| 1. |
- Caldera, Trinidad, et al.
(författare)
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Parasuicide in a low income country : results from a three year hospital surveillance in Nicaragua.
- 2004
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 32:5, s. 349-355
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Tidskriftsartikel (refereegranskat)abstract
- Aims: A study was undertaken to assess the incidence of parasuicide in Nicaragua, to identify groups at risk, and to describe the characteristics of parasuicides, such as methods used and seasonal and diurnal patterns. Method: All hospital-admitted parasuicide cases in the area of León, Nicaragua, were assessed over a three-year period using standardized instruments. Results: Two hundred and thirty-three parasuicide cases were identified in the catchment area giving a parasuicide rate of 66.3/100,000 inhabitants per year based on the population 10 years and older. Corresponding figure for 15 years and older was 71.3. A majority were females (68.8%), who were significantly younger than the males (mean 20.8 years vs. mean 24.6 years). The highest rates were found in the age group 15 - 19 years with a female rate three times higher than the male rate (302.9 vs. 98.9). Pesticides, a highly lethal substance, were used as method in 19.1% of the attempts. Consistent seasonal variation with peaks in May - June and September - October were found over the years. Among parasuicide cases, 46.5% had been in contact with the healthcare system within 6 months before attempting suicide. Conclusions: Parasuicides represent a significant health problem among young people in Nicaragua. Preventive efforts should be directed especially towards the life situation for young girls, limitation of availability of suicide means, increased awareness in schools concerning suicidal problems, as well as improved management of patients with mental health problems within primary healthcare.
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| 2. |
- Ellsberg, Mary Carroll
(författare)
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Candies in hell : research and action on domestic violence against women in Nicaragua
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the research was to explore the magnitude and characteristics of domestic violence against women in Leon, Nicaragua. A cross-sectional survey was carried out among a representative sample of 488 women between the ages of 15-49 years. In-depth interviews were performed with women who had experienced violence. Also, participatory techniques were used in 19 focus groups of men and women from diverse sectors of Nicaraguan society to gain an understanding of how Nicaraguans view social and legal sanctions for domestic violence.Among ever-married women (n=360) lifetime prevalence of physical violence was 52%, and current prevalence (during the last 12 months) was 27%. Seventy percent of the violence was classified as severe. No significant differences were found with regard to women's age, educational attainment, or occupation and the prevalence of partner abuse. Significant positive associations were found between the risk of wife abuse and poverty, number of children, history of violence in husband's family, husband's controlling behavior and lack of social networks. Abused women were six times more likely to present emotional distress than non-abused women. Emotional distress was more related to the severity of the abuse than to how long ago it had taken place. A significant positive association was found between wife abuse and problems among the children, including physical abuse. Nearly half of the abused women reported that their children had witnessed the violence. Both the qualitative as well as the quantitative data indicated that abused women frequently experience feelings of shame, isolation and entrapment, which in turn contribute to their difficulty in recognizing the violence and disengaging from the violent relationship. Women in Nicaragua used a variety of strategies to protect themselves from violence and most abused women eventually did leave abusive relationships. Temporary leaving and help seeking were critical steps in the process of overcoming violence. However, many women indicated that they did not receive support for their situation.The results of the prevalence survey were compared to findings from two other population-based studies carried out subsequently in Nicaragua. This comparison suggested that under-reporting is a significant threat to the validity of prevalence research on violence, and underscored the importance of incorporating specific measures to enhance disclosure into the research plan, such as providing more than one opportunity to disclose violence and using behaviorally specific language.Moreover, measures that have been primarily viewed from the perspective of ethics and safety, such as ensuring privacy and confidentiality and providing special training and support for interviewers, may have a significant impact on data quality, due to their effect on the disclosure of violence.The survey results and the narrative analysis suggest that domestic violence is a serious public health problem in Nicaragua. The focus group research found that opinions regarding domestic violence differed sharply between men and women, but that broad sectors of society felt that psychological violence was as serious as physical violence, and that new laws and programs were needed to punish violent offenders and to prevent future violence.The results of the research were discussed widely in Nicaragua, and contributed to the debate on the reform of the Nicaraguan Criminal Code with regard to sanctions for domestic violence and protection for victims of violence.
