273567 “Nou bezwen anpil chita” (we need many chairs): Perceptions of and attitudes towards suicide in rural Haiti

Tuesday, October 30, 2012

Ashley Hagaman, MPH , School of Human Evolution and Social Change, Arizona State University, Decatur, GA
Suicide is a complex, yet preventable public health problem resulting from the interaction of psychological, social, biological and environmental factors. Few studies examine local socio-cultural explanatory models of suicide outside the Western milieu, and community studies in Haiti are lacking. This study sought to describe cultural attitudes and models of suicide held by healthcare professionals and community members in rural Haiti. Semi-structured, in-depth interviews were conducted amongst 8 biomedical healthcare professionals and 16 lay community members to determine norms, perceived causal pathways, and attitudes towards suicidal behavior. Qualitative data analysis, drawing on grounded theory, addressed inductive and deductive themes including perceived suicide commonality, veracity of suicidal ideation claims, religious constructs related to suicide, suicide narratives, causal factors, and support resources for suicidality. Compared to community members, healthcare professionals were less likely to consider completed suicide a “common” and important issue. According to community respondents' accounts, pesticide poisoning was used only by women to complete suicide, while men chose sharp objects or hanging as their lethal method. Suicide narratives identified as common causes strained love relationships, public shame, extreme poverty, and “sent spirits” related to Vodou practice. These observed discrepancies between health professionals' and community members' perceptions suggest that the formal health structure may be ill-equipped to respond to suicide-related needs. Prayer and religious practice may be potential protective factors and resources for future prevention programs. Successful interventions should consider the lay contextual understanding and perceived etiology of suicide, address potential provider bias, and incorporate traditional, community-based, and religious resources.

Learning Areas:
Diversity and culture
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. List locally identified causes of suicidal behavior in rural Haiti. 2. Describe cultural attitudes and models of suicide amongst healthcare professionals and community members in rural Haiti. 3. Differentiate the conflicting understanding of suicide in Haiti and its importance to future programs that may address psycho-social issues. 4. Recognize the need for rigorous, relevant, and community-based research exploring complex topics (such as suicide) in order to design appropriate and effective mental health interventions.

Keywords: Mental Health, Violence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have collaborated on several chronic disease explorations where I spearheaded mixed-methods study design and data analysis. My research interests include mental health, suicide, and the social determinants of chronic disease in marginalized populations. I specifically led several epidemiologic explorations of suicide in Haiti and amongst Bhutanese refugees.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.