Prevalence of suicidal ideation, suicidal attempt and completed suicide in Ethiopia: a systematic review and meta-analysis protocol

Suicide is a complex process ranging from suicidal ideation to planning of suicide, suicidal attempt, and completed suicide [1, 2]. Two overlapping terms are used to describe the concept of suicide [1, 3, 4]. These are (i) suicidal attempt/self-harm/suicidal intent, refers to a deliberated direct destruction of body tissues with a conscious suicidal intent, and (ii) non-suicidal attempt/self-injury (NSSI), refers to a deliberated direct destruction of body tissues without a conscious suicidal intent [1, 3, 4]. Most standard guidelines focus on self-harm irrespective of the intent, and there are commonly four different forms of suicidal behaviors [1, 3]. These are (i) suicidal ideation, refers to thoughts fantasies and wishes about ending of one’s own life, (ii) suicide plan, refers to planning on how to end one’s own life, (iii) suicide attempt, refers to the self-destructive act with intent to end one’s own life, and (iv) completed suicide, refers to the act of self-harm with a fatal outcome [1‐3]. Suicide is a worldwide phenomenon that takes a heavy toll on the individuals, families, and communities [5]. Globally, one million people die due to suicide per year (one person every 40 s) [5‐9]. It is the tenth leading cause of death worldwide, but the second and third leading cause for those age group between 15 and 29 years and 15–44 years respectively [1, 7, 9‐12]. It is predicted that, by 2020, annual suicide fatalities will be increased to 1.5 million (one every 20 s) [5]. According to the World Health Organization (WHO) study among 21 countries, approximately, the 12 months and lifetime prevalence of suicidal attempt was 0.3 to 0.4% respectively 2 and 9% for suicidal ideation [10]. Suicidal attempt is more common than suicide deaths [5, 8]. For example, in the USA, there are more than 30 suicidal attempts for each suicide death [10]. In Africa, the overall magnitude of suicide ranged from 2–3% [range 0.7–6.0%] [11, 13]. In Ethiopia, the prevalence of suicidal behaviors ranged from 0.9 to 60% [14‐16] for suicidal ideation, 3.8 to 27% [14, 17] for suicidal attempt, and 13.96% per 100,000 [18, 19] for completed suicide.

Suicidal ideation, plan, and attempt are major risk factors for completed suicide [1, 5]. Among individual with lifetime suicidal ideation, the probability of ever making suicidal plan was 33%, and attempted suicide was 30%. For lifetime history of suicidal ideation and plan, the probability of completed suicide was 55% [8]. Factors such as psychiatric disorder [20], hopelessness, and substance use were also associated with completed suicide [1, 3, 5, 20]. Suicide is an emergency psychiatric problem [9, 20, 21] and need an urgent treatment; yet, stigma, taboo, laws, and other associated cultural criticism affect the societies’ attitude and practice toward the identification and treatment of suicidal behaviors [3, 5, 8, 9, 13, 21]. In spite of the high burden of suicidal behaviors, developing countries [11, 13] like Ethiopia give little research attention, and the available individual studies also reported inconsistent results, which need comprehensive up-to-date information. Thus, the aim of this proposed systematic review and meta-analysis is to assess the prevalence of suicidal ideation, suicidal attempt, and completed suicide in Ethiopia.

This protocol is designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P 2015 Guidelines) [22]. This review protocol has been registered in the PROSPERO, International Prospective Register of Systematic Reviews, with the registration number of CRD42018112836.

To the best of the authors’ knowledge, there is no systematic review and meta-analysis has been reported about the suicidal ideation, suicidal attempt, and completed suicide in Ethiopia. This needs a comprehensive epidemiological evidence for further research and decision-making for the prevention and control of suicide. Thus, this systematic review and meta-analysis will explore the available epidemiological evidences about suicidal ideation, suicidal attempt, and completed suicide in Ethiopia. The results of this systematic review and meta-analysis will serve to draw attention and raise awareness among policy maker, health care practitioners, and researchers on the growing epidemiological concern of suicidal ideation, attempted suicide, and completed suicide in Ethiopia. This study will be based on published data; thus, approval of ethical clearance will not be required. The final report of the systematic review and meta-analysis will be disseminated in the form of a scientific paper (published) in a peer-reviewed journal. Moreover, the results will be presented at conferences and submitted to relevant health authorities. We plan to update the review in the future to evaluate the changes in epidemiological evidences.