Attempted suicide in Vietnam

Abstract: Suicide and attempted suicide is currently a major public health problem in rapidly developing countries but there are limited studies on this field in Asian countries. These are the first studies on suicidal behavior in Vietnam. The aim of the studies was to: 1) investigate the prevalence of suicide attempts, plans, ideation and medical attention following a suicide attempt in Vietnam and in nine other countries, 2) investigate the relation between lifetime suicidal thoughts and psychological factors, lifestyles and depression 3) investigate the characteristics of suicide attempters and describe similarities and differences of risk factors between suicide attempts in Vietnam and in the West 4) identify suicidal processes, suicidal communication and family relationships among young suicide attempters. For this purpose, one component of the WHO SUPRE-MISS (Multisite Intervention Study on Suicidal Behaviors within the SUicide PREvention initiative) was preformed in 2280 randomly selected residents of an urban community (Dongda district) (Study I and II) and in 2321 residents of a rural suburb of Hanoi (SocSon district) (Study IV). A retrospective study on medical records of 509 suicide attempters in Bachmai hospital, the biggest general hospital in Vietnam, was investigated (Study III). In study V, 19 young suicide attempters admitted to Socson district hospital were interviewed in depth. Suicide attempts (0.4-4.2%), plans (1.1-15.6%) and ideation (2.6-25.4%) varied by a factor of 10-14 across sites. Depending on the site, the ratios between attempts, plans, and thoughts of suicide differed substantially (Study I). In Vietnam, prevalence rates for lifetime suicidal thoughts, suicide plans and suicide attempts were 8.9%, 1.1% and 0.4%, respectively. Suicidal thoughts are associated with multiple characteristics, such as female gender, single/widowed/separated/divorced marital status, low income, lifestyle (use of alcohol, sedatives and pain relief medication), but not with low education or employment status (Study II). The large number of people who had suicidal thoughts is at the range score of mild, moderate or severe depression within the Beck Depression Inventory and at the range score of poor well being according to WHO Well Being Index (Study IV). Despite some differences between suicide attempters in Vietnam and the West, such as rural Vietnamese frequently using pesticides and rat poison for attempting suicide and only a small proportion of patients were diagnosed as psychiatrically ill in Vietnam, there are substantial similarities. Both in Vietnam and in the West, suicide attempters are young, and more females than males attempt suicide. In urban areas, suicide attempters are similar to the suicide attempters in the West: patients employ analgesics and antipyretics (e.g. paracetamol) more often as the method to attempted suicide than other methods. The causes are also similar to the results obtained in studies from Western countries: acute life stressors due to unsolved conflicts with parents, partners and others. Among young suicide attempters, suicidal thoughts are fluctuating and quickly passing but distress was present a long time before the suicide attempts. Thirteen of 19 young suicide attempters expressed suicidal communication to other people, but only in 3 cases in direct verbal form (Study III and V). Some suicide-preventive strategies used in the West may be applicable in Vietnam. Reducing access to pesticide and rat poison is comparable to Western efforts to make paracetamol or firearms less freely available. In addition to classical suicide preventive strategies it seems that psychosocial interventions in the form of programs targeting school drop-outs, domestic violence, and communication and coping abilities should be developed.