title: Parasuicide in a low-income country: results from three-year hospital surveillance in Nicaragua.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  All hospital-admitted parasuicide cases in the area of Leon, 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.
authors.affiliation: Department of Mental Health, University of León UNAN, Nicaragua.
authors.forename: Trinidad
authors.initials: T
authors.lastname: Caldera
authors.forename: Andrés
authors.initials: A
authors.lastname: Herrera
authors.forename: Ellinor Salander
authors.initials: ES
authors.lastname: Renberg
authors.forename: Gunnar
authors.initials: G
authors.lastname: Kullgren
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003906:Developing Countries; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009527:Nicaragua / Q000453:epidemiology; D011159:Population Surveillance; D011203:Poverty / Q000523:psychology*; D016728:Self-Injurious Behavior / Q000453:epidemiology*