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| 3. |
- Caldera Aburto, José Trinidad
(författare)
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Mental health in Nicaragua : with special reference to psychological trauma and suicidal behaviour
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis explores mental health problems relating to war and natural disaster and suicidal behaviour in the Nicaraguan population. The more specific aims of the study were to assess the prevalence and sociodemographic correlates of mental disorder in a community-based study during time of war (Paper I), to assess the mental health impact of Hurricane Mitch in 1998 (Paper II), to assess the incidence of hospitalized parasuicide cases and groups at risk (Paper III), and to examine suicide intent among attempters relating to gender, suicide method and sociodemographic factors and identify predictors for repetition of an attempt (Paper IV).Method: Based on 4453 family food ration books for families living in an urban area of León, Subtiava, 219 families including 746 adults were selected through a systematic sampling procedure. The study was conducted in 1987 during the war. We were able to reach 584 adults for interview according to the Present State Examination for ICD-9 diagnoses and Self-Report Questionnaire (Paper I). In Paper II, 496 adult primary health care attendees were interviewed six months after Hurricane Mitch according to the Harvard Trauma Questionnaire and were diagnosed for post-traumatic stress disorder (PTSD) according to DSM-IV. In Papers III and IV, all cases from León city admitted to HEODRA Hospital for a suicide attempt over a three-year period (n=233) were interviewed regarding sociodemographic factors and method, time and place of the suicide attempt. A subgroup of 204 cases was interviewed using the Suicide Intent Scale (SIS). Out of those 106 cases were followed-up regarding repetition of attempt or completed suicide after a mean period of 1172 days.Results: In the Paper I study, the one-month prevalence of any mental disorder was 28.8% for men and 30.8% for women. Among men, alcoholism was the most common diagnosis, whereas neurosis, crisis reaction and depression were dominant among women. Alcoholism was scored as the second most severe disorder after psychosis in terms of functional level. In the Mitch study six months after the hurricane, traumatic events were common and 39% reported death or serious injury of a close relative as a result of the hurricane. The prevalence of PTSD ranged from 4.5% in the least damaged area to 9.0% in the worst damaged area. At the prolonged follow-up six months later, half of the cases still retained their diagnosis. Trauma-related symptoms were common and death of a relative, destroyed house, female sex, illiteracy and previous mental health problems were associated with a higher level of symptoms. Suicidal ideation was reported among 8.5% and was significantly associated with previous mental health problems and illiteracy. The studies regarding hospitalized parasuicides showed the highest rate among girls aged 15–19 years (302 attempts per 100 000 inhabitants and year). After drug intoxication, pesticide was the second most common method and most often used by men (23%). Half of the women had recent contact with health care services before attempting suicide. There were significant peaks regarding time of attempt in terms of seasonal and diurnal distribution. Overall scores regarding seriousness of the intent (SIS) were equal between the sexes, but the pattern of SIS items showed significant gender differences in terms of relation to background factors and method used. For women, having a child was one factor associated with higher seriousness. Factor analysis of SIS items revealed a four-factor solution, explaining 59% of the variance. Risk for fatal repetition was 3.2% after three years and for non-fatal repetition 4.8%. During follow-up, three men (11%) had completed suicide but no women. We failed to identify any predictors for repetition from background factors or SIS.Conclusion: The studies have identified different groups at risk for mental health problems relating to war and disasters. Parasuicide rates equalled those from European countries. Whereas young girls dominated, attempts among men were more severe in terms of the methods used and completed suicide at follow-up. SIS seemed to give a meaningful pattern among women but not for men. In our study, seriousness of attempt in terms of method or suicide intent did not predict repetition. Overall non-fatal repetition rate was very low as compared to other studies.
