Suicide and islam

Brain-derived neurotrophic factor and C-reactive protein (CRP) biomarkers in suicide attempter and non-attempter major depression disorder (MDD) patients

BACKGROUND

In the available literature, levels of BDNF and CRP have been reported to correlate with suicide in depressive patients but there are inconsistencies in the results. We aimed to evaluate and compare BDNF and CRP concentrations in MDD patients with(MDD + SA) and without suicide attempts (MDD-SA) and healthy controls.

METHODS

30 (MDD + SA) patients, 30 (MDD-SA) patients, and 26 healthy controls were enrolled in the study. Age, sex, and BMI of patients were recorded. Blood sample was obtained for measurement of BDNF and CRP. Smoking and drug history, family history of suicide, and history of self-harm were also documented. Data were analyzed with SPSS version 22 and R version 4.1.1.

RESULTS

86 patients in three groups were evaluated (mean age: 28.45 ± 9.27 years, 56.71% female). Baseline and demographic parameters except for self-harm (40%, 3.3%, and 0% for MDD + SA, MDD-SA, and healthy controls, respectively, p = 0.001) did not differ between groups. CRP level was not significantly different between groups. BDNF showed a significant difference between groups (17.35, 16.45, and 19.43 for three groups, respectively, p < 0.001). An increase in BDNF decreased the odds of both depression and suicide. Roc curve showed excellent power for BDNF in discriminating MDD groups With healthy group.Roc can notdicrimiate MDD + SA and MDD-SA.

CONCLUSION

In our study, the concentration of BDNF differed significantly between depressed patients with/without suicide attempts and healthy controls which shows the association of BDNF with depression development and not suicide attempts. We could not find any association between CRP level and suicide attempt but still larger cohorts are needed for a definite conclusion.

Mortality in Qatari individuals with mental illness: a retrospective cohort study

INTRODUCTION

There is substantial evidence that people with mental illness have higher mortality rates than the general population. However, most of the studies were from Western countries, and it is not clear whether this finding also applies to Arab countries like Qatar.

OBJECTIVES

We aimed to explore whether mortality in patients with mental illness in Qatar, is different from those without.

METHODS

We conducted a retrospective cohort study, including all Qatari nationals deceased in 2017 and 2018, using the list of registered deaths from Hamad Medical Corporation (HMC) Mortuary. We divided the cohort of deceased people into two groups: with and without mental illness. For each of the groups, we collected the age at death, the reported cause of death as well as sociodemographic and clinical data.

RESULTS

There were 602 registered deaths in 2017 and 589 deaths in 2018. The prevalence of mental illness was 20.4%. Compared to subjects without mental illness, subjects with mental illness surprisingly had higher age at death (median ± IQR = 76.5 ± 22.1 years vs. 62.7 ± 32.9 years; p < .001). This difference persisted even after we controlled for covariates. Individuals with mental illness were more likely to die of an infection (OR = 1.98[1.44;2.71]), or of chronic respiratory disease (OR = 3.53 [1.66;7.52]) but less likely to die because of accidental (OR = 0.21[0.09;0.49]) or congenital causes (OR = 0.18[0.04;0.77]).

CONCLUSION

Contrary to most previous studies, we did not find that mortality was higher in Qatari individuals with mental illness. Sociocultural factors, free and easy-to-access healthcare, and an enhanced role of mental health professionals in detecting medical comorbidities may explain this finding.

Revisiting Associations Among Parent and Adolescent Religiosity and Early Adolescent Suicide Risk in the United States

The contributions of religion to reduced suicide risk have been studied in adults and adolescents, though to our knowledge no comprehensive investigation has been conducted in early adolescents, at a time coinciding with emergence of suicide risk trajectories. In this largest study to date on this topic, we aimed to characterise the contributions of various measures of "private" and "public" religiosity to early adolescent suicide ideation (SI) and suicide attempt (SA) histories using information from a large, epidemiologically informed U.S. sample of adolescents (N = 7068; mean age = 12.89 years, 47% female) and their parents. In all youth, parent-reported adolescent religious importance was associated with reduced odds of SA (OR = 0.75, CI = 0.61-0.92, P = .005). Muslim youth were more likely (OR = 1.52, CI = 1.02-2.22, P = .033), and Catholic youth were less likely (OR = 0.80, CI = 0.67-0.95, P = .014), to report SI. A variety of sex differences were noted, with significant protective associations of adolescent self-reported religiosity on SI and SA, religious service attendance on SI, and religious importance on SI, in female-but not male-youth; and significant protective associations of religious importance on SA in male-but not female-youth. Against expectations, there was no evidence that parent religiosity moderated the link between youth religiosity and SI or SA. These results shed light on the roles of cultural and familial context in youth suicide risk, which may ultimately be targeted in screening and interventional approaches.

An Exploratory Qualitative Analysis of the Stanford-Templeton Convenings on Islam and Suicide

For over 70 years, studies have reported lower rates of completed suicide in Muslim-majority countries and individuals who identify as Muslim. To this point, the mechanisms underlying the relationship between Islam and lower risk of suicide remain understudied. In an effort to advance our understanding, we convened a bilingual international interdisciplinary panel of experts for a discussion of the current state and future directions of the field. In this paper, we present an exploratory qualitative analysis of the core themes that emerged from the group interviews. We also derive a general theoretical model of the association between Islam and suicide risk.

Associations between Sleep Disturbance and Suicidal Ideation Severity in Iranian University Students: Evaluating Emotion Regulation Difficulties and Distress Tolerance

AIM

Although sleep disturbance is associated with suicide ideation, underlying cognitive-affective mechanisms that may explain this association are not well understood. The aim of the present study was to concurrently evaluate whether emotion regulation difficulties and distress tolerance explain this association among Iranian university students.

METHOD

A total of 679 Iranian university students (66.42% females; Mage = 24.34 years, SD = 4.86) completed a battery of online self-report questionnaire. Structural equation modeling was used to empirically explore the relations among variables.

RESULTS

Sleep disturbance was positively associated with suicide ideation. Higher sleep disturbance symptoms were associated with higher levels of suicide ideation. Sleep disturbance was indirectly related to suicide ideation through both emotion regulation difficulties and distress tolerance.

CONCLUSION

Findings expand knowledge of cognitive-emotional processes that may explain the sleep disturbance-suicide ideation association among Iranian university students. Iranian students experiencing sleep disturbance may benefit from intervention strategies targeting emotion regulation skills and distress tolerance to reduce suicide ideation.

