Sociocultural determinants of suicide ideation: a comparison between American and Ghanaian college samples

Suicide attempt management among Turkish and American adolescents: A comparison of two pediatric emergency departments

Background/aim

Suicide is one of the leading causes of death among adolescents. This study aimed to compare the characteristics and short-term outcomes of Turkish and American adolescents with suicide attempts and determine the differences in management and resource utilization between two pediatric emergency departments; one in Türkiye and one in the United States of America.

Materials and methods

Adolescents who presented to the emergency departments with a chief complaint of suicide attempt between October 2017 and September 2018 were eligible for including in the study. Characteristics and other information of 217 (131 American and 86 Turkish) suicide attempter adolescents were retrieved from medical records. Outcome was defined as re-admission to the emergency department for another suicide attempt within 3 months of the index visit.

Results

Overall, 78% of adolescents were female. Abuse history (physical/sexual) was more common among American adolescents (p = 0.005), whereas uncontrolled psychiatric diseases were more evident in Turkish cases (p < 0.001). Social worker assessment and hospitalization rates were significantly lower, with shorter mean duration of follow-up in the emergency department among Turkish compared to American adolescents (respectively, p < 0.001, p < 0.001 and p = 0.002). Repeated suicide attempts within three months were significantly higher in the Turkish group compared to the American one (29% vs. 8%, p < 0.001). Receiving a social worker assessment, hospitalization and longer observation in emergency department reduced the incidence of repeated suicide attempts (respectively, p < 0.001, p = 0.003 and p = 0.012).

Conclusion

Turkish adolescents had shorter observation time in the emergency department, received fewer assessment by social workers and were less likely to be hospitalized. These may have contributed to the higher rate of repeat suicide attempts following discharge from the emergency department. Adequate resources are needed to help decrease the burden of suicide among Turkish adolescents.

Linking suicide and social determinants of health in South Korea: An investigation of structural determinants

Introduction

Studies have shown that suicide is closely related to various social factors. However, due to the restriction in the data scale, our understanding of these social factors is still limited. We propose a conceptual framework for understanding social determinants of suicide at the national level and investigate the relationships between structural determinants (i.e., gender, employment statuses, and occupation) and suicide outcomes (i.e., types of suicide, places of suicide, suicide methods, and warning signs) in South Korea.

Methods

We linked a national-level suicide registry from the Korea Psychological Autopsy Center with the Social Determinants of Health framework proposed by the World Health Organization's Commission on Social Determinants of Health.

Results

First, male and female suicide victims have clear differences in their typical suicide methods (fire vs. drug overdose), primary warning signs (verbal vs. mood), and places of death (suburb vs. home). Second, employees accounted for the largest proportion of murder-suicides (>30%). The proportion of students was much higher for joint suicides than for individual suicides and murder-suicides. Third, among individuals choosing pesticides as their suicide method, over 50% were primary workers. In terms of drug overdoses, professionals and laborers accounted for the largest percentage; the former also constituted the largest proportion in the method of jumping from heights.

Conclusion

A clear connection exists between the investigated structural factors and various suicide outcomes, with gender, social class, and occupation all impacting suicide.

Silent and Lethal: Consequences of Sexual Violence Against Married Women in Ghana

Extant research, mostly in western countries, confirms the consequences of sexual violence against women, but academic scholarship on this topic remains scant for Ghana. This study built on existing research by exploring the consequences of sexual violence against married women in the Eastern Region of Ghana. Data were obtained from in-depth interviews purposely conducted with 15 survivors of sexual violence. The thematic analysis showed that sexual violence was accompanied by physical and emotional abuse. Following sexual violence and abuse, these women experienced physical injuries, psychological problems, sexual and reproductive health problems, and suicidal ideations. These health difficulties significantly undermined their economic activities and depleted their income. Sexual violence clearly affects women's empowerment; campaigns against gender-based violence should make sexual violence a top priority in Ghana and elsewhere.

Suicide Across Buddhism, American Indian-Alaskan Native, and African Traditional Religions, Atheism and Agnosticism: An Updated Systematic Review

Religion can exert a powerful influence on human behavior, including suicide. Research has demonstrated that religiosity can potentially serve as a protective factor against suicidal behavior, but may also, at times, serve as a risk factor. In clinical practice with individuals managing suicidality, a clear understanding of the influence of religion on suicidality is required to effectively assess for risk of suicide. In the 10 years since the article, 'Religion and suicide: Buddhism, American Indian/Alaskan Native (AIAN) and African religions, Atheism, and Agnosticism' (Lizardi and Gearing, J Relig Health 49:377-384, 2010), there has been a significant increase in research advancing our understanding of the nature of this relationship across faiths and beliefs. Consequently, this article provides an expanded and updated review of the research in the 10 years since our original publication examining the relationship between suicide and religion across Buddhism, AIAN, African religions, as well as atheism, agnosticism. The databases PsycINFO, MEDLINE, SocINDEX, and CINAHL databases were searched for published articles on religion and suicide over the last decade, between 2009 and 2019. Epidemiological data on suicidality across these world religions, and attitudes and beliefs toward suicide are presented. Updated recommended practice guidelines for effectively incorporating religiosity into suicide risk assessment and treatment are provided, and areas of future research are identified.

Factors associated with suicidal ideation in drug addicts based on the theory of planned behavior

BACKGROUND

Several studies have attempted to understand the link among drug addicts and suicidal ideation. The purpose of this study was to investigate the factors associated with suicidal ideation in drug addicts based on the Theory of Planned Behavior (TPB).

METHOD

This cross-sectional study was conducted with 2160 of drug addicts in private and public clinics for quitting addiction through methadone treatment in Shiraz city, Fars province, Iran from October 2018 to June 2019. Data gathering tools were a questionnaire on demographic characteristics, the Beck Scale for Suicidal Ideation and a questionnaire based on constructs of TPB. Data were analysed by SPSS 22 using descriptive statistics (mean, standard deviation, and frequency) and statistical tests (independent t-test, Pearson correlation coefficient, and linear regression). The significance level was considered 0.05.

