Front. Child Adolesc. PsychiatryFrontiers in Child and Adolescent PsychiatryFront. Child Adolesc. Psychiatry2813-4540Frontiers Media S.A.10.3389/frcha.2024.1342257Child and Adolescent PsychiatryOriginal ResearchPrevalence and factors associated with suicidal ideation and attempts among mentally ill patients in the psychiatry OPD at St. Paul's Hospital Millennium Medical College, Addis Ababa, EthiopiaMohammedAwol Dawud1*MennaTakele2AyalewMohammed3TeshomeTesfalem2AlayuMikiyas1TesfayNeamin1Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, EthiopiaDepartment of Epidemiology, School of Public Health, St Paul's Hospital Millennium Medical College, Addis Ababa, EthiopiaDepartment of Psychiatry, Hawasa University, Hawasa, Ethiopia
Edited by: Massy Mutumba, University of Michigan, United States
Reviewed by: Sigita Lesinskiene, Vilnius University, Lithuania
Karen Schmeelk-Cone, University of Rochester Medical Center, United States
Correspondence: Awol Dawud Mohammed awol.mod@gmail.com
Abbreviations CI, confidence interval; MDD, major depression disorder; OR, odds ratio; OPD, outpatient department; OSSS, Oslo Social Support Scale; SPHMMC, St. Paul Hospital Millennium Medical College; SBQ-R, Suicidal Behavior Questionnaire-Revised; SPSS, Statistical Package for the Social Sciences.
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Background
Every year, more than 800,000 people die due to suicide (one person every 40 s), ranking as the second leading cause of death next to traffic accidents in individuals aged 15–29 years. The objective of this study was to assess the prevalence and factors associated with suicidal ideation and attempts among mentally ill patients.
Method
An institutional-based, cross-sectional study was conducted between December 2019 and January 2020. Data were collected using a convenient sampling technique until the required sample size was achieved. The total sample size was 385. The Suicidal Behavior Questionnaire-Revised (SBQ-R), Oslo Social Support Scale, and self-prepared to assess suicide were used. Data collection was carried out by psychiatry professionals through face-to face interviews. Data were analyzed, and bivariate and multivariable logistic regression analyses were conducted using Statistical Package for the Social Sciences (SPSS) version 23.
Result
A total of 385 patients participated in the study. Of these, 216 (56%) were men. The prevalence of suicide ideation was 255 (66.2%). The odds of suicidal ideation and attempt was almost three times higher [adjusted odds ratio (AOR) = 2.79, 95% confidence interval (CI) 1.11–6.98]; among patients who felt hopeless, the OR was around two times higher (AOR = 2.44, 95% CI 1.17–5.08); among patients who had a family history of suicide, the OR was almost three times higher (AOR = 2.56, 95% CI 1.00–6.53); among patients who stopped their medication, the OR was approximately two times higher (AOR = 2.25, 95% CI 1.14–4.46); the OR of suicidal ideation and attempts was almost six and four times higher (AOR = 5.86, 95% CI 1.30–26.41; and AOR = 3.61, 95% CI 1.01–12.88) among patients who were educated to primary and secondary level, respectively.
Conclusion
In this study, carried out in Ethiopia, suicidal ideation and attempts were more common among men than women. The prevalence of suicidal ideation and attempts showed a significant public health issue among hospital-attending and chronic mentally ill adolescents, which requires a large emphasis. We recommend that suicide prevention needs to involve non-governmental and non-profit organizations, universities, and civil society at different levels.
suicidal ideationprevalencementally illsuicidal attemptsrisk factorsection-at-acceptanceDevelopmental Psychopathology and Mental HealthBackground
Suicide is a serious, preventable public health problem that results in social, emotional, and economic consequences for family, friends, and colleagues (1). Because suicide remains a sensitive issue, it is very likely that it is underreported due to stigma, criminalization, and weak surveillance systems. It demands our attention and action even though its prevention and control are difficult (2).
