THE EXAMINATION OF PARENTAL ROLE IN CURBING SUICIDAL ACTIONS IN NIGERIAN TETIARY INSTITUTIONS
Chapter Two
Literature Review
2.1 Conceptual Framework
2.1.1 Concept of Suicidal behavior
Suicidal behaviour refers to a deliberate act intended to end one’s life in order to escape unbearable suffering or to help change adverse conditions of living (Kerkhof, 2004). It is the intentional act of taking one’s own life or the destruction of one’s own interest or prospects (Yerkes, 1994; George, 2007). Maris (2002) described suicidal behaviour as problem-solving behaviour. Udoh (2000) saw suicidal behaviour as any willful act which is designed to end one’s own life. For many, according to him, it is a crime against oneself, nature, humanity and God. LaGreca (1988) referred to it as the conscious, intentional taking of one’s own life through an identifiable, discrete act. Most suicides recorded in early history (Stillion, McDowell, & May, 1989) involved theme of regret and atonement. For instance, the Old Testament described suicide of Sampson seemingly as a self-inflicted punishment for failing to stand strong in his faith. The New Testament described the suicide of Judas Iscariot, who killed himself in an attempt to atone for his betrayal of Jesus of Nazareth. Suicidal behaviour has been an age-long phenomenon.
Stillion (1995) described suicidal behaviour as an intra-psychic conflict and suggested that much of the pain experienced by suicidal people was from unresolved struggles among the id, ego, and superego. He opined that suicidal behaviour might also result from anger or aggression turned inward. This view was supported by Horner and Fredericks (2005); and Amazeen, (2005) who stated that suicidal behaviours might result from intra-psychic and unresolved struggles among the id, ego, and superego. They maintained that suicidal behaviour might result from anger or aggression turned inward and the desire to end one’s live.
Suicidal behaviour could also be defined as intent to commit suicide or as having ever attempted suicide in lifetime (Walter et al., 2005). It implies all the intentions, ideations or actions pertaining to, leading to, or involving suicide (Kastenbaum & Kastenbaum, 1993). It is a conglomeration of some seemingly insurmountable personal problems of individuals which make them think that the only solution is to die. Their main purpose is to seek a solution to an overwhelming problem. Suicidal behaviour is sometimes associated with the mental health status of individuals who cannot cope with their lives (Kerkhof, 2004, WHO, 2006). Suicidal behaviour demonstrates that something is fundamentally wrong, either with an individual or with the situation in which the individual exists, or with both the individual and the situation. It does not show up without any reason. It involves not only pain, but the individual’s unwillingness to tolerate that pain, the decision not to endure it, and the active will to stop it (Leming & Dickson, 1994; WHO, 2008).
Suicidal behaviour could be fatal (completed), non-fatal (attempted), ideation
(thinking about), or self-destructive behaviours (Lester, 1999; Seiden & Gleiser, 2000; and Canetto, 2001). Robert, (2008) typically call those suicidal actions in which the person dies completed suicide (fatal), and those in which the person survives attempted suicide (non-fatal). Suicidal and self-destructive behaviours represent distinct, although somewhat overlapping phenomena (Seiden & Gleiser, 2000). Suicidal behaviour thus refers to the ideas, intentions, plans and attempts to end ones life immediately, while self-destructive behaviours refer to indirect, slowly killing behaviour that has no immediate end of life. For example, sex abuse is a self-destructive behaviour because the abuser and the abused can contract HIV which may eventually lead to full blown AIDS and death. A study (Taylor, 1990) conducted by Cornell University Medical School revealed that men infected with AIDS were 36 times more likely than average males to commit suicide. The study also found that AIDS patients were far more likely to choose to end their lives than were men with other fatal diseases This was also supported by WHO (2008) who reported that AIDS patients were more likely to commit suicide than were people with other terminal diseases because of the stigmatization against the AIDS patients.