RESULTS

The mean age of the participants was 39.24 ± 11.92; 80.28% of them had a history of quit and 43.19% of them had a history of arrest and imprisonment. According to the results, 19.63% of the participants had suicidal ideation and 10.97% had a history of suicide attempt during their lifetime. The constructs of attitude, subjective norms, perceived behavioral control, and intent predicted suicidal ideation in the subjects. Intent and perceived behavioral control constructs were the strongest predictors of suicidal ideation, respectively. In general, the studied variables predicted 54.8% of suicidal ideation.

CONCLUSION

The structures of attitude, subjective norms and perceived behavioral control and intent predicted suicidal ideation in the drug addicts, so the theory of planned behavior will be a good framework for educational interventions to reduce suicide in them.

Depression, Suicidal Ideation and Perceived Stress in Italian Humanities Students: A Cross-Sectional Study

Mental health issues are common among university students. Nevertheless, few studies focused on Italian students. This study aimed to assess prevalence and associated factors of perceived stress (PS), depressive symptoms (DS) and suicidal ideation (SI) in an Italian sample. A cross-sectional study was conducted amongst a convenience sample of students in humanities field (2018). Questionnaires were self-administered. Outcomes were assessed through Beck Depression Inventory-II (DS, SI) and Perceived Stress Scale (PS). Multivariable regressions were performed (p-value < 0.05 significant; sample size = 203). DS and SI prevalence was 30.6% and 8.8%. PS median score was 20 (IQR = 11), 87.7% reported moderate/severe PS. DS likelihood was increased by psychiatric disorders family history and not attending first year of course and decreased by not thinking that university hinders personal activities. Chronic disease and higher stress score increased SI probability; good/excellent family cohesion reduced it. Being female, thinking that university hinders resting/relaxing, seeing a psychologist/psychiatrist were positively associated with PS; having no worries about future was negatively associated. A high prevalence of mental health issues was reported, with miscellaneous associated factors that were linked to both private and social aspects. Universities must be aware of this to provide efficient preventive measures.

A cross-cultural study of attitudes toward suicide among young people in India, Italy and Australia

BACKGROUND

An understanding of the cultural aspects of suicidal behavior is essential for the development of culturally appropriate suicide prevention and intervention strategies.

AIMS

This study explored the attitudes toward youth suicide in 686 Italian, Indian and Australian undergraduate students (18-24 years old).

METHOD

A 21-item suicide attitude inventory titled Attitude towards Youth Suicide (AtYS) scale, included in this paper, was used in the three samples.

RESULTS

Four factors were extracted, labeled negative attitudes toward suicide, belief that suicide was not preventable, suicide as acceptable and normal, and the existence of risk signs for suicide. Country differences were found for all four subscales, with Indian students having the most negative attitudes toward suicide. Sex differences were found in all three countries with women, on the whole, having less negative attitudes toward suicide, more belief in the preventability of suicide in India and more belief in risk signs for suicide in Italy.

CONCLUSION

Attitudes are linked to suicide in a complex manner. More quantitative and qualitative studies, including in lower-income and non-English speaking Western societies, are needed.

Suicide among university students: prevalence, risks and protective factors

Background: Research evidence on suicide in Ghana so far has focused mostly on suicide in the adult population and less work on the younger population such as university students and other vulnerable groups such as children, youth and the aged. Aims: This study was conducted to determine lifetime and current prevalence of suicidal ideation or attempts and identify the associated risks and protective factors among university students in Ghana. Methods: Using a cross-sectional design, 1003 university students (507 males and 496 females) with a mean age of 20.5 years (SD = 5.95) were administered questionnaires that measured suicide, psychological distress, self-esteem and subjective wellbeing. Results: We found the following prevalence rates of suicidal behaviours: ideations 15.2%, attempted 6.3%, death wishes 24.3% and suicidal plan 6.8%. Psychological distress was a risk factor for both suicidal ideation and suicidal attempt. Subjective wellbeing was protective of suicide attempt while self-esteem was protective of suicidal ideation. Conclusions: These findings underscore the need for school-based mental health-promoting programmes that enhance young people's self-esteem, reduce psychological distress and boost subjective wellbeing.

Is Religiosity Related to Suicidal Ideation Among Tunisian Muslim Youth After the January 14th Revolution?

Religiosity has been hypothesized to play protective roles against suicide. In Tunisia, despite the gravity of the issue after the 2011 Revolution and the rise of suicide rates among adolescents and young adults, a significant lack of data remains. The present work aimed to evaluate the associations between suicide and religiosity in university students. The Suicidal Ideations Questionnaire and The Arabic Religiosity scale were used to determine associations between suicidality and religiosity. We found a strong negative correlations found between suicidal ideations and the three sub-scores of religiosity after controlling for the associations between psychosocial variables and suicidal ideations scores. Our findings emphasize the importance of assessing the role of religiosity to the subject and understanding how suicide is conceptualized and perceived in the subject's religion when dealing with suicidal ideation and behaviors among college students. A better knowledge of religious beliefs and even an integration of Islamic beliefs and practices in the psychotherapeutic process of Muslim youth may be helpful to cope with suicide.

Prevalence of suicidal behaviour among nursing and midwifery college students in Ghana

AIM

To provide exploratory and descriptive evidence on the prevalence estimate and some demographic correlates of suicidal behaviour among nursing and midwifery college students in Ghana.

DESIGN

We used a cross-sectional survey design.

METHOD

An anonymous survey involving a randomly selected sample of 305 nursing and midwifery college students was conducted in March-May 2017. The Suicide Behavior Questionnaire-Revised was used to assess suicidal behaviour (i.e., ideation, planning, threat and attempt) and suicidal behaviour risk.

