Management of parasuicide at Kenyatta National Hospital

Abstract

This was a cross- sectional study carried out at the Kenyatta National Teaching and Referral Hospital, Nairobi. Doctors working in the casualty, medical and surgical inpatient wards were interviewed in an attempt to establish the management pattern of attempted suicide cases. The data was collected from consenting participants using a semi-structured questionnaire designed by the author. Variables in the questionnaire included sociodemographic characteristics such as age, gender, marital status; professional qualification, number of years in employment, number of attempted suicide cases seen in the last one week, one month and one year; mode of management, assessment of suicide risk, frequency of use of the suicide intent scale and perceived obstacles to management.

Of the .220 doctors in the selected sample, only 126 (57.3%) responded. The 126 respondents comprised of 107 (85%) males and 18 (14%) female doctors. One (0.8%) doctor did not state the gender. Of the respondents, 86 (68.3%) were aged below 35 years; with only 1 (0.8%) doctor aged below 25years and 2 0.6%) doctors aged over 50 years. The median age group was 30-34 years with a standard deviation of 1.3. One hundred and thirteen (90%) were Christians and 83 (65.9%) were married. Majority, 97 (77 %), of the respondents 'worked in the wards, with 29 (23%) working in casualty. Eighty-three (66%) of the doctors had practiced medicine for 7 years or less, with a median of 6 years of practice. The non-psychiatric doctors at Kenyatta National Hospital recognized that attempted suicide was a psychiatric emergency that was often precipitated by social factors, in particular, relational conflict. They also recognized that psychiatric morbidity; especially depression, predisposed patients to attempt suicide. Referral to psychiatrists and counsellors for management of attempted suicide and prescription of antidepressants were the management methods most commonly used. Obstacles to management cited were lack of necessary knowledge and skills, inadequate numbers of mental health specialists to refer to, inaccessibility and/or unavailability of mental health specialists to refer to and insufficient time to adequately manage the patients.

The doctors recognized attempted suicide to be a psychiatric emergency but faced major obstacles in managing patients who attempted suicide. These findings were discussed and remedial measures suggested.