In Nigeria, suicidal actions are regarded as taboos. In South Eastern States of Nigeria, suicide is described as bad death and an abhorred act. It is also labeled as an immoral and abhorred act in many other cultures of other parts of Nigeria. For example, the Ibibio of Akwa Ibom State describe suicide as “Uyire Ekpan” that is bad death and abhorred act (Atiata, 2006). Such actions are sometimes concealed and shrouded with secrecy by the family members of the victims or the attempters. This is to avoid stigmatization of the family members by the entire community. This accounts for the dearth of data on suicidal behaviours in Nigeria. For the purposes of this study, suicidal behaviour refers to the act, the intentions, ideation, an attempt or instance of taking one’s own life and indirect self-destructive behaviours, especially by a person of years of discretion and sound mind. Prevalence in this context refers to the degree of common occurrence or widespread or practice of suicidal behaviours among undergraduates of universities in South Eastern States of Nigeria. It is the process of suicidal behaviour that may be found everywhere in universities in South Eastern States of Nigeria.
The prevalence of suicidal behaviours has been known to vary with several factors including sex, nationality, ethnicity, socio-economic problems (Moscicki, 2001; Canino & Roberts, 2001), yet most of the studies have had adolescents and youths as their focus. While there have been studies on suicidal behaviours of adolescents and youths in civilized countries of the world (Reynolds & Mazza, 2000; Shaffer & Hicks, 2004; Roberts, 2000), there is a paucity of data on the suicidal behaviours of adolescents and youths in Nigeria, especially the undergraduates of universities, majority of who are the adolescents and youths. Because of this paucity of data in Nigeria, majority of the related reviewed literatures were taken from journals, textbooks, inserts, seminar papers and unpublished projects reports, essentially of foreign backgrounds.
Marecek (2001) outlined some of the causes of suicidal behaviour to include discrete crisis usually involving inter-personal difficulties such as disappointments, or difficulty with a love relationship. Others were failures in school or work, family conflicts, household problems, economic problems, personal problems, and achievement–related conflicts. He included unwanted pregnancy, rape, drug addiction and frustrated urges as contributors to suicidal behaviour. Pillary and Van der Veen (2001) averred that families that suffer chronic tension, marital conflict, poor communication, poor problem identification, role conflict and low cohesion were statistically associated with suicidal behaviours particularly for women. Similarly gender linked tensions were internationally associated with suicidal behaviour (Sefa-Dedeh & Canetto, 1999), particularly in Asian countries and in countries where women have low social status (Canetto, 2002; Vijaya Kumar & Thilothammal, 2000).
Bertolote et al. (2004) had the same view when they reported that gender-linked tensions were associated with suicidal behaviours worldwide, especially, in Asian countries and in countries where women have low social status.
Aiken (1994) reported that United States newspapers occasionally carried stories of older married couples, who because they had been the repeated victims of crime or suffer from severe neglect or chronic illnesses became despondent and decided to end their lives together. Durkheim (1991) postulated the sociological view that suicidal behaviour occurs as a result of pains individual experiences from not fitting well within their societies. He pointed out that although suicidal behaviour is supremely individual and personal act, it also has a social and non-individual aspect. Egoistic suicidal behaviour, he noted, occurs when the person is inadequately integrated into the society, such as intellectuals or persons whose talents or situations in life place them in a special category (a celebrity or star), and are therefore less likely to be linked to society in conventional ways. He further pointed out that altruistic suicidal behaviour happens when the individual is overly integrated into the society (an exaggerated concern for the community) and is willing to die for the group, like Kamikaze pilots of world war 11 or the terrorists of today. This was later re-emphasized by Simpson and Durkheim, (1997).
Anomic suicidal behaviour results from the lack of regulation of the individual when the norms governing existence no longer control that individual (feels let down by the failure of social institutions), such as business person committing suicide after a stock market crash or one suddenly losing his or her job (Stillion, 1995). In fatalistic suicidal behaviour, one dies in despair of being unable to make it in a society allowing little opportunity for satisfaction on individual fulfillment (Leming & Dickson, 1994). Both the altruistic and fatalistic suicidal behaviour involve excessive control of the individual by the society (Kastenbaum, 1995).
Suicidal behaviour has also been attributed to many psychological states, including hostility, shame, guilt, anxiety, inferiority complex, dependency and disorganization. Krauss (1996) believed that suicidal behaviour results when an individual is deprived of a cherished goal or relationship and destroys the representation of the goals on object within the self. This was also supported by Appel (2007) who averred that a broken cherished love relationship could lead to suicidal behaviour. Faber (1994) stated that the variable most intimately related to suicidal behaviour is hopelessness. Hopelessness is characterized by a depreciated self-image and loss of gratification from significant relationship or roles in life. May and Van Winkle (1994) hypothesized that those tribes characterized by low social integration, where band-level organization is generally the most binding form of social control, have higher rates of suicidal behaviour in most years. Those tribes who have higher levels of social integration, where clan level organization is augmented by broader level of control at the community level (e.g. clan and communal groups) organized around larger permanent group-supporting functions have lower rates.