Several environmental, psychosocial, and behavioral factors have been found to be associated with suicidal ideation, suicidal attempts, and suicide. Suicidal behaviors often coexist with other health risk behaviors, such as aggressive behavior, smoking, and experiences of sexual intercourse (3, 4). Suicide ideation and attempted suicide were also related to many severe mental health problems, such as anxiety, schizophrenia, bipolar disorder, mood disorder, depression, and others (5).
The method of the suicide attempt influences the morbidity and completion rates, independent of the severity of the intent to die at the time of suicidal behavior. The most common methods of attempting suicide are hanging, poisoning, slashing, and shooting (6, 7).
The burden of suicide constitutes a serious public health issue worldwide, and mental health professionals need to increase their awareness of the warning signs for suicide. Suicide warning signs are associated with acute factors that inform clinicians about observable signs and expressed emotions, and are important for saving lives by early detection and intervention for those at risk (8).
Every year, more than 800,000 people die due to suicide (one person every 40 s), ranking it the second leading cause of death next to traffic accidents in individuals aged 15–29 years. Among nearly 250 causes of death, suicide was the 14th leading cause of global mortality (9). In addition, it is also predicted that, by 2020, the rate of death due to suicide will be increased to one every 20 s (10). Suicide accounts for 50% and 71% of all violent deaths globally in men and women, respectively.
Internationally, suicide rates range from highs of more than 25 per 100,000 individuals in Scandinavia, Switzerland, Germany, Austria, the eastern European countries, and Japan to less than 10 per 100,000 in Spain, Italy, Ireland, Egypt, and the Netherlands (11). Rates of suicide among adolescents and young adults have increased considerably in recent decades (12).
In sub-Saharan Africa, death from suicide is estimated to be 34,000 per year (13). The prevalence of suicide ideation was estimated to be 7% in Tanzania (3), 6.2% in Seychelles (14), 31.3% in Zambia (15), 23.3% in Benin (5), and 21.6% in Uganda. This even occurs even though some mental health problems may arise from infectious diseases (16). However, in Ethiopia, there was no adequate research on the magnitude or burden of suicidal ideation and attempts. The aim of the present study was to determine the prevalence of suicidal ideation and attempts and the factors associated with suicidal ideation and attempts among mentally ill patients.
MethodStudy area
Saint Paul's Hospital Millennium Medical College (SPHMMC) was established at the center of the country, in Addis Ababa, through a decree of the Council of Ministers in 2010, although the medical school was opened in 2007. The hospital was established in 1968 by the late Emperor Haile Selassie. It is governed by a board under the Federal Ministry of Health. The SPHMMC has many specialist programs and has many departments, including a psychiatry department. The psychiatry department started approximately 40 years earlier, i.e., in the 1975 Ethiopian calendar.
Study design and period
An institutional-based, cross-sectional study was conducted between December 2019 and January 2020.
Sample size determination
The sample size was determined using a single population proportion formula as follows:n=(Za/2)2P(1−P)d2where P = the prevalence 64.8% (0.648) from the study by Mekonnen and Kebede (17), and the absolute precision or tolerable margin of error (d) = 5% (0.05). Zα/2 = Z value at (α = 0.05) = 1.96 corresponding to the 95% confidence interval (CI). After adjusting for a 10% contingency for non-response rates, a total of 385 study populations were involved in the study.
Sampling techniques and procedures
All patients presenting at the SPHMMC Psychiatry Patient Department (outpatient department, OPD) between December 2019 and January 2020 were included in this study using a consecutive sampling technique until the required sample size was achieved. Both new and follow-up patients were included in the study.
Data collection procedures and instruments
Data were collected using an interviewer-administered structured questionnaire. The questionnaire included sociodemographic characteristics, patient clinical characteristics, social support of the patient, environmental risk factors, methods used for suicide attempts, and items related to patients’ suicidal behavior, i.e., ideation and attempt. A pretest was carried out with 5% of the sample size at St. Peter Specialized Hospital among patients with mental illness before the actual study was conducted and the data collection tool was revised based on the findings of the pretest. Data collectors were 10 trained psychiatric nurses; 2 senior mental health experts were assigned as supervisors to the data collectors. The patients were diagnosed by psychiatrists, psychiatry residents, and senior or mental health professionals. Therefore, the diagnosis and some clinical factors were reviewed from each patient's chart.
