Research paperSuicidality and associated risk factors in outpatients attending a general medical facility in rural Kenya

- Improving mental health care in Kenya requires data from general medical clinics.
- 20% of study participants reported suicidal ideation (SI).
- 18% of study participants with SI attempted suicide in the past month.
- Major Depressive Disorder (MDD) was associated with 19 fold increase in SI.
- Treatment of MDD may be a scalable first step to address high risk SI.

BackgroundLow-and-Middle-Income-Countries (LMICs) account for 75% of global suicides. While primary care populations in high-income countries (HIC) typically have higher prevalence of suicidal behavior relative to general populations, few studies have explored suicidal behavior among general medical outpatients in LMICs. This study addresses the research gap by characterizing potential risk factors for suicidal ideation in a large general medical outpatient setting in rural Kenya.MethodsA cross-sectional study of adult general medical outpatients attending a rural sub-county hospital in Kaloleni, Kenya. Primary outcomes included major depressive disorder (MDD), posttraumatic stress disorder (PTSD) and suicidal behavior measured by the Mini International Neuropsychiatric Interview (MINI 5.0). We use binary logistic regression to model suicidality, mental disorders, intimate partner violence, and lifetime abuse.Results394 outpatients completed the assessment. The prevalence of SI over the past month was 20%. 18% of those with suicidal ideation over the past month also attempted suicide in the past month. Participants who met criteria for MDD (suicidality item removed) were 19 times [CI: 4.56, 79.05] more likely to report suicidal ideation compared to those without MDD (adjusted odds ratio 12.15 [CI: 2.66, 55.49]).LimitationsThis was a cross sectional study design with convenience sampling and hence vulnerable to selection and recall bias.ConclusionThe prevalence of SI and its strong association with actual suicide attempt in this population, make an urgent public health case for intervention. These data identify MDD as a highly significant correlate of SI.