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ORIGINAL RESEARCH

Suicidal Behavior and Associated Factors Among

Students in Mettu University, South West Ethiopia,
2019: An Institutional Based Cross-Sectional Study
This article was published in the following Dove Press journal:
Psychology Research and Behavior Management

Zakir Abdu Background: Suicidal behavior is a leading cause of injury and death worldwide. It is
Mohammedamin Hajure a public health issue that is estimated to contribute more than 2.4% to the global burden of
Defaru Desalegn disease by the year 2020. University and college students are among groups affected more
than the general population. However, there is a scarcity of studies on the magnitude and
Department of Psychiatry, Faculty of
Health and Medical Sciences, Mettu associated factors of suicidal behavior among University students in Ethiopia, particularly in
University, Mettu, Ethiopia Mettu University. Therefore, we assessed the prevalence of suicidal behavior and associated
factors among Mettu University students.
Methods: Institution-based multistage stratified cross-sectional study design was conducted
Video abstract among 523 regular main campus students of Mettu University. The Suicidal Behaviors
Questionnaire Revised (SBQ-R) was used to screen the presence of suicidal behavior
symptoms. Data analysis was done using SPSS version 20.
Results: Lifetime prevalence of suicidal ideation, plan, and attempt was 58.3%, 37.3%, and
4.4%, respectively, with one-year prevalence of suicidal ideation at 34%. The multivariate
logistic regression analysis revealed that the odds of suicidal ideation were higher among
female gender, students who had poor social support, family history of suicide attempt,
lifetime alcohol use, rural residence, and less frequently engaging in religious practice; these
factors were significantly associated with suicidality.
Conclusion: Nearly one-fourth of respondents report suicidal behavior. Prevalence of
suicide was found to be higher. Prevention and coping actions regarding identified factors
Point your SmartPhone at the code above. If you have a QR to reduce burden of suicide are needed.
code reader the video abstract will appear. Or use:
https://youtu.be/VnFTiTuzCpI Keywords: suicidal behavior, prevalence, Mettu University, students

Introduction
Suicide is a growing public health problem all over the world.1 Everyone just as
dead from suicide as you are from cancer.2 According to the World Health
Organization (WHO) about one million people worldwide die of suicide
every year (mean mortality rate: 16 per 100,000), that is, one death every 40
seconds. This figure is estimated to increase to 1.53 million deaths by suicide in
the year 2020, with one death every 20 seconds and one suicide attempt occurring
Correspondence: Zakir Abdu; every one to two seconds.3,4
Mohammedamin Hajure Adolescence and young adulthood carry a risk for suicidal behaviors.5,6 About
Department of Psychiatry, Faculty of
Health and Medical Sciences, Mettu 1 million people worldwide commit suicide each year and college and university
University, P.O. Box: 318, Mettu, Ethiopia students with suicidal ideation are at high risk of suicide.7 Suicide is the leading
Email zakirabdu45@gmail.com;
sikoado340@gmail.com cause of death among college and university students and it accounts for 19% of all

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http://doi.org/10.2147/PRBM.S240827
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Abdu et al Dovepress