Shneidman (1999) outlined four categories of suicidal behaviour: surcease, psychotic, cultural and referred. Surcease suicidal behaviour is attempted with the desire to be released from pain, emotional or physical. For example, a person with a painful terminal illness who wished to escape further suffering may perceive suicide as a way to do so. This type of suicidal behaviour is sometimes referred to as “auto-euthanasia”, self-administered mercy killing. Psychotic suicidal behaviour results from the impaired logic of the delusional or hallucinatory state of mind associated with clinically diagnosed schizophrenia or manic– depressive psychosis. The victim may try to eradicate the psychic malignancy or punish himself or herself by self-destruction, even though there is no conscious intention to die.
Cultural suicidal behaviour results from the interactions between self-concept and cultural beliefs about death. In medieval Japanese society, ritual suicide called hara-kiri, or seppuku, was culturally accepted, even demanded, in certain circumstances, especially among the warriors or samurai class. Similarly, until modern times, certain castes in India were expected to practice suttee, which called for the wife of a nobleman to throw herself upon a funeral pyre (a heap of wood upon which a corpse is burnt), (Shneidman, 1999). This assertion was re-iterated by George in 2007 when he said that until modern times certain castes in India were to practice suttee, which called for the wife of a nobleman to throw herself upon a funeral pyre of her husband in honour of the dead nobleman (George, 2007).
Referral suicidal behaviour results from destructive logic, such that the victim “confuses the self as experienced by the self with the self as experienced by others”. In other words, the victim’s self-concept is confused with imaginings of what others think about him. The victims of referred suicidal behavior tend to feel lonely, helpless, and fearful. They typically experience difficulties in establishing and maintaining meaningful personal relationships. These problems with self-identity coupled with an inability to feel comfortable, relating to others, often involved the victim’s self-perception as a failure. The implication of Shneidman’s categories of suicidal behaviour is that students with terminal illness like cancer or AIDS, or mentally deranged, might engage in suicidal behaviour. Those who have negative self-image about themselves or those confused of what others think about them might also be tempted to engage in self-destructive behaviours, (Shneidman, 1999; George, 2007).
Factors associated with suicidal behaviours
It is speculated that an important phenomenon occurred in the present generation of Nigerians that resulted in many people wanting too many things that were not available contributing to an increased abnormality in people’s attitudes and behaviours. This probably plunged the nation into the present economic crisis which may have weakened family ties and school discipline; and accelerated a breakdown in relationship in various settings. These and other factors are associated with suicide and suicidal behaviours. Some of these factors include: bad economic times, family disruption, and bereavement, pressure of work, poor relationship and personal factors.
Bad economic times
Kastenbaum, (1991) in Okafor and Okafor (1998) reported that bad economic times were associated with an increase in suicide rates. They maintained that although data were not available in Nigeria to confirm this assertion, it was most likely that periods of recession in Nigeria had led to a general rise in suicide. That bad economic times resulted in unavailability of jobs, loss of jobs and different forms of financial reverses. When people were worn down by tribulations and hardships they asserted, the people might long for a ‘rest in peace’ or a ‘better refuge.’ This motivation may lead to suicides and suicidal behaviours.
Family disruption
Several family disruptions such as separation, divorce, death, parental psychopathology, and family violence have been associated with the suicidality among students (Green, 1978; Okafor & Okafor, 1998). These studies agree that parental attitudes, feelings and actions influence the child and produce in the child lasting identification which, in turn, becomes apparent in the child’s perceptions and fantasies of him or herself and others. When a parent, for instance, is violent, the child may wish to escape from the intolerable interactions of his or her parents. It was also observed that children seem to imitate their parents’ aggressive behaviour as well as to identify with the parents’ hostility and criticism of him or her. As a result, the child regards him or herself as bad, hostile, destructive, and worthless (Okafor & Okafor, 1998). Suicidal behaviour may, therefore, be one drastic mechanism available to the child for unburdening his or her intolerable feelings.
