Psychiatric morbidity among patients admitted with a suicide attempt at MTRH, Eldoret-Kenya

Abstract

Background: Suicide is a global health problem that has prompted the World Health Organization (WHO) to announce the Mental Health Action to reduce suicide rates. It is estimated that annually, 1 million people die by suicide globally. In Kenya, the suicide mortality rate was reported to be 6.1 per 100,000 population in 2019. Suicide attempt is a crucial risk factor for subsequent suicide, making it a psychiatric emergency. As such, transient factors that reflect an imminent risk of suicide must be treated as a crisis that needs to be thoroughly investigated and thereafter be accorded immediate intervention. Objectives: This study aimed to determine the patterns of psychiatric morbidity, methods of suicide employed as well as their socio-demographic and clinical factors that may predispose patients admitted at Moi Teaching and Referral Hospital (MTRH) to attempted suicide. Methods: This was a cross-sectional study conducted between August 2019 and July 2021 among 154 adult patients admitted at MTRH with current history of attempted suicide. All potential participants who met the eligibility criteria and consented to participate were enrolled. Their socio-demographic and clinical characteristics data were collected using a structured questionnaire while the validated Mini International Neuropsychiatric Interview Version 7.0 was employed in screening for mental disorders. Potential participants' ability to give an informed consent was assessed using the University of California Brief Assessment of Capacity to Consent (UBACC) questionnaire. Categorical data were reported descriptively as frequencies with corresponding proportions. Inferential data analysis techniques using Pearson chisquare and Fisher‘s exact tests were performed using STATA version 14 and the results presented in the form of charts and tables. Results: Majority 109 (70.8%) of the participants were less than 35 years old with more than two thirds 107 (69.5%) being male. About half 76 (49.4%) of the participants were not married, professed the Christian faith 112 (72.7%), had attained a secondary level of education 65 (42.2%), unemployed 57 (37.0%) and earned a monthly income below Ksh10,000) 133 (86.4%). Ingestion of organophosphate 110 (71.4%) was the most frequent method adopted for attempting suicide followed by prescription drug overdose 14 (9.1%). Major depressive disorder (MDD) 60 (39.0%), alcohol use disorder (AUD) 50 (32.5%), psychotic disorder 27 (17.5%) and bipolar 26 (16.9%) were the most prevalent mental disorders. Male participants had a four-fold significantly increased likelihood (AOR = 3.99; 95% CI: 1.59, 11.30; p=0.005) of alcohol use disorder associated with attempted suicide. Conclusion: The leading psychiatric morbidities were major depressive disorder (MDD) and alcohol use disorder (AUD). Organophosphate poison ingestion and prescription drug overdose were the most employed patterns of attempted suicide. Young male adults (below 35 years) with AUD and female with MDD were vulnerable to attempting suicide. Recommendation: There is need to inculcate routine mental health screening across various demographics for hospitalized patients outside the psychiatric unit to aid in early detection and prevention of attempted suicide. Organophosphate purchase and use should be regulated by government agencies, and sensitization on consequences of prescription drug overdose should be enhanced. Organophosphates purchase and use should be regulated by government agencies. Furthermore, programs targeting at risk groups should be established and implemented.