deaths for this population.8 Studies have confirmed that Botswana (23.1%), Uganda (19.6%), and Tanzania
suicide ranks as the first or second leading cause of death (11.2%).19 A study done in Ghana showed the prevalence
among college and university students.9–11 of suicidal behavior in a university was 18.2% for suicidal
In general, the prevalence of suicidal behaviors among ideation, 22.5% for suicidal plans and 22.2% for suicidal
college students ranged from 1.3% to 32.7%.12,13 About attempts.20 A study conducted in Uganda showed that
1100 college students die by suicide each year.13 21.6% of participants had considered suicidal behavior in
Furthermore, about 6.4% to 9.5% of college/university the past 12 months.21 One study conducted in Tanzania
students seriously consider suicide, and 1.3% to 1.5% revealed that 7% (n=149) of students attending high
made a suicide attempt at the end of the school year.13 In school had thought about suicide with 6.3% (n=136) hav-
university students, suicidal ideation may present at ing created a plan to carry out an attempt.22
a particularly important moment, due to leaving adoles- One study carried out by WHO showed that risk fac-
cence and entering the young adult age and the adversities tors for suicidal behaviors in both developed and develop-
experienced in academic life.10 ing countries include female sex, younger age, unmarried
Methods of suicide are drug overdose, poisoning, status, and having a mental illness.23
hanging, jumping into wells and others.3 The top three The suicidal behavior of university students cannot be
methods used in suicides of young people include firearm regarded as an issue only for students and their families; it
(46%), suffocation (37%), and poisoning (8%). Most ado- impacts all society and the majority of the population in the
lescents used hanging as a method of attempting suicide in university was founded in the productive age. However,
both sexes with a higher preference in males, but poison- little has been explored about suicidal behavior and asso-
ing was preferred by females.11,14 ciated factors among students at the national level, especially
One study conducted in Europe reported the prevalence at Mettu University. Therefore, this study aimed to assess the
of suicidal thoughts and behavior in college students in eight prevalence of suicidal behavior and its associated factors
different countries and revealed that 32.7% of the among students of Mettu University, Southwest Ethiopia.
participants had lifetime prevalence of suicidal ideation,
17.5% suicide plans, and 4.3% had attempted suicide.
Materials and Methods
Furthermore, the 12-month prevalence of suicidal ideation
was 17.2%, suicide plans 8.8%, and suicide attempts 1.0%.15
Study Setting
This is an institutional based cross-sectional study con-
A study done at Cambridge University revealed that the
ducted in Mettu University from April to June 2019. Mettu
lifetime prevalence of suicidal ideation, plans, and attempts
University is one of the higher institutions in Ethiopia,
was 22.3%, 6.1%, and 3.2%, respectively. For 12-month
and is a third generation university. It is found in Mettu
prevalence, this was 10.6%, 3.0%, and 1.2%, respectively.6
town which is the capital town of Ilu Aba Bor adminis-
A study done in Swaziland among school-going ado-
trative zone of Oromia Regional State and it is located
lescents showed that 18.3% of 1866 females and 15.6% of
600 km southwest of the capital city, Addis Ababa. Mettu
1672 males students had suicidal behavior.16 One result
University established in 2011. Mettu University currently
from the University of Maryland revealed that 11.4% of
has two2 campuses. The main campus is a study area
college students seriously considered attempting suicide in
containing 7 faculties: the faculty of health science,
the past year and 7.9% made suicide ideation.9 Two results
the faculty of natural and computational science,
from Brazil indicated that the prevalence of suicidal idea-
the faculty of social science and humanity, and the school
tion is 9.9% and 12.5%.10,17
of law. The campus has a total of 43 departments and 8290
Two studies in China reported suicide among univer-
regular undergraduate students.
sity students’ accounts 10.72%7 and 19%.8 A study con-
ducted in Iran confirmed 4.1% of 1517 students had
thoughts of suicide.15 In India, the lifetime prevalence of Study Population
suicidal ideation among university students is 11.7%, and All regular undergraduate students of Mettu University
in Pakistan, the overall rate of suicidal ideation is 31.4%.18 were included in the sample during the data collection
One study in Sub-Saharan countries showed that period. In our study, the inclusion criteria were all regular
Zambia had the highest prevalence of suicidal ideation undergraduate students at the main campus of Mettu
(31.9%) among all students, followed by Kenya (27.9%), University and the exclusion criterion was regular students