Items used to assess suicidal ideation and attempt were used, adapted from Suicidal Behavior Questionnaire-Revised (SBQ-R) (18). The items included in the questionnaire were as follows: item 1 taps into lifetime suicidal ideation and attempt; item 2 assesses the frequency of suicidal ideation over the past 12 months; and item 3 taps into the threat of suicidal behavior. The level of social support among patients with mental illness was assessed using the three-item Oslo Social Support Scale (OSSS) and the scores were in the range of 3–14 (19).
Data processing and analysis
Data were checked for completeness and consistency, and then coded and entered into Epi info version 7.2.1.0. They were then exported to Statistical Package for the Social Sciences (SPSS) version 23 for analysis. Descriptive analyses of ratios, proportions, and rates were computed. Bivariate and multivariate logistic regression analyses were also conducted. Variables with a P-value <0.2 in the bivariate analysis were fitted to multivariable logistic regression. Those variables with a P-value <0.05 in the multivariable analysis were considered to be significant.
ResultsSociodemographic characteristics
A total of 385 participants (age range = 18–85 years) were enrolled in the study, with a response rate of 100%. Of the total participants, 216 (56%) were men. Of the participants, 197 (51%) were single, 232 (48.9%) were illiterate, 140 (36.4%) had a level of education from grade 9 to 12, and 77 (18.4%) were private/non-governmental organization (NGO) employees (Table 1).
Sociodemographic characteristics of study participant patients with mental illness were attending the Psychiatric Department of SPHMMC in Addis Ababa.
No.
Variables
Category
Frequency
Percentage
1
Age (years)
28–37
133
34
18–27
95
25
38–47
79
21
≥48
78
20
2
Sex
Male
216
56
Female
169
44
3
Marital status
Single
197
51
Married
126
33
Divorced
39
10
Widowed
23
6
4
Education
9th–12th grade
140
37
1st–8th grade
109
28
College and above
105
27
Illiterate
31
8
5
Occupation
Private/NGO Employee
71
18
No job
60
16
Gov’t employee
59
15
Housewife
52
14
Merchant
42
11
Student
42
11
Daily laborer
31
8
Farmer
8
2
Other
20
5
6
Income (Birr)
<1,000
195
51
1,000–2,000
56
14
2,000–4,000
61
16
≥5,000
73
19
7
Residence
Rural
23
6
Urban
362
94
8
Social support
Poor
168
44
Moderate
136
35
Strong
81
21
Clinical characteristics of participants
In total, 297 (77%) participants were diagnosed as mentally ill before presenting at SPHMMC. As to the duration of being psychiatric patients, among the study participants, 195 (51%) reported that they experienced mental illnesses for more than 5 years before coming to SPHMMC (Table 2).
Clinical characteristics of participants visiting psychiatric OPD of SPHMMC, Addis Ababa, 2020.
No.
Variables
Category
Frequency
Percentage
1
Having mental illness before coming here?
Yes
297
77
No
88
23
>60 months
195
51
13–60 months
82
21
≤12 months
20
5
3
Having chronic diseases
Yes
51
13
No
334
87
4
Family history of mental illness
Yes
183
48
No
202
52
5
Family history of suicide
Yes
79
21
No
306
79
6
Stopping of medication
Yes
156
41
No
229
59
7
Episode of the illness
No episode
151
39
Single episode
108
28
2–4 episodes
92
24
5 and above
19
5
Continuous
15
4
8
Substance use
Yes
89
23
No
296
77
9
Substance
Khat
72
19
Alcohol
70
18
Cigarette
70
18
Hashish
9
2
Ganja
8
2
Cocaine
2
1
Cannabis
1
0.50
Of the participants with suicidal ideation and attempts, 71 (34.4%) were diagnosed with major depression disorder (MDD) and 53 (25.6%) were diagnosed with schizophrenia (Table 3).
Mental illnesses diagnosed among the study participants and those who reported in both suicidal ideation and attempts during the study period, SPHMMC, 2020.
Sno.