Unveiling shadows: analyzing suicide reporting in Muslim-majority countries vis-à-vis WHO's media guidelines

Numerous studies have been conducted globally to assess the compliance level of newspapers with the World Health Organization's media guidelines for responsible suicide reporting. To identify and review such studies conducted in Muslim-majority countries between 2014 and 2022, we searched PubMed and Google Scholar databases. We identified 12 eligible studies from Pakistan (n = 4), Bangladesh (n = 2), Malaysia (n = 1), Indonesia (n = 1), Iraq (n = 1), Iran (n = 1), Nigeria (n = 1), and Egypt (n = 1). These studies indicated an overall lack of adherence to the guidelines. However, the level of nonadherence was particularly high in Pakistan. Effective suicide prevention programs may help in promoting responsible reporting of suicide.

Trust in higher guidance and suicidality in Afghan students under the Taliban regime{fr}(Confianza en la orientación superior y suicidalidad en estudiantes afganos bajo el régimen Talibán)

Background/Objective

After years of war, political instability and natural catastrophes high rates of PTSD and depression have been found in the Afghan population. On this background, it was investigated whether religious beliefs (trust in higher guidance; TIHG) moderated the association between PTSD symptoms and/or depression and suicidal ideation.

Method

A total of 279 Afghan university students (61.6% women; aged 18 to 30 years) took part in this cross-sectional study between July and November 2022. Self-report measures of PTSD, depression, suicidal ideation, trust in higher guidance were used.

Results

Severe PTSD symptoms were reported by 58.4%, clinically relevant depression symptoms were reported by 55.2% and current suicidal ideation was reported by 44.4% of the sample. TIHG moderated the impact of PTSD symptoms, on suicidal ideation. TIHG and depression were unrelated.

Conclusion

PTSD symptoms, depression and suicidal ideation show an alarmingly high prevalence in this specific sample of Afghan students. TIHG seems to be a resilience factor of special importance.

Analysis of Newspaper Reporting of Non-fatal Suicide Attempts During the Covid-19 Lockdown in Pakistan

Background: This study was aimed to observe newspaper reports about non-fatal suicide attempts in Pakistan during the COVID-19 lockdown. Methods: We performed content analysis of news reports about incomplete suicides from four vernacular newspapers of Pakistan between March and August 2020. Results: A total of 87 news reports about suicide attempts were examined; the vast majority of the suicide attempters was Muslims (78%), males (64%), females (36%) with (33%) mentions of age, ranging from 19-30 years, and married were (76%). However, occupation was largely missing from (93%) of the news. Self-poisoning was the commonly reported method in (65%) of suicide attempts, whereas familial discord was the leading risk factor for (72%) of suicide attempts. Conclusions: Although psychological intervention is crucial to reduce familial discords as risk factors, monitoring the mental health conditions of people vulnerable to suicide and the figures on attempted suicides should be maintained and collected nationally and regionally.

Trends of completed suicide rates among Malaysian elderly between 1995 and 2020

BACKGROUND

Suicide among the elderly has become a global public health concern. This study was carried out to determine the trend of completed suicide rates according to age, sex, and ethnicity and the suicidal methods among the elderly in Malaysia.

METHODS

All suicide-related deaths in elderly aged 60 years and above from the Year 1995 to 2020 reported to the National Registration Department (NRD) were analyzed. Causes of death for suicide were coded based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). The completed suicide rate was calculated by dividing the completed suicide number by the total elderly population for the respective year.

RESULTS

Overall, the analysis of 1,600 suicide-related deaths was investigated over 26 years. Male was seen to be correlated with higher suicidal risk, with a male-female relative risk (RR) = 1.89 (95%CI:1.46,2.45). The risk of suicide was also found to be significantly higher for those aged 60 to 74 years old and Chinese, with RR = 4.26 (95%CI:2.94, 6.18) and RR = 5.81 (95%CI: 3.70, 9.12), respectively. Hanging was found to be a statistically significant suicide method (IRR:4.76, 95%CI:2.34,9.65) as compared to pesticide poisoning. The completed suicide rate was fluctuating over the years.

CONCLUSIONS

In conclusion, it is believed that Malaysia's elderly suicide rate has reached an alarmingly high incidence. By identifying the crucial criteria of sociodemographic factors, the government and responsible agencies have the essential and additional information to put together a more effective strategy and approach to overcome the issue in the future.

Evaluation of psychometric properties of the Persian version of the predicaments questionnaire, exploring social attitudes to suicide

Background

Due to the growing prevalence of suicide, assessing people's attitudes toward suicide is necessary. Therefore, this study aimed to examine the psychometric properties of the Persian version of the Predicaments Questionnaire (PQ), measuring social attitudes toward suicide.

Methods

This psychometrics study evaluated face validity, content validity, temporal stability, internal consistency, and construct validity. First, the questionnaire was translated into Persian by the translate-back-translate method. The Persian version was provided to 10 experts in psychiatry for further revision. Two indicators, CVR and CVI, were calculated to evaluate the content validity. To check the face validity, we prepared a form and gave it to 10 people outside the campus to submit their opinions. Temporal stability was investigated by the test-retest method, reporting Intraclass correlation (ICC). Internal consistency was assessed by reporting Cronbach's alpha and McDonald's Omega coefficients. Construct validity was assessed using the confirmatory factor analysis to determine the number of dimensions of the questionnaire.

Results

A total of 151 students were enrolled with a mean age of 25 (SD = 0.32). The Persian PQ was valid in terms of content validity and face validity. Furthermore, it was reliable as Cronbach's alpha, McDonald's Omega, and the ICC were 0.94, 0.943, and 0.998, respectively. In addition, the confirmatory factor analysis yielded one dimension. Finally, after reviewing the experts' comments, the final amendments were made, and only question 29 was removed from the final version.

Conclusion

Consequently, the Persian version of the PQ is acceptable in terms of content validity, face validity, temporal stability, and internal consistency.

Suicidal behavior in a migrant majority population and impact on trends during the early Covid-19 period: a cross sectional study in Qatar

Background

Qatar is a high-income country with 90% of the population being economic migrants from low income countries. Due to this unique population composition, it has been suggested that Qatar may not follow suicide trends of high-income countries. Additionally, there is paucity of information on suicidal trends and rates due to social and cultural reasons. The Covid-19 pandemic has additionally impacted mental health of migrants differently form native Qataris.

Objectives

This study explores suicidal behavior trends among individuals attending the main Emergency Department in the state of Qatar for mental health emergencies. The study also compared these trends for pre-pandemic period to early post pandemic period.

Methods

A cross-sectional study of individuals attending the main emergency department of the country from 1st December 2019 to 30th June 2020 was carried out using a composite data collection form. This identified 799 individuals presenting with mental health emergencies. Suicidal behaviors, relevant sociodemographic data, along with factors known to be associated with suicidal behaviors were collected for this group.

Results

24.9% (n = 199) of the sample presented with suicidal behaviors. Younger age (31.16 ± 9.497), current hopelessness (70; 54.7%), history of suicidal thoughts (50; 47.2%), history of suicidal attempts (43; 34.7%), history of self-harm thoughts (35; 39.3%), history of self-harm attempts (41; 37.6%) were highly significantly associated with suicidal behavior (p < 0.01). Qataris formed 27% of the group presenting with suicidal behaviors although they constitute only around 10% of the population. There was no significant change in the rate of presenting with suicidal behaviors during the early stages of the Covid-19 pandemic.