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Dovepress Abdu et al

who are critically ill and unable to read and write because for suicidal plan, item 1 questions #3a and #3b were used;
of illness during data collection. and for suicidal attempt, item 1 questions #4a and #4b
were used.
Sample Size The second question evaluated how frequently, over
The minimum number of sample size required for this the preceding 12 months, the respondent had been having
study was determined by using the formula to estimate ideations of suicide (i.e. how often have you thought about
single population proportion, n=((z ᾳ/2)2p(1-p))/d2 by killing yourself in the past year?). The third question
using the following assumptions: prevalence of suicidal enquired about threats to engage in suicidal behavior (i.e.
ideation among students of the University of Gondar in have you ever told someone that you were going to com-
Ethiopia was 19.9%,13 a 95% confidence interval (CI), 5% mit suicide, or that you might do it?). The last question
margin of error, and a non-response rate of 10%. We explored the participants’ self-reported likelihood of enga-
applied the single population proportion formula to give ging in a suicidal behavior in the future (how likely is it
n = (1.96)2 × 0.199(1–0.199)/(0.05)2 = 245. that you will attempt suicide someday?). A recent valida-
The total number of regular students in the main cam- tion study among Nigerian university students showed
pus is 8290, which is less than 10,000. Hence, using finite Cronbach’s alpha of 0.80, indicating the SBQ-R as
population correction formula, the final sample size was a reliable screening tool in non-clinical samples in West
calculated as: nf = ni/(1 + ni/N), where nf= final sample Africa.25 A broad range of information is obtained with
size; ni = initial sample size calculated above (245); a very brief administration and it has a sensitivity of 93%,
N=total number of regular students; hence, nf = 245/(1 + a specificity of 95% with a score of 3–18 and cutoff point
245/8290) = 238. ≥7 for the adult general population.26
Since multistage stratified sampling technique was BDI-II was used to screen for the presence and absence
used to select students, using design effect the sample of depression.6 BDI has a high degree of sensitivity (0.98)
size was multiplied by 2, giving 476, considering that the and specificity (0.95) for detecting depression.27 It is valid
questionnaire was self-administered, and finally adding and reliable to assess the presence and absence of
a 10% non-response rate, the final number of the study depression.24 The internal consistency (Cronbach’s α)
subject became 523. was higher in many countries ranging from 0.75 to 0.92.
Every item: 0–3 scores, global score: 0–63.24
Sampling Technique The OSLO−3 social support scale was used, but assess-
The multi-stage stratified sampling technique was used to ment based on the mean score of individual students.
select the study participants. Stratification was first done A sum index was made by summarizing the raw scores,
on the faculty/college level, then by the department and the sum ranging from 3 to 14. A mean score of below 6.7
finally by the year of study. is poor support, and a mean score of 6.7 and above was
good social support. It was reliable in the study
Data Collection Procedure and Tools (Cronbach’s α = 0.91) done at Woloyta University.25
A self-administered structured questionnaire was used to Then, this questionnaire was translated to Amharic and
collect information. Questionnaires about demographics, Afan Oromo language then retranslated back to English
family, and campus-related and chronic illness factors so as to see and keep the consistency. The English version
were developed after an extensive review of the literature of the questionnaire was used for actual data collection.
and similar study tools. Suicide Behavior Questionnaire
Revised (SBQ-R) was made up of the four-item developed Data Processing and Analysis
by.24 The phrasing of each item was such that it asked Collected data were checked, coded, and entered into Epi
about different aspects of suicidal behaviors (i.e. ideation/ Data Version 3.1. Then, the data were exported to the
thoughts, plan/planning, threats, and attempts). The first Statistical Package for Social Science Version 23.0 for
item explored whether the respondent had ever had further analysis. For the analysis of obtaining data simple
thoughts of suicide or engaged in suicidal behaviorin his/ descriptive statistics were used. Bivariate analysis was
her lifetime (i.e. have you ever thought about or attempted used to determine the significance of the association.
to kill yourself?). In the current study, specifically for Variables that showed strong association in bivariate ana-
lifetime suicidal ideation, item 1 question #2 was used; lysis were entered into multivariate logistic regressions to

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control for confounders and the significance of the associa- Substance use: Use of any substances mentioned such
tion was determined by 95% confidence interval. as alcohol, cigarette, and khat.
Lifetime substance use: Use of alcohol, cigarette,
khat, etc., once or more in the participant's lifetime.
Data Quality Control
Practicing religion: Participants who pray by their
To identify potential problems and to make important
religion, explained as follows:
modifications, the questionnaire was pre-tested on 5% of
Regular practicing religion: participants who pray daily.
the total study participants randomly selected in the same
Sometimes practicing religion: participants who do not
population outside the study area in the College of
pray daily.
Agriculture of Mettu University on Bedelle campus one
Truancy: Students were considered truant if they missed
week before the actual data collection date. The prepared
more than 3 days of school within the reference period.22
questionnaire was checked thoroughly for its complete-
University students: Students who are enrolled or
ness, objective and variables before it was distributed to
attending their education in Mettu University in 2018.
respondents. Also, the collected data were checked for
Critically ill: Participants complaining of pain due to
completeness and to take immediate action in detecting
any type of illness or objectively known as being ill and
cases. The supervisor was eight first degree holders unable to read and write because of illness during data
instructor. A pre-test was done after training was given collection. Critical illness was decided by trained super-
to the supervisors on how to supervise data collection and visors as they identify participants with illness before
make a diagnosis of detected cases. At the end of each data distributing the questionnaires.
collection day, the principal investigator also checked the
completeness of filling questionnaires. Any error, ambigu- Ethical Clearance
ity, incompleteness, or other encountered problem were The study was carried out after ethical clearance was
addressed immediately after the supervisor received the obtained from the ethical review board of the faculty of
completed questionnaire from each student. health and medical sciences of Mettu University. An official
letter was obtained from Mettu University president’s office,
Assessment and an approbation letter was obtained from the head of
Suicidal behaviors: = individuals who scored SBQ-R 7 the department of psychiatry. Selected students were told
and above were labeled as high risk, and below 7 as low about the nature, purposes, benefits, and adverse effects of
risk.26 the study and were invited to participate. Confidentiality was
Depression: Depression was scored according to BDI- ensured and all related questions they raised were answered.
IIthe instrument. BDI-II has 21 items and every item has
0–3 scores with a global score of 0–63. Participants who
scored 14 and more were considered to be depressed while
Results
participants who scored 13 or lower were not depressed.24 Socio-Demographic Characteristics of
Level of social support: The OSLO−3 social support the Study Participants
scale was used.25 For this study social support is measured A total of 523 participants were recruited for the study,
based on the mean score of students. which makes the response rate 100%. The mean (±SD) age
of the respondents was 21 (±2.2) years. Among the
● Poor support – students with a mean score of below respondents, 374 (71.5%) were in the age range of 18–22
6.7. years, 270 (51.6%) were male, 306 (58.5%) were from
● Good support and – students with a mean score of 6.7 rural backgrounds, 214 (40.9%) and 152 (29.1%) were
and above. protestant and orthodox religion followers, respectively
(Table 1).
Chronic illness: Illnesses that can be managed, but cannot More than half of the participants reported having
be cured, and have a greater risk of developing suicidal drunk alcohol in their lifetime and less than one-fourth
behavior, for example, heart diseases, diabetic mellitus, reported current usage. Khat and tobacco use was rela-
HIV/AIDS, and past mental illness. The response to tively modest; 18.3% had chewed khat and 14.9% had
chronic illness is from the self-report of the participants. smoked cigarettes (Table 2).