Variable (Diagnosis)
Suicidal ideation and attempts
Frequency
Percentage
1
MDD
71
34.4
2
Schizophrenia
53
25.6
3
Bipolar
28
13.5
4
Substance use disorder
21
10
5
Generalized anxiety disorder
14
7
6
Seizure disorder
7
3.4
7
Somatic disorder
4
2
8
Other mental illnessa
9
4
Other illness: epilepsy 3, panic 2, hypersomnia 1, social phobia 1, post-prenatal psychosis 1, and post-traumatic 1.
Prevalence of suicide ideation and attempts
Of the 385 respondents, 255 (66.2%) [men = 143 (37%), women = 112 (29%)] had suicidal ideation and 210 (55%) attempted suicide [men = 115 (30%), women = 95 (25%)]. Of the study participants, 207 (54%) had thought of suicide and attempt. Of them, 19 (5%) were told by someone that they were going to commit suicide or they might have to do it in their lifetime (Table 4).
Frequency distribution of suicide ideation and attempt among mental Ill patients in SPHMMC, Addis Ababa, Ethiopia, 2020 (n = 385).
Variable
Category
Frequency
Percentage
Male
Percentage
Female
Percentage
Have you ever thought about killing yourself?
Yes
255
66
143
37
112
29
No
130
34
73
19
57
15
Have you ever attempted to kill your self
Yes
210
55
115
30
95
25
No
175
45
101
26
74
19
Suicidal ideation and attempts?
Yes
207
54
113
29
94
25
No
178
46
103
27
75
19
Have you ever told someone commit suicide
Yes
19
5
12
3
7
2
No
239
62
133
35
106
28
Suicidal ideation or attempts?
Yes
258
67
145
38
113
29
No
127
33
71
18
56
15
Among all participants, the age range of 28–37 years was the most affected age group (see Figure 1).
Distribution of suicide ideation and attempt by age among mental Ill patients of psychiatry OPD of SPHMMC, Addis Ababa, Ethiopia, 2020 (N = 385).
Of the participants, 142 (55%) rarely had suicidal ideation and attempts (one time only) and 7 (3%) had five or more suicidal thoughts and attempts (Figure 2).
Percentage distribution of frequency of suicide ideation and attempt among mental Ill patients in SPHMMC, Addis Ababa, Ethiopia, 2020 (n = 385).
Methods of suicidal ideation and attempts
Of the participants, 98 (47%) thought of attempting suicide using drug overdose/poisoning and 92 (44%) of them thought of attempting suicide by hanging themselves. The smallest proportion of participants (n =5, 2%) thought of attempting suicide using a gun.
From all methods listed in the questionnaire and the participants applied to them and thought to kill themselves based on sex drug dose/poisoning were the highest one female (51) and male (47) (Figure 3).
Frequency distribution of methods of suicidal ideation and attempts at sex among mentally Ill patients in SPHMMC, Addis Ababa, Ethiopia, 2020.
Factors associated with suicidal ideation and attempt
In the bivariate analysis, the following information was collected: age, marital status, occupation, education, religion, monthly income, residence of the participant, duration of mental illness, family history of mental illness, family history of suicide, stopped mental illness medication, Oslo Social Support Scale, recurrence/relapse of mental illness, current psychiatric diagnosis, feelings of hopelessness, having mental health issues, and death in family (Table 5).
Bivariate logistic regression results of suicide ideation and attempt among mental Ill patients in SPHMMC, Addis Ababa, Ethiopia, 2020 (n = 385).