Bereavement
Losses of significant others are difficult for people of any age, and especially so with tenuously adjusted youths. The loss of a loved one can be experienced as so unbearable that the survivor is tempted to join the deceased. Loss of a parent at a young age for instance may result in feelings of undeserved guilt, unbearable grief, or fear of mental illness. These unbearable grieves and undeserved guilt may lead to suicide and suicidal behaviours
Pressure of work
Pressure of work, particularly academic pressure seems related to suicide, but in a simple way. Typical student victim of suicide has respectable academic record, but felt that he or she is not performing up to expectations. People who feel unable to live up to what others expect of them may develop feelings of shame and guilt which are capable of leaving them open to developing a sense of worthlessness and inadequacy. Parents who expect too much from their children or put too much pressure for achievement and success on them may contribute to the development of these undesired negative feelings that may result in suicide and suicidal behaviours in their children. These negative feelings may also lead to poor relationships.
Poor relationship
A feeling of isolation may result when one is unable to establish close and meaningful relationships with friends, parents and older role models. A lover may be rejected, and employee passed over for promotion, or another child preferred and pampered leaving inside him or her feeing of burning resentment and hurt. A repeatedly unfairly treated, achievements never recognized no matter how hard one tried, love and appreciation withheld are some of the predisposing factors for suicide and suicidal behaviours. Somebody who is denied attention or lacks effective relationships with peers may do something wrong to have that attention. He or she then, may decide to punish others by punishing him or herself. In later life, social isolation is among the factors that increase the likelihood of suicide. This is so in societies where appreciate and useful roles are not created for the older citizens.
Personal factors
At the personal level, self – directed aggression which seems to encompass Freud’s view of lurking death wish and also extends to ‘partial’ suicides, such as accident proneness, drug addiction, and excessive risk taking is identified as a main curse of suicide. A desire for rebirth and restitution in which children and suicidal schizophrenics, for instance, often speak of loss of doing away with ‘bad me.’ Finally, despair, loss of self - esteem and poor self – image are also predisposing factors for suicide and suicidal behaviours.
Other factors
Other factors associated with suicidal behaviours according to Lewinsohn, Hops, Roberts, Seeley, and Andrews, (2003) include family history of suicidal behaviour; family dysfunction; and peer difficulties. This view was supported by Hovey and King (2004); George (2007); Canino and Roberts (2007), who added school failure and problems; parents/child conflict and substance abuse/dependence as contributing factors to suicidal behaviours.
History of suicidal attempts substantially increases the risk of psychopathology and psychosocial dysfunction; and of subsequent suicidal behaviours among adolescents (Garrison, Addy, Jackson, McKeown, & Waller, 1999; Pfeffer, 1999; Roberts, Roberts & Chen, 2002; Bertolote, Fleischmann, De Leo & Wasserman, 2004). Arsenault et al. (2004) and Gould et al. (2008) also found out that mood, anxiety, and substance disorder substantially increase the risk for suicide attempts in youth. Canetto (2001); Canetto and Feldman (2002), comparing females engaging in non–fatal versus fatal suicidal behaviour indicated that high–risk women experienced helplessness/hopelessness, feelings of self-blame, and a series of confusion and disorganization.
Rhodes, Lewinsohn and Seeley, (2001); Kobak et al. (2001); Tunstall, Prince and Mann, (2000) identified other factors of suicidal behaviours to include marital disorders, depression, bipolar disorders, dementia and substance use. This identification was supported by Slutske et al. (2002); Statham et al. (2002); Crosby, Cheltenham and Sacks (2003); and Breslau, Peterson, Kessler, and Schultz (2003); Appel (2007); and WHO, (2008). These various researchers maintained that factors associated with suicidal behaviours included addictive disorders, marital disorders, depression, bipolar disorders, mental disorders, access to firearms, or other lethal means, recent and severe stressful life events, and intoxication.
Pillary and Van der Veen (2001) averred that families that suffer chronic tension, poor communication, poor problem identification, role conflict, and low cohesion were statistically associated with suicidal behaviour, particularly for women. Similarly, gender-linked tensions were internationally associated with suicidal behaviour (Sefa-Dedeh & Canetto, 1999), particularly in Asian countries and countries where women have low social status. This view was also supported by Canetto (2002); Vijay Kumar and Thilothammal (2000); Horner, (2005); Shaffer, (2006); and Barraclough, (2007). These researchers in their various studies came to conclusions that family disruptions and families that suffer chronic tensions, poor communication, poor problem identification, role conflict and low cohesion were statistically associated with suicidal behaviours, especially for women who have low social status. Sex abuse (fornication, lesbianism, rape, adultery, and homosexuality) has been found to be an important precursor for suicidal behaviour (Muehrer, 2000; Westerfeld et al. 2000). McBeeStrayer and Rogers (2002), pointed out that physical abuse, verbal abuse, emotional abuse, a feeling of not being accepted by others for who you are, alcohol abuse, drug abuse and father’s alcoholism have been important predictive factors for suicidal behaviours.