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Table 1 Socio-Demographic Characteristics of Mettu University Table 2 Frequency Distribution of Substance Related and
Students, Mettu, South West Ethiopia, 2019 (n=523) Psychosocial Factors Among Students of Mettu University,
Mettu, South West Ethiopia, 2019 (n=523)
Variable Category Frequency Percentage
Variable Category Frequency Percentage
Sex Male 270 51.6
Female 253 48.4 Year of Study First 130 24.9
Second 133 25.4
Age (in years) 21 (± 2.2)
Third 107 20.5
(mean ±SD)
Fourth 77 14.7
Residence Urban 217 41.5 Fifth 76 14.5
Rural 306 58.5
Religious Practice Yes 342 65.4
Ethnicity Oromo 321 61.4 No 181 34.6
Amhara 117 22.4
Missing Class in the Past None 329 62.9
Tigre 41 7.8
30 Days 1–2 days 149 28.5
Gurage 25 4.8
3 or more 45 8.6
Others* 19 3.6
days
Religion Protestants 214 40.9
Frequency of Religious Always 432 82.6
Orthodox 152 29.1
Practice Sometimes 91 17.4
Muslim 137 26.2
Others** 20 3.8 Social Support Poor 277 53.0
Good 246 47.0
Family Marital Living 395 75.5
Status together Alcohol
Separated 64 12.2 Lifetime use Yes 299 57.2
Divorced 24 4.6 Current use Yes 127 42.5
Widowed 40 7.6
Cigarette
Notes: *Silte, Agnuak, Kafa, Walayita, Dawuro; **Catholic, Wakeffata. Lifetime Yes 78 14.9
Current use Yes 53 67.9

Prevalence of Suicidal Behavior Khat

The overall estimate of suicidal behavior among univer- Lifetime use Yes 98 18.3
Current use Yes 67 68.4
sity students was 28.9, 95% CI (25.0–32.5) using SBQ-
R. The lifetime prevalence of suicidal ideation, plan,
and attempt was 58.3%, 37.3%, and 4.4%, respectively. Factors Associated with Suicidal Ideation
The prevalence of suicidal ideation over the last 12 Among University Students
months was 34%. No significant gender differences As shown in Table 5, in binary logistic regression, suicidal
were found in SBQ-R total score. Lifetime prevalence behavior was positively associated with depression (crude odd
of suicidal ideation was 27.2% for males and 31.2% for ratio (COR) = 1.53; 95% CI (1.05, 2.24)), poor social support
females, suicide plan was 21.8% for males and 15.5% (COR = 1.64; 95% CI (1.11, 2.41)), family history of suicide
for females, and suicide attempt was 2.7% for males and attempt (COR = 3.59; 95% CI (2.34, 5.52)), lifetime alcohol
1.7% for females. use (COR = 1.56; 95% CI (1.07, 2.28)), rural residence (COR =
Prevalence of suicidal ideation was high among male 2.39; 95% CI (1.57, 3.65)), being in the first year of study
(162 (31.0%)) when compared to female 143 (27.3%) (COR = 1.68; 95% CI (1.01, 2.78)), and less frequently enga-
students. But suicide attempts were high among female ging in religious practice (COR = 1.93; 95% CI (1.11, 3.35)).
(13 (2.5%)) when compared to male (10 (1.9%)) students. However, multivariate logistic regression analysis
Prevalence of suicidal plan was somewhat the same revealed that the odds of suicidal behavior were higher
between both genders (Table 3). among female gender (AOR = 1.54; 95% CI (1.01, 2.36)),
Prevalence of suicidal ideation, plan, and attempt was poor social support (AOR = 1.66; 95% CI (1.09, 2.53)),
high among those students who had poor social support family history of suicide attempt (AOR = 4.29; 95% CI
when compared to students who had good social support (2.69, 6.84)), lifetime alcohol use (AOR = 1.65; 95% CI
(Table 4). (1.09, 2.52)), rural residence (AOR = 2.66; 95% CI (1.68,

