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Permalink Reply by Yasmeen(S.admin) on June 25, 2012 at 11:21am

Suicide among Adolescent

Adolescent suicide is a complex, yet a preventable public health issue both in industrial and developing countries. Studies have shown that suicide is the leading cause of premature death across the world taking the life of one individual every five minute. According a report of WHO (2010), suicide accounts approximately one million deaths per annum. It is the third leading cause of death among 15-44 years olds, and the second leading cause of death among 10-24 years olds in some countries (WHO, 2010). If we look into the situation of Pakistan its population is approximately 162 million with 97% being Muslims and suicide is considered as a condemned act in Islam (Khan, 2007). Evidence from different studies shows that there are no official statistics on suicide in Pakistan and most of the suicide information comes from newspapers, NGOs and police departments of different cities. Khan (2007), states that most suicide occurs in young people (single men and married women) under the age of 30 years. Further, it says that 5,800 suicides occurred in nine months of 2006 in Pakistan. So, based on the above mentioned studies it is cleared that adolescent suicide is becoming a major health concern worldwide. But unfortunately, the problem is not receiving attention globally as it deserves. Therefore, national and international effort should be taken to tackle this tragic phenomenon. Causes of Suicide
The reason why people commit suicide is a multifaceted phenomenon and it is usually the result of a number of factors which include psychological, socio-economic, demographic, biological, and environmental factors. There are ample of evidences that psychological factors are the major causes that lead to suicide among most of the adolescent worldwide. For example, “depression combined with alcohol abuser occurs in 80-90% of those who commit suicide” (WHO, 2006). Moreover, it also states that by 2020, depression will become the second leading cause of disability worldwide. As far as the situation of Pakistan is concerned Khan (2007), states that almost 34% of Pakistani population suffers from common mental disorders, and depression is alone is responsible for 90% of suicide in the country. So this high prevalence of mental disorders worldwide has become an important global health burden which requires increase spending on mental health as well as proper utilization of the available resources. There appears to be a strong association between poor socio-economic condition and suicide. “Suicide rates are highest among developed countries particularly those which have developed rapidly. Within these countries suicide rates are highest for sub-groups that have remained socio-economically disadvantage” (WHO, 2008). According to WHO (2008), Pakistan is the country with lowest Human Development index (HDI) and Australia remains the highest in economic prosperity. The contributing characteristic relating to socio-economic includes low educational status, employment, income, occupation, poverty and social class. A person with low socio-economic status often lack access to the community resources that promote and support human development. So deprivation from these basic characteristic makes a person more prone to suicidal attempts because sometimes it becomes more formidable for these peoples to strive with life. It has been observed that comparatively higher ratio of female to male suicide have been reported in most of the studies. According to WHO (2008), in some countries like India, Pakistan, and Sri Lanka where arranged marriages are common and due to which the social and familial pressure on a women to stay married even in abusive relationship appears to be one of the factors that increases the suicide in women. According to a special report on daily times on May 7, 2012, 70% of youths in the age 18-30 years who attempt suicide in Karachi are females. Moreover, a report compiled by Human Right Program Chitral (HRPC, 2012), states that more than 30 women aged between 15-35 years ended their lives by their own hand during the last two years. Further, dowries, unhappy marriages, harassment, family issues and attitude of the society towards the women further complicate this problem. Another, precipitating factors for suicide among adolescent are some of the biological factors that are heritable in the families. According to Donald et al. (2007), a number of biological factors have been associated with suicide like low cerebrospinal fluid, platelet disorders, hormonal imbalances and abnormal sleep patterns. The environment sometime becomes a place of stress for most the adolescent whether it would be institutional or home environment. As the society is getting increasingly competitive so the pressure on adolescent to do well in exams often put them under high stress and pressure. According to WHO (2008), the shame associated with failure in exam have been the cause for suicide among young people in countries like Sri-Lanka, Indian, china, and Japan. Therefore, these shames associated with exam failure or in any other area push these adolescent to attempt a complete suicide. Moreover, according to (Donald et al., 2007) adolescent with substance abuse disorder, being bullied, history of abuse, life on street (throwaway or runaway adolescents), involvement in wars and chronic illness are on high risk of suicide. Another factor in our society which needs the focus of attention of each one of us is the ***ual abuse of adolescent. Millions of adolescent are becoming the victims of physical and ***ual abuses and most of them goes unreported worldwide. According to Donald et al. (2007), there are approximately 3 million reported annual cases of abuses in those under 18 year of age in the united states; these reported are subdivided into neglect 53%, physical abuse 26%, ***ual abuse 14% and emotional abuse in 5%. According to WHO (2008), in some countries suicide is considered as a crime and great stigma is attached to the surviving families and these families are reluctant to report suicide or to seek help. However, if we talk about a country like Pakistan the stigma is even much greater. Therefore, it is one of the main reason and a growing concern in our society where more work should be carried out.
Common Methods of Suicide
Secondly, to discuss the most common methods of suicide among adolescent it is important to have a look at the prevalence of each method. A review of literature suggests that the common method of suicide among adolescent are poisoning, hanging, firearm, jumping from height, self-shooting and drowning. According to Donald et al. (2007), the most common method of suicide in 10-19 years old were Firearms 49%, Suffocation (mainly hanging) 38%, poisoning 7% and miscellaneous 6% and it is estimated that for every complete suicide there are at least 10-20 deliberate self-harms (DSH). However, according to Khan (2007), in Pakistan the three most common methods are hanging, ingestion of insecticide and firearms. Moreover, it also states that hanging is difficult to control, while restricting the availability of latter two can potentially prevent 50% of suicides. According to WHO (2008), the efforts to focus on suicide methods are responsible for a significant proportion of suicide rate. It also mentions that China, India, Pakistan and Sri Lanka are the countries where pesticide- related suicides are prevalent. Therefore, public awareness to promote safe storage of poisoning agents (such as pesticides, charcoal and other chemicals), securing jumping sites and restricting the availability of firearms are some approaches that can help to reduce suicide rates among the adolescent.
Suicide Warning Signs
Suicide warning signs are the earliest indications that shows a person might be at a high risk of immediate suicide, having serious thoughts about taking his/her life or making a plan to take the action. “A suicide warning sign is the earliest detectable sign that indicates heightened risk for suicide in the near term (i.e., within minutes, hours, or days)” (Rudd, 2008). Therefore, it is very important to recognize the warning signs in high risk individuals in order to prevent these tragic phenomena’s in our society. Some of the most relevant warning signs stated by Rudd (2008) are previous suicide attempts, threat of suicide, depression, unusual changes in personality or behaviors, increased use of drugs and major change in life. Moreover, frequently talking or joking about committing suicide, saying goodbye to family and friends, frequent crying, giving away their valuable things to others and often complaining about life are some of the warning signs identified by other studies and these have been called as red flag as well.
Conclusion and Recommendations
As far as suicide prevention is concerned, it is social pathology which requires a multi-sectorial approach. There is a need for collaboration between government, non-governmental organizations and health care professional to take up this challenge. As a healthcare professional it becomes our responsibility to encourage people with depression and other mental illnesses to seek health care. Training to primary care physicians to recognize and treat psychiatric disorder should be the primary focus in order to improve better mental health services in the communities. Moreover, it is necessary to educate those health care professionals who are working with high risk individuals and families to recognize depression and related mental disorders so that early preventive step will be taken. According to Dore et al. (2006), selective prevention and screening programs for youth who are at particular risk needs to be initiated. Moreover, it states that target program for school dropouts because they are often socially-isolated and are engaged in unhealthy activities. According to WHO (2008), increasing public awareness through the distribution of pamphlets, posters, commentaries in newspaper and on television are the approaches which help in reducing the suicide rates. Moreover, special training programs for parents, teachers, social workers, youth leaders, religious leader and caregivers are some of the strategies recommended by World Health Organization that can help in suicide prevention. Further, suicide prevention strategies which include crisis management, self-esteem enhancement, development of social skill and healthy decision making need to initiated among youth at school level. Lastly, more researches should be carried out at national and international level in order to better understand the root causes of suicide both at micro and macro level and on its prevention accordingly.

