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    February 13, 2013

Detail

In The Name of ALLAH  The Almighty
 



Suicide among Young Adults

“When people kill themselves, they think they're ending the pain, but all they're doing is passing it on to those they leave behind” (Jeannette Walls).

Suicide is the act of deliberately or intentionally taking one's own life (Center for Disease Control and Prevention, 2010). Most suicides occur among young adults i.e. over the age of 25 (Beautrais, 2000). Erikson’s stages of human development describe the young adult age group between 20 to 40 years. Suicide is a common cause of unnatural death and is significant as a major public health problem in Pakistan.

It is considered that the act of suicide is started to increase more in human life from 1970’s. In this year, the rise in depression as well as suicide attempts and deaths were first reported among adolescents and young adults. It seems that the 'baby boomers', which were born after World War II, had increased rates of depression and other illnesses, including drug abuse and alcoholism (Klerman, 1988). On contrary, many countries have experienced an increase rate of suicides over the years 1960-64 to 1990-94 (Beautrais, 2000).

Worldwide, approximately 900,000 suicides reported each year, including 200,000 adolescents and young adults (Ahmad &Rizwan, 2010). In a descriptive data, four ethnic groups including South Asia (Pakistan) indicates that risk of suicide among adolescents and young adults were reported to be rising. Moreover, suicide is the 8th leading cause of death in males and 16th leading cause among females worldwide (Bhui& McKenzie, 2008). According to CDC (2010) fact sheets report, males are more likely to commit suicide at a rate of five times than females whereas females are more likely to attempt suicide than males. Whereas, in 2003, American Indian/Alaskan Native, non-Hispanics have the highest suicide rate in which males were two to four times that of same-age males in other racial/ethnic groups and eleven times that of same-age females ("2006 fact sheet," 2006). Likewise, a study presented by Bhui& McKenzie (2008) shows that in South Asia (Pakistan) 50% out of 166 are among young adults who commit suicide among which 68% were males. Whereas, in the Ghizar District, the remote area of Northern Areas of Pakistan, 49 women committed suicide during the year 2000 to 2004. Suicide rates of women were undertaken among 15-24 years and crude specific rates were found to be 61.07/100,000 per year by taking average mean population for women for 5 years as 65,783 (Khan, Ahmed & Khan, 2008). In disparity to this, according to Human Rights Commission of Pakistan (HRCP) 98 men and 40 women committed suicide between December 26, 2008 and January 25, 2009 out of the 138 people. (138 committed suicide, 2009). Hence, this empirical statistics shows that in some areas of Pakistan women are more prone to commit suicide and in other areas men are more prone to commit suicide.

In Pakistan, the existence of suicidal behavior is considered as a social taboo which makes Pakistani population more vulnerable to suicide. Family also hides suicidal behavior of individual to avoid legal actions, religious humiliation and social disgrace due to which it becomes difficult to identify suicidal cases. Regardless of highly underreported suicides in Pakistan, its cases are raising very rapidly which are based on empirical research studies that have explored only the reasons and risk factors of suicides in Pakistan (Ayub, 2008).

Recently researchers have begun to investigate the effects of suicide. Cited in a study of Goode, (2003), Dr. John Jordan, the author of Review of Research on Suicide (2001) said that the health of survivors is physically, emotionally and psychologically affected badly because some people pass through a normal grief process and heal quickly; but others go in depression feel guilt, rejection, shame, and adopt isolation. Their health is also affected because sometimes they are viewed negatively by others. In addition, the family members of the person are affected, as stated in a study of Goode, (2003) wives who had lost their husbands are viewed more blameworthy than wives whose husbands had died from heart attacks or in accidents. Due to this factor they are also vulnerable to depression; this is the worse effect of suicide and a major risk factor for family members that they are prone to commit suicide.