RESULTS

The lifetime prevalence of suicide ideations (15.4%; 95% confidence interval [CI] = 0.11-0.20), plans (6.6%; 95% CI = 0.04-0.10), attempts (2.3%; 95% CI = 0.01-0.05), threats (13.4%; 95% CI = 0.10-0.18) and 12-month prevalence of ideations (21.3%; 95% CI = 0.17-0.26) are comparable to estimates found in both high-income and low- and middle-income countries. However, associations between the demographic variables studied and suicidal behaviour risk were not statistically significant.

Prevalence and correlates of suicidal ideation among college students: A mental health survey in Jilin Province, China

BACKGROUND

The prevention of suicidal ideation plays a key role in reducing suicide rates. This study aimed to determine the prevalence of suicidal ideation among college students in Jilin Province, China, and to analyse the risk factors associated with suicidal ideation.

METHODS

A total of 6284 valid data collection sheets were collected using the stratified cluster sampling method. The data collected were divided into four sections, namely, socio-demographic information, family and social interactions, daily habits, and mental health self-rating scales.

RESULTS

The prevalence of suicidal ideation in the past 12 months was 9.2%. A multivariate logistic regression analysis showed that being a senior (OR = 1.769, 95%CI:1.225-2.555), general family relationships (OR = 1.641, 95%CI:1.172-2.298), frequent parental quarrels (OR = 1.398, 95%CI:1.027-1.902)/parental separation (OR = 2.497, 95%CI:1.414-4.408), the level of satisfaction with motherly love (OR = 2.261, 95%CI:1.454-3.515), having only one or two friend(s) (OR = 1.530, 95%CI:1.038-2.254), frequent excursions to bars/ karaoke halls/ song and dance halls (OR = 1.673, 95%CI:1.257-2.229) or billiard halls with friends (OR = 1.865, 95%CI:1.270-2.740), smoking (OR = 2.175, 95%CI:1.603-2.951), moderate sleep quality (OR = 1.636, 95%CI:1.115-2.402), and depressive symptoms (OR = 2.078, 95%CI: 1.710-2.525) were risk factors for suicidal ideation. Family factors had the most influence on suicidal ideation, whereas depression symptoms were identified to be a mediating factor between family, social interactions, or daily habits and suicidal ideation, and it only exerted direct effects.

LIMITATIONS

This cross-sectional study cannot provide causal interpretations.

CONCLUSION

Our findings showed the prevalence of suicidal ideation among college students in Jilin province. Among all the risk factors associated with suicidal ideation, family factors should be the main concern in the prevention of suicidal ideation, and interventions that target depression symptoms are key to reducing suicidal ideation.

The association of religiosity with suicidal ideation and suicide attempts in the United Kingdom

OBJECTIVE

The goal was to analyze the association of religiosity with suicidal ideation and suicide attempts in a UK nationally representative sample.

METHODS

This study used cross-sectional data from 7403 people who participated in the 2007 Adult Psychiatric Morbidity Survey (APMS). Religion was assessed with the question 'Do you have a specific religion?' with 'yes' and 'no' answer options. Lifetime and past 12-month suicidal ideation and suicide attempts were assessed. The association between religiosity and suicidality was studied in multivariable logistic regression models adjusted for sociodemographic, behavioural, and psychopathological factors.

RESULTS

Compared to those without a religion, the prevalence of past 12-month suicidal ideation (3.2% vs. 5.4%), past 12-month suicide attempts (0.4% vs. 0.9%), lifetime suicidal ideation (11.2% vs. 16.4%), and lifetime suicide attempts (3.6% vs. 6.0%) was lower among those with a religion. In the fully adjusted model, having a religion was significantly associated with lower odds for all types of suicidality except past 12-month suicide attempts: suicidal ideation (past 12-month: OR = 0.71, 95% CI = 0.51-0.99; lifetime: OR = 0.83, 95% CI = 0.69-0.99) and suicide attempts (past 12-month: OR = 0.71, 95% CI = 0.35-1.45; lifetime: OR = 0.69, 95% CI = 0.53-0.90).

CONCLUSION

There is a negative association between religiosity and suicidality in the UK. Future studies should focus on the underlying mechanisms.

Reasons for attempting suicide: An exploratory study in Ghana

This study examined the reasons for suicide attempts among patients in Ghana. Semi-structured interviews were conducted among 30 informants who had been hospitalized for attempted suicide. Interpretative Phenomenological Analysis (IPA) was used to analyse the transcribed narratives, and five main themes emerged: 1) lack of support; 2) abandonment; 3) shame; 4) existential struggles; and 5) supernatural reasons. There were gender differences with abandonment reported by only women and shame associated with economic difficulties reported only by men. Findings are discussed within the context of a socio-cultural theory of suicide behaviour, and implications for the prevention of suicide and care of suicidal persons are suggested.

"We Now Have a Patient and Not a Criminal": An Exploratory Study of Judges and Lawyers' Views on Suicide Attempters and the Law in Ghana

This study explored the views of judges and lawyers of the superior courts of Ghana on the law criminalizing attempted suicide. Qualitative data were collected from 12 experienced legal practitioners of the superior courts (five judges and seven lawyers) using a semi-structured interview schedule. Thematic analysis of the data yielded three main perspectives: In defence of the Law, Advocating a Repeal, and Pro-Health Orientation. Although exploratory, the findings of this study offer cues for stepping up suicide literacy and advocacy programmes toward either a repeal of the law or a reform.

The potential role of attitudes towards suicide between mental health status and suicidal ideation among Chinese children and adolescents

BACKGROUND

The objective of this study was to investigate the contributions of mental health status and attitudes towards suicide on suicidal ideation in a sample of 6568 Chinese children and adolescents in China. Attitudes towards suicide were investigated as a possible moderator and mediator of the influence of mental health status on suicidal ideation.

