Suicidality among inpatients who absconded from a tertiary mental health facility in Uganda: a retrospective study

Suicidality and absconding from psychiatric care are two critical phenomena that complicate mental health care in developing countries. The aim of this study was twofold. First, to determine the prevalence of suicidality among absconders over two decades. Secondly, we set out to determine overall factors that influence the likelihood of having suicidal behaviors among absconders, as well as factors specific to each diagnosis.

This was a retrospective chart review of files of patients who absconded from inpatient psychiatric care at a tertiary psychiatric facility in southwestern Uganda between 2000 and 2020. A pre-tested electronic questionnaire was used for data abstraction of sociodemographic characteristics, documented suicidality, and other clinical variables. Data cleaning and analysis were conducted using STATA V.17. Logistic regression was performed for factors associated with suicidality.

Among the absconders, 9.5% exhibited suicidality. Factors that heightened the odds of suicidality among absconders included being divorced or separated (adjusted odds ratio [aOR] = 2.00, 95% Confidence Interval [CI]: 1.20-3.31, p = 0.007), having depression (aOR = 5.41, 95% CI: 2.47-11.82, p < 0.001), a history of substance use (aOR = 1.50, 95% CI: 1.01-2.23, p = 0.049), and experiencing violence before hospitalization (aOR = 1.83, 95% CI: 1.14-2.94, p = 0.013). In contrast, substance use disorder (aOR = 0.25, 95% CI: 0.10-0.62, p = 0.003) and having schizophrenic spectrum disorders (aOR = 0.35, 95% CI: 0.18-0.68, p = 0.002) were linked to a decreased likelihood of suicidality among those who absconded.

This study reveals a high burden of suicidality among individuals who abscond, with important risk factors such as marital status, depression, and a history of experiencing violence. It was noted that substance use disorder and schizophrenia spectrum disorders are associated with a reduced suicide risk. This study shows a significant interplay between clinical and demographic factors in predicting suicidality.