Study design and period
The institution-based cross-sectional study was conducted from May to June 2019 G.C.
Alamata is one of the eight weredas in the south Tigray. Located 187 km by korem line, and 174 km by mehoni line from Mekelle and 600 km north from Addis Ababa. The town has 4 zones and 15 ketena. Zone 01 has a total population of 11198 (m=5707, f=5491) and the total household of 3294 Zone 02 has a total population of 18062 (male = 8739, female =9323) and the total household of 5312 Zone 03 total population of 16202 (male =7629, female =8573) and the total household of 4765 Zone 04 total population of 17273 (male =8413, female =8860) and the total household of 5080. The total surface area of the town is 1829.3 hectare. Total population of the town is 62, 735(male = 30,488 & female =32,247) and Total household is 18,451 with annual increments of the population is 4.61%. It is a lowland area and 1,564m above the sea. Annual rainfall in average is 691.5 ml and annual Temperature in 0C from 22 0C - 26 0C.
Alamata General Hospital is located in zone 02 was founded on 1983E.C Starts as General hospital. It gives service for around 165,205 populations. 82,903(50.2%) & females, 82,302(49.8) males .reproductive age Female 5043 & Male 5303.the catchment areas are Alamata town, Alamata rural, Mara region( kobo), Afar region, Bala & Kukufto. Alamata General hospital has 255 staffs divided in 4 Adult OPDs,1 under five OPD,1 IPD,1 MCH,1 EOPD,1 NICU,1 ART,1Dental OPD,1 Ophthalmic OPD,1 Psychiatry OPD,1 Physiotherapy OPD,1 TB OPD departments.
All DM patients who were attending AGH .
All DM patients who were attending Alamata General Hospital during the study period were included.
Inclusion and exclusion criteria
All DM patients who were 18 years old or above and attending at AGH were included in the study.
Those who were seriously ill, under the age of 18 and those with physical disabilities (unable to communicate).
Sample size and sampling procedure
Sample Size Determination
The sample size was determined using a single population proportion formula by
Where n= sample size
z= confidence interval of 95%=1.96
d= marginal error; 0.05
Since our sample population was less than 10,000 which was 200 we merged it to Nf using correction formula
Then we added 10% of the Nf for non-response rate
132+14=146 is the sample size we used to conduct our study
Convenience random sampling technique was used to select each study participants from the AGH and the data was collected until the quota was full.
I. Socio-demographic factors
- Age, Sex, Religion, Ethnicity, Marital status, Educational status, Occupational status, Residence, Living condition, Income
II. Psychosocial factors
- Social support
- Depression and anxiety
Data collection method and instruments
The study questionnaire had five components. Socio-demographic characteristics were collected by structured socio-demographic questionnaires. Depression and anxiety were collected by using HADS of seven stage questions and substance-related factors were collected by substance-related questionnaires. Social support was assessed by Oslo-3 item social support scale. It is 3 item questionnaires, commonly used to assess social support and it has been used in several studies,
Outcome variables, suicidal behaviour were assessed by using a structured questionnaire the data was collected by face to face interview. There were 2 data collectors from fourth-year psychiatric nursing students. Data was collected in the AGH from May to June 2019.
Data quality control
To control the quality of data the questionnaire was designed and modified appropriately. The questionnaire was pre-tested one week before the actual data collection on 5% (8) of patients at AHC and was not included in the main survey. The data collectors were supervised daily and the field questionnaires were checked daily by the supervisors and principal investigator. When there was any problem the solution was given by discussion with the advisors and data collectors.
Data analysis technique
Data analysis technique the collected data was analyzed using SPSS 23 software program. For this operation, proper data categorization and coding was used. For the analysis of obtained data simple descriptive statistics (mean, percentage, frequencies, and standard deviation) and cross-tabulation was used to determine the magnitude of suicidal behaviour among DM patients in AGH, Tigray, Ethiopia, 2019 G.C.
Suicidal behaviour is defined if the respondent ever had either suicidal ideation of attempt,
Suicidal ideation: is defined as if the respondent answers to the question have you ever seriously thought about committing suicide? If yes, the patient has suicidal ideation.
Suicidal attempt: is defined as if the respondent answers for the question have you ever attempted suicide? If yes, the patient has suicidal attempt,
Depression was assessed Individual who scored≥8 on depression subscale 7-items by assessing HADS, Anxiety: individual, who scored ≥8 on anxiety subscale 7-items by assessing HADS,
Social support: The presence of poor social support among medical patients was considered by the sum of Oslo 3-item score of 3-8.
Current users: when individuals or study subjects used specific substances like alcohol, smoking cigarette and khat currently.
Ever users: when study subjects or individuals used specific substances like alcohol, cigarette, and khat even once in their lifetime.
Never users: when study subjects or individuals no use specific substances like coffee, alcohol, cigarette, and khat even once in their lifetime.
Ethical clearance was obtained from the ethical review committee of Mekelle University. A formal letter of permission was obtained from MU and was submitted to AGH. Confidentiality of respondents was maintained. Informed written consent was obtained from each respondent and anyone not willing to take part in the study had full right to do so. Participants in the study who are highly suicidal were referred at the hospital for the assistant.
Dissemination and utilization of a result
After the data is analyzed, based on the findings obtained, conclusions and recommendations were made. Then the results of the study were submitted to AGH, Mekelle University, College of health science for future planning in routine assessments of mental health particularly suicide for a patient with DM in AGH.. Moreover, the findings of the study disseminated to regional health bureau.