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Table 3 Lifetime Prevalence Estimates of Suicidal Behavior (i.e. Ideation, Plan and Attempts), Suicidal Behavior Risk and Chi-Square
Test for Sociodemographic Variables Among Students of Mettu University, Mettu, South West Ethiopia, 2019 (n=523)
Variable Ideation Plan Attempts Suicidal Behavior Risk χ2 P-value

N (%) 305 (58.3%) N (%) 195 (37.3%) N (%) 23 (4.4%) High Low

N (%) 151(28.9%) N (%) 372 (71.1%)

Gender
Male 162 (31.0%) 98 (18.7%) 10 (1.9%) 92 (17.6%) 178 (34.0%) 0.119 0.007
Female 143 (27.3%) 97 (18.5%) 13 (2.5%) 59 (11.3%) 194 (37.1%)

Residence
Rural 184 (35.2%) 121 (23.2%) 14 (2.7%) 113 (21.6%) 206 (39.4%) 0.181 0.000
Urban 121 (23.1%) 74 (14.1%) 9 (1.7%) 38 (7.3%) 166 (31.7%)

Ethnicity
Oromo 202 (38.6%) 106 (20.3%) 13 (2.5%) 86 (16.4%) 235 (%) 0.078 0.532
Amhara 61 (11.7%) 50 (9.6%) 6 (1.2%) 39 (7.5%) 78 (14.9%)
Tigre 20 (3.8%) 17 (3.3%) 4 13 (2.5%) 28 (5.4%)
Gurage 12 (2.3%) 13 (2.5%) 0 9 (1.7%) 16 (3.1%)
Others* 10 (1.9%) 9 (1.7%) 0 4 (2.9%) 15 (2.9%)

Religion
Protestant 125 (23.9%) 83 (15.9%) 6 (1.2%) 65 (12.4%) 149 (28.5%) 0.076 0.386
Orthodox 86 (16.4%) 62 (11.8%) 4 37 (7.1%) 115 (22.0%)
Muslim 84 (16.1%) 40 (7.6%) 13 (2.4%) 41 (7.8%) 96 (18.4%)
Others** 10 (1.9%) 10 (1.9%) 0 8 (1.5%) 12 (2.3%)

Year of Study
First 24 (4.6%) 25 (4.8%) 13 (2.5%) 61 (11.7%) 161 (30.8%) 0.221 0.000
Second 19 (3.6%) 17 (3.3%) 2 50 (9.6%) 55 (10.5%)
Third 34 (6.5%) 14 (2.7%) 11 (2.1%) 32 (6.1%) 122 (23.3%)
Fourth 0 4 4 2 5 (1.0%)
Fifth 4 0 0 6 (1.1%) 29 (5.5%)

Family Marital Status

Living together 225 (43.0%) 152 (29.1%) 18 (3.4%) 117 (22.4%) 278 (53.2%) 0.127 0.0047
Separated 33 (6.3%) 27 (5.1%) 4 19 (3.6%) 45 (8.6%)
Divorced 10 (1.9%) 13 (2.5%) 1 6 (1.1%) 18 (3.4%)
Widowed 37 (7.1%) 3 0 9 (1.7%) 31 (5.9%)

Faculty/College
Health 146(27.9%) 44(8.4%) 12(2.2%) 85(16.3%) 117(22.4%) 0.279 0.000
Law 34(6.5%) 31(5.9%) 0 25(4.8%) 40(7.6%)
Applied 58(11.1%) 48(9.1%) 7(1.3%) 17(3.3%) 96(18.4%)
Technology 67(12.8%) 72(13.8%) 4 24(4.6%) 119(22.8%)

Notes: *Silte, Agnuak, Kafa, Walayita, Dawuro; **Catholic, Wakeffata.