Conclusions

This study reports an annual incidence of suicidal behaviors in Qatar lower than that has been previously reported. The authors surmise that this may be due to improved availability and early intervention of mental health services and decreased stigma around mental health.

Rate and Associated Factors of Suicidal Behavior among Adolescents in Bangladesh and Indonesia: Global School-Based Student Health Survey Data Analysis

OBJECTIVE

Suicidal behavior among adolescents is a major public health problem that is understudied in South East Asian Muslim-majority countries. We aimed to investigate the rate and associated factors of suicidal behavior among adolescents in Bangladesh and Indonesia.

METHODS

The Global School-based Student Health Survey data of Bangladesh and Indonesia were used in this study. The data consist of a total of 9052 school-aged students from Bangladesh (2570, 28.4%) and Indonesia (6482, 71.6%). Suicidal behavior was assessed using three questions that measure suicidal ideation, suicidal plan, and suicidal attempts.

RESULTS

The overall rate of suicidal behavior (suicidal ideation, suicidal plan, and suicidal attempts) was 8.8%, and no significant difference between the two countries (8.9% in Bangladesh and 8.7 in Indonesia) was observed (p=0.81). Factors that independently increased the likelihood of suicidal behavior include female gender, missed class, physical fight four times or more, experienced bullying, anxiety, loneliness, rarely eating fruit, current alcohol use, and sedentary behavior (p < 0.05). Meanwhile, factors that independently decreased the likelihood of suicidal behavior include parental supervision and having close friends, either one, two, three persons, or more (p < 0.05).

CONCLUSION

The study revealed rates and risk factors of suicidal behaviors among the school-going adolescents of two Muslim-majority countries in South East Asia. Prevention strategies should be considered guided by the risk factors for school-going adolescents.

Mental health and suicidality in Afghan students after the Taliban takeover in 2021

BACKGROUND

On the 15th of August 2021, Kabul was captured by the Taliban, leading to the fall of the Islamic Republic of Afghanistan. The present study investigated PTSD symptoms, depression, suicide risk and facets of positive mental health in the immediate aftermath of the Taliban take-over.

METHODS

A total of 214 Afghan university students (73.7% women; age in years: M(SD) = 23.92 (5.77)) took part in this cross-sectional study between August and November 2021. Self-report measures of PTSD, depression, suicide ideation/behavior, positive mental health, social support, and posttraumatic growth were used.

RESULTS

Severe posttraumatic stress disorders symptoms were reported by 70%, clinically relevant depression symptoms were reported by 69.7% and significant suicide ideation/behavior was reported by 38.6% of the sample. Posttraumatic growth moderated the impact of depression on suicide risk. No interaction effects were found for positive mental health and social support.

LIMITATION

The study focused on a specific group of highly educated and predominantly female Afghan students limiting the generalizability of the findings.

CONCLUSION

PTSD symptoms, depression and suicidality show an alarmingly high prevalence in this specific sample of Afghan students. Various protective factors seem to be insufficient to buffer the association between PTSD, depression and suicide risk.

Self-reported sleep and exercise patterns in patients admitted with suicidal attempts: a cross-sectional comparative study

BACKGROUND

There is evidence that sleep disturbances and exercise are risk factors for suicide attempts; however, whether sleep disturbances are independently associated with suicide attempts is debatable. We compared the sleep and exercise patterns of individuals who attempted suicide to those of the general population and investigated whether sleep disturbances were independently associated with suicide attempts.

METHODS

Over a year, individuals presented to the emergency department at Hamad General Hospital and Mental Health Services in Doha with suicide attempts (n = 127) filled out questionnaires on sleep and exercise, demographics, and clinical measures. A control group (n = 126) from two primary care centers filled out the same questionnaires during the same period.

RESULTS

Subjects in the suicide group were significantly younger, single, had a lower level of education, and showed considerably more early insomnia, daytime tiredness, interrupted sleep, and no regular exercise. The most common diagnoses seen with suicidality were adjustment disorder and major depression, and the most common method used to attempt suicide was an overdose. After multiple regression analysis, being Arab, belonging to the category "other nationalities," unemployment, and early insomnia were significantly associated with an increased risk of suicide attempts.

CONCLUSION

This is the first comparative study on suicide in the Arabian Gulf. Individuals in Qatar with acute stress, depressive symptoms, sleep disturbances, and lack of exercise are at increased risk of attempting suicide. Thus, clinicians need to routinely screen for sleep and physical activity because of their significant contribution to physical and mental well-being.

An analysis of age-standardized suicide rates in Muslim-majority countries in 2000-2019

BACKGROUND

This study examines the 20-year trend of suicide in 46 Muslim-majority countries throughout the world and compares their suicide rates and trends with the global average. Ecological-level associations between the proportion of the Muslim population, the age-standardized suicide rates, male-to-female suicide rate ratio, and the Human Development Index (HDI) in 2019 were examined.

METHODS

Age-standardized suicide rates were extracted from the WHO Global Health Estimates database for the period between 2000 and 2019. The rates in each country were compared with the age-standardized global average during the past 20 years. The countries were further grouped according to their regions/sub-regions to calculate the regional and sub-regional weighted age-standardized suicide rates involving Muslim-majority countries. Correlation analyses were conducted between the proportion of Muslims, age-standardized suicide rate, male: female suicide rate ratio, and the HDI in all countries. Joinpoint regression was used to analyze the age-standardized suicide rates in 2000-2019.

RESULTS

The 46 countries retained for analysis included an estimated 1.39 billion Muslims from a total worldwide Muslim population of 1.57 billion. Of these countries, eleven (23.9%) had an age-standardized suicide rate above the global average in 2019. In terms of regional/sub-regional suicide rates, Muslim-majority countries in the Sub-Saharan region recorded the highest weighted average age-standardized suicide rate of 10.02/100,000 population, and Southeastern Asia recorded the lowest rate (2.58/100,000 population). There were significant correlations between the Muslim population proportion and male-to-female rate ratios (r=-0.324, p=0.028), HDI index and age-standardized suicide rates (r=-0.506, p<0.001), and HDI index and male-to-female rate ratios (r=0.503, p<0.001) in 2019. Joinpoint analysis revealed that seven Muslim-majority countries (15.2%) recorded an increase in the average annual percentage change regarding age-standardized suicide rates during 2000-2019.

CONCLUSIONS

Most Muslim-majority countries had lower age-standardized suicide rates than the global average, which might reflect religious belief and practice or due to Muslim laws in their judicial and social structure which may lead to underreporting. This finding needs further in-depth country and region-specific study with regard to its implication for public policy.