METHODS

Descriptive statistical analyses, Pearson correlation analyses and hierarchical regression analyses were adopted as methods of data analyses.

RESULTS

Approximately 35.38% of children and adolescents in our study reported having suicidal ideation. Mental health status and attitudes towards suicide both had an independent effect on the severity of suicidal ideation. Results indicated that mental health status was positively associated with suicidal ideation, while attitudes towards suicide were negatively associated with suicidal ideation. Moderation analysis showed that the impact of mental health status on suicidal ideation was significantly greater among children and adolescents who reported favourable attitudes towards suicide. Attitudes towards suicide partially mediated the link between mental health status and the severity of suicidal ideation. Specifically, students who experienced poorer mental health status might be more likely to report significantly more favourable attitudes towards suicide, which in turn promote greater suicidal ideation.

CONCLUSIONS

These results have implications for the prevention of youth suicide, suggesting that mental health status and attitudes towards suicide could be important targets for prevention and intervention for children and adolescents at risk of suicidal ideation.

Self-efficacy as a mediator of the relationship between parental closeness and suicidal ideation among Malaysian adolescents

BACKGROUND

Suicide has become a serious worldwide mental health problem, including Asian countries. Suicidal ideation happens prior to the actual suicidal behaviour; thus, identifying the roots of suicidal ideation is vital. This study investigated the relationships between parental closeness, self-efficacy and suicidal ideation among adolescents in Malaysia. The mediation effect of self-efficacy on the relationship between parental closeness and suicidal ideation was also examined.

METHOD

A total of 684 school-going adolescents aged 14-17 years old were recruited via multistage cluster sampling. Bivariate analysis was conducted using Pearson's correlation analysis. The mediation model was tested using SPSS macro developed by Preacher and Hayes.

RESULTS

The results showed that mother closeness, father closeness and self-efficacy had significant negative correlation with suicidal ideation. Specifically, self-efficacy emerged as a partial mediator in the relation between mother closeness and suicidal ideation. Self-efficacy also fully mediated the relationship between father closeness and suicidal ideation.

CONCLUSIONS

The findings implied that mother closeness had stronger correlation with adolescents' suicidal ideation compared to father closeness, while self-efficacy plays an important role in the relationship between parental closeness and suicidal ideation. Prevention and intervention efforts by practitioners dealing with adolescents' mental health issues, specifically on suicidal ideation, should seriously consider providing them with skills to enhance mother-adolescent relationship and their self-efficacy.

Suicide and Mortuary Beliefs and Practices of the Akan of Ghana

Akan society has traditionally held a negative and condemnatory view of suicide. Evidence of this is reflected in the lack of public mourning, brevity of the grieving period, and denial of proper burial rites and funeral obsequies for the suicide. Furthermore, because suicide is regarded as an abomination against the living, the departed ancestors, as well as the gods of the land, the political authorities of the land must be notified immediately of suicide deaths so that proper placatory and propitiation rituals can be undertaken to forestall any catastrophic diseases, accidents, and natural disasters. Given the current paucity of scholarship on the issue, it is the purpose of this article to explore in depth traditional Akan mortuary beliefs and practices governing suicidal death.

Does Religiosity Mediate Suicidal Tendencies? A South African Study of Muslim Tertiary Students

Despite international studies into religion's protective mechanism against suicidal tendencies, within South Africa there is a paucity of research investigating this relationship. This quantitative study investigates the relationship between religiosity and suicidal tendencies in a sample of Muslim students (N = 111). Two scales were used to test the hypothesis that religion mediates suicidal tendency: the Religious Orientation Test and the Multi-Attitude Suicide Tendency Scale. The findings confirmed this hypothesis but disconfirmed our second hypothesis that there would be gender differences between the variables. We concluded that a high degree of religiosity acts as a protective mechanism against suicidal tendencies and discuss the implications of our findings.

Erratic electricity supply (Dumsor) and anxiety disorders among university students in Ghana: a cross sectional study

Background

Ghana is currently experiencing electricity supply crisis that is believed to have some impact on the mental wellbeing of the population, especially among university students that have become increasingly dependent on uninterrupted electricity supply to fully function academically. There is no known study that explores the link between infrequent electricity supply and generalized anxiety disorders in sub-Saharan Africa. This study aimed to explore that link and determine the proportion of university students whose anxiety levels may be influenced by the electricity supply crisis that the country is experiencing at the moment.

Methods

This exploratory study used the Generalized Anxiety Disorder 7-item scale (GAD-7) to conduct the study on the University of Ghana campus. The likelihood ratio (LR) test and Fisher’s Exact tests were used to determine any association between the electricity supply crisis and anxiety levels among students. Unadjusted odds ratio and corresponding confidence intervals were estimated and ordinal logistic regression technique was used for the effect of covariates on anxiety.

Results

Overall, nearly 26 % of students interviewed felt nervous, anxious or on edge almost every day due to the erratic power supply. The proportion of students determined to be classified having minimal, mild, moderate and severe anxiety due to the erratic power supply was 24.2, 30.7, 22.1 and 23.1 % respectively. Students were significantly more likely to be anxious if the frequency of power outage increased (OR 1.36; CI 1.23–1.49).

Conclusions

Our finding in this study suggests that although the erratic power supply does not allude to any clinical confirmation of the students having anxiety disorders, it does point to a fact that even in a resource-poor country like Ghana, where constant supply of electricity is not always guaranteed, students may not be entirely immune to the health and well-being implications of failures in some sectors of the economy such as power supply.

