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  May 23, 2012

Chitral Times Detail

In The Name of ALLAH The Almighty

Suicide among Adolescent

Adolescent suicide is a complex, yet a preventable public health issue both in industrial and developing countries. Studies have shown that suicide is the leading cause of premature death across the world taking the life of one individual every five minute. According a report of WHO (2010), suicide accounts approximately one million deaths per annum. It is the third leading cause of death among 15-44 years olds, and the second leading cause of death among 10-24 years olds in some countries (WHO, 2010). If we look into the situation of Pakistan its population is approximately 162 million with 97% being Muslims and suicide is considered as a condemned act in Islam (Khan, 2007). Evidence from different studies shows that there are no official statistics on suicide in Pakistan and most of the suicide information comes from newspapers, NGOs and police departments of different cities. Khan (2007), states that most suicide occurs in young people (single men and married women) under the age of 30 years. Further, it says that 5,800 suicides occurred in nine months of 2006 in Pakistan. So, based on the above mentioned studies it is cleared that adolescent suicide is becoming a major health concern worldwide. But unfortunately, the problem is not receiving attention globally as it deserves. Therefore, national and international effort should be taken to tackle this tragic phenomenon.

Causes of Suicide
The reason why people commit suicide is a multifaceted phenomenon and it is usually the result of a number of factors which include psychological, socio-economic, demographic, biological, and environmental factors. There are ample of evidences that psychological factors are the major causes that lead to suicide among most of the adolescent worldwide. For example, “depression combined with alcohol abuser occurs in 80-90% of those who commit suicide” (WHO, 2006). Moreover, it also states that by 2020, depression will become the second leading cause of disability worldwide. As far as the situation of Pakistan is concerned Khan (2007), states that almost 34% of Pakistani population suffers from common mental disorders, and depression is alone is responsible for 90% of suicide in the country. So this high prevalence of mental disorders worldwide has become an important global health burden which requires increase spending on mental health as well as proper utilization of the available resources. There appears to be a strong association between poor socio-economic condition and suicide. “Suicide rates are highest among developed countries particularly those which have developed rapidly. Within these countries suicide rates are highest for sub-groups that have remained socio-economically disadvantage” (WHO, 2008). According to WHO (2008), Pakistan is the country with lowest Human Development index (HDI) and Australia remains the highest in economic prosperity. The contributing characteristic relating to socio-economic includes low educational status, employment, income, occupation, poverty and social class. A person with low socio-economic status often lack access to the community resources that promote and support human development. So deprivation from these basic characteristic makes a person more prone to suicidal attempts because sometimes it becomes more formidable for these peoples to strive with life. It has been observed that comparatively higher ratio of female to male suicide have been reported in most of the studies. According to WHO (2008), in some countries like India, Pakistan, and Sri Lanka where arranged marriages are common and due to which the social and familial pressure on a women to stay married even in abusive relationship appears to be one of the factors that increases the suicide in women. According to a special report on daily times on May 7, 2012, 70% of youths in the age 18-30 years who attempt suicide in Karachi are females. Moreover, a report compiled by Human Right Program Chitral (HRPC, 2012), states that more than 30 women aged between 15-35 years ended their lives by their own hand during the last two years. Further, dowries, unhappy marriages, harassment, family issues and attitude of the society towards the women further complicate this problem. Another, precipitating factors for suicide among adolescent are some of the biological factors that are heritable in the families. According to Donald et al. (2007), a number of biological factors have been associated with suicide like low cerebrospinal fluid, platelet disorders, hormonal imbalances and abnormal sleep patterns. The environment sometime becomes a place of stress for most the adolescent whether it would be institutional or home environment. As the society is getting increasingly competitive so the pressure on adolescent to do well in exams often put them under high stress and pressure. According to WHO (2008), the shame associated with failure in exam have been the cause for suicide among young people in countries like Sri-Lanka, Indian, china, and Japan. Therefore, these shames associated with exam failure or in any other area push these adolescent to attempt a complete suicide. Moreover, according to (Donald et al., 2007) adolescent with substance abuse disorder, being bullied, history of abuse, life on street (throwaway or runaway adolescents), involvement in wars and chronic illness are on high risk of suicide. Another factor in our society which needs the focus of attention of each one of us is the sexual abuse of adolescent. Millions of adolescent are becoming the victims of physical and sexual abuses and most of them goes unreported worldwide. According to Donald et al. (2007), there are approximately 3 million reported annual cases of abuses in those under 18 year of age in the united states; these reported are subdivided into neglect 53%, physical abuse 26%, sexual abuse 14% and emotional abuse in 5%. According to WHO (2008), in some countries suicide is considered as a crime and great stigma is attached to the surviving families and these families are reluctant to report suicide or to seek help. However, if we talk about a country like Pakistan the stigma is even much greater. Therefore, it is one of the main reason and a growing concern in our society where more work should be carried out.

