Depression and Suicidal Behavior in Uganda
Depression and suicide ideation are prevalent in the general population but their recognition and detection in primary care is problematic. The present study investigated the reliability and validity of the RISLE and its potential use in detecting depressed and/or suicidal individuals in the general population. Methods of study Members of the general population in two districts of Uganda, Adjumani and Bugiri, and fresh students at Makerere University, participated in the study. Two pilot studies were conducted before the collection of data: at Makerere University among fresh students sampled from all faculties in 2001, and in each of the districts in the course of interviewer and research assistants’ training in 2002. Makerere University, Uganda National Council for Science and Technology and the Ethical Committee at Karolinska Institutet approved the study. The Dean of Students and the health and civic leaderships of the respective study sites granted further permission for the study. Analysis Data analysis comprised of general descriptive analysis. Principal component analysis and discriminant function analysis were used to refine the RISLE and construct a shorter 36-item version. Receiver operating characteristic curve was constructed to determine sensitivity and specificity of the short RISLE. The determination of sensitivity, specificity, predictive values, and likelihood ratios, and Cohen’s kappa values at several cut-off points were made to determine the level of agreement between the RISLE and clinical interview method as the gold standard in the study. Validity was assessed by comparing results obtained with the RISLE to results obtained with the 13- item Beck Depression Inventory (BDI) and the 21-item Beck Scale for Suicide ideation (BSS). Results Results revealed good concurrent validity and reliability of both the longer and shorter versions of the RISLE and high correlations between both versions. The probability of a correct detection of an individual with current depressive disorder was 79%, any current psychiatric disorder was 83% and past month suicidality was 83%. Cut-off points varied according to the nature of population studied. The cut-off point for the population in Adjumani district was 10 for any current psychiatric disorder, and 6 for any psychiatric disorder among students. Sensitivity and specificity of the RISLE at cut-off points 10 and 6 were 74.6% and 77.1%, and 88.1% and 60.4% respectively. Positive predictive values for current psychiatric disorder were 82.0% and 75.6% at cut-off points of 10 and 6 respectively. Agreement between the RISLE and clinical interview method was 0.508 at cutoff point 10 for the general population and 0.501 at cut-off point 6 for students. Thirty six percent of the respondents in the general population reported a lifetime experience of suicide ideation and 13% had experienced this in the previous week. The overall prevalence of probably clinically significant depression (BDI score of 20-39) in the general population was 17.4%. Higher rates of suicide ideation and depressed mood were found in females and residents of Adjumani district. Students entering Makerere University showed high prevalence of mental health problems. Conclusions The results of the present study show that the RISLE may be used in conjunction with clinical interview method in the detection and confirmation of individuals with current psychiatric illness and suicidal feelings in the general population. Further work is required to establish its worth as a screening device and its performance in different populations.
- Social Sciences