Prevalence and correlates of suicidal behavior among adults with chronic health conditions in Malawi

Abstract

Over 70% of completed suicides occur in low- and middle-income countries. However, limited information is available on suicidal behavior encompassing ideation, plans, and attempts among high-risk populations in these settings. We investigated the prevalence and correlates of suicidal behavior among adult patients receiving care for chronic health conditions in Neno District, Malawi. As part of a randomized controlled trial to treat major depressive disorder, 2,240 chronic care patients with low mood and/or anhedonia were screened for depression disorder using the Patient Health Questionnaire (PHQ-9). Those who expressed suicidal ideation were further assessed on a suicidality assessment tool. We conducted univariate analysis to determine the prevalence of suicidal behavior, as well as multivariable logistic regression to investigate its relationship with patients’ demographic characteristics. The prevalence of suicidal behavior was 10.3% among screened patients. Of this percentage, 34% reported suicidal ideation in the last week, 7% had attempted suicide in the past, 26% had an existing self-harm plan, and 10% were currently experiencing suicidal ideation. Elevated depressive symptoms were associated with suicidal behavior ( p < 0.000) Younger age was associated with greater odds of reporting suicidal behavior ( p = 0.001), while female sex was associated with greater odds of reporting suicidal behavior ( p = 0.02). Prevalence of suicidal behavior are elevated among adult patients with chronic conditions in Malawi: roughly 1 in 10 individuals report suicidality. Timely, targeted interventions should be implemented to address this problem.