Physical activity counselling in people with suicidal ideation: a secondary analysis of a pilot study in Ugandan primary care settings

Abstract

Introduction: primary care settings are ideal to implement suicide risk reduction initiatives in low-and middle-income countries. Health staff working in primary care settings are often over-burdened and under-resourced. Task-shifting through lifestyle counseling by lay health workers might be a relevant intervention. The aim of this secondary analysis from a pilot study exploring the efficacy of lay health worker (LHW)-led physical activity (PA) counselling for primary care patients with mental health problems (PCMH) was to investigate the efficacy of PA on reducing suicidal ideation. Methods: from 130 Ugandan PCMH screened in two centers, 8.5% (n=11) reported suicidal ideation. These 11 PCMH (9♀, median age= 52 years, interquartile range= 37 years) participated once weekly for 8 weeks in group PA counselling based on the mental contrasting and implementation of intentions framework. All participants completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the Simple Physical Activity Questionnaire (SIMPAQ) pre-and immediately post-intervention. Results: in PCMH with suicidal ideation (PHQ-9 item 9≥1) the prevalence of suicidal ideation dropped to 9% post-intervention, i.e. only one patient reported suicidal ideation post-intervention. Following the intervention, significant (P<0.05) increases in walking, exercising and incidental PA (SIMPAQ) levels, and reductions in depressive and anxiety symptoms were observed. Conclusion: our data demonstrate that LHW-led PA counselling might be promising intervention in reducing suicidal ideation in primary care patients in low-resourced settings. Randomized controlled trials are warranted to confirm these beneficial findings.