الفهرس 
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Abstract
Suicide is a huge, complex, multidimensional event but largely preventable public health problem. It is a global cause of death and disability. Suicide attempts result in a significant social and economic burden for communities due to the utilization of health services to treat the injury, the psychological and social impact of the behavior on the individual and his/her associates and, occasionally, the long-term disability due to the injury.
The aim of the present work is to study suicidal ideation and behavior among mentally ill patients in El-Mamura Psychiatric Hospital in Alexandria. The specific objectives were to adapt and test psychometric properties of an Arabic version of Columbia Suicide Severity Rating Scale (C-SSRS) among a sample of mentally ill patients, describe pattern of suicidal ideation and behavior among mentally ill patients at
El-Mamura Psychiatric Hospital and identify some determinants of suicidal ideation and/or behavior.
A cross-sectional study design was conducted in the outpatient clinic of El-Mamoura hospital in Alexandria, Egypt targetingAdult patients attending clinic. The minimum required sample size was determined, Using EPI-INFO, 2016 version 7.2, to be at least 320, based on a prevalence rate of 50% for suicidal ideation and behavior among patients with mental illness,an acceptable margin of error of 5% and confidence level of 95%.
A systematic random sampling technique was used. Every fifth patient attending the above mentioned clinic was recruited for the study if he/she fulfills the eligibility criteria. The clinic was visited by the researcher three times weekly until the predetermined sample size was achieved.
Participants were subjected to the following:
I. A pre-designed structured interview questionnaire to collect the following data:
1. Demographic and socio-economic data including age, sex, marital status, residence, occupation, educational level, family size and income.
2. History of current psychiatric illness: diagnosis, age of onset, duration of illness, treatments received and history of hospitalization.
3. Family history of psychiatric illness and suicidal behavior.
4. Personal habits including smoking and substance abuse.
5. Major life stressors including familial, economic, educational and other stressors.
II. Columbia–Suicide Severity Rating Scale (C-SSRS)
It is a structured interview questionnaire that was originally designed to quantify the severity of suicidal ideation and behavior. It consists of four subscales namely, suicidal ideation severity, suicidal ideation intensity, suicidal behavior and suicidal behavior lethality. Suicidal ideation severity subscale scores range between 0-5 where zero score excludes suicidal ideation, Suicidal ideation intensity subscale Total scores ranged between 5-25 and if the patient did not endorse any suicidal ideation the intensity rating is 0 and Suicidal behavior subscale ranged between 0-5 where zero score denoted no suicidal attempt. Suicidal behavior lethality subscale divided into slight, medium and severe physical damage. An Arabic version of C-SSRS was adapted.
III. Review of patient’s medical record file was conducted to collect data related to diagnosis and medications prescribed.
The study revealed the following results:
• The age of patients ranged from 18 to 85 years of age with a mean of 36.73±10.83. The highest percentages of patients were aged 30 to less than 40 years old (31.87 %).
• Males constituted 55.63% while females were 44.37%.
• Suicidal ideations/attempts were the highest among patients aged 30 to less than 40 years old.
• Suicidal ideations/attempts were present in 17.42% of male patients compared to 16.90% of female patients with no statistically significant risk revealed.
• Suicidal ideations/attempts were the highest among patients with family size<3 (28.57%) and the least among those with family size 3-<5 (15.91%).
• Suicidal ideations were more among urban residents (17.67%) than rural residents (15.91%).
• Those who completed basic education rated the highest on suicidal ideation (28.75%) followed by university graduates (17.65%) while illiterate or just read and write rated 8.86%.
• Suicidal ideations/attempts were more encountered among those who had no job (28.46%), compared to those who had free business or work as manual workers or clerks(15.38%, 12.50% and 5.41% respectively).
• Suicidal ideations/attempts rated the highest among those who reported having insufficient monthly income and borrows (21.43%) and the least among those with sufficient income (12.70%).
• Mentally ill patients with low socioeconomic score were 1.12 times more prone to have suicidal ideation compared to those with middle socioeconomic score.
• Suicidal ideations/attempts rated higher among patients with a dual psychiatric diagnosis (78.95%) compared to those with single diagnosis (13.29%).
• Patients with depressive disorder were four times more likely to have suicidal thoughts compared to those with schizophrenic spectrum disorders. (OR=4.01, CI=1.90-8.45).
• Suicidal ideations/attempts were higher among patients with duration of illness < 1 month (45.45%) compared to those with duration > 1 year (14.75%) with significant increased odds of 4.81 times and CI=1.39-16.73.
• ECT sessions recorded the highest of suicidal ideation (68.42%) followed by Hypnotics or sedatives (53.62%) then antidepressants (18.47%) while mood stabilizers recorded the least rate (7.83%). Patients receiving ECT sessions were 15 times more likely to be at significant risk for suicidal ideations/attempts.
• Suicidal ideations/attempts were more among patients with positive history of hospitalization (33.80%) compared to those with negative history. suicidal ideations were higher among patients who were admitted once (20.00%) compared to those with history of 3 or more admissions (16.22%) with no statistically significant risk revealed (OR=1.29, CI=0.42-3.94).
• Suicidal ideations/attempts and referral for admission. All studied patients classified with suicidal attempts on C-SSRS were referred by an independent psychiatrist for hospital admission compared to 86.05% of those with suicidal ideation without an attempt and 9.43% of those without suicidal ideations. These differences were statistically significant.
• Suicidal thoughts suicidal thoughts were lower among patients with history of substance use (9.68%) compared to those with no history of substance use (24.24%).
• Suicidal thoughts/attempts were nearly equal regarding patients with history of chronic disease (17.14%) compared to those with no history of chronic disease (17.20%). They were the highest among patients who reported financial stressors (60.87%) while the least rate was reported for work or education and marital status change (18.91%, 18.75% respectively).
• One third of the studied patients had a wish to die (33.75%), some of them had suicidal ideations (17.19%).
• Suicidal intent without specific plan ranked the first in order (38.18%) followed by suicidal thoughts with a method without specific plan or intent (36.37%). Suicidal thoughts with intent and specific plan were reported by 20.00% of patients with suicidal thoughts, while only 5.45% reported suicidal thoughts without a method. The mean suicide ideation severity score was 3.52 ±0.94 with a range of 1-5.
• Control of suicidal thoughts with little difficulty was reported by less than half of the patients with suicidal ideations (45.46%) followed by control with some difficulty (18.18%). The deterrents that prevent suicide were reported by 65.45% of the patients with suicidal thoughts, while mostly nothing /nothing at all makes the patients stop rated 10.91%.
• Regarding the reasons for suicidal thoughts, “mostly to get rid of the pain and stop it /absolutely to get rid of the pain and stop it” were reported by 92.72%, while “absolutely to get attention, revenge, reaction/ mostly to get attention, revenge or reaction”were rated by 9.09%. The mean intensity of suicidal thoughts was 16.68 ±4.50 with a range of 5-25.
• Patients with suicidal thoughts and preparatory acts constituted 3.75% of the studied patients. Most patients with actual suicidal attempt reported only one suicidal attempt (75.00%), while twice or thrice suicidal attempts were reported by 16.67% and 8.33% respectively.