Quality of media reporting of suicide in Iraq

BACKGROUND

Mass media has an important role in influencing the suicidal behavior of the general population. However, the quality of news reporting of suicide has not been assessed in Iraq.

AIM

We aimed to assess the quality of news reports in Iraq while reporting the suicidal behaviors.

METHODS

The search was done on Google in November and December 2020 with the search term 'suicide news in Iraq' and accessible news reports distributed in Kurdish, Arabic, and English languages were taken out. We scrutinized the news reports to identify the reporting characteristics and compared them with the World Health Organization (WHO) guidelines.

RESULTS

A total of 130 news reports were analyzed; among them 23.8% were Kurdish, 63.8% were Arabic, and 12.3% were in the English language. About 31.5% of the reports mentioned the name and 40.8% mentioned the occupation. The name of method was mentioned in 88.5%, mono-causality was found in about 34.6%, the term 'suicide' was mentioned in the headline in 94.6%, and method of suicide was mentioned in the headline of about 27.7% of the reports. Only 5.4% of the reports traced mental illness, 6.9% mentioned expert opinion, and none of the reports mentioned prevention program, and educative information.

CONCLUSION

The study revealed that news reports of suicidal behavior in Iraq are poorly adherent to the WHO reporting guidelines. Further studies are warranted to identify the responsible factors and culture-specific prevention strategies.

The Psychological Impacts of COVID-19 Pandemic among Emerging Adults: An Observational Cross-Sectional Study

(1) Background: COVID-19 has had psychological impacts, particularly anxiety, depression, anger, and suicidal ideation, on the world’s populace, including young persons who were prone to mental health disorders even before the pandemic. We described the psychological impacts of COVID-19 among emerging adults aged 18–30 years in Saudi Arabia. (2) Methods: A cross-sectional survey was done among a randomly sampled population in Saudi Arabia between July 2020 and May 2021 using the DSM-5 Self-rated Level 1 Cross-Cutting Symptom Measure and Ask Suicide Questionnaire. Logistic regression was used to assess participant characteristics associated with reporting symptoms of mental disorders under each of the 13 domains that would warrant further investigation. (3) Results: Approximately, 91% of participants experienced different mental health symptoms; these participants are more likely to be young, female students, those who had a history of being diagnosed with a mental disorder, and those diagnosed or treated for COVID-19. (4) Conclusion: This study strongly showed an increased prevalence of mental health symptoms among young persons during the COVID-19 pandemic. Addressing the mental health burden among young persons in time using simple, self-administered screening tools linked to interventions will prevent dire consequences in the future.

Religion and Suicide among Chinese Rural Youths

In this research we used data collected with psychological autopsy method to compare 392 suicides with 416 living controls among adolescents and young adults in rural China. Informants were asked whether the subjects in the study believed in a religion (and which religion) and whether they believed in a life after death. For the suicides, 7.8% believed in a religion compared to 5.8% of the living controls. For the suicides, 11.2% believed in a life after death compared to 8.4% of the controls. Suicide was predicted by the presence of a mental illness, a history of suicide in the family, poor social support, low status (power) in the family, and less education. Belief in a life after death did not contribute to the prediction of suicide in men or in women, but belief in a religion did predict suicide for the men. The relatively uncommon belief in a religion meant that the impact of Christianity versus Buddhism is less likely to be studied. Suggestions were made for future research.

Centering decriminalization of suicide in low - and middle - income countries on effective suicide prevention strategies

Globally, over 800,000 people die by suicide every year. For every one completed suicide, 20 more attempts have been made. As previous attempts are one of the strongest predictors of future suicide, help-seeking in moments of crisis, particularly after an attempt, may have important implications for suicide prevention. Unfortunately, the criminalization of suicide in several countries hinders help-seeking, increases the stigmatization of those who attempt suicide and obstructs the accurate tracking of suicides. Here, we highlight the negative effects of suicide criminalization and discuss evidence-based strategies for suicide prevention such as means restriction, improved mental health literacy and access to psychosocial support, and responsible media coverage of suicides.

Attitude Towards Suicide and Help-Seeking Behavior Among Medical Undergraduates in a Malaysian University

OBJECTIVE

The attitude of medical personnel towards suicide may influence the outcome of suicidal-patients management. This study aimed to determine the attitudes of medical undergraduates towards suicide and its association with their help-seeking behavior.

METHODS

A cross-sectional study involving 290 medical undergraduates was conducted in a Malaysian university. The questionnaires on the attitude towards suicide and general help-seeking behavior were used as research instruments.

RESULTS

The mean age of the participants was 22.4 years. Participants who did psychiatry posting indicated a greater tendency to agree on suicide as a way of communication (p = 0.008) than those who did not. Participants previously diagnosed with a psychiatric illness indicated a greater ability to understand and accept suicide (p < 0.001) as well as a greater tendency to agree on the normality of suicide (p = 0.019) than those without a previous diagnosis. Those who attended a suicide prevention program also indicated a greater tendency to agree that loneliness and avoidance could be triggers to suicide (p = 0.037) than those who did not. No correlation was found between the "attitude towards suicide" and "general help-seeking behavior" variable.

CONCLUSION

Education programs in suicide prevention and management need to be incorporated early into the undergraduate medical curriculum to cultivate a more positive attitude towards suicide and help-seeking behavior.

Psychological autopsy study and risk factors for suicide in Muslim countries

BACKGROUND

Suicide and risk factors have been poorly studied in the Muslim-majority countries that hinder the formulation of prevention strategies and affect suicide prevention eventually.

OBJECTIVES

We aimed at identifying and analyzing the psychological autopsy studies assessing the risk factors for suicide conducted in Muslim-majority countries.

METHODS

We did a search to trace all the available psychological autopsy studies in the Muslim countries with the search term "psychological autopsy study in Muslim countries." We also checked the available bibliographies to identify the psychological autopsy studies in the Muslim countries so that all the possible studies could be included.

RESULTS

Out of the Muslim countries, only eight psychological autopsy studies were identified in five countries (Bangladesh [1], Indonesia [1], Iran [1], Pakistan [2], and Turkey [3]). Six studies adopted a case-control study design, and all were carried out in urban settings. The prevalence of psychiatric disorders among case-control studies varied from 52.8% in Turkey to 96% in Pakistan. Psychiatric illness, self-harm, and stressful life events were the commonly replicated risk factors for suicide across studies.

CONCLUSIONS

Psychological autopsy studies have been conducted only in five Muslim countries revealing that the risk factor for suicide is certainly under-researched in the incumbent countries. This review identified a similar list of risk factors for suicide, namely, psychiatric disorder, past non-fatal attempts, and adverse life events compared to the Western countries even though the rate varies.

Cultural and interpersonal risk factors for suicide ideation and suicide attempts among Muslim college students from 11 nations

BACKGROUND

Research on suicidality in low to middle-income countries is scarce. We addressed this issue by investigating suicidality in a cross-national college student samples from 11 predominantly low to middle-income majority Muslim countries.