4.22)) and less frequently engaging in religious practice respectively, with the prevalence of suicidal ideation over
(AOR = 2.49; 95% CI (1.35, 4.62)); these factors were sig- the last 12 months showing 34%.
nificantly associated with suicidal behavior. We found no The chi-square test showed that subjects belonging to
evidence of associations between suicidal ideation and suicidal ideation were more likely to be males (P=0.007),
family relationship status, or personal and family history of with poor social support (P=0.012), and with alcohol use
physical or mental illness (Table 6). (P=0.027), which was consistent with a study done in Italy.28
The findings of this study showed that prevalence of
Discussion suicidal ideation, plan, and attempt were 58.3%, 37.3%,
This study revealed the lifetime prevalence of suicidal and 4.4%, respectively, with prevalence of suicidal idea-
ideation, plan, and attempt was 58.3%, 37.3%, and 4.4%, tion over the last 12 months showing 34%. This study

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Table 4 Lifetime Prevalence Estimates of Suicidal Behavior (i.e. Ideation, Plan and Attempts), Suicidal Behavior Risk and Chi-Square
Test with Respect to Psychosocial Factor and Substance Use Among Students of Mettu University, Mettu, South West Ethiopia, 2019
(n=523)
Variable Ideation Plan Attempts Suicidal Behavior Risk χ2 P-value

N (%) 305(58.3%) N (%) 195 (37.3%) N (%) 23 (4.4%) High N (%) Low N (%)

151(28.9%) 372 (71.1%)

Social Support
Poor 158 (30.2%) 105 (20.1%) 14(2.6%) 58 (11.1%) 188 (35.9%) 0.110 0.012
Good 147 (28.1%) 90 (17.2%) 9 (1.8%) 93 (17.8%) 184 (35.2%)

Frequency of Religious Practice

Sometimes 202 (38.6%) 122 (23.4%) 18(3.4%) 133(25.4%) 295 (56.4%) 0.103 0.018
Always 103 (19.7%) 73 (14.0%) 5 (1.0%) 18 (3.4%) 77 (14.7%)

Lifetime Alcohol Use

No 140 (26.8%) 79 (15.1%) 5 (1.0%) 76 (14.5%) 148 (28.3%) 0.097 0.027
Yes 165 (31.5%) 116 (12.2%) 18 (3.4%) 75 (14.3%) 224 (42.8%)

Cigarette Smoking
No 255 (48.8%) 174 (33.2%) 16 (3.1%) 127 (24.3%) 318 (60.8%) 0.151 0.018
Yes 50 (9.6%) 21 (4.0%) 7 (1.4%) 24 (4.6%) 54 (10.3%)

Khat Chewing
No 249 (47.6%) 156 (29.8%) 20 (3.8%) 115 (22.0%) 310 (59.3%) 0.065 0.698
Yes 56 (10.7%) 39 (7.4%) 3 36 (6.9%) 62 (11.9%)

Family History of Suicide Attempt

Yes 64 (12.2%) 50 (9.5%) 6 (1.1%) 33 (11.7%) 53 (11.3%) 0.264 0.000
No 241 (46.1%) 145 (27.7%) 17 (3.2%) 118 (17.2%) 319 (59.8%)

Depression
Yes 165 (31.5%) 84 (15.1%) 12 (2.3%) 50 (12.4%) 129 (37.7%) 0.090 0.040
No 140 (26.8%) 111 (21.3%) 11 (2.1%) 100 (16.4%) 118 (33.5%)

finding was in line with studies done in Europe and suicidal attempt observed in the current sample could partly
Cambridge University, which found the prevalence of be explained by the sample size and study design used.
suicidal attempts to be 4.3% and 3.2%,6,14 respectively. Factors positively associated with suicide were female
The probable reason for the similarity of findings might be gender, poor social support, not frequently engaging in
the same tool and design were used both in the current and religious practice, family history of suicide attempt, rural
previous studies. In addition, other reasons might be residence, and lifetime alcohol use.
that the studies were conducted in similar populations. Sex may significantly affect the prevalence of suicidal
However, a study conducted among 1654 rural Chinese behavior. In the current study, the odds of having suicide
individuals aged 16–34 years revealed lifetime and one-year behavior in female respondents were higher compared to
suicidal ideation of 45.1% and 19.3%,29 which was lower in male respondents, which is in agreement with the results
than the current study (58.3% and 34%). Additionally, our of other published studies in different settings.7,8,11,12 The
sample shows higher lifetime and past 12-month prevalence discrepancy might be explained on the basis of gender role
of suicidal ideation and planning, compared to studies con- socialization theory, which states that females are expected to
ducted at Cambridge University,6 University of Maryland,9 be dependent and indecisive, and express their stress via rumi-
and Belgium.5 The discrepancy might be related to tools of nation, so females have a higher rate of suicide attempts than
study and sociocultural background of the population. males.32
In other words, the prevalence of suicide attempts in our A study conducted in one college in China indicated that
study was higher compared to studies in Brazil 12.5%,17 practicing religion is a protective factor for suicidal
China 19%,8 Morocco 6.5%,30 and Australian (4.2%)4 and behavior.33 In alignment with this study, our study revealed
American populations (4.1%).31 The particularly high less frequently engaging in religious practice increases odds

