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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 23  |  Issue : 2  |  Page : 93-98

Depression and suicidal ideation among young persons in Benin City, Edo State: An assessment of prevalence and risk factors


1 Department of Community Health, College of Medical Sciences, University of Benin; Department of Community Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
2 Department of Community Health, College of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria

Date of Web Publication14-Nov-2019

Correspondence Address:
Esohe Olivia Ogboghodo
Department of Community Health, College of Medical Sciences, University of Benin, PMB 1154, Benin City, Edo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmhhb.jmhhb_13_19

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  Abstract 


Background: Globally, more than 300 million people of all ages suffer from depression. It is a serious mental health problem that has as one of its ripple effects, suicidal ideations, which may lead to suicide attempts or suicide. Suicide accounts for an estimated 6% of all deaths among young people. Depression and suicide result from a complex interaction of social, psychological, and biological factors. This study was carried out to assess the prevalence and risk factors of depression and suicidal ideation among young persons in Benin City, Edo State, Nigeria. Methods: This was a descriptive cross-sectional study among young persons in Benin City, Edo State, Nigeria. A multistaged sampling technique was used to select respondents. Data were collected using pretested structured self-administered questionnaire which was adapted from the Patient Health Questionnaire 9. Data analysis was by IBM SPSS version 22.0, and the level of significance was set at P < 0.05. Results: A total of 504 respondents were participated in this study. The prevalence of depression and suicidal ideation among the respondents was 223 (44.2%) and 75 (14.9%), respectively. Significant determinants of prevalence of depression were presence of social factors (P < 0.001), medical factors (P = 0.005), and economic factors (P = 0.005). Respondents, who were depressed, were also more likely to have suicidal ideations (P < 0.001, confidence interval = 0.233–0.645). Conclusion: Over two-fifths of the respondents were depressed and less than a tenth had suicidal ideations. It is very pertinent for the government and medical personnel to put in synergistic efforts to ensure that depression among young persons is promptly addressed.

Keywords: Depression, prevalence, suicidal ideation, young persons


How to cite this article:
Ogboghodo EO, Osadiaye E, Omosun-Fadal T. Depression and suicidal ideation among young persons in Benin City, Edo State: An assessment of prevalence and risk factors. J Mental Health Hum Behav 2018;23:93-8

How to cite this URL:
Ogboghodo EO, Osadiaye E, Omosun-Fadal T. Depression and suicidal ideation among young persons in Benin City, Edo State: An assessment of prevalence and risk factors. J Mental Health Hum Behav [serial online] 2018 [cited 2019 Dec 11];23:93-8. Available from: http://www.jmhhb.org/text.asp?2018/23/2/93/270982




  Introduction Top


Depression is a common mental disorder that presents with sad mood, loss of interest or pleasure, feeling of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration.[1] Depression is a significant contributor to the global burden of disease and affects people in all communities across the world.[2] Globally, more than 300 million people of all ages suffer from depression.[3] Depression is common among adolescents and young persons (ages 10–25), affecting many people before the age of 18.[4]

Depression is often associated with other mental illness, and it is estimated that two-thirds of young people with depression have at least one comorbid mental disorder compared to young people who are not depressed. It is a serious mental health problem that may lead to different ripple effects in individuals. One of such ripple effects is suicidal ideation or suicidal thoughts, which may lead to suicide attempts or suicide.[5] Depressive disorders in young people are a major risk factor for suicide.[6] Lifetime risk of suicide among patients with untreated depression ranges from 2.2% to 15%. Persons suffering from depression are at 25 times greater risk for suicide than the general population.[7]

Suicidality or suicidal behavior exists along a continuum that extends from suicidal ideation or thoughts, suicide-related communications, suicide attempts, and finally suicide.[5] Suicide was recently identified by the World Health Organization (WHO) as a priority condition in the Mental Health Gap Action Programme as a significant social and public health problem.[8] Suicide accounts for an estimated 6% of all deaths among young people and the third leading cause of mortality among males aged 10–24 years.[9] This represents an annual age-standardized suicide rate of 11.4/100,000 globally and 6.11/100,000 population in Nigeria.[10] The extent of underreporting of the suicide cases due to lack of robust registration systems or stigma against suicide attempters and their family, indicates that the real number of suicide is likely to be even higher.[10] Overall, rates of completed suicide are higher in males than in females. This holds true for all age groups, with a male-to-female ratio of about 4:1 in adolescents and young adults. Several studies conducted in several parts of Nigeria have documented a 3.2% prevalence of suicidal ideation and 0.7% for suicide attempt.[11]

