Attitudes toward suicide among South African secondary school pupils

Brain fag syndrome: a culture-bound syndrome that may be approaching extinction

Aims and method To explore the current salience of 'brain fag' as a nosological, diagnostic and clinical construct in modern West African psychiatry. A semi-structured questionnaire and vignette based on classical symptoms of brain fag syndrome were used to explore current knowledge, explanatory models and practice among Nigerian psychiatrists. Results Of 102 psychiatrists who responded, 98% recognised the term 'brain fag syndrome' and most recognised the scenario presented. However, only 22% made a diagnosis of brain fag syndrome in their practice preferring diagnoses of anxiety, affective and somatic disorders. Clinical implications A decreasing number of Nigerian psychiatrists are making a diagnosis of 'brain fag syndrome'. We found strong evidence of nosological and diagnostic decline in the syndrome in its place of birth. This may signal the early extinction of this disorder or nosological metamorphosis from a 'culture-bound' syndrome in West African psychiatric practice.

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.

Suicide and related health risk behaviours among school learners in South Africa: results from the 2002 and 2008 national youth risk behaviour surveys

BACKGROUND

Attempted and completed suicide constitute a major public health problem among young people world-wide, including South Africa (SA). Suicide attempt and completed suicide increase during the adolescent period. One in 5 adolescents considers attempting suicide, but statistics are frequently unreliable.

METHODS

Data for this study were derived from the 2002 and 2008 South African Youth Risk Behaviour Surveys (YRBS). The study population comprised grades 8, 9, 10 and 11 students in governmental schools in the nine provinces of SA (N = 10,699 in 2002 and 10,270 in 2008). Key outcome measures were suicide ideation and suicide attempts.

RESULTS

Of the total sample, 18% of the students in 2002 and 19% in 2008 reported to have seriously considered and/or made a plan to commit suicide during the past six months (Suicide ideation), whereas 18.5% of students in 2002 and 21.8% in 2008 reported that they had attempted suicide at least 1 time during the past six months. On both suicide measures girls have higher prevalence scores than boys, and older school learners score higher than younger learners. In addition, 32% of the learners reported feelings of sadness or hopelessness. These feelings contributed significantly to the explanation of suicide ideation and suicide attempt next to being the victim or actor in violent acts and illegal substance use.

CONCLUSION

The prevalence of suicide ideation and suicide attempts among South African adolescents is high and seems to be influenced by a wide spectrum of factors at the demographic, psychological and behavioural level. Hence, more research is needed to determine the behavioural and psychological determinants of suicide among youngsters in order to develop comprehensive intervention strategies for suicide prevention and care.

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 systematic review of scales that measure attitudes toward suicide

BACKGROUND

Studies on attitudes toward suicide are of great interest to researchers worldwide. Although various instruments have been developed to measure attitudes toward suicide, psychometric properties of these instruments have not been systematically reviewed and organized.

AIM

We aimed to identify valid, reliable and feasible attitudinal scales by systematically reviewing published articles on scale development and validation studies. In particular, this study focused on scales used for a wide range of populations to measure multidimensional attitudes toward suicide and related issues.

METHODS

Electronic searches of two databases, PubMed and PsychInfo, were performed. Scales with unique names were identified and listed after reviewing selected publications, and then evaluated for psychometric properties, multidimensionality and appropriateness for a wide range of populations.

RESULTS

A total of 2,210 publications were identified by the first electronic search. In the final review process of the selected publications, three scales - the Suicide Opinion Questionnaire (SOQ), Suicide Attitude Questionnaire (SUIATT) and Attitudes Toward Suicide (ATTS) - were identified.

CONCLUSION

Each of these scales has its own characteristics and should be used in accordance with research purposes.

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.

Suicide-Related Behaviours among Secondary School Adolescents in the Welkom and Bethlehem Areas of the Free State Province (South Africa)