METHODS

The sample consisted of 7427 college students (56% female) who reported to be affiliated with Islam. Data on self-construal, social support, negative life-events, acceptability of suicide, suicidal ideation, and suicide attempts were collected with self-administered questionnaires.

RESULTS

Acceptability of suicide and the experience of negative life-events were positively, and perceived social support was negatively associated with suicidal ideation. Interdependent self-construal was negatively related to the acceptability of suicide and positively associated with perceived social support, implying a negative indirect effect on suicidal ideation although its direct effect was positive. The number of negative life-events was the strongest positive predictor of ever attempting suicide. The interdependent self-construal moderated the association of negative life-events with suicide attempts.

LIMITATIONS

Cross-sectional and self-report nature of the study were its major limitations. Participants may have suppressed their responses about suicide because of religious and legal reasons.

CONCLUSION

Remarkable similarities across 11 country samples emerged in the linkages between cultural and interpersonal factors with suicidality. Our findings highlight the value of a nuanced approach to suicidality, that can recognize the differences in the processes associated with suicidal ideation and suicide attempts, as well as the need to consider the interplay of a broad range of personal, interpersonal, and cultural influences.

Attempted suicide and suicide of young Turkish women in Europe and Turkey: A systematic literature review of characteristics and precipitating factors

BACKGROUND

The increased risk of suicidal behaviour among Turkish women living in Europe and Turkey is a serious public health problem. This study compares and synthesises the empirical evidence of demographic, social, psychological and interpersonal characteristics and precipitating factors in the suicides and attempted suicides of Turkish women in Europe and Turkey.

METHODS

We systematically searched eight databases (PsycINFO, PubMed, Med Line, Web of Science, Smart Cat, Safety Lit, BASE and Ulakbim), using search terms in English, Turkish, German and Dutch, as well as the reference lists of the retrieved papers. We extracted data on countries/regions, population characteristics, sample characteristics, recruitment, method of data collection, type of suicidal behaviour (suicide or attempted suicide) and precipitating factors and characteristics. The results were qualitatively synthesised.

RESULTS

We retrieved nine studies on attempted suicide in Europe (from Germany, Switzerland and the Netherlands), 17 studies on attempted suicide in Turkey and 10 studies on suicide in Turkey (36 in total). Overall, we found similar precipitating factors and characteristics of attempted suicide and suicide in Turkey and Europe, including socio-demographic factors (young age and not being enrolled in the labour market), poverty and, to some extent, mental illness. Moreover, conflicts with family or spouses and violence against women, including so-called honour violence, were particularly common for women living in or originating from traditional areas in Turkey.

CONCLUSION

The framework of intersectionality is relevant to understanding our results, because structural inequalities in gender roles, gender role expectations as well as power imbalances among socio-economic classes collectively impact the suicidal behaviour of Turkish women. Moreover, the importance of violence against women points to the cultural continuity of the patriarchal and oppressive structures of Europe and Turkey. Suicide prevention efforts should address cultural attitudes underlying violence against women and girls through community education programmes, cultural and gender-sensitive care provision and jurisdiction.

A longitudinal study of suicide and suicide attempt in northwest of Iran: incidence, predictors, and socioeconomic status and the role of sociocultural status

Background

A detailed community-level understanding of socioeconomic status (SES) and sociocultural status (SCS) of suicides and suicide attempters (SAs) in a prospective design could have significant implications for policymakers at the local prevention and treatment levels. The effect of SCS and SES on SAs is poorly understood and investigated in Iran. The present study aimed to investigate the incidence, trend, and role of SES and SCS on suicide and SAs.

Methods

A longitudinal study was conducted based on the registry for SAs in Malekan County, Iran, from 2015 to 2018. Demographic characteristics, SES, SCS, incidence rates, and predictors of suicidal behaviors were measured via structured instruments. Simple and multiple logistic regressions were used to estimate crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 853 SAs (32 suicides and 821 attempts) were identified during the study. Trend analysis revealed that the suicide rate significantly decreased from 2014 (10.28) to 2018 (1.75) per 100,000. In the final multiple variable models, age (26–40), male sex, unemployment, antisocial activities, history of SA, hanging method, and season (spring) increased the suicide risk while religious commitment had protective effects on suicide.

Conclusions

Our findings indicated that demographic characteristics, low SES, and SCS are associated with suicide. In this county, trend of suicide and SA were decreased from 2014 to 2018. This study findings highlight the need to consider a wide range of contextual variables, socio-demographic, SES, and SCS in suicide prevention strategies. Improving inter-sectoral collaborations and policymakers’ attitudes are imperative for SA reduction.

The stigmatization of suicide: A study of stories told by college students in China

This study unpacks the dimensions of suicide stigma through an analysis of the stories told by college students in China. The phronetic iterative approach was used to analyze the interview data of 30 college students. Findings showed that college students use the strategy of othering in creating a distinction between us and them. Those who attempt or die by suicide are labeled as irresponsible, fragile, impulsive, and attention-seeking. Suicides of ingroup members are usually described as controllable, while the suicides of outgroup members are often deemed uncontrollable. Finally, suicides lead to a status loss for individuals and their social groups.

When Friends Bring You Down: Peer Stress Proliferation and Suicidality

Peers play a significant role in adolescent mental well-being and suicidality. While social integration among peers is often assumed to benefit mental health, a growing literature recognizes that peer relationships can increase suicidality. Conceptualizing friends' disclosure of mental distress as a stressor on teens' own mental health clarifies how distressed peers relate to suicidal ideation given integration in key social contexts, such as school. This study applies the stress process to examine peer depression and self-harm disclosure as stressors predicting teens' suicidal ideation. Using cross-sectional data from an understudied context, youth in Saudi Arabia (n = 545, 50% female, mean age = 16.8), models find friends' disclosure of depression and self-harm are associated with adolescents' higher suicidal ideation net of their own depression. Teens who are more attached to school see higher risk of suicidality from friends' depression, while friends' self-harm predicts higher suicidality overall. Results challenge assumptions of uniformly beneficial social integration by indicating that friends' mental distress, particularly self-harm, can act as a stressor increasing youth suicidality.

Epidemiology of suicide attempts and deaths: a population-based study in Fars, Iran (2011-16)

BACKGROUND

Suicide is a critical psychological issue worldwide with an increasing trend. This study investigated suicide comprehensively.

METHODS

In this cross-sectional study, we reviewed data of 28 552 suicide attempts during 2011-16, in Southern Iran. To calculate age-standardized incidence rates, population statistics were derived from the Statistical Center of Iran and the National Organization for Civil Registration. We used the standard population of World Health Organization 2012 to adjust the suicide attempts and deaths rates by age.

