Study design and period: An institution based cross-sectional study was conducted at the University of Gondar College of Medicine and Health Sciences, March 2019, Northwest Ethiopia.
Study Setting: The University of Gondar is one of the oldest Universities in Ethiopia. It was established in 1954 as the Public Health College and Training Center. It has 12 departments, including schools of medicine. The study was conducted on 1397 medical students. The University of Gondar, CHMS is located in Gondar town, which is 728 km far from the capital city Addis Ababa.
Study population: Undergraduate medical students at the University of Gondar College of Medicine and Health Sciences included in the sample and excluded critically ill students.
Sample size calculation and sampling procedures: The sample size was calculated by using the single population proportion formula with a 95% CI, a 5% margin of error, and suicidal ideation, and attempt of 50% because of no published work in our country. Assuming a 10% non-response rate, 423 students were recruited randomly by using the simple random sampling technique. The number of medical students in the college with their identification number taken from the UoG CMHS registrar office; the required sample was selected through lottery methods. The lists of dormitory students took from the UoG CMHS student’s union dormitory affairs.
Data collection tools
Data were collected using self-administered questionnaire which contained suicidal ideation and attempt as the dependent variable and several other explanatory variables that included socio-demographic factors, social support, clinical factors, and substance use factors. Data on social support was assessed by Oslo social support scale (27). It has a three items social support scale (OSS-3) which provided a brief measure of social support and functioning and it is considered to be one of the best predictors of mental health. It covered different fields of social support by measuring the number of people the respondent feels close to the interest and concern shown by others, and the ease of obtaining practical help from others. Social support was collected by the Oslo 3-item social support scale which had a 3-item questionnaire commonly used to assess social support and used in several studies. The sum score scale ranges from 3 to 14, and had three broad categories: “poor support” 3-8, “moderate support” 9-11, and “strong support” 12-14(27).
Depression was assessed by using Patient Health Questionnaire (PHQ-9) and its score was greater or equal to 10; (5–9 mild depression, 10–14 moderate depression, 15–19 moderately severe depression, and 20–27 severe depression). PHQ-9 screening tool has nine items and was validated in Ethiopia with sensitivity of 86% and specificity of 67% (28).
Suicide ideation and attempt were measured according to the WHO questionnaire. If the respondent provided a “Yes” answers to the question, “Have you ever seriously thought about committing or attempted suicide, respectively?” they were considered to have had suicidal ideation or attempt, respectively (29).
Data processing and analysis
Data were entered into Epi-info version 7software after checking for completeness and exported to SPSS version 20 for analysis. Univariate analysis was done to see the association of each independent variable with the dependent variable. Those variables a P-value less than 0.2 were entered into the multivariate logistic regression model to identify the effect of each independent variable with the outcome variables. The strength of the association presented by the adjusted odds ratio with a 95% Confidence interval, and a P-value less than 0.05 was considered statistically significant.
Socio-demographic characteristics
A total of 393 participants was included in the study with a response rate of 92.9%. The mean age of the respondents was 22.16 (±1.86) years. Out of the participants, 241 (61.3%) were male; 254 (64.6%) were the age of greater than 25 years, and 304 (77.4%) were coming from the urban residence. Nearly three-fourth (72%) of the participants was Orthodox Christian; and more than half (55.5%) their cumulative grade was between 2.76 to 3.5. The median monthly income of the participants was 1000 Birr and ranges from 50 to 6036 Ethiopian Birr (table 1).
Clinical and social characteristics
Of the participants, 50 (12.7%) had a family history of mental illness, 13 (3.3%) had a history of mental illness, 33 (8.4%) had a family history of suicidal attempt, and 122 (31%) had depression. Regarding social factors, 104 (26.5%), and 202 (51.4%) of the respondents had poor and moderate social supports (table 2).
Substance use characteristics
At the movement, 168 (42.7%) were drinking alcohol, 51 (13%) were chewing Chat, and 37 (9.4%) were taking tobacco. Of the participants, 205 (52.5%) were drinking alcohol, 66 (16.8%) were chewing Chat, and 45 (11.5%) had been taking tobacco ever use respectively (table3).
The prevalence of suicidal ideation and attempt
This study showed that the prevalence of suicidal ideation and attempt of the participants were 14% and 7.4%, with a 95% CI (10.9, 18.1) and (5.1, 10.2), respectively. Out of the participants, 29 (7.4%) had a suicidal plan (table 4).
Factors associated with suicidal ideation and attempt
Among all covariates, Female sex, depression, current and ever Chat chewing, current drinking alcohol, and smoking cigarettes, history of mental illness, family history of mental illness, and social support had less than 0.2 P-values in the bi-variable logistic regression and considered as the multivariable logistic regression model. The multivariate analysis suggested that the female sex was more than five times (95%; CI: 2.42, 11.20) more likely to have suicidal ideation compared with the male sex. Depression was ten times (95%; CI: 4.80, 21.52) more risky to develop suicidal ideation compared to counterparts. At the moment, chewing khat was 4.46 times (95%; CI: 1.32, 15.02) more risky for suicidal ideation compared to students who did not chew khat and having poor social support more than four times (95%; CI: 1.43, 13.87) to develop suicidal ideation compared to good social support (table 5). On the other hand, female sex was more than eight times (95%; CI: 3.04, 21.39) to develop suicidal attempt compared with counterparts and depression also has 10.66 times (95%; CI: 4.01, 28.01) higher risk to develop suicidal attempt compared to students who did not have depression. Finally, having a history of mental illness was about 5.53 times (95%; CI: 1.20, 25.50) more likely to increase suicidal attempt compared to counterparts (table 5).