Variables
Category
Suicide ideation and attempt
Crude odd ratio (95% CI)
P-value
Yes
No
Age (years)
18–27
55
40
1.348 (0.770–2.361)
0.296
28–37
73
60
1.524 (0.834–2.784)
0.171
38–47
42
37
1.258 (0.672–2.352)
0.473
≥48
37
41
1
Marital status
Single
111
86
0.830 (0.343–2.007)
0.679
Divorced
14
25
0.360 (0.124–1.042)
0.060
Married
68
58
0.754 (0.304–1.868)
0.541
Widowed
14
9
1
Educational status
Illiterate
12
19
0.669 (0.295–1.515)
0.335
1–8th grade
60
49
1.297 (0.757–2.219)
0.344
9–12th grade
84
56
1.588 (0.953–2.267)
0.076
≥College
51
54
1
Occupation
Farmer
5
4
1.500 (0.288–7.807)
0.630
Housewife
32
21
2.400 (0.836–6.891)
0.104
Merchant
22
21
1.650 (0.560–4.860)
0.364
Gov’t employee
31
28
1.661 (0.593–4.653)
0.335
Private/NGO employee
37
38
1.378 (0.503–3.779)
0.533
Student
25
16
2.437 (0.820–7.250)
0.109
Daily labor
22
20
1.821 (0.582–5.698)
0.303
Jobless
33
29
1.833 (0.655–5.131)
0.248
Others
5
5
1
Income (Birr)
<1,000
113
82
1
10,001–2,000
28
28
0.726 (0.400–1.317)
0.292
2,001–4,000
29
32
0.658 (0.369–1.171)
0.155
>4,000
37
36
0.746 (0.435–1.280)
0.287
Family history of mental illness
Yes
119
64
2.40 (1.59–3.63)
≤0.001
No
88
114
1
Family history of suicide
Yes
59
20
3.14 (1.80–5.48)
≤0.001
No
148
158
1
On medication for mental illness
Yes
183
147
1
No
24
31
0.62 (0.35–1.11)
0.106
Stop medication
Yes
108
48
2.95 (1.924–4.537)
≤0.001
No
99
130
1
Current psychiatric diagnosis
Schizophrenia
52
50
1
MDD
97
40
1.61 (0.93–2.76)
0.090
Bipolar disorder
28
18
1.49 (0.73–3.03)
0.265
Other psychotic disorder
3
14
0.20 (0.05–0.76)
0.018
Anxiety disorders
18
17
1.02 (0.47–2.19)
0.963
Substance use disorder
21
18
1.12 (0.53–2.35)
0.761
Somatic disorder
4
13
0.29 (0.09–0.96)
0.044
Other disorder
14
8
1.68 (0.65–4.35)
0.284
Social support
Poor
112
56
2.27 (1.60–4.77)
≤0.001
Moderate
61
75
1.12 (0.64–1.96)
0.679
Strong
34
47
1
Feeling of hopeless (N = 258)
Yes
153
29
2.14 (1.13–4.05)
0.018
No
54
22
1
Duration of illness (months) (N = 297)
≤12
10
10
0.95 (0.37–2.38)
0.913
13–60
51
31
1.56 (0.92,2.64)
0.097
≥61
100
95
1
Recurrences/relapse of mental illness
Continuous
11
4
5.39 (1.63–17.77)
0.006
Single
61
47
2.54 (1.53–4.23)
≤0.001
2–4
69
23
5.88 (3.29–10.50)
≤0.001
>5
15
4
7.35 (2.32–23.30)
0.001
No relapse
51
100
1
Family death
Yes
48
7
1.89 (0.80–3.04)
0.183
No
159
44
1
The odds of suicidal ideation and attempt were lower among divorced people [adjusted odds ratio (AOR) = 0.31, 95% CI 0.11–0.85, p-value = 0.022] compared to single people; individuals with a primary and secondary education had a more likely risk of suicide ideation and attempts than those educated to college level and above (AOR = 5.86, 95% CI 1.30–26.41; and AOR = 3.61, 95% CI 1.01–12.88), respectively (Table 6). Individuals who stopped their mental illness medication had a higher risk of suicide ideation and attempt than those continuing with their medication (AOR = 2.56, 95% CI 1.00–6.53), and individuals with a family history of suicide had a more likely risk of suicide ideation and attempts than those who do not have a family history of suicide or higher (AOR = 2.44, 95% CI 1.17–5.08) (Table 1).
Multivariate logistic regression on prevalence and associated factors of suicidal ideation and attempts among mentally Ill patients in psychiatry OPD at SPHMMC, in Addis Ababa, Ethiopia, 2020 (n = 385).
