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Trauma exposure, depression, suicidal ideation, and alcohol use in people with severe mental disorder in Ethiopia

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Abstract

Purpose

To investigate exposure to traumatic and stressful events and their association with depression, suicidal ideation, and alcohol abuse in people with severe mental disorder (SMD) in Ethiopia.

Methods

As part of the Programme for Improving Mental health carE, 300 people with SMD (84% primary psychosis, 11% bipolar disorder, and 16% depression with psychotic features) in a rural district were identified by psychiatric nurses. A cross-sectional assessment included clinical characteristics, experience of being restrained, exposure to stressful events as measured by an adapted version of the List of Threatening Experiences scale, traumatic events as measured by endorsement of 13 locally relevant potentially traumatic events that occurred since the onset of the participant’s mental illness, depression symptoms measured by the Patient Health Questionnaire, the Suicidal Behavior Module of the Composite International Diagnostic Interview, and hazardous drinking which was calculated as a sum score of eight or higher on the Alcohol Use Disorders Identification Test.

Results

Almost half of participants reported being restrained since becoming ill, which was associated with more suicidal ideation and less hazardous drinking. More than one-third experienced traumatic events since becoming ill, including being assaulted, beaten, or raped. Exposure to traumatic events was associated with hazardous drinking.

Conclusions

In this rural Ethiopian setting, people with SMD experienced high levels of traumatic and stressful events which were associated with co-morbid conditions. Greater attention needs to be given to trauma prevention and integration of treatment for trauma sequelae in efforts to expand integrated mental health care.

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Acknowledgements

This study is a direct output of the PRogramme for Improving Mental health carE (PRIME). This work was supported by the UK Department for International Development (201446). The views expressed do not necessarily reflect the UK Government’s official policies. LN’s time was funded by the National Institute of Mental Health (NIMH) Grant numbers #T32MH093310 and #K23MH110601. The funders had no role in data collection, analysis, writing, or decision to submit the article for publication.

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Authors and Affiliations

  1. Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA, 02118, USA

    Lauren C. Ng

  2. Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia

    Girmay Medhin

  3. Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Charlotte Hanlon & Abebaw Fekadu

  4. Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

    Charlotte Hanlon & Abebaw Fekadu

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  1. Lauren C. Ng
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  2. Girmay Medhin
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  3. Charlotte Hanlon
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  4. Abebaw Fekadu
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Corresponding author

Correspondence to Lauren C. Ng.

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The authors declare that they have no competing interests.

Ethics approval

The study was approved by the Institutional Review Board of the College of Health Sciences of Addis Ababa University. The secondary analyses presented here were reviewed by the Boston University Medical Campus Institutional Review Board and were determined to not be human subjects’ research.

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All participants gave informed consent to participate.

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Ng, L.C., Medhin, G., Hanlon, C. et al. Trauma exposure, depression, suicidal ideation, and alcohol use in people with severe mental disorder in Ethiopia. Soc Psychiatry Psychiatr Epidemiol 54, 835–842 (2019). https://doi.org/10.1007/s00127-019-01673-2

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  • DOI: https://doi.org/10.1007/s00127-019-01673-2

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