There are several methods to commit suicide including hanging, poisoning, jumping, gunshot and self-fire etc. In California females more likely poison themselves and males shoot themselves (Otsuki, Kim & Peterson, 2010) whereas in Pakistan hanging, poisoning and firearms are common methods (Khan, 2007). The broader perspective of causes includes psychopathology, stressful life events, suicide contagion, interpersonal conflicts, and socioeconomic and political factors.
Psychopathology describes the relationship between mental illnesses and suicidal ideations. People with depression, personality changes, phobias, obsessive compulsive disorder, somatoform disorder, and substance abuse and anxiety disorders are susceptible to suicide. At least 90% of the youth suicide victims had psychiatric disorders at the time of death (Liu &Tein, 2005, p.196). Depression is now more prevalent among people who aged between 20 to 30 years. Among young women, depression is high and at its peak in their mid-30s (Stillion& McDowell, 1996). In contrast, almost 34% of Pakistani youth suffers from common mental disorders among them 90% suffersfrom depression (Khan, 2007).

Problem in intimate personal relationships is another cause as young adults are working to establish the intimacy in their relationship. A difficulty in interpersonal relationship leads to separations and divorces and is associated with depression in both the genders (Stillion& McDowell, 1996). Most of the people who commit or attempt suicides have experienced failure or rejection in love which leads to suicide (Richards, 2003).

The socioeconomic and political factors describe relation of poverty and unemployment to suicide. “The Nation” (2011) reports that a mother committed suicide in Lahore due to severe financial constraints. Samaa news channel (2011) reports about a 35 year old man who took poison from the frustration of losing his job. Political matters grounds the rich to be richer and the poor to be entangled in poverty. The unemployed youth is brainwashed to attempt suicide bombing. This affects the country’s socio-economic and political conditions in a negative way.

Several negative life events also lead to suicide completion among young adults. These events may consist of ignorance during childhood, physical or sexual abuse, past suicide attempts, hopelessness and disconnection from family and peers. According to Websdale (2003) a significant number of 6,000 women commit suicide in the United States each year because they are abused by intimate male partners. Due to the above reasons, the victims are unable to cope with the stress and commit suicide.

Stories shown by media, newspaper articles, and the factious and non-factious performance have a positive impact on young adults to attempt suicide as they find the stories similar to their life stressors and choose suicide as the last solution to get rid of them (Gould, Jamieson &Romer, 2003).

Awareness and knowledge about suicidal prevention and management is less identified in comparison to cause and effects. Suicide can be prevented in four phase’s i.e. primordial, primary, secondary and tertiary prevention.

The primordial prevention includes mass education as a main approach to prevent suicide among healthy individuals when there is no presence of risk factors. Population health is viewed as a broad emphasis rather than individual’s perspective. Public health’s long term goal is the lasting change in factors that place people at risk by social ecology modification that will reduce suicidal rates (Strategic Direction for the Prevention of Suicidal Behavior, CDC). Different workshops and media plays important role in primordial prevention. Gould, Jamieson and Romer (2003) report that media plays a powerful role in educating people about suicide prevention, its warning signs, trends, causes and recent treatment modalities. Stories about the harmful effects of suicide are portrayed by media and reduce the prevalence of suicide.

Unemployment is another prevalent cause, uneducated youth are less selective but have low economic opportunities whereas educated youth are particular and they are in search of better jobs, thus constituted a major part of frictional unemployment. One of the reasons of unemployment among educated people is lack of training and skills which is needed in labor market especially in Pakistan. The needs of youth must be addressed at country level keeping in view the educational, social and labor market employments. To create youth employment opportunities, there is need of integrated approach which comprises of supportive economic policies belonging to labor demand and supply (Ahmed &Azim, 2010).

The word primary prevention shows prevention before the occurrence of suicide in conditions as depression, impulsive behavior, or alcohol and drug abuse (National Center for Injury Prevention and Control, n.d.). To deal with these disorders first of all health care providers should be well skilled, able to manage depression and other chaos. Likewise, many people with depression and related disorders visit primary care providers where they report physical complaints rather than psychological symptoms (WHO, 2008).

This shows that how the knowledge of health care provider is necessary in these situations. A cross sectional study displays that individuals or group of people can be taught about the self-appraisal strategy. There are three ways of self-appraisal; social support, emotional coping and situational coping. All the three appraisals lie under the umbrella of resilience appraisals. Social support includes assistance from other people including family and friends in terms of emotional support, financial support and advisory. Emotional coping consist of purposeful use of distraction techniques to deal with one’s emotional needs. Situational coping refers to deal with problem or stressor itself. The schematic appraisal model of suicide suggests that positive self-appraisals might provide a source of resilience (Johnson, Gooding, Wood &Tarrier, 2009).

