. Psychiatry 32, 16 – 22.

Van Heeringen, C., 2001. Understanding Suicidal Behaviour: The Suicidal Process Approach to Research, Treatment and Preven- tion. John Wiley and Sons, Chichester.

Waern, M., Spak, F., Sundh, V., 2002. Suicidal ideation in a female population sample relationship with depression, anxiety disorder and alcohol dependence/abuse. Eur. Arch. Psychiatry Clin. Neu- rosci. 252, 81 – 85.

Weissman, M.M., Bland, R.C., Canino, G.J., Greenwald, S., Hwu, H.G., Joyce, P.R., Karam, E.G., Lee, C.K., Lellouch, J., Lepine, J.P., Newman, S.C., Rubio-Stipec, M., Wells, J.E., Wickramar- atne, P.J., Wittchen, H.U., Yeh, E.K., 1999. Prevalence of suicide ideation and suicide attempts in nine countries. Psychol. Med. 29, 9 – 17.

M. Agoub et al. / Journal of Affective Disorders 90 (2006) 223–226 226


Documents relatifs

To assess the impact of regional and local sources among the sites, a linear correlation between the time series of each PMF factor at the two urban background stations (SIRTA and

The Lyon Metropolitan Area (Métropole de Lyon) is a public authority with special status resulting from the merger on 1 January 2015 of the Urban Community of Lyon and the parts

This study is the first one conducted in Moroccan and Maghrebian population in community sample exploring the prevalence of anxiety disorders, and it's the first time we have data

The EPDS has demonstrated effectiveness as a screen- ing tool for postpartum depression in the maternal and infantile health units in Moroccan primary healthcare settings at the time

There are also an infinite number of AB- draw graphs, since any graph of even order with two universal vertices is AB-draw (consider any strategy where Bob, during his first

Indeed, in public testimony before a United States National Research Council committee  in  2007  (see  for  example  reference  [2])  representatives  from 

While the reference (REF) largely relies on poor food waste separation and sub- sequent incineration with energy recovery, scenarios I-to-V differ from REF either by having an

It uses the language for technical calculation called (MATLAB). The algorithm used in this work is described below: a) Start from the depot, b) Examine the outputs that have not

Matthias Catteau, Fares Gouzi, Léo Blervaque, Emilie Passerieux, Marine Blaquière, Bronia Ayoub, François Bughin, Jacques Mercier, Maurice Hayot,.

Title Page Abstract Introduction Conclusions References Tables Figures ◭ ◮ ◭ ◮ Back Close.. Full Screen

✓ دنع ةيئاصحإ ةللاد تاذ قورف دجوتو امك لادلا ىوتسم ةل ( α ≤ 0.05 ) يف وتسم ى ثانلإا حلاصل سنجلل ىزعت يفطاعلا نامرحلا. ✓ ريغتم ىلا ىزعت يدلاولا

Once it is recognized that suburbanites commuting to the central business district may consume the public services supplied by the central city, the tax gap widens because the

In this paper, it is examined whether the structure of constrained submarkets constructed according to three a priori classifications (property type, house value and geographical

Nous avons constat´e que les approximations 2D sont tr`es pr´ecises ; aucune approximation pr´ecise n’existe pour la PSF 3D du WFFM ; pour les st´enop´es de tailles standards,

In order to determine the prevalence of Trichinella spiralis infections in abattoirs of the metropolitan area of Toluca where pigs from commercial farms as well as backyard pigs are

In other words, the sum of the total current daily

Sevillano Sour Orange Bouquet de Fleurs SO Marsh Shamouti Eremocitrus Round kumquat Nagami kumquat Kumquat Microcitrus Microcitrus Rubidoux Pomeroy $ $ ' Mediterranean Avana

L’accès à ce site Web et l’utilisation de son contenu sont assujettis aux conditions présentées dans le site LISEZ CES CONDITIONS ATTENTIVEMENT AVANT D’UTILISER CE SITE WEB.

The uniform deceleration required to obtain the aforementioned radiation patterns can be implemented using a capacitor or an atomic potential. This can be realized in

In this last scenario, the PT cost is set to 0€ (100% subsidy) while the soft mode incentive would be a mileage cycle/walk reward of €0.2 /km.. As it can be seen from the below

On trouve déjà en cette attente, au moins partiellement, le schéma de cette allégorie qu’est le désert des Tartares :en général elle a lieu dans un espace clos, salle ou

Paradoxi- cally, individuals of foreign origin typically belonged either to type 4 (characterized by desyn- chronized eating rhythms and a majority of meals taken in front of