Depression results from a complex interaction of social, psychological, and biological factors. People, who have gone through adverse life events, such as unemployment, bereavement, and psychological trauma, are more prone to developing depression.[3] Nevertheless, there is no single factor that will lead to the onset of depression. Genes and family tendencies can deter whether someone is likely to be more susceptible to depression, but many other factors aforementioned can act as potential triggers including the most trending factor now, which is the pressure of modern life on young people.[12]

Several risk factors for suicidal behavior have also been reported at the health system, community, and individual level. The system level-risk factors focus on access to means of suicide and health care. The individual factors include demographic features, female gender, younger age, lower education level, and unmarried status, while stigma and discrimination are reported to be relevant community factors. Mood disorders, such as depression, are also important risk factors as earlier stated. Other risk factors include previous suicide attempt, psychopathology, and family history of depression, physical and sexual abuse.[13] Lack of treatment for common mental disorders has a high economic cost. New evidence from a study led by WHO shows that depression and anxiety disorders cost the global economy more than US$ 1 trillion each year.[14]

Research on depression and suicidality in Nigeria will provide statistics that can guide mental health experts and related professionals on how to overcome these problems.[5] As a result, mental health professionals may gain insight regarding perspectives relating to mental health treatment and possibly, the ultimate outcome would be to gain a better understanding of barriers to treatment, hence opening lines of communication between persons and mental health professionals for effective, comprehensive services for individuals in need of mental health services.[15]


  Methods Top


The study utilized a descriptive cross-sectional study design and was carried out between April 2017 and March 2018 to assess the prevalence and risk factors of depression and suicidal ideation among young persons in Benin City, Edo State, Nigeria. The study population comprised young persons (ages 10–25 years) living in Benin City, who gave their consent in Benin City, Edo State. Benin City is made up of three local government areas (LGAs) (of the 18 LGA's in the state), namely Egor, Oredo, and Ikpoba-Okha, comprising both urban and rural wards (12, 10, and 10 wards, respectively). A minimum sample size of 504 was calculated using the Cochran formula for calculating single proportion[16] considering an 18% prevalence of depression among rural adolescents in 2012[17] and a 10% nonresponse rate. Respondents were selected using a multistage sampling technique comprising three stages. In Stage 1, simple random sampling by balloting was used to select two LGAs (Egor and Ikpoba-Okha) of the three that makeup Benin City. In Stage 2, using a list of the wards in each selected LGA as the sampling frame, a ward each was selected from Egor and Ikpoba-Okha LGAs by means of simple random sampling technique by balloting. In Stage 3, cluster sampling technique was utilized. In the selected wards, a list of the communities was obtained, and each community served as a cluster. One cluster was selected from each ward using simple random sampling technique by balloting, and all persons who met the inclusion criteria (aged 10–25) and gave consent were included in the study. Data were collected using a pre-tested structured self-administered questionnaire written in the English language.

The questionnaire used in this study contained both open- and close-ended questions and comprised three sections;: Section A sought information on the sociodemographic characteristics of the respondents and Section B sought information on the prevalence of depression and suicidal ideation among respondents. The Patient Health Questionnaire (PHQ)-9 was utilized.[18] This questionnaire is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. This questionnaire offers concise, self-administered tools for assessing depression. It incorporates DSM-IV depression criteria with other leading major depressive symptoms into brief self-report instruments that are commonly used for screening and diagnosis, as well as selecting and monitoring treatment. The PHQ-9 also has been used in many studies in primary care settings, as well as with older individuals and with those who have physically disabling conditions. It is free to users and available in English and over 30 other languages.[19]

The diagnostic validity of the 9-item PHQ-9 has been established in many studies. Reliability and validity of the tool have indicated that it has sound psychometric properties. Internal consistency of the PHQ-9 has been shown to be high. The PHQ-2 which comprises the first two items of PHQ-9 screens for depression as a “ first step” approach. Respondents who screen positive for PHQ-2 are further evaluated with the PHQ-9 to determine whether they meet the criteria for a depressive disorder. Question 9 of the PHQ-9 is a single screening question on suicide risk, and a positive response needs further suicide-risk assessment.[18],[19],[20]

Section C sought information on the risk factors for depression and suicidal ideation. A pretest of the study tool was done at Ovia North-East LGA, Edo State. Pretesting was done to enhance clarity, comprehensibility, validity and reliability of data tools, and corrections were effected prior to commencement of the study.

