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Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study

Published online by Cambridge University Press:  16 February 2017

M. Jordans ,
S. Rathod ,
A. Fekadu ,
G. Medhin ,
F. Kigozi ,
B. Kohrt ,
N. Luitel ,
I. Petersen ,
R. Shidhaye  and
J. Ssebunnya
...Show all authors
M. Jordans*
Affiliation:
Research and Development Department, HealthNet TPO-Amsterdam, Netherlands Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
S. Rathod
Affiliation:
Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
A. Fekadu
Affiliation:
Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
G. Medhin
Affiliation:
Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
F. Kigozi
Affiliation:
Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda
B. Kohrt
Affiliation:
Duke Global Health Institute, Duke University, Durham, USA Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal
N. Luitel
Affiliation:
Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal
I. Petersen
Affiliation:
Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
R. Shidhaye
Affiliation:
Centre for the Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India; Sangath, India CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
J. Ssebunnya
Affiliation:
Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda
V. Patel
Affiliation:
Center for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK Sangath, Goa, India
C. Lund
Affiliation:
Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
*
*Address for correspondence: Dr M. Jordans, Lizzy Ansinghstraat 163, 1072 RG Amsterdam, The Netherlands (Email: [email protected])
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Abstract

Aims

Suicidal behaviour is an under-reported and hidden cause of death in most low- and middle-income countries (LMIC) due to lack of national systematic reporting for cause-specific mortality, high levels of stigma and religious or cultural sanctions. The lack of information on non-fatal suicidal behaviour (ideation, plans and attempts) in LMIC is a major barrier to design and implementation of prevention strategies. This study aims to determine the prevalence of non-fatal suicidal behaviour within community- and health facility-based populations in LMIC.

Methods

Twelve-month prevalence of suicidal ideation, plans and attempts were established through community samples (n = 6689) and primary care attendees (n = 6470) from districts in Ethiopia, Uganda, South Africa, India and Nepal using the Composite International Diagnostic Interview suicidality module. Participants were also screened for depression and alcohol use disorder.

Results

We found that one out of ten persons (10.3%) presenting at primary care facilities reported suicidal ideation within the past year, and 1 out of 45 (2.2%) reported attempting suicide in the same period. The range of suicidal ideation was 3.5–11.1% in community samples and 5.0–14.8% in health facility samples. A higher proportion of facility attendees reported suicidal ideation than community residents (10.3 and 8.1%, respectively). Adults in the South African facilities were most likely to endorse suicidal ideation (14.8%), planning (9.5%) and attempts (7.4%). Risk profiles associated with suicidal behaviour (i.e. being female, younger age, current mental disorders and lower educational and economic status) were highly consistent across countries.

Conclusion

The high prevalence of suicidal ideation in primary care points towards important opportunities to implement suicide risk reduction initiatives. Evidence-supported strategies including screening and treatment of depression in primary care can be implemented through the World Health Organization's mental health Global Action Programme suicide prevention and depression treatment guidelines. Suicidal ideation and behaviours in the community sample will require detection strategies to identify at risks persons not presenting to health facilities.

Keywords

Low- and middle-income countriessuicidal behavioursuicidal ideation
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 4 , August 2018 , pp. 393 - 402
Copyright
Copyright © Cambridge University Press 2017 

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