Variables
Category
Suicide ideation and attempt
AOR (95% CI)
P-value
Yes
No
Marital status
Single
111
86
1
Divorced
14
25
0.31 (0.11–0.85)
0.022
Married
68
58
0.90 (0.45–1.81)
0.771
Widowed
14
9
1.61 (0.39–6.58)
0.506
Educational status
Illiterate
12
19
7.71 (0.84,70.44)
0.070
1–8th grade
60
49
5.86 (1.30–26.41)
0.021
9–12th grade
84
56
3.61 (1.01–12.88)
0.048
≥College
51
54
1
Social support
Poor
112
56
2.25 (1.14–4.46)
0.020
Moderate
61
75
0.66 (0.33–1.35)
0.667
Strong
34
47
1
Family history of mental illness
Yes
119
64
1.94 (1.12–3.36)
0.017
No
88
114
1
Family history of suicide
Yes
59
20
2.44 (1.17–5.08)
0.017
No
148
158
1
Stop psychiatric medication
Yes
108
48
2.56 (1.00–6.53)
0.049
No
99
130
1
Current psychiatric diagnosis
Schizophrenia
52
50
1
MDD
97
40
1.70 (0.85–3.42)
0.135
Bipolar D/os
28
18
1.49 (0.62–3.60)
0.377
Other psychotic D/os
3
14
0.13 (0.03–0.61)
0.010
Anxiety disorders
18
17
1.68 (0.66–4.28)
0.278
SUD
21
18
1.39 (0.45–4.34)
0.561
Somatic D/os
4
13
0.47 (0.10–2.13)
0.325
Other D/os
14
8
2.29 (0.72–7.28)
0.159
Felt hopeless
Yes
153
29
2.79 (1.11–6.98)
0.028
No
54
22
1
Discussion
In this study, the sociodemographic of the participants’ sex was different from other studies: our study consisted of 56% men and 44% women. The percentage of women was higher in the study carried out in Dangla (men = 48.3%, women = 51.7%) (8). This might be due to a high level of participation in social activities or the suppression of women in that study area. In the study carried out in Gondar Hospital, 54% of participants were men and 46% were women (20); in a study carried out in Istanbul, Turkey, 30.8% were women and 69.2% were men (21). However, many studies show that men had more suicidal ideation and attempts than women.
In our study, the primary and secondary education level had 5.86 times and 3.61 times more likely risk of association of suicidal ideation and attempts (AOR = 5.86, 95% CI 1.30–26.41; and AOR = 3.61, 95% CI 1.01–12.88, respectively). The level of education in the present study was higher than that in the study carried out in Amanuel Hospital (AOR = 1.63, 95% CI 0.68–3.89; and AOR = 2.51, 95% CI 1.11–5.68, respectively) (22). This might be due to academic failure or low satisfaction in the future of their job due to their education.
In addition, hopelessness was a more likely risk of association with suicidal ideation and attempts. The present study had a 2.79 times more likely risk of association of suicidal ideation and attempts (AOR = 2.79, 95% CI 1.11–6.98). This was slightly higher than that in a study carried out in Amanuel Hospital (AOR = 2.510, 95% CI 1.459–4.320) (22). This might be due to those psychotic patients who do not see futurity, have no plans to live, do not think positively, and are not anxious to take any opportunities that might put them in a better position.
In our study, we determined that suicidal behavior was significantly less common in patients with mental illness who were divorced compared with those who were single or never married. This study was also lower than that in a study carried out in the USA (AOR = 2.1, 95 CI 1.83–2.33) (23). Thus, studies further suggested that the highest risk increase was in never-married individuals and those who were separated or divorced (24). Similarly, being single was associated with an increased risk of suicide in women aged 20–34 years (20). Furthermore, individuals who had poor social support were 2.25 times more likely to have suicidal ideation and attempts than patients who had strong social support. This was similar to the results from recent studies (25, 26).