RESULTS

The mean age of participants was 26.8 ± 10.6 years with the highest suicide attempts rates in the age groups of 15-24 and 25-34 years (48% and 32.5%, respectively); 58.7% were women and 52.9% were single. Case-fatality rate (CFR) was 6.27%. Annual age-standardized incidence rates of suicide attempts during the 6-year period has increased (P < 0.001), and that of deaths were not incremental (P > 0.05). Logistic regression model showed male sex, rural area, older age, psychological and somatic disorders, and family history of suicide as significant factors.

CONCLUSIONS

In this comprehensive study, although the age-standardized mortality rate of suicide in southern Iran was lower than in other countries, the increasing trend of suicide attempts during the study period served as an alarming sign in this province.

Suicide by poisoning in Pakistan: review of regional trends, toxicity and management of commonly used agents in the past three decades

BACKGROUND

Suicide is one of the leading mental health crises and takes one life every 40 seconds. Four out of every five suicides occur in low- and middle-income countries. Despite religion being a protective factor against suicide, the estimated number of suicides is rapidly increasing in Pakistan.

AIMS

Our review focuses on the trends of suicide and means of self-poisoning in the past three decades, and the management of commonly used poisons.

METHOD

We searched two electronic databases (PubMed and PakMediNet) for published English-language studies describing agents used for suicide in different regions of Pakistan. A total of 46 out of 85 papers (N = 54 747 cases) met our inclusion criteria.

RESULTS

Suicidal behaviour was more common among individuals younger than 30 years. Females comprised 60% of those who attempted suicide in our study sample, although the ratio of completed suicides favoured males. There were regional trends in the choice of agent for overdose. Organophosphate poisoning was reported across the nation, with a predominance of cases from the agricultural belt of South Punjab and interior Sindh. Aluminium phosphide ('wheat pills') was a preferred agent in North Punjab, whereas paraphenylenediamine ('kala pathar') was implicated in deaths by suicide from South Punjab. Urban areas had other means for suicide, including household chemicals, benzodiazepines, kerosene oil and rat poison.

CONCLUSIONS

Urgent steps are needed, including psychoeducational campaigns on mental health and suicide, staff training, medical resources for prompt treatment of self-poisoning and updated governmental policy to regulate pesticide sales.

Psychosocial and Clinical Profiles of the Cases Visiting the Emergency Department Due to Accidental Self-harm and Suicide Attempts in Doha, Qatar: A Retrospective Study

The aims of this study were to retrospectively assess the profiles of subjects with suicide attempts and self-harm in Doha, Qatar; and whether the available data were complete. We reviewed all the records of fatal and non-fatal suicides together with accidental self-ham cases seen in the major Emergency Department in Doha, over a one-year period. There was 37 completed suicide, mostly male expatriates in mid 30 s who died by hanging. In cases with suicide intent (N = 270), more males were admitted to Psychiatry than women. Overdose was the common method and the majority had mood disorders. In self-harm cases with no suicide intent (N = 150) the majority were not seen by Psychiatry. The profiles of suicide cases in Qatar are similar to those reported internationally. However, there is a major need to establish a comprehensive system to register and assess all self-harm patients in Qatar.

Time Trends and Predictions of Suicide Mortality for People Aged 70 Years and Over From 1990 to 2030 Based on the Global Burden of Disease Study 2017

Background: High suicide rate in the elderly is an important global public health problem but has not received the attention it deserves. This study aimed to examine time trends of suicide mortality for people aged 70 years and over by sex, age, and location from 1990 to 2017, and to provide predictions up to 2030. Methods: Using data from the Global Burden of Disease study 2017, we presented elderly suicide mortality changes and compared the patterns for the elderly with that for all ages. We estimated associations between socio-demographic index (SDI) and suicide mortality rates using a restricted cubic spline smoother, and predicted suicide mortality rates up to 2030. Results: In 2017, 118,813 people aged 70 years and over died from suicide, indicating a mortality rate of 27.5 per 100,000, with the highest rates in Eastern Sub-Saharan Africa, Western Sub-Saharan Africa, and Central Sub-Saharan Africa, and for countries and territories, the highest were in South Korea, Zimbabwe, Lesotho, Mozambique, and Senegal. Between 1990 and 2017, suicide mortality rate for the elderly aged 70 years and over decreased globally (percentage change -29.1%), and the largest decreases occurred in East Asia, Southern Latin America, and Western Europe. Nationally, the largest decrease was found in Chile, followed by Czech Republic, Hungary, Turkey, and Philippines. For most countries, the elderly mortality rate was higher than the age-standardized rate, with the largest percentage differences in China and countries in Sub-Saharan Africa. The elderly suicide mortality rate decreased as SDI increased, except for a slight rebound at mid to high SDI. According to projections, 10 out of 195 countries were expected to meet the SDGs indicator of a third reduction by 2030. Conclusions: Variability in suicide mortality rates for the elderly aged 70 years and over by sex, age, region, country, and SDI can guide preventive policies, but causes of the variability need further study. Comprehensive strategies should be adopted to reduce suicide rates and close the gap to the 2030 SDGs.

Looking Into Recent Suicide Rates and Trends in Malaysia: A Comparative Analysis

Background: Suicide is a preventable cause of death. Examining suicide rates and trends are important in shaping national suicide prevention strategies. Therefore, the objectives of this study were to analyze age-standardized suicide trends of Malaysia between 2000 and 2019 using the WHO Global Health Estimates data, and to compare the 2019 rate with countries from the Association of South-East Asian Nations (ASEAN), Muslim majority countries, and the Group of Seven (G7). Methods: The age-standardized suicide rates data were extracted from the WHO Global Health Estimates. We calculated the average age-standardized suicide rates of the last 3 years from 2017 to 2019. Joinpoint regression analysis was conducted to calculate the average annual percentage change (APC) of the age-standardized suicide rates in Malaysia from 2000 to 2019. Results: Between 2000 and 2019, the minimum and maximum suicide rates for both sexes in Malaysia were 4.9 and 6.1 per 100,000 population respectively, whilst the past 3-year (2017-2019) average rates were 5.6, 8.8, and 2.4 for both sexes, males, and females, respectively. The suicide rates decreased significantly for both sexes between 2000 and 2013. Between 2014 and 2019, the suicide rates increased significantly for males. In 2019, Malaysia recorded the rate of 5.8 per 100,000 population, with an estimated 1,841 suicide deaths, i.e., ~5 deaths per day. The Malaysian suicide rate was the second highest amongst selected Muslim majority countries, in the middle range amongst ASEAN countries, and lower than all G7 countries except Italy. Conclusions: There is a need to further explore factors contributing to the higher suicide rates among Malaysian males. In light of the rising suicide rates in Malaysia, national mental health and suicide prevention initiatives are discussed and the importance of high-quality suicide surveillance data is emphasized.