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Table 5 Bivariable Logistic Regression Examining the Associations Table 6 Multivariable Logistic Regression Examining the
Between Demographic, Clinical, Substance, Psychosocial Factors; Associations Between Demographic, Clinical, Substance,
and Suicidal Behavior Among Students of Mettu University, Mettu Psychosocial Factors; and Suicidal Behavior Among Students of
Town, South West Ethiopia, 2019 (n=523) Mettu University, Mettu Town, South West Ethiopia, 2019
(n=523)
Study Variables Suicide COR(95% CI) P-
value Study Suicide AOR(95% CI) P-value
Yes N (%) No N (%)
Variables
Yes N (%) No N (%)
Sex
Male 59 (23.3%) 194 (76.7%) Ref 0.007 Sex
Female 92 (34.1%) 178 (65.9%) 1.69(1.16, 2.49) Male 59 (23.3%) 194 (76.7%) Ref 0.049
Female 92 (34.1%) 178 (65.9%) 1.54 (1.01, 2.36)
Lifetime Alcohol
Use Social Support
Yes 76 (33.9%) 148 (66.1%) 1.56 (1.07, 2.28) 0.022 Good 58 (23.6%) 188 (76.4%) Ref 0.019
No 75 (25.1%) 224 (74.9%) Ref Poor 93 (66.4%) 184 (66.4%) 1.66 (1.09, 2.53)

Social Support 0.012 Lifetime Alcohol

Good 58 (23.6%) 188 (76.4%) 1.64 (1.11, 2.41) Use
Poor 93 (66.4%) 184 (66.4%) Ref Yes 76 (33.9%) 148 (66.1%) 1.65 (1.09, 2.52) 0.018
No 75 (25.1%) 224 (74.9%) Ref
Year of Study
1st year 65 (29.1%) 158 (70.9%) 1.68 (1.01, 2.78) 0.044 Religion Practice
2nd year 38 (40.9%) 55 (59.1%) 0.67 (0.41, 1.09) 0.107 Always 18 (18.9%) 77 (81.1%) Ref 0.004
3rd year 32 (21.6%) 116 (78.4%) 1.74 (0.73, 4.11) 0.209 Sometimes 133 (31.1%) 295 (68.9%) 2.49 (1.35, 4.62)
4th year 10 (41.7%) 14 (58.3%) 0.51 (0.19, 1.27) 0.145
Family History
5th year 6 (17.1%) 29 (82.9%) Ref
of Suicide
Depression Attempt
Yes 82 (33.7%) 211 (75.4%) 1.53 (1.05, 2.24) 0.028 Yes 61 (50.8%) 59 (49.2%) 4.29 (2.69, 6.84) < 0.001
No 69 (24.6%) 161 (66.3%) Ref No 90 (22.3%) 313 (77.7%) Ref

Religion Practice Residence

Always 18 (18.9%) 77 (81.1%) Ref 0.020 Rural 113 (35.4%) 206 (64.6%) 2.66 (1.68, 4.22) < 0.001
Sometimes 133 (31.1%) 295 (68.9%) 1.93 (1.11, 3.35) Urban 38 (18.6%) 166 (81.4%) Ref