The questionnaires were collated, screened for completeness, numbered serially was entered into IBM SPSS statistics for windows, version 21.0. (IBM Corp., Armonk, NY). The prevalence of depression and suicidal ideation among young persons was assessed using nine questions in a four-point Likert scale which was scored as follows: not at all (0), several days (1), more than half the days (2), and nearly every day (3). The maximum achievable score was 27, while the least achievable score was 0. Scores ≥5 were considered as having depressive symptoms. Scores 5–9 had mild depressive symptoms, 10–14 had moderate depressive symptoms, 15–19 had moderately severe depressive symptoms, and scores 20–27 had severe depressive symptoms. Any respondent who responded positive to question 9 was considered to have suicidal ideations.[18]

Univariate analysis was done to assess the distribution of the variables. Multivariate analysis using binary logistic regression was carried out using the “enter approach” to determine the significant predictors of outcome variables, which were prevalence of depression and suicidal ideation. The statistical measure for the analysis was the adjusted odds ratio and 95% confidence interval (CI). The level of significance of statistical associations was set at P < 0.05.

Ethical clearance to conduct this study was sought and obtained from the Ethical Committee, University of Benin Teaching Hospital. Approval was obtained from the community head before the study was carried out. Informed consent was obtained from each respondent before conducting interviews. Confidentiality and privacy of the respondents was guaranteed during the interviews. To ensure confidentiality, serial numbers rather than names were used to identify the respondents. To ensure privacy, interviews were conducted in secluded areas in or around the home to allow the respondents speak freely about sensitive issues. Respondents were informed that they had the right to decline participation or to withdraw from the study at any time they wished. Respondents were also informed that there were no penalties or loss of benefits for refusal to participate in the study or withdrawal from it. Respondents who had moderate-to-severe depression were referred for further evaluation and management. All data were kept secure and made available to only members of the research team.


  Results Top


A total of 504 respondents were participated in this study. The mean age ± SD of respondents was 20.35 ± 2.31 years, and a higher proportion of 325 (64.5%) respondents were aged between 20 and 24 years. Over half of the respondents, 302 (59.9%) were female and 479 (95.0%) were single. Majority of the respondents, 453 (89.9%) had tertiary level of education. Over two-thirds of the respondents, 340 (67.5%) lived with either parents or relatives [Table 1].
Table 1: Sociodemographic characteristics of respondents

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Two hundred and twenty-three (44.2%) of the respondents were depressed and 75 (14.9%) had suicidal ideations. Of those depressed, 154 (69.1%) had mild depression, 56 (25.1%) had moderate depression, 10 (4.5%) had moderately severe depression, and 3 (1.3%) had severe depression [Table 2].
Table 2: Prevalence of depression, suicidal ideation, and risk factors of depression and suicidal ideation among respondents

