Suicide and Self-Injury
Srishti Sardana, M.A., M.S.
Doctoral Candidate & Medical Psychology Intern
Duke Psychiatry and Behavioral Sciences, Duke University School of Medicine
Durham, North Carolina
Brandon Knettel, Ph.D.
Assistant Professor
Duke University
Durham, North Carolina
Background. Suicide is a serious global health issue that causes significant premature mortality. Nearly 800,000 people die by suicide each year, making it the 15th leading cause of death worldwide, with 77% of deaths by suicide occurring in low- and middle-income countries. Data from the African continent consistently shows suicide rates higher than the global average, despite the high likelihood that suicide is underestimated in many African settings due to challenges in data collection, high rates of mental health stigma, and policies that promote silence about suicidal thoughts and behavior. The challenges of suicide in Africa, as with any setting, are complex and intertwined with systems of public policy, health behavior, personal decision-making, and access to mental health treatment. Method. We conducted a systematic review of counseling interventions focused on suicide prevention among adults living in Africa per PRISMA guidelines. Our search included published manuscripts, dissertations, theses, and conference abstracts on a range of study designs across 6 different databases. Of the 2438 titles and abstracts reviewed, 33 studies met criteria for full-text review and 11 were included in the final analysis. Results. Studies included 726 participants on average (range: 25-3107) and focused on a variety of populations, including people living with HIV, out of school youth, university students, and women undergoing obstetric fistula repair. Counseling represented several theoretical orientations, including one study which assessed a dialectical behavioral therapy (DBT) program; however, other cognitive and behavioral therapies were entirely absent. There was a near-equal split in individual versus group counseling modalities and the use of professional versus lay counselors. The majority of interventions had primary outcomes focused on mental health or social variables with a secondary focus on suicide, and the mechanisms of change for suicide prevention were poorly articulated.
Implications. This review of counseling interventions for suicide prevention in Africa is, to our knowledge, the first conducted on this topic. There is a clear paucity of studies in this area, particularly those using evidence-based interventions for suicide prevention and those with suicide prevention as their primary outcome. The syndemic impact of ecological disasters and humanitarian crises are expected to pose increasing threats to mental health and well-being of populations globally in the coming years, with suicide being a priority area for prevention for the World Health Organization. The findings in this review are vital for informing policy, research, and health care, including investment in the development, implementation, and scale-up of new suicide prevention interventions.