Mental disorders, suicide attempt and suicide: differences in the association in refugees compared with Swedish-born individuals

BACKGROUND

Mental disorders are associated with an elevated risk for suicide attempt and suicide. Whether the strength of the associations also holds for refugees is unclear.

AIMS

To examine the relationship between specific mental disorders and suicide attempt and suicide in refugees and Swedish-born individuals.

METHOD

This longitudinal cohort study included 5 083 447 individuals aged 16-64 years, residing in Sweden in 2004, where 196 757 were refugees. Mental disorders were defined as having a diagnosis in psychiatric care during 2000-2004. Estimates of risk of suicide attempt and suicide were calculated as hazard ratios with 95% confidence intervals. Adjustments were made for important confounding factors, including history of attempt. The reference group comprised Swedish-born individuals without mental disorders.

RESULTS

Rates for suicide attempt in individuals with a mental disorder were lower in refugees compared with Swedish-born individuals (480 v. 850 per 100 000 person-years, respectively). This pattern was true for most specific disorders: compared with the reference group, among refugees, multivariable-adjusted hazard ratios for suicide attempt ranged from 3.0 (anxiety) to 7.4 (substance misuse), and among Swedish-born individuals, from 4.9 (stress-related disorder) to 9.3 (substance misuse). For schizophrenia, bipolar disorder and personality disorder, estimates for suicide attempt were comparable between refugees and Swedish-born individuals. Similar patterns were seen for suicide.

CONCLUSIONS

For most mental disorders, refugees were less likely to be admitted to hospital for suicide attempt or die by suicide compared with Swedish-born individuals. Further research on risk and protective factors for suicide attempt and suicide among refugees with mental disorders is warranted.

DECLARATION OF INTEREST

None.

Domestic Violence as a Risk Factor for Attempted Suicide in Married Women

High rates of suicide attempts and domestic violence (DV) in women of reproductive age group have been reported from South India, but the association between them was not studied. Hence, this study was undertaken to assess whether DV is a risk factor for attempted suicide in married women of reproductive age group. A hospital-based case-control study with 77 incident cases of attempted suicide in married women of the age group of 18 to 45 years and 153 controls belonging to the same age group, without history of suicide attempt, was undertaken over a period of 6 months. Univariate and multivariate analyses were done. The crude odds ratio (cOR) for DV was found to be 6.15 (95% confidence interval [95% CI] = [2.95, 12.82], p value = .0001). Other statistically significant risk factors included younger age group (below 30 years); gross family income > Rs. 5,000; higher occupational status of spouse; having poor social support; having a family history of psychiatric disorders, substance use disorders, and suicide/suicide attempt; higher impulsiveness scores; having higher scores of stressful life events over the past 12 months, and alcohol use disorder in husband. Islamic faith was found to be a significant protective factor. On logistic regression, DV was found to be an independent risk factor for attempted suicide in this study population (adjusted OR = 3.79, 95% CI = [1.35, 10.62], p value = .011). Age groups, stressful life events, impulsiveness, and alcohol use disorder in husband were the confounders adjusted for in logistic regression along with other significant risk and protective factors. Significant dose-response relationship was also observed between DV and attempted suicide. In accordance with the stress-diathesis model for suicidal behavior, DV is found to be a stressor which precipitates suicide attempt in those with diathesis like family history of psychiatric disorders. Clinical, research, and policy implications of the findings are discussed.

Masculinity and Suicide in Bangladesh

Suicide is a serious but under-researched public health problem in Bangladesh. In light of this, we sought to explore the association between masculinities and suicide. We interviewed 20 family members/friends of men who died by suicide across 12 rural areas of the Jhenaidah district, Bangladesh. We found that male suicide was attributed to men's inability to fulfil hegemonic masculine demands such as financial provision and meeting the sexual needs of their spouses. Suicide was also linked to men's loss of self-respect and respect from others. Some participants mentioned that men committed suicide as an act of self-sacrifice, while others cited mental and physical illness. As a result of these findings, we propose that addressing socio-cultural and religious issues associated with men's troubles may help to prevent suicide. At the same time, changing the restrictive gender roles and masculinity-related ideals is also needed to counter the problem.

Suicidal Behavior in the Mediterranean Countries

Introduction:

Suicidal behavior is a serious public health problem worldwide and shows large intersocietal variation. This study aimed at comparatively investigating the aspects of suicidal behavior in 22 countries surrounding the Mediterranean Sea.

Methods:

The study was conducted with official data retrieved from several sources. The suicidal mortality data were collected from World Health Organization’s data repository. Descriptive statistics, group comparison, correlational and regression statistical analyses were used to summarize the data.

Results:

The average age standardized suicide rates in the Mediterranean countries are lower than the world average. Except in Morocco, more men kill themselves than women. Suicide rates are lower in Mediterranean Muslim than in Mediterranean Christian countries. Slovenia, France and Croatia have the highest suicide mortality rates. Greatest percentages of suicidal ideation are seen in Croatia, Turkey and Slovenia and the greatest percentages of suicidal attempts are seen in Palestine, Cyprus, Greece and Slovenia. According to the results of the multiple regression analyses, the coefficient of human inequality index was associated with lower both-sex and male suicide rates. Greater percentages of people saying religion is unimportant in daily life in a country were found to be related to higher female suicide rates.

Conclusion:

The findings from the study have shown that the prevalence of suicidal deaths, thoughts and attempts vary between the Mediterranean countries. Lower suicide rates are observed in the Muslim Mediterranean nations than in the Judeo-Christian ones. However, the rates of suicide mortality in non-Arab Muslim nations being comparable to the rates in non-Muslim countries confirm the concerns over mis/underreporting of suicidal behavior in Arab Muslim countries due to religio-cultural stigma attached to suicide. The average suicidal mortality rates are lower in Mediterranean countries than the world average. Generally, more men than women kill themselves. Results from the multivariate analysis revealed that as the level of human inequality increases the rates for both-sex and male suicidal mortality decreases. Religion seem to be protective against female suicides. The study has also shown that more research is needed about suicidal behavior in the Mediterranean countries.

Depressive Feelings in Religious Minorities: Does the Religious Context Matter?

In the present study, the authors examine the extent to which depressive feelings vary across religious denominations and how this relates to the religious context. We apply a multilevel model using data from the sixth (2012) and seventh (2014) wave of the European Social Surveys, comparing 268 regions within 28 European countries. We find that religious minorities report more depressive feelings than non-minorities, except in regions with a majority of Muslims. A higher likelihood to experience discrimination, as well as the higher proportion of migrants within the religious minority groups, explains a substantial part of this mental health disparity.

