Suicidal behavior among psychiatric patients in Rwanda


1. Title: 

Suicidal behavior among psychiatric patients in Rwanda

2. Project period: 

01.09.2021 – 31.08.2022 

3. Investigator(s): 

Maja Grønlund Bendtsen, MSc Medicine, University of Copenhagen

4. Supervisors and external collaborative partners: 

  • Main supervisor: Jessica Carlsson (Competence Centre for Transcultural Psychiatry, CTP)
  • Co- supervisors: Laura Glahder Lindberg (CTP), Kate Andreasson (Research Center at Psychiatric Hospital North Zealand), J. Arnbjerg (PhD-student at Aarhus University) and Emmanuel (PhD-student at Aarhus University)

5. Introduction: 

Every year more than 700.000 people die due to suicide (1). More than half of the people completing suicide in low- and middle- income countries (LMICs) have an underlying mental health disorder (2). Of all mental health disorders, bipolar disorder has the highest occurrence of suicide with a rate 20-30 times that of the general population (3).
There is no national suicide prevention strategy in Rwanda, no treatment guidelines and there exists no structured system nor any interventions for helping people at immediate risk of suicide. Additionally, suicide has been under-researched in Rwanda and there are no studies assessing suicidal behavior among people with a history of suicide behavior or with a diagnose of a mental health disorder, nor any studies assessing help-seeking behavior of those at risk of suicide.
This study on suicidal behavior and help-seeking behavior in Rwanda will create awareness and will help to identify potentially interventions to help those in risk of suicide.

5.1 Aim/s: 

The overall aim is to explore the experiences and prevalence of suicidal behavior among individuals with bipolar disorder in Rwanda. 

6. Methods 

The study will apply a mixed-method approach consisting of both a quantitative part and a qualitative part. 

6.1 Number of participants (N)
Quantitative part: 155 patients. Qualitative part: 8-15 patients 

6.2 Population
The study will use data on suicidal behavior from an ongoing randomized controlled trial (RCT) on psychoeducation for outpatients with bipolar disorder in Rwanda. Participants included in the RCT are patients with bipolar disease type I or II that meet DSM-V diagnostic criteria given by a trained psychiatrist and age ≥ 18 years. The qualitative part of the study will consist of in depth-interviews with participants from the RCT who have reported a history of suicidal behavior.

6.3 Description of data and data collection
Data will be collected from the dataset of the RCT. The primary outcome is the prevalence of suicidal behavior among the population. The qualitative part of the study will consist of in depth-interviews with participants from the RCT and it will be conducted with a phenomenological approach as suggested by Giorgi (4). An interview guide covering the living experience of suicidal behavior, will be used to retrieve descriptive information from the participants. Interviews will be conducted in Kinyarwanda and recorded, transcribed and translated to English.

6.4 Application/acceptance from the Danish Data Protection Agency, the National Committee on Health Research Ethics
The research protocol and the study-related documents has been approved by the College of Medical and Health Science Institutional Review Board in Rwanda.

6.5 Analysis
Descriptive statistics will be performed to describe the prevalence of suicidal behavior. In accordance with the phenomenological framework a phenomenological analytic approach will be applied when analyzing qualitative data.

7. Expected results

It is expected that there is a difference between the documented prevalence of suicidal behavior reported in the files and the actual self-reports of suicidal behavior among psychiatric patients. It is expected that information gained from exploring the living experience of suicidal behavior, will bring knowledge on how potentially interventions program can help those at risk of suicide in Rwanda. 

The project will result in a master thesis at the University of Copenhagen and for the dissemination of the outcome of the project, the aim is to publish articles in scientific journals. 

8. Expected impact

There is a limited number of studies in LMICs conducted on suicide and there is an absence of suicide preventive strategies in LMICs. The findings of this research will highlight the need to implement policies and interventions to prevent suicide attempts. 

9. References 

1.  WHO https mortality database [Internet]. World Health Organization. 2021. Available from:://www.who.int/news-room/fact-sheets/detail/suicide
2.  Psychiatric_morbidity_and_suicidal_behaviour_in_low__and_middle_income_countries__A_systematic_review_and_meta_analysis_.pdf.
3.  Chen Y, Dilsaver SC. Lifetime Rates of Suicide Attempts among Subjects with Bipolar and Unipolar Disorders Relative to Subjects with Other Axis I Disorders. 1996;3223(95):0–3.
4.  Giorgi A. The Theory, Practice, and Evaluation of the Phenomenological Method as a Qualitative Research Procedure. J Phenomenol Psychol. 1997;28(2):235–60.

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