Correspondingly, the main goals of secondary and tertiary prevention is early detection of suicidal ideation, planning, and appropriate referral and treatment for suicide risk along with the rehabilitation for the people who have attempted suicide (National Center for Injury Prevention and Control, n.d.). Therefore, it is needed to arrange sessions or trainings for gatekeepers (teachers, counselors, coaches, police, merchants, and recreation staff, trained volunteers, social workers, peers).At Hong Kong the gatekeepers programs were done on supermarket staff because charcoal is commonly used in suicide. The successful completion of program was only because of reducing availability of charcoal from the supermarkets (WHO, 2008).

Japan’s Ministry of Health, Labor and Welfare in collaboration with Akita University initiated a community-based public health suicide prevention program which ran in six towns in Akita (high suicides rates in Akita). The project offered much training in suicide prevention, screening for depression and counseling. After running this project, there was a significant reduction in suicidal cases in town (WHO, 2008).

Furthermore, counseling and psychotherapy is another solution of suicide. Many young adult have a great difficulty in problem solving, managing stress and expressing their feelings. After counseling, several therapies could be helpful to prevent suicide. One is Cognitive Behavioral Therapy (CBT), according to U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (2009) in a randomized controlled trial using CBT reports that this therapy has reduced 50% suicide attempt in adults who had made an earlier attempt as contrast to those similar groups who receive treatment as usual. Similarly, a study was done in group of women who took Dialectical Behavioral Therapy (DBT); they had fewer hospitalizations for suicide ideation, lower medical risk, and were less likely to drop out of treatment.

Moreover, mindfulness is also a therapy which assists anxious and depressed people by paying attention towards some stimuli through their senses. WHO (2008) states that Thailand is participating with other Asian countries in strategies to prevent suicide (STOP) by taking guidelines of media from World Health Organization. As a result, in Thailand practice of reporting suicides on the front page of newspapers has reduced because of fulfilling those guidelines.

To overcome this issue at grass root level, we recommend that there should be tele-help lines for people experiencing stressful events. This is done by using catharsis which helps them in ventilating their feelings and finding out ways to solve their problems with different coping strategies; this will reduce suicides related to traumatic events. Secondly, the help lines will generate income opportunities for unemployed and will further reduce suicides related to unemployment. Moreover, medications must not be given without prescription in order to reduce means of suicide. Policies should be followed to cancel the license of pharmacist along with the payment of penalty if he/she provides lethal medications without prescription. In Pakistan, there are laws present against suicides i.e. Rs. 50,000 penalty but unfortunately are not being followed; the policies should be strictly followed to reduce the suicide rates. Furthermore, support groups must be present for people with depression, stressors and suicide attempts to help people out of problems and reduce consequences. Hospitals should report strictly the cases of self-injuries so that the institutes have exact data of people committing or attempting suicides which will help in prevention and control of issue. People should practice their religion regularly as all the religions in the world forbid self-injuries and suicides and ensures life as a precious gift.

In Pakistan there is less data obtainable on suicide than other parts of the world. Researches should be conducted on analytical based studies including case control studies and cohort studies. Furthermore, randomized experimental studies should be conducted on this issue all over the world. In Pakistan, the descriptive and empirical data are available whereas cross sectional studies are less to none presented. Due to unavailability of these studies, the prevalence is also less existing in Pakistan. The experiments should be conducted related to cognitive and dialectal based therapies as they have shown remarkable results in other researches. Moreover, projects on prevention at large scale should be conducted at different areas so that more people can get benefit and will add onto the research studies.
“Suicide is the sinerest form of criticism life gets.” (Wilfred Sheed, The Good Word, 1978) so we should take measures to stop this sin and to save and give meaning to precious lives.



By:
Sunita Lalani, Zainish Zafarullah Hajiani,
Sajid Khan, Ina Abdul Majeed and Jasmin Zahid
Students of BScN (undergraduate nursing program) at
Aga Khan University School Of Nursing and Midwifery
Karachi.
 

 

 

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