Profile of suicide in rural Cameroon: are health systems doing enough?

Objectives To describe the characteristics of suicide and assess the capacity of health services at the district level in Cameroon to deliver quality mental health care. Methods The study covered the period between 1999 and 2008 and was carried out in Guidiguis health district which had a population of 145 700 inhabitants in 2008. Data collection was based on psychological autopsy methods. To collect data, we used documentary review of medical archives, semi‐structured interviews of relatives of suicide completers, a focus group discussion of health committee members and a survey to consulting nurses working at the primary health care level. Results Forty‐seven suicides were recorded from 1999 to 2008: 37 (78.7%) males and 10 (21.3%) females, yielding rates of reported suicides that ranged from 0.89 to 6.54 per 100 000 inhabitants. The most frequently used suicide method was the ingestion of toxic agricultural chemicals (in 76.6% of cases). According to the relatives, the suicides were due to an ongoing chronic illness (31.9%), sexual and marital conflicts (25.5%), witchcraft (14.9%), financial problems (8.5%) or unknown cause (25.5%). In 25 (53.2%) cases, suicide victims exhibited symptoms suggestive of a mental disorder but only six of the suicide committers who presented behavioural symptoms sought health care. Only two of the 15 consulting nurses were able to cite at least three symptoms of depression and were aware that depression can lead to suicide. All of the nurses acknowledged that they had never received any specific training or supervision in mental health care. Conclusions Suicides are not a rare event in rural settings in Cameroon. The health district capacity to provide quality mental care is almost insignificant. The integration of minimal mental health care services at the community and primary health care levels should be considered a priority in sub‐Saharan Africa. ObjectifsDécrire les caractéristiques des suicides et évaluer la capacité des services de santé à l’échelle du district, au Cameroun pour fournir des soins de santé mentale de qualité.MéthodesL’étude a porté sur la période comprise entre 1999 et 2008, et a été menée dans le district de santé de Guidiguis qui avait une population de 145.700 habitants en 2008. La collecte des données a été basée sur des méthodes d'autopsie psychologique. Pour recueillir les données, nous avons utilisé la revue documentaire des archives médicales, des entretiens semi‐structurés avec les parents d