Alcohol has been reported to be commonly involved as precipitating factor in much suicidal behaviour. Numerous studies, for example, have demonstrated that alcoholics have much higher annual and lifetime rates of suicide and suicidal attempts than do those in the general population (Bonges, Walters & Kessler, 2000; Meril, Milner, Owens and Vale, 1999; Murphy, 1999).
Boarding school students may be at increased risk for suicide attempts and ideation (Manson, Ackerson, Dick, Brown, & Fleming 2000; Sack, Beiser, Phillips & Baker-Brown, 2000) due to the characteristics (peer influence) that may direct them there and also to disruption of critical development process. Off-campus students may also be at risk for suicide attempts and indirect self-destructive behaviour because of the societal influence on them. Undergraduates of universities in South Eastern States of Nigeria may also be at increased risk for suicide attempts and ideations due to peer influence. These risk factors may inform the development of effective, preventive intervention strategies for the protection against suicidal behaviours and co morbid behaviours that often co-occur.
2.1.3 Preventive Measures
Suicidal prevention is an umbrella term for the collective efforts of local citizen organizations, mental health practitioners and related processionals to reduce the incidence of suicide. Such efforts include preventive and proactive measures within the realms of medicine and mental health, as well as public health and other fields-since protective factors such as social support and connectedness, as well as environmental risk factors such as access to lethal means, appear to play significant roles in the prevention of suicide, suicide should not be viewed solely as a medical or mental issues (Maine, 2004).
Suicide prevention interventions fall into two broad categories: prevention targeted at the level of the individual and prevention targeted at the level of population (Bertolote, 2004). In 2001, the United States Department of Health and Human Services, under the direction of the Surgeon General, published the National strategy for suicide prevention, establishing a framework for suicide prevention in the U.S. The document calls for a public health approach to suicide prevention, focusing on identifying patterns of suicide and suicidal behavior throughout a group or population (as opposed to exploring the history and health conditions that could lead to suicide in a single individual) (Bertolote, 2004).
The document also outlines eleven specific objectives for the prevention of suicidal behaviours. These include promoting awareness that suicide is a public health that is preventable; developing broad-based support for suicide prevention; developing and implementing strategies to reduce the stigma associated with being a consumer of mental health, substance abuse and suicide prevention services; developing and implementing community-based suicide prevention programmes; promoting efforts to reduce access to lethal means and methods of self-harm; implementing training for recognition of at-risk behaviour and delivery of effective treatment; developing and promoting effective clinical and professional practices; increasing access to and community linkages with mental health and substance abuse services; improving reporting and portrayals of suicidal behaviours, mental illness and substance abuse in the entertainment and news media; promoting and supporting research on suicide and suicide prevention; andexpanding surveillance systems.
The Jed Foundation, a nonprofit organization working to reduce the rate of suicide and the prevalence of emotional distress among college students, working in collaboration with the suicide prevention resource centre in U.S., developed a model for comprehensive mental health promotion and suicide prevention for colleges and universities, a research-based model that is useful in conceptualising suicide prevention broadly (i.e., not just for colleges and universities) (Jed foundation, 2005). The model pinpoints the following strategies: identifying students at risk; increasing help-seeking behaviours; providing mental health services; following crisis management procedures; restricting access to potentially lethal means; developing life skills; and promoting social networks.
Various specific suicide prevention strategies have been used. They include: selecting and training of volunteer citizen groups offering confidential referral services; promoting mental resilience through optimism and connectedness; education about suicide, including risk factors, warning sign and the availability of help increasing the proficiency of health and welfare services at responding to people in need. This includes better training for health professionals and employing crisis counselling organizations. Reducing domestic violence and substance abuse are long-term strategies to reduce many mental health problems. Reducing access to convenient means of suicide (e.g. Toxic substances, handguns); reducing the quantity of dosages supplied in packages of non-prescription medicines e.g. aspirin; and interventions targeted at high risk groups.