Permalink Reply by Yasmeen(S.admin) on June 25, 2012 at 11:29am

newspapers of past month

Published: March 29, 2012

Everyday around five to six teenage suicide attempts are taking place in the city.

Last year, around 1,153 people attempted suicide across Pakistan and 2,131 were successful. HRCP cites data from the National Poison Control Centre in Karachi which receives five or six cases in which people have deliberately tried to ingest poison to end their lives. About 60% of all reported cases are of teenage girls whose families do not want to register the cases as attempted suicide.

HRCP Chairperson Zohra Yusuf said that young women are committing suicide because they are unable to cope with the pressure of everyday life. “Factors such as poverty and forced marriage are making young women commit suicide,” she said.

“Yaqoob shot himself dead with a pistol at his home after his father, Kaleem, scolded him for not taking interest in his studies,” reads a report on the National pages of today’s newspaper.

It goes on to add: “Mr Kaleem told police that his son was unwilling to go to school due to bullying by his class teacher. He said that he would also scold Mr Yaqoob whenever he resisted going to school. Frustrated with the harsh attitude of his father and teacher, Mr Yaqoob went home and shot himself dead with a pistol.”

Fourteen-year-old Yaqoob was the fifth such teenage student to take his life within the span of two weeks.

Teenage is the best of times and also the worst. It is the age of innocence mixed with a little foolishness. On the threshold of a carefree childhood and a wiser adult life, the world is their oyster, when nothing seems impossible as they strive to reach for the sky.

So when one hears of five young teenagers committing suicide in such quick succession, one cannot help but wonder what happened to a life of fun and frolic snuffed so callously.

Eighteen-year-old Khursheed studying at Islamabad Model College for Boys shot himself with his father’s pistol when his father scolded him for refusing to take an entry test; 17–year-old Shan from Gharibabad swallowed poison after his parents attempted to stop him from spending time with friends and not concentrating on studies; seventh-grader Abdul Mobin in Abbottabad who took his life because of torture at school and a 13-year-old student in Karachi hanged himself by the ceiling fan after he failed in exams.

Why would young people get so bored with life just as they enter its most exciting phase?

“If they don’t have the right balance of opportunities, resources and hope, they can get ‘bored’ and hopeless,” explains Dr Murad Musa Khan, chairman of the Department of Psychiatry at Aga Khan University Hospital, Karachi.

Perturbed by the recent suicides, Khan says there is every reason for concern because “even one suicide is one too many”. He sees “lots” of young people, some even as young as 12, who have attempted suicide because of “academic pressures, relationship problems, identity problems, parental discord, use of drugs, bullying (including cyber-bullying)”. In addition, there are many, he says, who suffer from low self-confidence and low self-esteem.

However, Karachi-based clinical psychologist, Dr Asha Bedar, does not believe child or teen suicide is a result of boredom. “It’s usually about either mental illness (e.g., depression) or emotional disturbance caused by circumstances.”

While many adults associate childhood/teenage with fun and a carefree outlook towards life, Bedar points out: “unfortunately, that is not the case for many children and young people around us.”

Like adults, she says, many children and young people suffer from mental illness, such as depression (often undiagnosed and therefore untreated in a country like Pakistan) and extreme emotional distress or disturbance caused by circumstances around them.” During her practice, she sees many young people who have attempted but “even more who have thought about suicide”.

Bedar emphasises that other than a mental illness, abuse has been one of the most common issues which many young people, who come to her, have suffered from. “This could be exposure to severe violence at home – perhaps a home environment characterised by tight parental control, terror and sadness. Or it could be ongoing exposure to severe physical violence/bullying outside the home, sexual abuse (including rape), cyber-bullying, blackmailing.”

The reasons why young people (aged anywhere 14 to 24), or even younger, commit or attempt suicide, are multiple says Khan. Usually, however, a combination of “life stresses and a vulnerable personality” veering the person towards depression, with “hopelessness” as a predominant feeling, leads on to suicidal behaviour.

According to the independent 2012 annual report of the Human Rights Commission of Pakistan (HRCP), poverty and an uncertain future are turning teenage girls in Karachi to end their lives.

