Suicidal behaviour is considered a worldwide problem and an increasing source of concern. This study shows a significant tendency toward an increased rate of severe suicidal behaviour (prevalence of 82%) among youths with psychiatric disorders which has been documented in previous studies [10
The family dysfunctions in this study include the following: youths from a single-parent family (never married, separated widows/widowers), youths who have parents with psychiatric disorders (alcohol use, mood disorders), a family history of severe suicidal behaviours and violent and abusive family structures (parenting behaviour with no emotional attachment), maladaptive maternal rejecting parenting behaviour, parents' inadequate authority (under-protective parenting behaviour) and parents’ lack of time to observe and deal with the child’s emotional distress. These findings are comparable to previous studies that have shown that mental health problems compromise a mother’s or a father’s parenting abilities, and this poses a threat to their youths’ adjustment and behaviour [17
]. Thus, a parent with a psychiatric disorder has also a maladaptive parenting behaviour. The perceived maternal-parental rejection or paternal under-protection obstructs interaction between parents and their children. The parenting behaviour in such a family setting is perceived by children to be a poor emotional expression: ‘I have no interest in you’. This, therefore, disconnects children from their parents, creating a barrier for children to explore and form connecting bonds with their parent(s). This un-connectedness between the child and a parent leads to confusion, conflict and frustration in the growing child, a precursor for a youth/child to develop psychopathology and suicidal behaviour.
These findings are comparable to evidence from previous studies which have documented that parents of depressed youths also have depression [33
]. These relationships seen in other studies are similar in this outpatient setting in Kenya. These findings are also consistent with other studies which assessed the co-morbidity of psychiatric disorders and showed a significantly increased risk for youth suicidal behaviour [5
]. It is also comparable to a study by Beautrais et al., which examined precipitating factors and life events in serious suicide attempts among youths aged 13 through 24 years [37
]. Also, these relationships between maternal rejecting behaviour and depression and offspring suicidality may suggest the need for therapeutic approaches that treat the family unit, not just individuals separately, and the relationship between paternal death and child suicidal behaviour may suggest that those whose parents die should receive targeted suicide prevention programming.
Another important finding of this study is the relationships between psychopathology (MDD and alcohol/substance use disorder) and suicidal behaviour among youths that did not show any significant difference according to gender. This striking finding emerging from this study is the extent to which suicidal behaviour co-exists with psychiatric disorders among youths. Majority of the youths had severe psychiatric disorders (depression, alcohol use problems, multiple substance use disorders and anxiety disorders). Unlike in earlier studies, women were more likely to engage in suicidal behaviours than men, probably because they had a higher prevalence of depression, which was a strong predictor of suicide attempts. In this study, alcohol dependence in youths may be the equivalent of depression or anxiety. These are externalizing syndromes which may have been un-documented in previous studies and therefore may explain why there is no difference in gender in this study. This was documented by Buglass and Horton in 1974 and Appleby in 1992 [38
It can be postulated, therefore, that youths resort to suicidal behaviour so that they can externalize their problems, which is a reflection of increased risk associated with the co-morbidity of internalizing axis disorders, such as depression and anxiety disorders.
The results also indicate that the presence of multiple disorders is associated with an increased risk for suicidal behaviour (two to three co-morbid disorders and four or more co-morbid disorders compared to only one disorder). This indicates that the increasing presence of co-morbid psychiatric disorders increases the number of psychiatric symptoms and therefore difficulty to bear, hence the increased odds of suicidal behaviour. This is consistent with previous study findings [32
] which have documented that suicidal behaviour co-exists among patients with multiple psychiatric disorders. This finding is also similar to several surveys which have indicated that up to three-quarter of those who eventually take their own lives show one or more symptoms of depression co-existing with other psychiatric disorders or substance abuse disorders [15
]. These results are comparable to other findings which have revealed that youths who use alcohol and illicit drugs (multiple substance use) have co-morbid depressive disorder and are identified among adolescents who commit suicide [15
]. Nonetheless, these results suggest that gender differences in the link between psychopathology and suicide should be explored further in other samples in which rates of suicide attempts are higher, especially among male respondents.
Certain limitations of the current study should be considered in interpreting the findings. The diagnosis and symptom assessment relied on the DSM-IV criteria. Future research should confirm these results using the most recent version of DSM. However, the use of the DSM-IV criteria allowed comparative data to be obtained from both parents and youths who were assessed concurrently for psychopathological symptoms, increasing the reliability of our statistics. An additional weakness of the current study is the binary index (yes/no) of both psychiatric disorders and suicidal behaviour that was utilized as sum criteria in making the DSM-IV diagnoses. Another weakness of this study is that we could not fully examine the important relationship between suicide and symptoms of anxiety disorders, conduct disorder, schizophrenia and bipolar disorder because of the low base rates of these syndromes in the studied population.