Gender Differences Related to Attitudes Toward Suicide and Suicidal Behavior

This descriptive study examined gender differences related to attitudes toward suicide among randomly selected urban residents. Data was collected using a standardized questionnaire through face-to-face interview. Our findings revealed that men hold more pro preventive attitudes to help persons with suicidal thoughts (80.3 %, p = 0.05) and agreed that suicidal attempts are impulsive (78.6 %, p = 0.01). However, they hold permissive attitude to help persons with incurable diseases and expressing death wishes to die (66 %, p = 0.05). A majority of men (78.6 %) than women agreed that "suicidal attempt is essentially a cry for help" (χ (2) = 11.798, p = 0.05). These gender differences need to be taken into consideration when developing appropriate programs to prevent suicide. Further, decriminalizing the law, high-quality research and raising awareness about suicide prevention among the general population is crucial in developing countries like India.

Postmortem Presence of Drugs and Method of Violent Suicide

The link between substance use and suicide is well established. However, little research analyzes how substance use is related to the method of suicide. This paper analyzes how specific drugs are associated with method of suicide, a critical topic because drug use bears on the etiology of suicide and may lead to policies aimed at deterring suicide. We use the COVDRS and logistic regression to examine postmortem presence of drugs among 3,389 hanging and firearm suicides in Colorado from 2004-2009. Net of demographic controls, we find that opiates are positively associated with firearms (OR: 1.92, 95% L: 1.27, 95% U: 2.86]) while antidepressants are positively associated with hanging (OR: 1.45, 95% L: 1.04, 95% U: 2.03). For cocaine and opiates, the association between drug use and violent method vary by educational attainment. Importantly, knowledge of the presence and type of specific drug is strongly associated with the method of suicide.

Adolescent suicide in Ghana: a content analysis of media reports

Adolescent suicide is now a major health concern for many countries. However, there is paucity of systematic studies and lack of official statistics on adolescent suicide in Ghana. Mass media coverage of adolescent suicide (even though crude), at least, may reflect the reality of the phenomenon. With an ecological orientation, this study used qualitative content analysis to analyse the pattern of 44 media reports of adolescent suicide in Ghana from January 2001 through September 2014. Results showed that hanging was the dominant method used. The behaviour usually takes place within or near the adolescent's home environment. The act was often attributed to precursors within the microsystem (family and school) of the deceased. This study serves a seminal function for future empirical studies aimed at deeper examination of the phenomenon in order to inform prevention programmes.

Adolescent suicide in Ghana: a content analysis of media reports

Adolescent suicide is now a major health concern for many countries. However, there is paucity of systematic studies and lack of official statistics on adolescent suicide in Ghana. Mass media coverage of adolescent suicide (even though crude), at least, may reflect the reality of the phenomenon. With an ecological orientation, this study used qualitative content analysis to analyse the pattern of 44 media reports of adolescent suicide in Ghana from January 2001 through September 2014. Results showed that hanging was the dominant method used. The behaviour usually takes place within or near the adolescent's home environment. The act was often attributed to precursors within the microsystem (family and school) of the deceased. This study serves a seminal function for future empirical studies aimed at deeper examination of the phenomenon in order to inform prevention programmes.

I Would Rather Just Go Through With It Than Be Called a Wussy: An Exploration of How a Group of Young South African Men Think and Talk About Suicide

Worldwide suicide is a deeply gendered phenomenon. In South Africa, approximately 80% of suicide completers are male. This study aimed to investigate how a group of young South African men understand and think about suicidal behavior. In-depth semistructured interviews and thematic analysis using a grounded theory approach revealed that this group of young South African men had permissive attitudes to suicide and viewed suicide as a morally defensible alternative in specific situations. They spoke of suicide as a goal-directed behavior that provides a means of regaining control, asserting power, communicating, and rendering oneself visible. From this perspective, suicide was understood as a brave act requiring strength and determination. These data have congruence with the Theory of Gender and Health, which proposes that constructions of masculinity may be implicated in the attitudes and beliefs young men in South Africa hold toward suicide.

Correlation between family environment and suicidal ideation in university students in China

Background: This study investigated the association between suicidal ideation and family environment. The sample included 5183 Chinese university students. A number of studies on suicidal ideation have focused on individuals rather than families. This paper reviews the general principles of suicidal ideation and the consequences resulting from the family environment. Methods: This study used six different colleges as the dataset, which included 2645 males and 2538 females. Students were questioned with respect to social demographics and suicidal ideation factors. The data were analyzed with factor and logistic analyses to determine the association between suicidal ideation and poor family environment. Results: The prevalence of suicidal ideation was 9.2% (476/5183). Most participants with suicidal ideation had significant similarities: they had poor family structures and relationships, their parents had unstable work, and their parents used improper parenting styles. Female students were more likely to have suicidal thoughts than male students. Conclusions: This study shows that suicidal ideation is a public health issue among Chinese university students and demonstrates the importance of considering the family environment when examining university students’ suicidal ideation. Understanding family-related suicidal ideation risk factors can help to predict and prevent suicides among university students.

Child abuse and suicidal ideation among adolescents in China

The present study examined the relationship among physical abuse, psychological abuse, perceived family functioning and adolescent suicidal ideation in Shanghai, China. Perceived family functioning was investigated as a possible moderator between physical abuse, psychological abuse and suicidal ideation. A cross sectional survey using convenience sampling was conducted. A total of 560 valid self-administered questionnaires were completed by the students aged from 12 to 17 in Shanghai. Descriptive statistical analyses, Pearson correlations analyses, and hierarchical regression analyses were adopted as methods of data analyses. Results indicated that physical abuse was significantly associated with greater adolescent suicidal ideation, while a higher level of perceived family functioning was significantly associated with lower suicidal ideation. However, psychological abuse was not associated with suicidal ideation. Perceived family functioning was shown to be a moderator between physical abuse and suicidal ideation. Specifically, mutuality and family communication moderated the relationship between physical abuse and suicidal ideation. To decrease adolescent suicidal ideation, measures are suggested to prevent physical abuse and enhance family functioning. First, it is important to increase the parents' awareness of the meaning and boundaries of physical abuse, as well as the role it plays in contributing to adolescent suicidal ideation. Second, parents should be taught appropriate parenting skills and knowledge and be guided to treat the children as individuals with their unique personality, rights and privileges. Third, it is important to promote family harmony, effective communication as well as mutual trust, concern and understanding among family members.