Citing the National Poison Control Centre, at Jinnah Post Graduate Medical Centre, in Karachi, HRCP’s annual report for 2011, reported that there were 1,153 attempted suicides across Pakistan and 2,131 suicides in 2011 with five or six teenagers attempting suicide every day in Karachi. Of these, 60 per cent are teenage girls and families are reluctant to register the case as attempted suicide.

In 2002, the World Health Organization estimated that over 15,000 suicides were committed in Pakistan, but Khan estimates it to be “probably about 5,000 to 7,000 suicides” annually. In addition, he says, there are approximately 50,000 to 150,000 cases of attempted suicides. The majority of suicides and attempted suicides are in people under the age of 30 years.

Of these, he says, approximately 25 per cent of the cases would be in the teens. “These figures are the best estimate one can ascertain from all the studies on suicide that are available,” Khan tells Dawn.com.

In almost all settings all over the world, including Pakistan, says Musa, more girls than boys attempt suicide but more boys commit suicide than girls.

“Generally speaking girls are under more stress all over the world including Pakistan and making a suicide attempt is a sign of extreme stress/distress,” he says.

But why are young people in Pakistan so troubled?

Musa has no qualms about putting the blame squarely on the adults. “Because the elders have failed to provide the young with a safe and secure environment for them to live and prosper under,” he says, adding: “Just drive around on a Sunday and see the number of young boys playing cricket on the roads or dirty grounds. Why can’t proper grounds and equipment be provided to these young men?” He thinks the issue of suicides is both a human rights one and a fundamental rights one.

Dr Shifa Naeem, a Karachi-based psychiatrist, believes today’s teenagers “are exposed to many more stresses” than their counterparts were a generation or two back.

“Expectations are higher from them, while support systems are weaker,” she says explaining the scenario by taking two imaginary profiles of a teenager from the 1960s and one of today.

“The young teenager from the 1960s was spending some time of the day in physical exercise (as it used to be mandatory); he or she would have good chances of having an involved and committed teacher who’d also be a mentor. In addition, parents, too, were spending more time with them and life was generally simpler.” On the other hand, Naeem points out, the teenager of today is “expected to excel in studies and studying at a school which the parents can feel ‘proud’ of, should also look cool and be popular with all the kids at school, should have more friends on Facebook than the rest, have a glamorous life-style (similar to the one he or she sees on the TV and which includes marijuana, cigarettes and alcohol).”

That is not all. “A poor law-and-order situation and the helplessness and a sense of hopelessness prompted by injustices and ‘might is right’ – they all add up,” she concludes.

Bedar is of the view that while children are “typically resilient” and get over a difficult period; professional help must be sought for mental illness.

“One isolated incident does not cause a child to contemplate or attempt suicide – it is usually an ongoing chronic situation (for instance, abuse/violence at home or at school, debilitating poverty, etc.), something that makes the child feel completely helpless, fearful and trapped like there is no way out and no hope. One incident can, however, be a trigger, pushing a child/teenager over the edge, serving as the final straw,” she explains.

The more worrisome factor is that while some get “cured” so to say, many attempt and re-attempt and eventually succeed in killing themselves.

“The chances of a person re-attempting increase greatly after one attempt as the person crosses a certain threshold and the fear of the attempt is decreased,” says Khan, adding that he/she finds it easier to attempt it again.

“In many cases, the underlying psychological stressor is not addressed, though medical treatment is given (stomach washout, antidotes, among others). Each suicide attempter, he says, must undergo a psychological evaluation and the underlying psychological problem must be addressed.

Khan also emphasises that the way media reports the issue has a major impact on suicide attempts and suicide rates. “If it is glamorised and portrayed in such a way that it sounds that suicide is an acceptable way of dealing with life’s problems than it gives encouragement to other vulnerable people who may be in the same situation as the one who has committed suicide.”

 

 

Permalink Reply by Yasmeen(S.admin) on June 25, 2012 at 11:32am

The recent rise in the suicide rate among children and teenagers throughout Pakistan proves that no institution/system, whether family, education, or religion, can be singled out and held responsible for the gradual process of alienation that results in such unfortunate incidents.