It has also been suggested that news media can help prevent suicide by linking suicide with negative outcomes such as pain for the suicide and his survivors, conveying that the majority of people choose something other than suicide in order to solve their problems, avoiding mentioning suicide epidemics, and avoiding presenting authorities or sympathic, ordinary people as spokespersons for the reasonableness of suicide (Diekstra, 2005). Means reduction, reducing the odds that a suicide attempter will use highly lethal means, is an important component of suicide prevention. (Paris, 2004 June). For years, researchers and health policy planners have theorized and demonstrated that restricting lethal means helps reduce suicide rates (Thomas, 2005). One of the most famous historical examples of this is that of coal gas in the United Kingdom. Until the 1950’s the most common means of suicide in the UK was poisoning by gas inhalation. In 1958, natural gas (virtually free of carbon monoxide) was introduced, and over the next decade, composed over 50% of gas used. As carbon monoxide in gas decreased, suicides also decreased. The decrease was driven entirely by dramatic decreases in the number of suicide by carbon monoxide poisoning (Kreitman, 1976).
In the United States, numerous studies have concluded that firearm access in associated with increased suicide risk. Because guns are quick and more lethal than other suicide means (about 85% of attempts with a firearm are fatal, a much higher case fatality rate than other methods), they are often a major drive of suicide rates (CDC, 2006).
The report further concluded that reduction in the possession of firearms would
eventually reduce drastically, the rates of suicide and suicidal attempts in U.S. Finally, it was suggested that the best way to prevent suicide is to know the risk factors, be alert to the signs of depression and other mental disorders, recognize the warning signs of suicide, and intervene before the person can complete the process of self-destruction. This can help define the problem and provide a more comprehensive view of injury circumstances useful to inform researchers and guide public health officials in developing prevention strategies against suicide. Most suicide prevention programmes that do exist on American university campuses tend to be essentially educational in nature, aiming to make students more informed about stress, self-destructive behaviours and suicides (Finding Hope and Help College Initiative, 2002; Holdwick, 2000). Others focus on suicide prevention only following a campus suicide or suicide attempt with some efforts of this type aimed specifically at students who have made a suicide attempt (Holdwick, 2000; WHO, 2006). One such programme at the University of Illinois, operating on the assumption that suicidal students do not voluntarily seek help, requires students who attempt or threaten suicide to attend four weekly assessment sessions with a social worker, psychologist, or psychiatrist. According to the university’s statistics, the campus suicide rate decreased 54 per cent during the 18 years of the programme’s existence, and none of the 1500 students who had gone through the programme had attempted or committed suicide (Joffe, 2002).
In its seminal report entitled Reducing Risks for Mental Disorder, the Institute of Medicine (IOM), University of Colorado, offered six criteria for describing, and examining preventive intervention programmes. These criteria pertain to: well-defined risk and protective factors from a developmental perspective; the targeted population group; the intervention itself; the research design used to test the programme; evidence concerning the outcomes (Mrazek & Haggerty, 2004). These criteria should be used as general guidelines for analyzing the programmes selected for the prevention and intervention of suicidal behaviours
Shea (2002) reported that relatively, little was being done in USA to systematically identify at-risk students prior to suicidal behaviour and get them into treatment. A report from Massachusetts Institute of Technology (MIT) task force concluded that the school’s system puts pressure on students to recognize their own mental health needs (Shea, 2002). At the University of California at Berkeley, an editorial in the student newspaper, Suicide Prevention Efforts Shea (2002) called on campus mental health officials to expand outreach for the services they provide, noting, ‘students who are depressed often cannot get out of bed, let alone set up an appointment with the counselling and psychological services. It is unlikely that suicide prevention programmes without public outreach will be effective in treating such students.’ (Shea, 2002: Feb.18, 26). These imply that, greater efforts are needed to educate students, faculty administrators, campus counsellors, and clergy about suicidal behaviour, its known risk factors, and effective treatments.It will also encourage clinical services to directly address psychopathology, thereby breaking down stigma and dismounting myths about students’ suicide (Haas, Hendin & Mann, 2003).