Rural/urban background, depression and suicidal ideation in Chinese college students: a cross-sectional study

Objectives

The objective of this study was to examine, first, the relationship of having a rural vs. urban background with suicidal ideation in Chinese college students, and second, whether a potential relationship was mediated by depression.

Methods

A survey was conducted among 1,145 undergraduate students at a university in China. Suicidal ideation and depressive symptoms were measured by the revised Hopkins’ Symptom checklist (SCL-90-R). Associations between rural vs. urban background, depression and suicidal ideation were estimated by multivariable linear regression-based β coefficients, logistic regression-based odds ratios (ORs), and corresponding 95% confidence intervals (CIs). The magnitude of indirect effect and bias-corrected 95% CIs were obtained through bootstrap techniques.

Results

Rural background was positively associated with depression, which was in turn associated with suicidal ideation. The OR for rural status and suicidal ideation equaled 2.15 (95% CI = 1.36–3.41). This OR was slightly, though significantly (p<0.05) attenuated by additional adjustment for depressive symptoms (OR = 1.99, 95% CI = 1.15–3.44).

Conclusion

Having a rural background is a determinant of suicidal ideation in Chinese college students. Depression may only marginally mediate this association.

Influence of religious factors on attitudes towards suicidal behaviour in Ghana

The objective of this qualitative study was to understand how religion influences lay persons' attitudes towards suicide in Ghana. Twenty-seven adults from both rural and urban settings were interviewed. Interpretative phenomenological analysis was used to analyse the data. Results showed that the participants are committed to core and normative religious beliefs and practices they perceived as life preserving. Such an understanding influenced their view of suicidal behaviour as unacceptable. Nevertheless, religion facilitated their willingness to help people during suicidal crisis. Religious commitment theory is used to explain some of the findings of this study. Implications for suicide prevention are discussed.

The relationship of religious involvement indicators and social support to current and past suicidality among depressed older adults

Elderly people, particularly those with major depression, are at the highest risk for suicide than any other age group. Religious involvement is associated with a range of health outcomes including lower odds of death by suicide. However, not much is known about the effects of religious involvement on suicidal ideation in the elderly or which aspects of religiosity are beneficial. This study examined the relative influence of various conceptualizations of religious involvement, above and beyond the protective effects of social support, on current and past suicidality among depressed older adults. Participants were 248 depressed patients, 59 years and older, enrolled in the Neurocognitive Outcomes of Depression in the Elderly study. A psychiatrist assessed current suicidal ideation using the suicidal thoughts item from the Montgomery-Asberg Depression Rating Scale. Past history of suicide attempts, four religious involvement indicators, social support indicators, and control variables were assessed via self-report. Church attendance, above and beyond importance of religion, private religious practices, and social support, was associated with less suicidal ideation; perceived social support partially mediated this relationship. Current religious practices were not predictive of retrospective reports of past suicide attempts. Church attendance, rather than other religious involvement indicators, has the strongest relationship to current suicidal ideation. Clinicians should consider public religious activity patterns and perceived social support when assessing for other known risk and protective factors for suicide and in developing treatment plans.

Religious views on suicide among the Baganda, Uganda: a qualitative study

Relatively little research has been conducted on religion and suicide in Africa, yet religion has a lot of influence on people's way of life in Africa. To study religious views on suicide among the Baganda, Uganda, we used grounded theory and discourse analysis on a total of 28 focus groups and 30 key informant interviews. Suicide is largely seen as a breach of God's doctrine life is sacred, God's commandment thou shall not kill, and God's rule of agape. The study also focuses on the consequences of breaching God's divine providence: punishment from God and the Church. Religion still has a lot of influence on people's views on suicide in Uganda despite the challenges highlighted in the study. A recommendation from these results is that suicide prevention should cater to divergent views on religion and suicide. More qualitative research should be conducted in this area to facilitate theoretical comparison with this study.

Suicide in rural Haiti: clinical and community perceptions of prevalence, etiology, and prevention

Suicide is a complex global public health problem, yet few studies have examined local socio-cultural explanatory models and other contextual factors surrounding suicide in low-and-middle-income countries. Such research is critical, as suicide frequency and etiology, as well as care-seeking in the case of distress, differ contextually and by sub-groups within a population. This is the first study of its kind to explore the dual perspectives of both healthcare workers and community members regarding suicide in Haiti. We conducted semi-structured, in-depth interviews between May and June 2011 with eight biomedical healthcare workers and 16 lay community members. Qualitative data analysis, drawing on interpretive phenomenological analysis, addressed themes including perceived suicide frequency, veracity of suicidal ideation claims, perceived causal factors, religious constructs related to suicide, and support resources for suicidality. Compared to community members, healthcare workers underestimated the frequency of suicide and were less likely to interpret suicide-related claims as representing true intent. Religious perspectives influenced attitudes toward suicide, albeit in different ways: Christian concern with the afterlife resulted in suicide being unacceptable and sinful, while Vodou explanatory frameworks displaced blame and stigma away from suicidal individuals. Healthcare workers' failure to recognize suicide as a serious problem suggests that the formal health system is currently ill-equipped to respond to suicide-related needs. Religious practice and community supports in rural Haiti may serve as essential resources for prevention programs.

