Risk Factors for Suicide in Bangladesh

SUICIDE AND THEIR SIGNIFICANT RISK FACTORS PREVAILED IN BANGLADESH: A SYSTEMATIC REVIEW

1. Introduction:

A good number of people die each year by suicide, making it one of the 10 leading causes of death in the world accounting more than a million death annually. The average rate of suicide in Bangladesh has been reported to be 39.6/100000 population/year. About 10%-20% of emergency admission in the hospital in Bangladesh is attempted suicide. (Rahman HM. Socio-economic and Psycological Causes of Suicide in Jheneidah District. Department of Social Work, Rajshahi University, Bangladesh, 1986). Suicidal death indicates the socio-economical and health status of the community.Suicide rate in Bangladesh is unacceptably high.In Bangladesh,suicide is an unrecognized,hidden and silent epidemic.Studies in the journals shows, 80% of suicidal death occurred within 30 years of life.Suicidal deaths are more common among married person,specially in women.Hanging is the major method of committing suicide,and other suicidal deaths are due to poisoning,burn,drowning,firearms,fall from height,and road traffic accident.Besides this,Psychiatric disoreders,family history of attempted suicide,past history of attempted suicide are various influencing factors being noted in review studies.Emotional factors like love-affair,Economic hardship,failure in exams,chronic illness, also contributes to suicide. Other than this,two of the articles do agree on the fact that,some areas of Bangladesh like South-west region of Bangladesh specially Chuadanga, Jenaidah, Kustia and Meherpur districts are the highest prevalent area of suicide and most of them are young females. Mortality from suicide occurred at a rate of 39.6 per 100,000 populations per year from 1983-2002.

In summary,the 5 literature review on suicide in Bangladesh,have significant relevance in indicating the main risk and other factors that contributes to suicide.They agreed that, to prevent suicide,status of mental health and social well being should not be ignored and socio- economic development is needed.They also agreed on the shor­tcomings of a well designed and comprehensive programme needed in Bangladesh, to identify the causative factors.But all the studies were able to shed some insight about addressing the importance of researching the subject more.

This review tried to understand the position of Bangladesh on suicide and the factors involved in suicide,in order to prevent the epidemic episode in the near future,and to understand the research importance of the study..More specifically this review addressed the following questions:

What are the potential risk factors ?
Assess psychiatric illness,emotional and other factors that may precipitate suicide and its attempts?
What are the socio-demographic risk factors?

1.1. The Review:-

STUDY

N

DESIGN

Time of study

Hanging as a method of suicide retrospective analysis of postmortem cases

145

Survey

January 2003-december 2004

Suicidal Death Autopsy analysis at Dhaka Medical College

970

Cross-Sectional study

January 2008-December 2009

A community survey on the prevalence of suicide attempts and deaths in a selected rural area of Bangladesh

12,422

survey

2012

Psychiatric morbidity of suicide attempt patients requiring ICU interventions

44

Cross-sectional study

2010

Risk factors of suicide and para suicide in rural Bangladesh

230(113 Cases & 117 Controls)

Case control study

2013

2. Methods and Search Strategy:- A systematic review with a narrative synthesis was applied to compare the surveys done only on suicide topics,in Bangladesh.In order to find out the appropriate published recent literature for the current review,6 databases,i.e,DU Journal of psychology,Bangladesh Psychological Studies,JU Journal of Psychology,Bangladesh Psychological Review,Dhaka University Journal of Bioscience and Google Scholar,were consulted.Using the core search words ‘Suicide’, ‘Bangladesh’, ‘Suicidal thoughts’, ‘Published Journals’ was carried out.A number of studies were initially found,but not all were suitable and met the inclusion criteria for this review.Abstracts of the literature were then reviewed and five studies were short listed for systematic review due to its availability and relevance subjects and surveys.

2.1. Eligibility Criteria:-

Studies on only suicide,para suicide and suicidal attempt.
Suicide surveys are only done based on Bangladesh region only.
All of these studies had been published in popular journals.

3. Results:-

3.1. Information about the studies:-For this review 5 original papers were selected based on the specific inclusion criteria.These five studies are done on suicides,Para suicides and morbidity of suicides,and suicide attempts. Reports of cases on suicide are all based on Bangladesh area only.Two of them mostly paid special attention to rural ares of Bangladesh.Two of them shed light based on post mortem reports from Dhaka Medical College.And the other one study is about suicide and its prevelance in Bangladesh.There were acceptable amounts of sample size/population under the studies in every literature under this review.Table 1.1 depicts the studies with necessary information such as sample size,design,and time spans.A narrative synthesis approach has been used to summarize the observations.

3.2 Psychiatric disoreder or other mental health problems:-In the five studies,three had been identified the relation between suicide and the prevalence of psychiatric or other mental health problems.But the study “A community Survey on the prevalence of suicidal attempts and deaths in a selected rural area of Bangladesh”suggested that mental illness is rarely reported as a cause of suicide.They also suggested that,it is because-a developing country like Bangladesh,psychiatric disease are underestimated and family head was unwilling to disclose it because of stigmata of mental illness.The findings of other studies shows that,among the people committed suicide,almost averagely 70% had psychiatric disorder,or other types of mental health problems.Psychiatric disorders such as Schizophrenia,OCD,Substance abuse,Adjustment disorders,and stress and mood disorders were prevailed for many victims.Major mental health issue for suicide,para suicide & suicide attempts were depression.Others were mental instability,anxiety,emotional and stress related problems.

