Assessing and Responding to Suicide Risk in Health Research in Low-Resource Settings: Implementation of a Suicide Response Protocol in Ghana

Abstract

Introduction: Risk for suicide is high in low and middle-income countries (LMICs) where over 75% of deaths by suicide occur. Thus, assessing for suicidal ideation and behavior and intervening appropriately when conducting research in LMICs is a critical step toward lowering risk for suicide among at-risk research participants. This is important even when conducting non-psychiatric research, especially when evaluating high-risk populations such as those experiencing bereavement. In this paper, we address questions that commonly arise as researchers in LMICs consider assessing for suicide risk. Key considerations: Using expert opinion and review of the literature, we discuss factors to consider when establishing an interdisciplinary research team and effectively assessing for and responding to suicide risk. We pose key questions and responses, using examples from a case study in which our team implemented a suicide assessment and response protocol as part of a research study on maternal mortality in Ghana, a LMIC. Through discussion of this case study, we demonstrate the feasibility and importance of (1) an interdisciplinary research team involving providers from the local community, (2) a practical framework for assessing suicide risk among study participants, and (3) a protocol to respond when risk is indicated. Assessing for suicidal ideation and behavior and intervening appropriately when conducting research in LMICs is a critical step toward lowering risk for suicide among at-risk research participants. Conclusions: By assessing for risk, appropriate care and follow-up can be provided with the goal of ultimately reducing the likelihood of suicide. To optimize impact, suicide risk protocols should be individualized to the specific setting, language, and available resources.