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One hundred and twenty-two (24.2%) had recently lost a family member, 104 (20.6%) and 33 (6.5%) had a serious financial downfall and lost a job recently. Over a tenth of the respondents, 114 (22.6%) had recently had emotional problems, 87 (17.3%) and 44 (8.7%) failed at school and had experienced physical/sexual abuse, respectively [Table 2]. In both the adjusted and unadjusted analyses, males were less likely to be depressed compared to the females; however, this was not statistically significant (P = 0.325, CI = 0.582–1.196 and P = 0.149, CI = 0.501–1.111, respectively). Interestingly, respondents who were discovered to have no family risk factor for depression were more likely to be depressed compared to those who had one or more family risk factors in both the unadjusted and adjusted analyses (P = 0.229, CI = 0.873–1.766 and P = 0.304, CI = 0.832–1.802). In the unadjusted analyses, respondents who had no economic risk factors were less likely to be depressed compared to those who had one or more economic factors, and this was statistically significant (P = 0.005), the relationship, however, became no significant after adjusting for covariates (P = 0.561). The presence of social risk factors was a significant determinant of depression in both the unadjusted and adjusted analyses (P < 0.001, respectively) [Table 3]. Respondents who had no social risk factors were less likely to have suicidal ideations compared to those who had one or more social risk factors in both the unadjusted and adjusted analyses, and this was statistically significant (P < 0.001, CI = 0.209–0.573 and P = 0.008, CI = 0.246–0.806, respectively). Respondents who were not depressed also less likely to have suicidal ideations in the unadjusted (P < 0.001, CI = 0.233–0.645) and adjusted analyses (P = 0.011, CI = 0.286–0.849) [Table 4].
Table 3: Unadjusted and adjusted predictors of the prevalence of depression among respondents

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Table 4: Unadjusted and adjusted predictors of the prevalence of suicidal ideation among respondents

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  Discussion Top


Findings from the study showed that four in ten of the respondents screened positive for depression, and one in ten respondents had suicidal ideations. This is at variance with a study carried out in South Australia in 2012, where 18% of the participants screened positive for depression, and 20% experienced occasional self-harm or suicidal thoughts.[17] Respondents with no formal education were more likely to be depressed than those with formal education. This is in tandem with a study done in Nigeria in 2013, which revealed that there was a significant association between having no formal education and having diagnosis of depression. Patients with no formal education may earn less as they are likely to get poorly paid jobs. They may also have low earning power and may be predisposed to low self-esteem and lead to feelings of hopelessness.[21] Females had a higher rate of depression and suicidal ideation compared to males. This is in line with a 2013 study done in Nigeria, which showed that the prevalence of depression was more among females than males.[21] Contrasting findings were however obtained from the Study of the Economic burden of Depression done in Colombia, where it was revealed that the female sex was a factor associated with a lower risk of suicidal ideation.[22] The reason for this gender difference observed in our study could be as a result of combined factors such as the effects of estrogen on stress hormone (cortisol), sexual assault as girls, chronic strains, higher poverty, and sexual harassment at workplace, role overload, and greater reactivity to stressors.[21] It has, however, been reported that though women are twice as likely to experience depression than men, men are four times more likely than women to commit suicide.[23]

Depression is associated with a higher level of morbidity and mortality, the most significant being elevated mortality due to suicide. A high prevalence of depression also has social and economic consequences, as it results in an increased use of health facilities and a significant loss of productivity.[24] The significant determinants of depression from our study using the unadjusted odds ratio were economic factors such as unemployment and serious financial downfall; social factors such as physical/sexual abuse, smoking, alcoholism, substance abuse, and emotional problems; and medical factors such as chronic medical illness. This is similar to findings from a study conducted in Kano in 2016 which showed that depression was found to be more common among those with chronic medical conditions such as hypertension, chronic respiratory diseases, and diabetes mellitus.[25] Another study carried out in Geneva in 2000 which revealed findings similar to that in this study, showed that there were fairly strong associations between unemployment rates and suicide rates. The effects of unemployment are probably mediated by factors such as poverty, social deprivation, domestic difficulties, and hopelessness, and thereby leading to depression.[18] Respondents, who were depressed, were also more likely to have suicidal ideations, and this was a significant finding in both the unadjusted and adjusted analyses. This is similar to findings from a meta-analytic review carried out in 2017 which showed a moderately strong association between depressive symptoms and suicidal ideation (CI: 2.027–2.333, P < 0.0001).[25] It has been reported that major depression is the psychiatric diagnosis most commonly associated with suicide, and about two-thirds of people who complete suicide are depressed at the time of their deaths.[26]


  Conclusion Top


The prevalence of depression in this study was high, and about 15% of the respondents had suicidal ideations. Suicidal ideations were also found to be common among those who were depressed. We advocate that medical personnel have as part of their treatment plan for depressed.

Limitation to study

No further diagnostic or confirmatory tools were used to confirm or refute the crude findings generated from the used General Health Questionnaire (GHQ)-9 questionnaire and as such, prevalence of depression and suicidal ideation may be over or underreported.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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