Prevalence of Suicidal Behavior and Associated Psychiatric Morbidity Among Patients Admitted in the Maximum-security Unit at Mathari National Teaching and Referral Hospital

Abstract

Background Suicide is among the leading causes of death worldwide and is considered a major global health issue accounting for 1.3% of all deaths. Suicidal behavior has also been identified as a global issue as nearly all suicides are preceded by a failed suicidal attempt. Suicide attempts are considered the single most important predictor of death by suicide. Suicide and suicidal behavior are higher among psychiatric inpatients than the general population. Criminal record and incarceration have also been linked to higher rates of suicidal behavior. Patients in forensic units have the duality of mental illness and criminal record. Very few studies have looked into the prevalence of suicidal behavior and patterns of psychiatric morbidity among the patients admitted to forensic units. Objectives of the study This study examined the prevalence of suicidal behavior and associated psychiatric morbidity among patients admitted in the maximum-security unit at Mathari National Teaching and Referral Hospital. Methodology This was a descriptive cross-sectional population-based study carried out at the leading Psychiatric hospital which is the only hospital with a maximum-security unit. Research tools The researcher used a researcher developed socio demographic questionnaire, MINI 5.0 for psychiatric diagnosis and SBQ-R to assess suicidality. Data management 7 Data was analyzed using Microsoft excel and SPSS version 25. Univariate and bivariate analysis was done. Data was presented in tables, graphs, charts and also as narratives. Results The study had a total of 99 participants. 92 were male while 7 were female. Most of the patients were aged between 30-39 years (32%). Majority of the patients in the study had achieved primary education, had no marital partner, they were employed and had no family history of mental illness. The most common offence committed was murder (37%) followed by defilement (9%) and assault (7%). From the SBQ-R questionnaire, 16% of the patients were at increased risk of suicide. 35% had suicidal thoughts at least once in their lifetime with 65%(n=23) of these having had suicidal thoughts in the past one year. 20 patients (20%) reported to have attempted suicide. Majority of the patients were not at risk for suicide. The most prevalent psychiatric morbidity was psychotic disorders at 85%. A dual diagnosis Alcohol use disorder and psychosis as well as Major depressive disorder, substance use disorder and psychosis were common. Being married, having no formal education, unemployment, family history of mental illness and a diagnosis of psychosis were associated with increased risk of suicide in the study. Having primary level of education was found to be statistically significant. Conclusion Suicide is a global health issue, especially in lower middle-income countries like Africa. Forensic psychiatry patients, with mental illness and incarceration, face an elevated risk for suicidal behavior as seen in the study. Factors like unemployment, marital status, psychotic disorders, and family history contribute to suicide risk. However, only having primary level of education was found to be statistically significant. Prevalence of suicide is higher among men and those involved in violent crimes such as murder, defilement and assault. Psychiatric 8 morbidity, such as psychosis, substance use disorder and major depressive disorder are strongly associated with suicidal behavior