3.3. Age limits:-5 studies agree on the age limit that,maximum age group was up to 20,mostly ranging from 21 to 30(about 42% average).

3.4. Gender:-In each of 5 study,results finding was female victims and attempters were more than the male victims and attempters.And married persons were more likely commit suicide than unmarried persons.Findings of the literature observed that early marriage and motherhood,less freedom in choosing partner,absence of male offspring,domestic violence,economical dependence on husband are the associated factors with this findings.

3.5. Way of Committing Suicide:- Every topics shows that hanging is the most common methods used for suicide.There is a full study on hanging as a method of suicide retrospective analysis of post mortem cases.This study includes logic to this, is that, a thin rope around the neck will cause unconsciousness in 15 seconds.So the victims prefer it as a common method in believe of feeling less pain.As women commit more suicide than men,they also find hanging method more convenient,than other methods because of availability and to able to commit suicide at their own resident.The second mostly used methods is poisoning or using chemicals.Other methods includes-burn,fall from height,Firearm,drowning and road traffic accident.

3.6. Previous Connections:-Two studies-“Risk factors of suicide and para suicide” and “Suicide attempt patients requiring ICU interventions”Put emphasis on previous attempts on suicide.A statistics showed that out of 44 patients 29 has no history of attempting suicide,15 has previous experience of suicide attempt.Risk factors in suicide and para suicide also suggests previous attempts of suicide by any relatives is a signified factors in committing suicide among victims.

3.7. Rural Ares:-Two of the studies revealed that suicide is significant in number in rural ares of Bangladesh,comparing to other rigions.The South-west area of Bangladesh-Abhoanagar,Keshobpur,Jessore districts,Chuyadanga are some of the most prevalent area of suicide.Generally,socio-economic status,geographical environment,educational stutas,male dominance society are some reasons supporting this findings.

3.8. Other Risk Factors:-

Time- More people committed or attempted suicide during the second half of the day than the 1^st part.In a study it was included that from 8am to 12 noon,the percentage was 17.6%.Around 8.7% committed or attempted between 4.am and 8 in the morning.During the afternoon 12.00-4.00pm,lowest portion committed or tried suicide.

Religions– In one study,it shows that among 130 victims were muslims,9 were hindu,4 were Buddhist and 2 were cristians.

Emotional and other factors:- Quarrel between husband and wife,Failure in love affairs,drug addictions,unwanted pregnancy,incurable disease,poverty,unemployment,poor academic performance are the emotional and other risk factors for committing suicide.

3.9. Relevance and Validity:-Even though no nation wide survey on suicidal risk factors has yet been conducted in Bangladesh,reports from police records,media,court,hospitals and the focused study on selected populations of these 5 studies show relevance in there findings and the statistics,if we cross check ,we can validate the findings to one another.Its true that more broad and recent research should be conducted to find out more about suicide in this country.But all of these 5 studies kind of able to generalize the risk factors and able to put focus on suicide and suicide attempt committed in past years,based on Bangladesh region only.

Conclusion: While suicide represents a major cause of deaths especially in young people and female in Bangladesh,however these findings need to be considered very cautiously because of the methodological flaws.As it was not possible to collect data from the victims directly,relatives or second persons were involved in collecting data,they are not operational or concrete knowledge about the victims or the reasons behind the committing suicide of the victims.Actually many factors,such as mental states and perspective of a situation, works simulteniously at the time of committing suicide.Thats why more in depth and more vast areas should be included for more clear perspective about the topic.Additionally, these 5 empirical studies’s facts,knowledges and datas were insightful and helpful.

REFERENCES

Ahmad, M., & Hossain, M. (2011). Hanging as a Method of Suicide: Retrospective Analysis of Postmortem Cases. Journal of Armed Forces Medical College, Bangladesh, 6(2), 37–39. doi:10.3329/jafmc.v6i2.7273

Feroz, A. H. M., Islam, S. M. N., Reza, S., Rahman, A. K. M. M., Sen, J., & Mowla, M. (2012). Original Articles A Community Survey on the Prevalence of Suicidal Attempts and Deaths in a Selected Rural Area of Bangladesh, 3–9.

Hossain, M., Rahman, Z., & Akhter, S. (2012). Suicidal Death Autopsy Analysis at Dhaka Medical College. Bangladesh Medical Journal, 40(1), 18–21. doi:10.3329/bmj.v40i1.9957

Qusar, M. M. A. S., Morshed, N. M., Abdul, M., & Shaikh, K. (2010). PSYCHIATRIC MORBIDITY OF SUICIDE ATTEMPT PATIENTS REQUIRING ICU INTERVENTION, 7–11.

Reza, A. M. S., Feroz, A. H. M., Islam, S. M. N., Karim, N., Rabbani, G., & Alam, S. (2013). Risk Factors of Suicide and Para Suicide in Rural Bangladesh, 123–129.