The Prevalence and Factors Associated With Suicidal Behavior Among Young Patients Attending the Youth Center at Kenyatta National Hospital - a Mixed Methods Study

Abstract

Background: Suicidal behaviour, a spectrum of self-destructive behaviour ranging from temporary wishes of one’s death to completed suicide and is one of the major global sources of recurrent distress, especially among adolescents and young adults. Adolescent suicides are prevalent in low- and middle-income countries, accounting for 90% of all cases. A study of children and adolescents found high rates of suicidal behavior, including attempts (6% and 4.5%), plans (9.9% and 7.5%), thoughts (18% and 14.2%), and self-harm (13.7% and 14.2%), over their lifetime and the past year. Suicide is a complex and individualized phenomenon that is influenced by a variety of demographic, clinical, and psychosocial factors. These factors significantly increase the likelihood of experiencing suicidal behaviors, including suicidal thoughts and self-harm. There is a lack of research on the prevalence and contributing factors of suicidal behavior among young people in Kenya, particularly among those aged 13-24 who attend the youth center at KNH in Nairobi. This study aimed to examine the prevalence, experiences, risk factors, and perceptions of suicidal behavior in this population. Study Objective: The purpose of this study was to investigate the prevalence and factors associated with suicidal behavior, including suicidal ideation and self-harm, among young patients aged 13-24 years attending the youth center at KNH in Nairobi, Kenya. Study Design: A convergent parallel mixed methods study utilizing exploratory qualitative semi-structured interviews and an analytical cross-sectional quantitative design. Where 121 study subjects were handed questionnaires and interviewed for the quantitative and qualitative aspects of the research respectively. Consecutive sampling and purposive sampling techniques were used respectively to derive the study population for the quantitative and qualitative aspects of the research respectively for a period of four weeks. xii Study Setting: Youth Center, Kenyatta National Hospital in Nairobi, Kenya. Research tools: A semi-structured interview guide was utilized to interview each participant on their perspectives and experiences of suicidal behavior. Data will then be stored via audio recordings. Furthermore, a combined socio-demographic and psychosocial questionnaire was used to note the socio-demographic characteristics and psychosocial factors associated with the study participants. The SBQ-R (suicidal behavior questionnaire-revised) questionnaire was used to assess suicidal behaviors in the participants. Data analysis and management: This study used a thematic analysis approach to analyze the data collected from interviews. The transcripts were coded according to the questions in the interview guide and grouped into categories based on similarities. The analysis was largely inductive, allowing for the exploration of how participants make sense of and navigate their surroundings. One member of the research team coded the interviews and cross-checked the results with two other team members. The data was organized using Nvivo 12 software and the number of interviews referring to each theme was calculated. In addition to the thematic analysis, the data was analyzed quantitatively using SPSS software. Chi square tests and bivariate and multivariate logistic regression analyses were used to examine the differences between groups in terms of sociodemographic and psychosocial factors. The results were presented in tables with p-values. Study utility: The study can improve clinicians' understanding of patients at risk of suicide and enable more holistic management. Caregivers can learn about supporting those who have experienced suicidal behavior. Findings can inform advocacy for young people and impact future service design, reducing the burden on healthcare and affected individuals. xiii Results: This study identified the prevalence of suicidal behavior and suicide risk among the youth attending the youth clinic at the Kenyatta National Hospital was established to be 34.7%. The average SBQ-R score of the 121 rerspondents in the current study was 6.68 ± 5.23. An association was noted between gender and suicidal behavior with the females being at greater risk to engage in suicidal behavior (p = 0.05). In addition, higher levels of education were associated with a greater suicide risk (p = 0.034). A family history of psychiatric illness (p = 0.001) and history of abuse (p = 0.006) were also implicated in suicidal behavior. After adjusting for all the covariates in the study, it was established that only higher education levels, having children and a positive family history of psychiatric illness were significantly associated with increased suicide risk. several themes and sub themes related to knowledge, attitude and perceptions towards suicidal behavior both among the patients and the caregivers. The caregivers used words such as ‘self-harm behavior, mode of escape from pain, self-hatred, inability to accept self’ to describe their understsnding of suicidal behavior. Most caregivers had an empathetic and compassionate outlook towards suicidal patients. There was a recurring theme of uncertainty and lack of experience when dealing with and taking care of suicidal patients. Caregivers reported psychosocial factors like loneliness, psychiatric disorders e.g., depression, family stresses, marital infidelity, being an orphan, substance use as some of the factors that may predispose one to contemplating suicide. Environmental factors like bullying, cyberbullying, unhealthy comparison on social media, domestic violence were reported to cause some youth to consider suicide. Socioeconomic factors like poverty, loss of a job, failure in business were mentioned to cause suicide among the youth Conclusion: The prevalence of suicidal behavior and suicide risk among the youth attending the youth clinic at the Kenyatta National Hospital was established to be 34.7%. The study established xiv that higher educational attainment and levels, a family history of psychiatric illness, a history of abuse and having children were associated with increased suicide risk. It was also noted that a greater number of females displayed increased suicide risk when compared to the males. In addition, study participants with increased suicide risk reported increased suicidal thoughts and that social media had an impact on their social behavior. These areas are essential in developing effective prevention and intervention strategies in order to curb the high rate of suicidal behavior in the local setting