The Stigma of Suicide Scale

Background: There are presently no validated scales to adequately measure the stigma of suicide in the community. The Stigma of Suicide Scale (SOSS) is a new scale containing 58 descriptors of a “typical” person who completes suicide. Aims: To validate the SOSS as a tool for assessing stigma toward suicide, to examine the scale’s factor structure, and to assess correlates of stigmatizing attitudes. Method: In March 2010, 676 staff and students at the Australian National University completed the scale in an online survey. The construct validity of the SOSS was assessed by comparing its factors with factors extracted from the Suicide Opinion Questionnaire (SOQ). Results: Three factors were identified: stigma, isolation/depression, and glorification/normalization. Each factor had high internal consistency and strong concurrent validity with the Suicide Opinion Questionnaire. More than 25% of respondents agreed that people who suicided were “weak,” “reckless,” or “selfish.” Respondents who were female, who had a psychology degree, or who spoke only English at home were less stigmatizing. A 16-item version of the scale also demonstrated robust psychometric properties. Conclusions: The SOSS is the first attitudes scale designed to directly measure the stigma of suicide in the community. Results suggest that psychoeducation may successfully reduce stigma.

Exploring the relationship between religious service attendance, mental disorders, and suicidality among different ethnic groups: results from a nationally representative survey

BACKGROUND

To date, sufficient data have not been available to examine ethnic differences in religiosity and mental health in the general population. However, evidence exists to suggest that the protective effects of religion may differ across ethnic groups. This study examined the relationship between religious attendance and mental health across ethnic groups.

METHODS

The Collaborative Psychiatric Epidemiologic Survey (N = 20,130) is a large, ethnically diverse sample of adult, US respondents. Frequency of attendance at religious services was measured as: at least once per week (reference group), one to three times per month, less than once per month, or less than once per year. Multiple logistic regression analyses examined associations between religious attendance and mood, anxiety and substance use disorders, as well as suicidal ideation and attempts. Models adjusted for sociodemographics and comorbidity.

RESULTS

Results differed when performed within each ethnicity. Infrequent religious attendance was associated with substance use disorders in Whites and Africans only (Adjusted Odds Ratio (AOR) = 2.30 [95% CI = 1.77-2.99]; AOR = 1.86 [1.25-2.79], respectively), and with anxiety and suicidal ideation in Whites (AOR = 1.44 [1.10-1.88]; AOR = 1.58 [1.24-2.01]) and Hispanics only (AOR = 2.35 [1.17-4.73]; AOR = 1.70 [1.15-2.52]). Asians were the only group in which religious attendance was associated with mood disorders (AOR = 4.90 [1.54-15.60]). Interaction terms were nonsignificant.

CONCLUSIONS

The present study suggests that ethnicity is an important variable to consider in the relationship between religiosity and mental health. Future studies should attempt to either adjust for or stratify by ethnicity when examining these relationships.

A longitudinal evaluation of religiosity and psychosocial determinants of suicidal behaviors among a population-based sample in the United States

BACKGROUND

Relationships among religiosity and other psychosocial factors in determining suicidal behaviors in adolescence and in emerging adulthood have been inconclusive. We sought to investigate prospective relationships among religiosity, psychosocial factors and suicidal behaviors using a nationally representative sample of adolescents emerging into adulthood.

METHOD

Analysis was based on 9412 respondents from four waves of National Longitudinal Study of Adolescent Health. A Generalized Estimating Equation (GEE) procedure was used to fit a series of models on the response variable (suicidal behaviors) and a set of psychosocial and religiosity predictors taking into account the correlated structure of the datasets.

RESULTS

Analyses showed that adolescent suicidality and religious activity participation showed significant declines over time. Using multinomial logistic regression we found that females showed statistically significant risks of suicidal behaviors, but this effect declined in adulthood. In adjusted models, baseline attendance of a church weekly was associated with 42% reduction (95% Confidence Interval: 0.35-0.98) of suicide ideation in Wave III. Across all waves, low support from fathers (compared with mothers) consistently explained variability in suicidal behaviors among genders emerging into adulthood.

LIMITATIONS

Accurate measurement of religiosity is psychometrically challenging.

CONCLUSIONS

The findings of the study indicate that religious activity participation is associated with reduced suicidal behaviors among adolescents but this effect declines during emerging adulthood. Psychosocial supports particularly from fathers' have an enduring impact on reduced suicidal behaviors among adolescents and emerging adults. Prevention, identification and evaluation of disorders of suicidality need a careful assessment of underlying mental pain (psyache) to reduce the likelihood of aggravated suicide.

Intent in Manner Determination

Manner of death determination is a basic and traditional task for medical examiners. Though it has a history spanning centuries, many facets of manner determination continue to be problematic. Few issues are more vexing than the difficulties in determining intent. A survey of members of the National Association of Medical Examiners was performed to determine current practice and attitudes about the use of intent in manner determination. There were 168 completed responses, representing an approximately 20% response rate. The results reveal significant variation. While the concept of “volition” as distinct from “intent” has been common for over a decade, less than 60% of respondents made the distinction in their practice. There was also wide variation in the degree of certainty practitioners noted they used when determining manner with peaks at between 51-60% and 95-99%. Some of this represents real uncertainty in manner determination and some represents cultural and regional differences in practice. The variation and uncertainty in these determinations has led some to suggest that this role be abandoned. However, the statistical, policy, and cultural need for these determinations dictate that the function will be performed even if abandoned by the medical examiner community. Medical examiners are uniquely positioned and trained to fill this need, and should continue to do so.

Spirituality and Religiosity as Predictors of Depression and Suicidal Ideation: An Exploratory Study

In a sample of 149 undergraduate students, measures of religiosity and spirituality were positively associated with measures of depression, mania, and past suicidal ideation.

Attitudes of psychologists and nurses toward suicide and suicide prevention in Ghana: a qualitative study

BACKGROUND

One way of preventing suicide has been increasing awareness among health care professionals of their own attitudes and taboos toward suicide and its prevention.

