Muwanguzi Moses, Kaggwa Mark Mohan
Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Psychiatry & Behavioral Neurosciences, McMaster University, Ontario, ON, Canada.
BMC Psychiatry. 2025 Jul 1;25(1):628. doi: 10.1186/s12888-025-07122-6.
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.
自杀倾向和擅自离开精神科护理是发展中国家精神卫生保健中两个复杂的关键现象。本研究有两个目的。第一，确定二十多年来擅自离开者中自杀倾向的患病率。第二，我们着手确定影响擅自离开者出现自杀行为可能性的总体因素，以及每种诊断特有的因素。
这是一项对2000年至2020年期间在乌干达西南部一家三级精神科机构擅自离开住院精神科护理的患者病历进行的回顾性图表审查。使用预先测试的电子问卷对社会人口学特征、记录的自杀倾向和其他临床变量进行数据提取。使用STATA V.17进行数据清理和分析。对与自杀倾向相关的因素进行逻辑回归分析。
在擅自离开者中，9.5%表现出自杀倾向。增加擅自离开者自杀倾向几率的因素包括离婚或分居（调整后的优势比[aOR]=2.00，95%置信区间[CI]：1.20-3.31，p=0.007）、患有抑郁症（aOR=5.41，95%CI：2.47-11.82，p<0.001）、有物质使用史（aOR=1.50，95%CI：1.01-2.23，p=0.049）以及住院前遭受暴力（aOR=1.83，95%CI：1.14-2.94，p=0.013）。相比之下，物质使用障碍（aOR=0.25，95%CI：0.10-0.62，p=0.003）和患有精神分裂症谱系障碍（aOR=0.35，95%CI：0.18-0.68，p=0.002）与擅自离开者自杀倾向降低的可能性相关。
本研究揭示了擅自离开者中自杀倾向的高负担，以及婚姻状况、抑郁症和遭受暴力史等重要风险因素。值得注意的是，物质使用障碍和精神分裂症谱系障碍与自杀风险降低有关。本研究表明临床因素和人口统计学因素在预测自杀倾向方面存在显著相互作用。