Our aim was to investigate suicide-related behaviours among secondary school adolescents in the Free State province, South Africa. Participants in this study were 142 secondary school adolescents selected from urban and rural schools around Welkom and Bethlehem, in the Free State. A stratified random sampling method was used to select the schools. Eighty-six (60.6%) participants were female, and 56 (39.4%) were male. They were aged between 12 and 19 years, with a mean age of 16.18 years ( SD = 1.72). A questionnaire was used to obtain participants' demographic data, suicidal behaviours (suicidal ideation, thoughts, plans, and attempts), the severity of the suicidal attempt (where applicable) and how often suicidal attempts took place. Results show that the prevalence of extreme (pervasive) cases of suicidal ideation (i.e. almost every day in the past two weeks) is 12.0% (10.7% for males and 12.8% for females). There is no significant difference between suicidal ideation among males and among females. The prevalence of suicidal plans in the past two weeks and ‘ever’ (lifetime) were 7.7% and 18.3%, respectively. The prevalence of suicidal attempts in the past two weeks and ‘ever’ (lifetime) were 4.2% and 14.8%, respectively. There is no significant difference between the prevalence among males and females, early adolescents and late adolescents, adolescents from the Southern Sotho background and those from non-Southern Sotho speaking groups. Mental health workers and educators should use the above findings as baseline information when planning preventive and therapeutic strategies for the minimization of suicidal behaviours among adolescents in the province. The findings should also be considered when making policies on the health priority areas for funding.

A comparison of life events in suicidal and nonsuicidal adolescents and young adults with major depression and borderline personality disorder

This retrospective study assessed the correlations between various types of stressful life events (SLE) and suicidal adolescents and young adults with major depressive disorder (MDD;22), borderline personality disorder (BPD;18), and nonsuicidal adolescents and young adults with MDD (20) and BPD (20). A community control group of 40 participants was also evaluated. The measurements used were Life Events Checklist, Childhood Sexual Abuse Questionnaire, Suicide Risk Scale, and Beck Depression Inventory. Suicidal participants experienced a greater number of total lifetime negative events compared with nonsuicidal participants, irrespective of diagnosis, including a greater amount of negative life events in the year before the suicide attempt compared with the year before referral in the nonsuicidal group. Participants with MDD reported more lifetime negative events than participants with BPD. Suicidal adolescents did not have more lifetime death-related SLE than nonsuicidal adolescents, but MDD adolescents experienced more lifetime death-related SLE than BPD adolescents. Suicidal BPD participants reported more lifetime sex abuse-related SLE compared with nonsuicidal BPD participants. The complexity of the relationships between SLE and the interplay of both suicidality and underlying psychopathology is discussed with the relevant treatment implications.

Self-reported suicidal behavior and attitudes toward suicide and suicide prevention among psychology students in Ghana, Uganda, and Norway

Self-reported suicidal behavior and attitudes toward suicide in psychology students are reported and compared in Ghana, Uganda, and Norway. Small differences only were found in own suicidal behavior. However, experience of suicidal behavior in the surroundings was more common in Uganda than in Ghana and Norway. Although differences were found between the three countries in attitudes toward suicide, which emphasizes the need for culture-sensitive research and prevention, many of the differences were not as big as expected. The most pronounced difference was that the Norwegian students were more reluctant to take a stand on these questions compared to their African counterparts. Some differences were also found between the two African countries. The implications of the results for suicide prevention in Africa are discussed.

Acculturation and suicide attitudes: a study of perceptions about suicide among a sample of Ghanaian immigrants in the United States

To investigate whether a relationship exists between acculturation and attitudes about suicide, 81 Ghanaian immigrants living in the U.S. who responded to a mail inquiry were selected to participate in the current study. This particular immigrant sample was chosen because although they represent a rapidly growing group in the U.S., they have been rarely studied. Respondents consisted of 42 women and 36 men (3 did not identify their sex), with a mean age of 29.5 yr. (SD = 10.6). Participants completed measures of acculturation and attitudes about suicide. Results indicated significant correlations between length of residency in the United States and negative suicide attitudes, and also between psychological acculturation and negative suicide attitudes. No significant relationship was found between behavioral acculturation and suicide attitudes. Furthermore, length of residency was a stronger predictor of suicide attitudes than other subjective measures of acculturation. Implications and suggestions for further research are discussed.

Epidemiology of Suicide by Hanging in Transkei, South Africa

To describe the epidemiology of suicide by hanging, in Transkei region of South Africa. This is a record review of the autopsy register from 1993 to 2003. There is an increasing trend of hangings from 5.2 per 100,000 to 16.2 in 2003. The highest was in the 20- to 29-year age group. The least number of hangings of 2.2 per 100,000 was in those over 70 years of age. Males (86.4%) outnumber females. The ratio of male to female suicide is 6.4:1. The 2 youngest suicide victims were also males aged 9 years. Peak of these hangings is in May and November and least in September. There is increasing trend of hanging especially among young adults between 20 and 29 years old.

Teenagers' attitudes about coping strategies and help-seeking behavior for suicidality

OBJECTIVE

To identify youths' attitudes about coping and help-seeking strategies for suicidal ideation/behavior and examine their demographic and clinical correlates.