Common Methods of Suicide
Secondly, to discuss the most common methods of suicide among adolescent it is important to have a look at the prevalence of each method. A review of literature suggests that the common method of suicide among adolescent are poisoning, hanging, firearm, jumping from height, self-shooting and drowning. According to Donald et al. (2007), the most common method of suicide in 10-19 years old were Firearms 49%, Suffocation (mainly hanging) 38%, poisoning 7% and miscellaneous 6% and it is estimated that for every complete suicide there are at least 10-20 deliberate self-harms (DSH). However, according to Khan (2007), in Pakistan the three most common methods are hanging, ingestion of insecticide and firearms. Moreover, it also states that hanging is difficult to control, while restricting the availability of latter two can potentially prevent 50% of suicides. According to WHO (2008), the efforts to focus on suicide methods are responsible for a significant proportion of suicide rate. It also mentions that China, India, Pakistan and Sri Lanka are the countries where pesticide- related suicides are prevalent. Therefore, public awareness to promote safe storage of poisoning agents (such as pesticides, charcoal and other chemicals), securing jumping sites and restricting the availability of firearms are some approaches that can help to reduce suicide rates among the adolescent.

Suicide Warning Signs
Suicide warning signs are the earliest indications that shows a person might be at a high risk of immediate suicide, having serious thoughts about taking his/her life or making a plan to take the action. “A suicide warning sign is the earliest detectable sign that indicates heightened risk for suicide in the near term (i.e., within minutes, hours, or days)” (Rudd, 2008). Therefore, it is very important to recognize the warning signs in high risk individuals in order to prevent these tragic phenomena’s in our society. Some of the most relevant warning signs stated by Rudd (2008) are previous suicide attempts, threat of suicide, depression, unusual changes in personality or behaviors, increased use of drugs and major change in life. Moreover, frequently talking or joking about committing suicide, saying goodbye to family and friends, frequent crying, giving away their valuable things to others and often complaining about life are some of the warning signs identified by other studies and these have been called as red flag as well.

Conclusion and Recommendations
As far as suicide prevention is concerned, it is social pathology which requires a multi-sectorial approach. There is a need for collaboration between government, non-governmental organizations and health care professional to take up this challenge. As a healthcare professional it becomes our responsibility to encourage people with depression and other mental illnesses to seek health care. Training to primary care physicians to recognize and treat psychiatric disorder should be the primary focus in order to improve better mental health services in the communities. Moreover, it is necessary to educate those health care professionals who are working with high risk individuals and families to recognize depression and related mental disorders so that early preventive step will be taken. According to Dore et al. (2006), selective prevention and screening programs for youth who are at particular risk needs to be initiated. Moreover, it states that target program for school dropouts because they are often socially-isolated and are engaged in unhealthy activities. According to WHO (2008), increasing public awareness through the distribution of pamphlets, posters, commentaries in newspaper and on television are the approaches which help in reducing the suicide rates. Moreover, special training programs for parents, teachers, social workers, youth leaders, religious leader and caregivers are some of the strategies recommended by World Health Organization that can help in suicide prevention. Further, suicide prevention strategies which include crisis management, self-esteem enhancement, development of social skill and healthy decision making need to initiated among youth at school level. Lastly, more researches should be carried out at national and international level in order to better understand the root causes of suicide both at micro and macro level and on its prevention accordingly.

Zahir Ali
B.ScN Year IV
Aga Khan University, Karachi



mail @ chitraltimes@gmail.com

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