Implementation of a Suicide Prevention Package Co-Created with Lived-Experience Community Members in Ethiopia

An overwhelming majority of deaths by suicide occur in low- and middle-income countries (LMICs), but many LMICs do not have screening and intervention for suicide integrated into routine clinical practice. The long-term goal of this work is to ensure that LMICs have systematic suicide screening, assessment, and prevention across existing triage points (e.g. emergency, clinical outpatient, and inpatient units) guided by evidence-based implementation in similar contexts. The goal of this proposal is to assess the feasibility and acceptability of a culturally adapted, combined suicide screening and safety planning package for youth ages 10-18 in Ethiopia. Ethiopia is identified as the country of implementation because a) it is a low-income country; b) a suicide screening tool (the Ask Suicide-Screening Questions tool) has previously been validated in the local Amharic language by this study team; and c) the country has expressed political commitment to increasing mental health services, particularly for high-risk groups such as youth. The hypotheses are: (1) the combined intervention package will be both feasible and acceptable to Ethiopian youth, caregivers, and providers and will lead to improved provider self-efficacy in supporting youth with suicidal ideation and suicidal behavior (SI/SB); and (2) the combined intervention package will lead to a decrease in suicidal behavior. We plan to adapt and implement an intervention package through the following aims: 1) adapt safety planning for the Ethiopian context using the ADAPT-ITT framework and develop an appropriate clinical pathway for suicide screening, assessment, and safety planning in four diverse hospital sites; 2) implement and assess the developed intervention package and clinical pathway using evidence-based implementation science methodologies; and 3) evaluate the prevalence of SI/SB in Ethiopian youth and the correlation between the intervention package and clinician self-efficacy on SI/SB outcomes. Developing an acceptable screening and safety planning clinical pathway that is effective in improving SI/SB in Ethiopia will support current government commitment to expanding access to mental health services and serve as a model for other low-income countries. This proposal includes plans to disseminate findings firstly to decisionmakers in Ethiopia at the Ministry of Health and, secondly, through academic publications and presentations to the global community working on suicide prevention in youth.