METHOD

A self-report survey was completed by high school students (N = 2,419) in six New York State schools from 1998 through 2001. The relationship between suicide attitudes and gender, depression, substance problems, serious suicidal ideation/behavior, and first-hand experience with a suicidal peer was examined.

RESULTS

Two factors that approximate avoidance and approach coping responses, maladaptive coping strategies and help-seeking strategies, respectively, were identified. Boys scored higher than girls (t = 7.96, df = 2341, p < .001), and depressed youths (t = 15.56, df = 2323, p < .001), students with substance problems (t = 11.07, df = 2340, p < .001), and suicidal youths (t = 15.14, df = 2341, p < .001) scored significantly higher than their healthy counterparts on the maladaptive coping strategies factor. Students with first-hand experience with a suicidal peer scored significantly higher on the maladaptive coping strategies factor than those without this experience (t = 7.95, df = 2321, p < .001). Lower risk groups scored significantly higher on an adaptive help-seeking strategies factor.

CONCLUSIONS

High-risk adolescents' attitudes are characterized by core beliefs that support the use of maladaptive coping strategies in response to depression and suicidal thoughts and behaviors. Targeting such attitudes is a recommended component of youth suicide prevention efforts.

FAMILY ENVIRONMENTAL FACTORS AS CORRELATES FOR ADOLESCENT SUICIDAL BEHAVIORS IN THE LIMPOPO PROVINCE OF SOUTH AFRICA

The perceived family environmental factors that could correlate with adolescent suicidal behaviors in the Limpopo Province (South Africa) were investigated. The participants were 435 secondary school adolescents from the Pietersburg area in the Limpopo Province of whom 56% were female, and 44% were male, aged between 15–19 years. A questionnaire was used to determine demographic variables, family environmental factors (Moos & Moos, 1989), and suicidal behaviors. Logistic regression analysis showed that: conflict in a family was a significant correlate for three forms of suicidal behaviors studied; family independence, family cohesion, and family organization were also indicated as significant correlates for suicidal threats, however, family independence and organization correlate negatively with suicidal threat. Mental health workers and educators should consider these findings when planning preventive and therapeutic strategies for the minimization of suicidal behaviors among adolescents in the province.

A comparison of life events between suicidal adolescents with major depression and borderline personality disorder

The current study compared the correlations of different types of stressful life events (SLE) between suicidal adolescents with major depressive disorder (MDD) and suicidal adolescents with borderline personality disorder (BPD). Both groups were referred following an attempted suicide. Twenty adolescents with MDD and 20 adolescents with BPD who were consecutively referred to an outpatient clinic following a suicide attempt were evaluated. A community control group of adolescents with no lifetime history of suicidal behavior was also assessed. The following measurements were employed: the Suicide Risk Scale (SRS) Beck Depression Inventory (BDI), the Life Events Checklist (LEC), and the Childhood Sexual Abuse Questionnaire (CSEQ). Both groups of suicidal subjects reported more SLE in general and more physical abuse than community controls in the 12 months before the suicide attempt. The MDD adolescents had more lifetime death-related SLE than the BPD and control groups, while the BPD adolescents reported more lifetime sex abuse-related SLE than the other two groups. Thus, suicidal behavior in general may be related to the amount of SLE. However, different disease-specific life events may precipitate suicide attempts in adolescents with MDD and BPD.

The Prevalence of Suicidal Behaviours among Secondary School Adolescents in the Limpopo Province, South Africa

The aim of this study was to investigate the prevalence of suicidal behaviours among secondary school adolescents in the Limpopo Province. The participants in this study were 435 secondary school adolescents from Polokwane and surrounds. Two hundred and forty-three (56%) participants were female, and 192 (44%) were male. They were aged between 15 and 19 years, with a mean age of 17.25 years ( SD = 1.34). A questionnaire was used to record participants' demographic data and suicidal behaviours, including suicidal thoughts and threats, plans, and attempts to commit suicide). Thirty-seven percent of the secondary school adolescents surveyed indicated having thought of taking their own lives; 17% had made threats or informed others about their suicidal intentions; 16% had made plans to take their own lives but did not carry them through; 21% reported having attempted to take their own lives. These results indicate that a higher percentage of males than females had attempted suicide. The most frequent method used for attempting suicide was self-poisoning (44% of the attempters), followed by drug overdoses (25.3%), hanging (22%), self-stabbing (2.2%), and other methods, such as, jumping from heights, starvation, and drug abuse (6.6%).