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| 4. |
- Caldera, Trinidad, et al.
(författare)
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Psychological impact of the hurricane Mitch in Nicaragua in a one-year perspective
- 2001
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 36:3, s. 108-114
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Whereas natural disasters more commonly occur in low-income countries, almost all studies on psychological consequences have been conducted in the Western world. In countries where resources are poor it is of importance to know which groups should be targeted for early intervention after a disaster. The study aims at assessing the prevalence of post-traumatic stress disorder PTSD and of post-traumatic symptoms among people afflicted by hurricane Mitch in Nicaragua and at identifying risk factors for PTSD symptoms 6 months following a disaster. METHOD: At four primary health care centres, 496 consecutive adult patients were interviewed 6 months after hurricane Mitch regarding PTSD symptoms (Harvard Trauma Questionnaire, HTQ), disaster experiences and post-disaster help-seeking. RESULTS: All individuals resident in the area during Mitch were judged to have experienced a trauma fulfilling A criteria for PTSD. Regarding more specific traumas, 39% reported a close relative to be dead or seriously injured and 72% had their house partly or completely destroyed. Prevalence of PTSD ranged from 9.0% in the worst afflicted area to 4.5% in a less damaged area. From a dimensional perspective, PTSD symptoms according to HTQ 6 months after the disaster were significantly associated with the death of a relative (beta-coefficient 0.257, P = 0.000), a house destroyed (beta-coefficient 0.148, P = 0.001), female sex (beta-coefficient 0.139, P = 0.001), previous mental health problems (beta-coefficient 0.109, P = 0.009) and illiteracy (beta-coefficient 0.110, P = 0.009). Those with previous mental health problems (OR = 4.84; 95% CI = 3.04-7.66) were more likely than others to seek from help, any source whereas the opposite was true for illiterate people (OR = 0.38; 95% CI = 0.21-0.69). Of all respondents, 8.5% reported that they had thought of taking their lives, and illiterates (OR 2.84; 95% CI = 1.12-4.37) and those with previous mental health problems (OR 2.84; 95% CI = 1.12-4.57) were at particular risk for suicidal problems. One year after Mitch, half of those identified as PTSD cases at 6 months still fulfilled the criteria for a PTSD diagnosis. CONCLUSION: PTSD represents a serious mental health problem after a disaster. Those with illiteracy, females and those with previous mental health problems should be targets for early post-disaster intervention.
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| 5. |
- Valaldares, Eliette, et al.
(författare)
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Physical partner abuse during pregnancy: a risk factor for low birth weight in Nicaragua
- 2002
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Ingår i: Obstetrics and Gynecology. - 0029-7844 .- 1873-233X. ; 100:4, s. 700-705
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess whether being physically abused during pregnancy increases the risk of a low birth weight (LBW) infant. METHODS: We conducted a hospital-based case-control study in León, Nicaragua. Cases consisted of 101 newborns with a birth weight under 2500 g, and for each case two controls with a birth weight over 2500 g were selected randomly from infants born the same day. Anthropometry of newborns was done immediately after birth, and background information and data on experiences of violence and potential confounders were obtained through private interviews with mothers. Crude and adjusted odds ratios (ORs) and population-attributable proportion were calculated for exposure to partner abuse in relation to LBW. Multivariate logistic regression analysis was used to control for potential confounding. RESULTS: Seventy-five percent of LBW newborns (cases) were small for gestational age and 40% were preterm. Twenty-two percent of the mothers of LBW infants had experienced physical abuse during pregnancy by their intimate partners compared with 5% of controls. Low birth weight was associated with physical partner abuse even after adjustment for age, parity, smoking, and socioeconomic status (OR 3.9; 95% confidence interval 1.7, 9.3). Given a causal interpretation of the association, about 16% of the LBW in the infant population could be attributed to physical abuse by a partner in pregnancy. CONCLUSION: Physical abuse by a partner during pregnancy is an independent risk factor for LBW.
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