Suicide-related interpersonal needs of young Iranian people: A preliminary validation of thwarted belongingness and perceived burdensomeness constructs

The aim of the current study was to validate the Interpersonal Needs Questionnaire (INQ-15) and to test its reliability in Persian-speaking Iranian undergraduate students. In this cross-sectional study, 485 undergraduate students (age: 20.66 ± 1.42, 60% female) were assessed on the two subscales of perceived burdensomeness (PB) and thwarted belongingness (TB) and the Suicide Behavior Questionnaire-Revised (SBQ-R). Exploratory structural equation modelling (ESEM) confirmed the construct validity of INQ-14, excluding INQ#9. In addition, INQ#8, articulated in an equivalent Persian phrasing, loaded well on TB. The measurement model tested by confirmatory factor analysis (CFA) suggested INQ#11 to be eliminated, resulting in INQ-13-P to consist of PB and TB-7. The internal consistency and convergent/discriminant validity were established. The concurrent validity of PB was solidly established in terms of past year suicidal ideation (PY-SI) above and beyond anxiety, depression, prior suicidality, and TB-7. The effect of PB on PY-SI was stronger, where prior suicidality had already occurred or the perceived likelihood of future suicide (PLFS) was high. Moreover, TB-7 could only indicate PY-SI, where prior suicidality had already occurred or PLFS was high, albeit when PB was omitted. The interaction term was significant; however, beyond anxiety and depression, the effect of TB-7 on PY-SI was significant where PB was very high (n = 40, 8.25%). Therefore, future studies can utilize INQ-13-P as a valid and reliable instrument in Persian-speaking populations. However, further studies should examine the construct validity of TB and its relationship with suicide ideation in different populations.

Exploring the psychiatric and social risk factors contributing to suicidal behaviors in religious young adults

The religion-suicide relationship is complex, and evidence of the role of religion in suicidal behaviors is inconsistent. This cross-sectional study aims to explore suicidal ideation and attempts among Modern Orthodox Jews and to examine the risk factors for suicidality in the presence of religious practice and affiliation, help-seeking behaviors, and social support. 321 young adults aged 18 to 36 completed self-report questionnaires assessing religious commitment and perception of religion as important, suicidal risk, depression, somatic symptoms, alcohol misuse, social support, and help-seeking patterns. The past 12-month suicide ideation prevalence was 8.7%. 14% of the sample were at risk for suicide. Those at a higher risk for suicide were less involved in religious practices and perceived religion as less important. In addition, depressive symptoms and alcohol misuse at a younger age presented the highest correlation with suicidal risk. The high rate of suicidal ideation among Modern Orthodox young adults highlights their vulnerability in the face of a lack of social support and mental health resources. Due to the limitations inherent in a convenience sampling, i.e., limited generalizability, this study may represent an underestimation of a risk for suicide amongst Modern Orthodox adults.

The Role of Religion in Suicidal Behavior, Attitudes and Psychological Distress Among University Students: A Multinational Study

The purpose of this study was to determine the associations between religion, suicidal behavior, attitudes and psychological distress in 5572 students from 12 countries by means of a self-report questionnaire. Our results showed that an affiliation with Islam was associated with reduced risk for suicide ideation, however affiliating with Orthodox Christianity and no religion was related to increased risk for suicide ideation. While affiliating with Buddhism, Catholic religion and no religion was associated with lowered risk for attempting suicide, affiliation with Islam was related to heightened risk for attempting suicide. Affiliation with Hinduism, Orthodox Christianity, Catholicism, other religions and with no religion was associated with decreased risk for psychological distress but those reported affiliating with Islam evinced greater risk for psychological distress. The associations of the strength of religious belief to suicidal ideation and attempts were in the expected direction for most but had a positive relation in respondents affiliating with Catholicism and other religions. Students reporting affiliation with Islam, the Christian Orthodox religion and Buddhism were the least accepting of suicide but they displayed a more confronting interpersonal style to an imagined peer with a suicidal decision. It was concluded that the protective function of religion in educated segments of populations (university students) and in university students residing in Muslim countries where freedom from religion is restricted or religion is normative and/or compulsory is likely to be limited. Our findings suggest that public policies supporting religious freedom may augment the protective function of religion against suicide and psychological distress.

Mental health, suicidal ideation, and experience of bullying among university students in Pakistan

This study investigates mental health, access to treatment, suicidality, and bullying among Pakistani university students. Data were collected from a sample of 355 university students in Pakistan. For reference, we compared these data to a sample previously collected from German and Chinese students. Results indicated relatively poorer mental health and access to mental health treatments among the Pakistani sample, including a higher rate of recent suicidal ideation and bullying. Acknowledgment of these issues in Pakistani culture would be a good starting point to work on developing solutions to enhance the overall mental health of Pakistani students.

Suicidal Thoughts, Attempts and Motives Among University Students in 12 Muslim-Majority Countries

There is a scarcity of research on suicidal phenomena in the Muslim world. Therefore, this study aimed at investigating the self-reported prevalence of suicidal thoughts, attempts and motives in 12 Muslim countries. A total of 8417 (54.4% women) university students were surveyed by means of a self-report questionnaire. Overall, 22% of the participants reported suicidal ideation and 8.6% reported attempting suicide. The odds of suicidal thoughts were elevated in Azerbaijan, Indonesia and Saudi Arabia, while reduced ORs were recorded in Egypt, Jordan, Lebanon and Malaysia. While odds of suicide attempts were high in Azerbaijan, Palestine and Saudi Arabia reduced odds ratios (OR) were detected in Indonesia, Iran, Jordan, Lebanon, Malaysia and Tunisia. Taking drugs and using a sharp instrument were the two most frequently used methods to attempt suicide. Only 32.7% of attempts required medical attention. Escape motives were endorsed more than social motives by participants who attempted suicide. Suicidal behaviors were more frequent in women than in men. Compered to men, fewer attempts by women required medical attention. Moreover, our results show that making suicide illegal does not reduce the frequency of suicidal behavior. Results from this comparative study show that suicidal thoughts and attempts are frequent events in young adults in countries where religious scripture explicitly prohibit suicide and the frequencies of nonfatal suicidal behavior show large variation in nations adhering to the same religion.

Religion and Suicide: New Findings

Suicide rates and risk and protective factors vary across religions. There has been a significant increase in research in the area of religion and suicide since the article, "Religion and Suicide," reviewed these issues in 2009. This current article provides an updated review of the research since the original article was published. PsycINFO, MEDLINE, SocINDEX, and CINAHL databases were searched for articles on religion and suicide published between 2008 and 2017. Epidemiological data on suicidality and risk and protective factors across religions are explored. Updated general practice guidelines are provided, and areas for future research are identified.

Suicide and Its Legal Implications in Pakistan: A Literature Review

In recent decades, great strides have been made in understanding the science of suicide. Thus, it is imperative that Pakistani legal systems bridge the gap between Pakistani law and science. For instance, recent discoveries in public health, psychology, and neurobiology have shaped the etiological model of suicidal behavior and highlighted the high preponderance of certain psychiatric patients towards suicide. We present here a brief overview of psychiatric evidence implicated in suicides to better inform the Pakistani legal system of advances in the psychiatric literature.