Family History of
Suicide Attempt
Yes 61 (50.8%) 59 (49.2%) 3.59 (2.34, 5.52) < 0.00 university students who were members of a fraternity were
No 90 (22.3%) 313 (77.7%) Ref less likely to report suicide ideation.34
Residence Our results indicate that lifetime alcohol use was asso-
Rural 113 (35.4%) 206 (64.6%) 2.39 (1.57, 3.65) < 0.001 ciated with higher odds of suicidal behavior. Our findings
Urban 38 (18.6%) 166 (81.4%) Ref are in line with studies showing a positive relationship
between alcohol use and suicidal behavior.11,15,16,22
Alcohol use needs a special mention because it increases
of suicide by 2.49 times. This might be explained by the suicidality by itself, especially when related to adjustment
notion that a variety of stressful events are experienced at disorders which are a common condition among university
higher institution, and different means of resilience can help students and depression.35
to cope with stress. Students with a family history of suicidal attempts were
Poor social support was one of the predictors of suici- 4.29 more likely to have suicidal behavior compared to those
dal behavior in this study. Individuals who had poor social without. This was supported by studies conducted in different
support were 1.66 times more likely to have suicidal settings.3,10,11,30 Having a close relationship with someone
behavior than individuals who had strong social support. who has a history of suicide attempts can lead to the
This was similar to results from a recent study in behavior of the reproduction of the act, becoming conditioned
Maryland, Johns Hopkins University, countries of Sub- as a way of resolving conflicts, so increasing cases of suicide.28
Saharan Africa, China, Tanzania, and Ethiopia.7,9,12,19,22 Consistent with a study done in Italy36 our results do
This might be because of the notion that belongingness not confirm previous evidence reporting significant asso-
could protect against suicide is supported by evidence that ciations between depression and having suicidal behavior.

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Limitations effects of the study and invited to participate.

This study did not account for the presence of psychiatric Confidentiality was ensured and all related questions they
or psychological disorders other than depression, such as raised were answered. All participants were recruited
anxiety, which has been associated with suicide. Due to its directly in their respective classrooms after the end of
cross-sectional nature, the study could not explore the a class. They were asked to make 20 min available for
cause and effect relationship of variables. The other lim- completion of the questionnaires. Participation was com-
itation of the study is information bias, since the informa- pletely voluntary, with no economic or other motivation,
tion was collected on self-administered questionnaires. and each participant signed written informed consent for
Participants of the study were recruited from only one their participation. Participants’ right to refuse or discon-
university, which is Mettu University's main Campus. tinue participation at any time they want was strictly
Another limitation of the study was that students answer respected. The time of investigation avoided the beginning
the questionnaire in English, and self-report evaluation and end of the semester, when students are undergoing
could increase the prevalence of suicidal behaviors. The stress related to moving or preparing for final exams and
other limitation of this study is the lack of investigation of projects. A student who scores more than SBQ-R more
variables like other substances (such as cocaine, heroin, than 7, on the BDI-II more than 20 and had suicidal
amphetamine), temperament, familial status, or different wishes, thoughts or plans was linked to the student clinic.
types of university.
Data Sharing Statement
Conclusions The datasets used and analyzed during the current study are
Nearly half of Mettu University students reported depres- available from the corresponding author on reasonable request.
sive symptoms, and one in four reported suicidal behavior
(suicidal ideation, plan, and attempt). In the current study Acknowledgments
prevalence of suicide among university students was found We would like to thank Mettu University for providing
to be higher than studies conducted in a different setting. ethical approval to conduct this research. Our deepest
Being female, poor social support, lifetime alcohol use, thanks go to all study participants, data collectors, and
family history of suicide attempt, rural residence, and less supervisors who spent their valuable time for the good
frequently engaging in religious practice were identified as outcome of the research work.
independent factors predicting suicide ideation and attempt.
Author Contributions
Abbreviations ZA wrote the protocol, design the study, organized the data
CI, confidence Interval; DSM-5, Diagnostic and Statistical collection process, analyzed the data, and reviewed and
Manual of mental disorders Fifth Edition; ETB, Ethiopian edited the manuscript. DD revised and approved the protocol,
Birr; HIV/AIDS, human immune deficiency virus/acquired participated in data analysis, reviewed and edited the manu-
immune deficiency syndrome; OR, odds ratio; SBQ-R, script. MAH contributed to an analysis of the data, drafted
Suicidal Behavior Questionnaire Revised; SPSS, Statistical the manuscript, critically reviewed and approved the manu-
Package for Social Science; UK, United Kingdom; US, script for publication. All authors contributed to data analy-
United States; WHO, World Health Organization. sis, drafting or revising the article, gave final approval of the
version to be published, and agree to be accountable for all
aspects of the work.
Ethics Statement
The study was carried out in accordance with the princi-
ples of the Declaration of Helsinki. Ethical clearance is
Disclosure
The authors declare that they have no competing interests.
obtained from the ethical review board of faculty of health
and medical sciences of Mettu University. An official
letter was obtained from Mettu University president’s References
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