OBJECTIVE

The purpose of this study was to understand the attitudes of health professionals toward suicidal behavior and its prevention in Ghana.

METHODS

A total of 17 informants (9 clinical psychologists and 8 emergency ward nurses) in an urban center were interviewed using a semi-structured interview guide. Interpretative Phenomenological Analysis (IPA) was used to analyze the data.

RESULTS

We found that the attitudes of these health workers toward suicide and suicide prevention seemed to be transiting between morality and mental health. The psychologists generally saw suicide as a mental health issue, emphasized a caring and empathic view of suicidal persons and approached suicide prevention from a health-service point of view. Mental health education and improvements in primary health care were reported as practical approaches toward suicide prevention. The nurses on the other hand, held a moralistic attitude toward suicide as a crime, viewed suicide persons as blameworthy and approached suicide prevention from a proscriptive perspective. Informal approaches such as talking to people, strengthening the legal code against suicide and threatening suicidal persons with the religious consequences of the act were also indicated as practical approaches to suicide prevention. Educational level, clinical experience with suicidal persons, and religious values, are discussed as influencing the differences in attitudes toward suicide and suicide prevention between psychologists and nurses.

CONCLUSION

Health workers in Ghana need training in suicidology to improve both knowledge and skills relevant for suicide prevention.

The meanings of suicidal behaviour to psychology students in Ghana: a qualitative approach

The objective of this study was to examine psychology students' attitudes toward suicidal behaviour and the meanings they assign to the act. In-depth interviews were conducted with 15 final year psychology students at a university in Ghana. Interpretative Phenomenological Analysis (IPA) was used to analyze the data. The results indicated that the students had a generalized negative attitude toward suicide. Religious beliefs and family harmony are cultural contexts influencing the interpretation of suicidal behaviour as breach of divine and communal moralities. The implications of these meanings of suicidal behaviour for suicide prevention in Ghana are discussed.

A qualitative study of attitudes toward suicide and suicide prevention among psychology students in Ghana

The purpose of the present study was to investigate attitudes toward suicide and suicide prevention among psychology students in Ghana by means of a qualitative analysis of open-ended questions about causes of suicide and how suicide best can be prevented. The students mainly saw the causes as intra-personal and almost all of them believed that suicide can be prevented. The results indicated a huge impact of religion on the attitudes toward suicide as well as some lack of distinction between their religious and professional roles and responsibilities.

Racial Disparities in Risk and Protective Factors for Suicide

African Americans have evidenced lower rates of suicide relative to the general population despite being exposed to higher levels of risk factors. This paradox has been proposed to be a result of protective factors such as religiosity and higher levels of familial involvement. The purpose of this study is to further investigate protective and risk factors of suicide in a sample of African Americans and a similar sample of Caucasians. Suicide risk and protective factors were examined in relation to the constructs of the interpersonal-psychological theory of suicide (burdensomeness, belongingness, and acquired capability), hope theory (hope, goals, pathways, and agency), and religiosity. It was hypothesized that African Americans would have higher levels of both protective factors and risk factors relative to the Caucasians. Results were partially consistent with this hypothesis.

Attitudes toward suicide: the effect of suicide death in the family

There have been few reports on the effect of suicide death on family members' attitudes toward suicide. In order to estimate the extent to which suicide death affects attitudes toward suicide among family members of suicides, data of 264 informants from a case-control psychological autopsy study were analyzed. The results showed that there were no significant differences in attitudes toward suicide, measured by the General Social Survey's (GSS) four questions, between informants of suicides and informants of living controls, between family members of suicides and family members of living controls, or between family members of suicides and non-family members of suicides. Our findings did not support the hypothesis that suicide death affects the attitudes toward suicide in suicides' family members. However, some factors were found to be related to the pro-suicide attitudes measured by the four questions included in the GSS.

Suicidality and depression among adult patients admitted in general medical facilities in Kenya

AIM

To document Beck Depression Inventory (BDI) II suicidal symptoms among patients admitted to Kenyan non-psychiatric general medical facilities

METHODS

All consenting adults admitted within a period of 4 weeks at 10 general medical facilities in Kenya were interviewed for suicidal symptoms and depression using the BDI-II.

RESULTS

In all, 2,780 patients responded to item 9 (suicidal symptoms of the BDI-II). The prevalence of all BDI-II suicidal symptoms combined was 10.5%. Thoughts of 'killing oneself but have not carried them out' accounted for 9% of the suicidal symptoms. The younger age group had the highest prevalence of suicidal symptoms and the oldest age group had the least prevalence of suicidal symptoms. The more depressed the patients were on the overall BDI-II score, the higher the prevalence of suicidal symptoms.

CONCLUSION

On average 1 out of 10 of the patients had suicidal symptoms, more so in younger than the older people and in the more depressed. These symptoms had not been clinically recognised and therefore not managed. This calls for clinical practice that routinely enquires for suicidal symptoms in general medical wards.

Suicide in Different Cultures: A Thematic Comparison of Suicide Notes From Turkey and the United States

Suicide is a global concern, hence, cross-cultural research ought to be central; yet, there is a paucity of cross-cultural study in suicidology. A thematic or theoretical-conceptual analysis of 60 suicide notes drawn from Turkey and the United States, matched for age and sex, was undertaken, based on Leenaars’s empirical-based multidimensional model of suicide. The results suggested that there were more culturally common factors than specific differences; yet, not consistent with previous cross-cultural studies of suicide notes, differences emerged in Turkey notes expressing more indirect and veiled communications (indirect expressions). Specifically, Turkish notes expressed that there may be more reasons to the act than the person writes. It was concluded that the model may be applicable to suicide in both countries, but also much greater cross-cultural study is warranted on specific cultural risk factors. A question raised is whether the findings are related to collectivism versus individualism.