In this study, patients with a family history of mental disorders significantly increased the rate of suicidal ideation and attempt, which is 1.94 times more likely risk of suicidal ideation and attempts (AOR = 1.94, 95% CI 1.12–3.36), which is slightly lower than or comparable to a study carried out on psychiatry patients at Jimma University Hospital (AOR = 2.25, 95% CI 1.11–4.57) (2). In addition, suicidal behavior was more likely to occur in patients with a family history of suicidal behavior when compared with patients without a family history of suicidal behavior. Our findings seemed to be similar to those in studies showing that a history of suicide in the family could increase the risk of suicidal behavior in patients with mental illness (21, 27). In their study, Trémeau et al. indicated that a family history of suicide significantly increased the risk of suicide attempts, with higher lethality and frequency of suicide attempts (28).
As a limitation, institutional-based studies could not address those adolescents outside the institution, which assessed the lifetime prevalence of suicidal ideation and attempts at the point of current prevalence during the stated period. In addition, this study assessed their status of suicidal ideation and attempt based on their stated response; in this case, individuals may not disclose their actual thoughts or attempts about suicide.
Conclusion
In our study on the sociodemographic of sex, men were more affected by suicidal ideation and attempts than women. The prevalence of suicide ideation and attempts was high, showing a significant public health issue among hospital-attending and chronic mentally ill patients that requires a great emphasis. These risk factors were primary and secondary grade/school education, feelings of hopelessness, stopping mental illness medication, family history of mental illness, family history of suicide, being divorced, social support of the patient, and current psychotic diagnosis of other diagnosis of illness had positively or more likely risk of association with suicidal ideation and attempts.
Therefore, suicide prevention needs to involve different actors and disciplines working at suicide non-governmental and non-profit organizations, universities, and civil society at different levels. Early detection and intervention are the single most important prevention strategy of suicide in patients with mental illness. Thus, clinicians are strongly recommended to identify those patients with the abovementioned high-risk factors. The prediction of suicide in patients with mental illness is complex and difficult, and efforts at prevention should also focus on optimizing social support and adherence to psychiatric medication for people with mental illness. Furthermore, St. Paul’s Hospital should have a different psychiatry treatment center and rehabilitation center that separates them from other services.
Data availability statement
The data analyzed in this study is subject to the following licenses/restrictions: The data will be available based on reasonable request to the author. Requests to access these datasets should be directed to Awol Dawud, awol.mod@gmail.com.
Ethics statement
The studies involving humans were approved by St. Paul Hospital Millennium Medical College Ethical review committee. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.
The authors declare that no financial support was received for the research, authorship, and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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ReferencesAmareTMeseret WoldeyhannesSHaileKYeneabatT. Prevalence and associated factors of suicide ideation and attempt among adolescent high school students in Dangila Town, Northwest Ethiopia. Psychiatry J. (2018) 2018:1–9. 10.1155/2018/7631453LiebermanRCowanKC. Bullying and youth suicide: breaking the connection. Princ Leadersh. (2011) 12:12–7.DunlavyACAquahEOWilsonML. Suicidal ideation among school-attending adolescents in Dar es Salaam Tanzania. Tanzan J Health Res. (2015) 17(1).GhrayebFAWMohamed RusliAMohd IsmailIAl RifaiA. Prevalence of suicide ideation and attempt among Palestinian adolescents: a cross-sectional study. World J Med Sci. (2014) 10(3):261–6. 