Suicide and Suicide Attempts Among Patients Attending Primary Health Care Facilities in Uganda: A Medical Records Review

Abstract

Background Suicide is one of the leading causes of death globally, accounting for about 800,000 deaths annually. The suicide burden drastically increased since the beginning of the COVID-19 pandemic. In Uganda, no known study has determined the suicide rate since the beginning of the COVID-19 pandemic. Objective To determine the suicide mortality rate and describe the characteristics of victims of suicide attempts from January to December 2020 in south western Uganda. Methods This study was based on the health management information systems (HMIS) of patients’ registered data for the year 2020 at 15 selected primary health care facilities in four districts in south-western Uganda. We used a data extraction tool to capture demographic and clinical characteristics of the individuals who had attempted or completed suicide. We estimated yearly incidence rates of fatal and non-fatal suicide attempts, and used chi-square and t -test to determine the statistical difference between suicide attempt outcomes. Results A total of 130 non-fatal suicide attempts and 26 suicides were identified. Majority were male 69.87% (n = 109/156) and the mean age was 27.16 (SD = 14.71) years. The overall incidence of suicide attempts was about 60 attempts per 100,000 people, while that of completed suicide was about three deaths per 100,000 people. The suicide attempts increased following the first month of COVID-19 lockdown in the country (March 2020) and most individuals attempted suicide by poisoning (n = 144). Conclusion Suicide is a common occurrence in primary health care settings of Uganda and there has been a rapid increase in suicide attempts since the onset of the COVID-19 pandemic. With suicide by poisoning being common, there is need for proactive interventions, such as the control of pesticides and herbicides, to prevent suicide among members of this community, especially during pandemic conditions.

Prevalence of depression in Uganda: A systematic review and meta-analysis

“…Despite the lower increase in the burden of depression in sub-Saharan Africa, most individuals with depression go undiagnosed and untreated in the region [4]. This has led to some individuals having extreme complications of depression, such as suicide [5][6][7][8][9][10][11]. The effect is even worse in low-income countries such as Uganda, with a high prevalence of depression (i.e., approximately one-fifth of the population between 2010 and 2017, and 27% of outpatients being depressed based on previous systematic review and meta-analyses [12,13]).…”

Knowledge, attitudes, and experiences in suicide assessment and management: a qualitative study among primary health care workers in southwestern Uganda

“…They thought the individuals required rebukes instead of psychosocial support and treatment [ 37 , 38 ]. The negative attitudes may reflect the negative attitudes displayed by the government and cultural practices such as jailing individuals who have attempted and punishing the dead body of an individual who has died by suicide [ 8 , 14 – 16 ]. Therefore, to improve PHCW’s attitudes, we need to change the attitudes of the whole system involved in mental health, starting with the government laws.…”

“…Those who support the criminalization of suicide argue that: i) punishment is a deterrent, ii) criminal penalties for suicide attempts can express a society’s feelings of moral condemnation of certain behaviors, and iii) criminalization acts as an expression of the desire for retribution. No evidence suggests that criminalizing suicide has reduced the risk [ 8 ]. Evidence shows that criminalizing suicide hinders health-seeking behavior in a suicide crisis and receiving support to improve their mental health [ 43 ].…”

“…However, most individuals with suicidal behaviors in SSA do not receive appropriate assessment and management for their suicide risk [ 6 , 7 ]. This may be attributed to health providers’ knowledge gaps and negative attitudes towards suicide [ 7 , 8 ]. Yet, primary health care workers (PHCWs) are the gatekeepers for health care who are expected to screen for all diseases and either offer appropriate care or referral [ 9 , 10 ].…”

“…Some attitudes include considering suicide an immoral or criminal act, thereby blaming the individuals presenting with suicidality [ 13 ]. Such attitudes are reinforced by the fact that suicide is illegal in Uganda, and individuals who attempt suicide are jailed for a minimum of six months [ 8 , 14 ]. In addition, culturally, individuals who die by suicide are also punished (the dead body is beaten) and not given a proper burial to teach community members not to get involved in similar behaviors [ 15 , 16 ].…”