Suicidality and associated factors among people living with mental illness attending an outpatient clinic at a tertiary hospital in Uganda

Abstract

Background: Suicidality is one of the leading causes of mortality worldwide. Mental disorders are major predictors of suicidality. Individuals with severe symptoms of mental disorders face marked distress, significant restrictions in functioning across several life domains, and a higher risk of suicidality. The risk of suicidality is even higher among people with mental illness following discharge from hospital due to challenges of adjusting to life with a mental illness in the community, taking psychotropic medications which are life long, and acceptance of the diagnosis. Information on suicidality and associated factors among people with mental disorders especially in Uganda is sparse. This study aimed to determine the prevalence of suicidality and factors associated among people with mental illness attending an outpatient clinic at a tertiary hospital in Uganda. Methods: A cross sectional quantitative study design was adapted for this study. We used consecutive sampling to enroll 400 participants as determined by the Kish and Leslie formula. Recent suicidality (both ideation and attempts) was evaluated using the Columbia-Suicide Severity Rating Scale (C-SSRS). All the factors significant at bivariate analysis were entered into a multivariable regression model to determine the factors that were statistically significantly associated with suicidality. A p-value of ≤0.05 was considered statistically significant. Results: The study found that 8.50% of participants reported suicidal ideation out of whom 3.25% attempted suicide. Females exhibited higher prevalence of ideation (10.26%) and attempts (3.59%) compared to males. Rural residents had higher rates of ideation, while urban residents had more suicide attempts. The factors that remained statistically significantly associated with suicidality included being female (AOR=2.50, 95% CI 1.07–5.82; p=0.03), being separated or widowed (AOR=0.88, 95% CI 0.02–0.04; p=0.003)), having a family history of suicide (AOR=0.35, 95% CI 0.15–0.79; p=0.01) and being on two or more medications (AOR=0.22, 95% CI 0.08–0.62; p=0.004). Family social support (AOR=0.87, 95% CI 0.78–0.97; p=0.02) and Resilience (subscale of the internalized stigma of mental disorders) (AOR=1.54, 95% CI 1.18-2.00; p=0.001) also remained statistically significantly associated with suicidality Conclusions: The prevalence of suicidality is high among people with mental disorders accessing care as outpatients and it is associated with the female gender, being widowed or divorced, family history of suicide and resilience to stigma of mental illness. Routine screening and management of suicidality especially among females, those with positive family history of suicide and the widowed or divorced, taking into account stigma of mental disorders should be very crucial elements of the health care system targeting those accessing outpatient care.