10.5829/idosi.wjms.2014.10.3.82386RandallJRDokuDWilsonMLPeltzerK. Suicidal behaviour and related risk factors among school-aged youth in the republic of Benin. PLoS One. (2014) 9(2). 10.1371/journal.pone.0088233SadockBJSadockVARuizP. Synopsis of Psychiatry: Behavioral Sciences Clinical Psychiatry. 11th ed.New York: Wolters Kluwer (2015).AlemAKebedeDJacobssonLKullgrenG. Suicide attempts among adults in Butajira, Ethiopia. Acta Psychiatr Scand Suppl. (1999) 397:70–6. 10.1111/j.1600-0447.1999.tb10697.x10470358RuddMD. Suicide warning signs in clinical practice, Department of Psychology, Texas Tech University, MS 42051, Lubbock, TX 79409-2051, USA.JohnstonAKPirkisJEBurgessPM. Suicidal thoughts and behaviours among Australian adults: findings from the 2007 National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry. (2009) 43:635–43. 10.1080/0004867090297087419530020VärnikP. Suicide in the world. Int J Environ Res Public Health. (2012) 9(3):760–71. 10.3390/ijerph9030760PalmierJB. Prevalence and correlates of suicidal ideation among students in sub-Saharan Africa (master’s thesis). Georgia State University (2011). p. 1–55. 10.57709/2120397SijuwadePO. Suicide ideation among the adolescents: an exploratory study research. J Appl Sci. (2011) 6:167–73. 10.3923/rjasci.2011.167.173MarsBBurrowsSHjelmelandHGunnellD. Suicidal behavior across the African continent: a review of the literature. BMC Public Health. (2014) 14:1–8. 10.1186/1471-2458-14-60624383435MuulaASKazembeLNRudatsikiraESiziyaS. Suicidal ideation and associated factors among in-school adolescents in Zambia. Tanzan Health Res Bull. (2007) 9(3):202–6.18087900World Health Organization. Preventing suicide, Geneva (2014). Available online at: https://scholar.google.com/scholar?q=Worl+d+Health+Organization,+Preventing+suicide,+Geneva,+2014%3B+(Accessed+on+August+2019)&hl=en&as_sdt=0&as_vis=1&oi=scholart (Accessed August 2019).RudatsikiraEMuulaASSiziyaSTwa-TwaJ. Suicidal ideation and associated factors among school-going adolescents in rural Uganda. BMC Psychiatry. (2007) 7:1–6. 10.1186/1471-244X-7-6717214899MekonnenDKebedeY. The prevalence of suicidal ideation and attempts among individuals attending an adult psychiatry out-patient clinic in Gondar, Ethiopia. College of Medicine and Health Sciences, University of Gondar, Ethiopia (2006).OsmanABaggeCLGuitierrezPMKonicLCKooperBABarriosFX. The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment. (2001) 8:443–54. 10.1177/10731911010080040911785588AbiolaTUdofiaOZakariM. Psychometric properties of the 3-item Oslo Social Support Scale among clinical students of Bayero University Kano, Nigeria. Malaysian J Psychiatry. (2013) 22:32–41.CorcoranPNagarA. Suicide and marital status in Northern Ireland. Soc Psychiatry Epidemiol. (2009) 45:795–800. 10.1007/s00127-009-0120-7RossauCDMortensenPB. Risk factors for suicide in patients with schizophrenia: nested case-control study. Br J Psychiatry. (1997) 171:355–9. 10.1192/bjp.171.4.3559373425SchreiberJCulpepperLRoy-ByrnePPSolomonD. Suicidal ideation and behavior in adults (2020). Topic 1708, Version 56.0.HanaBCrosbybAEOrtegacLAGParksbSEComptondWMGfroereraJ. Suicidal ideation, suicide attempt, and occupations among employed adults aged 18–64 years in the United States. Compr Psychiatry. (2016) 66:176–86. 10.1016/j.comppsych.2016.02.00126995251AgerboE. Midlife suicide risk, partner’s psychiatric illness, spouse and child bereavement by suicide or other modes of death: a gender specific study. J Epidemiol Community Health. (2005) 59:407–12. 10.1136/jech.2004.02495015831691PeltzerKPengpidS. Suicidal ideation and associated factors among school-going adolescents in Thailand. Int J Environ Res Public Health. (2012) 9(2):462–73. 10.3390/ijerph902046222470303AbduZHajureMDesalegnD. Suicidal behavior and associated factors among students in Mettu University, South West Ethiopia: an institutional based cross-sectional study. Psychol Res Behav Manag. (2020) 13:233–43. 10.2147/PRBM.S24082732184684McGirrATousignantMRouthierDPouliotLChawkyNMargoleseHCRisk factors for completed suicide in schizophrenia and other chronic psychotic disorders: a case–control study. Schizophr Res. (2006) 84:132–43. 10.1016/j.schres.2006.02.02516626940TrémeauFStanerLDuvalFBaileyPCrocqMACorrêaHSuicidal behavior in schizophrenia and family history of suicide. Posters Images Neurosci. (2014) 3(2):120–1. 10.31887/DCNS.2001.3.2/ftremeau