The first step our government (federal and provincial) and NGOs should take is to ascertain the actual statistics about all
forms of suicides in Pakistan.

Secondly, identify the effective causes behind increasing rates of suicide.

And then through a nationwide campaign, parents, teachers and children must be trained to deal with the identified potential threats present in our society.

It is we who killed them, and it is time we took responsibility for our negligence.

Permalink Reply by Yasmeen(S.admin) on June 25, 2012 at 11:35am

Suicide is a global issue and the leading cause of death in the world claiming lives of around one million people every year.

Suicide is a multi-dimensional disorder, which results from a complex interaction of biological, genetic, psychological and environmental factors, said a psychiatrist of Sir Cowasji Jehangir Institute of Psychiatry (SCJ) Hyderabad Dr Darya Khan Laghari on Wednesday.

In a country like Pakistan where growing economic instability, especially poverty, has forced people to sell their children and body organs, he said that the reasons behind increasing rate of suicides could be understandable.

According to data revealed by the regional directorates of the Ministry of Law, Justice and Human rights in Karachi, Lahore, Peshawar and Quetta, he informed that 50 per cent of the suicides are committed due to poverty and economic hardships.

Dr Laghari said that some psychology experts also agreed with the fact that majority of suicides are usually linked to economic difficulties but there are other reasons behind committing suicides and these can be depressive disorders, unemployment, domestic violence, parental separation, growing economic instability, child abuse, bullying, rising inflation and loss of social cohesion which force a person to end his or her life or release them from the pain they are suffering from.

Besides economic instability, factors of suicides in Pakistan by certain analysis and surveys taken by people are, psychiatric disorders, marital status (being married), unemployment and negative and stressful life events, he said.

The psychiatrist said that these were just some figures, which appeared through the media, as most cases of suicides in Pakistan are not reported.

Dr Laghari said that Pakistan has witnessed a drastic increase in the number of suicides but the problem is that it does not collect national suicide statistics nor report them to WHO (World Health Organization) so due to that it has become very difficult to compile global suicide statistics thus making the planning of prevention programmes, almost impossible.

He said that the facts revealed that suicide has become a major health problem in Pakistan, and despite this there are no official statistics. One major reason for this is that when a person attempts suicide his or her family usually tries to cover the act.

He said that suicide has become quite a delicate and multifaceted problem in Pakistan. The rate of suicide is consistently higher in men than women. In fact men outnumber women by two to one and within the men, more single people commit suicides than married ones.

He said that the surveys and analysis revealed that suicide rate has become more common in youth then in adults in many countries and Pakistan is one of them. Suicide rates among youth are increasing due to unemployment, pressure of work and studies, depression, anxiety and increasing poverty, he said.

Dr Laghari further elaborated that Pakistan’s population is 162 million and ranked as the 6th most populous country in the world. The official unemployment stands at 12 per cent of the eligible workforce and health spending is only 0.7 per cent of the national annual budget, he said. He added that Pakistan is also a Muslim country and according to Islam suicide is forbidden. Islam is the only religion that has a clear scriptural ban on suicide, so, it has an independent effect on lowering suicide rates but still many people commit the act everyday in Pakistan.

Dr Laghari there is compelling evidence that the suicide ratio has gradually been increasing in Pakistan over the last few years and that the upward trend has been very dramatic with almost 3,000 cases of suicide being reported in 2001 nationally. Even this is considered to be an underestimation, as it is well known that in many developing countries suicide tends to be grossly under-reported, he added.

He said that suicide and depression are linked to each other as more than 80 per cent of people who commit suicide suffering from depression. He said studies suggest that lifetime risk of suicide in people with depression was 15 per cent, with alcoholism 7 to 15 percent and with schizophrenia, 4 to 10 per cent. However, a substantial proportion of people who commit suicide die without having seen a mental health professional, he said and added that detection, and referral and management of psychiatric disorders in primary care was an important step in suicide prevention.

Permalink Reply by Yasmeen(S.admin) on June 25, 2012 at 11:38am

giving news papers reports so u can take idea to make the assignment

• suicide-attacks-july-sep-report.pdf, 205 KB