2.1.4 Parental role and Suicide among youths
Sometimes, as a parent, you need to intervene. You need to be the person with the courage to bring up difficult topics like suicide and self-destructive behaviors. A young person feeling suicidal might not have the courage to tell you directly, because these feelings are very difficult and confusing. Be especially careful after a sudden loss, like a relationship break-up or death in the family. Often when young people experience their first loss, they can act recklessly, both emotionally and physically. And watch for substance use and abuse. Many adolescents and adults that die from suicide have a substance in their bodies at the time of death. Look and listen for clues that your child may be in trouble, like:
Acting helpless and hopeless
Suddenly isolating from friends and family
Talking about or expressing fatalistic statements
Talking about or expressing death in unusual ways, including journaling or art
Experimenting with or sudden interest in activities that could cause significant harm
Suddenly acting very irritable, perhaps violently (some people express their depression outward, not inward)
Taking behavior risks that might not kill, but might cause serious harm to their bodies
Having erratic sleep patterns causing mood changes
“Medicating” depression with alcohol or drugs, which amplify depression and impulsive behavior. These behaviors and statements may or may not be a sign that your child is considering suicide, but they are a sign that something is wrong, and as a parent you need to have the courage to confront the situation. Your child may really want to talk to you about these concerns, but might feel afraid, embarrassed, or not know how to bring it up.
Initiate a direct conversation. Find a time when the two of you can talk privately without interruption.
Point out the concerning behaviors. It may be helpful to say that you have heard that these behaviors may be related to suicide.
Express your feelings of concern. Assure your child that you love him and that you want to hear whatever he has to say.
Ask your child directly if they are feeling suicidal. You may feel tempted to ask “are you thinking of harming yourself?” or “are you depressed?” instead. These are helpful, but do not get to the core of the issue.
Thank them for telling you regardless of reaction. The intent is to make them feel comfortable sharing in the future.Remember: If they tell you they’re suicidal, it’s a good thing. It means that they trust you and want to open up. Keep this conversation going.
Focus on your child’s feelings rather than your own. People with suicidal thoughts often have very low self esteem, and you may feel tempted to focus on all of their good qualities, trying to build them up again. Instead, truly listen to how they’re feeling, and validate their pain and frustration.This will build a connection that will better tie them to life.
Ask your child if they want to get help, and what sort of help is most appealing.Reassure them that you want to go down this road together.
Thank your child for sharing their feelings with you. Reaffirm that you are available anytime they need to talk.
Sometimes parents feel shame or guilt because their child is having mental health or emotional health concerns. If you feel that way, don’t let it prevent you from finding help for your child. And get help yourself. Being a caregiver is difficult.
If Your Child Is Depressed or Suicidal
Discuss with your child the possibilities of obtaining counseling services or participating in a support group or youth group where he or she can talk more about his feelings and concerns.
Supervision is an important part of suicide prevention. If your child is particularly depressed, take the time to just hang out, and make sure your child is scheduled to be around others. Adolescent suicides usually happen during times of isolation, not when others are around. Crisis periods are usually short term in nature, and constant supervision during a crisis may be important. In some cases it may require 24-hour supervision for a couple days (i.e. the young person is never left alone).
Take a mental health day, even if that is a school day. Sometimes you know your children may be at a breaking point. Taking a mental health day matters. Sometimes a young person just needs to stay home and sleep. Or maybe some days you both sleep late and go to a fun movie, amusement park or the beach. Sometimes a quick two day vacation is a good idea (and small hotel rooms mean 24-hour supervision). Young people can be very focused on the present–change the present to something fun! Discuss ideas about positive activities that are unrelated but may help with the expression of depression or anger, such as sports, art, or community involvement.
Encourage sleep and good eating. The healthy mind needs a health body. Lack of sleep and nutrients do not allow the brain to function properly. Often it may be near impossible for a young person to get eight hours of sleep during stressful times. Encourage make-up sleep on the weekends. If your child needs to end their homework time early some nights in order to get enough sleep, it is okay!
Access to weapons or medication of a family member increases the risks for youth suicide. If your child expresses the desire to die, remove and restrict access to potentially fatal objects.
For better or worse, young people communicate electronically today. When possible monitor their use of social media. A sudden termination of social connections, or statements or posts made about suicide or self-harm may be warning signs. Many young people may post cries for help in this way.
If your child is searching for suicide websites or is “following” social media pages related to self-harm, this may be a sign there is something wrong. Watch closely.If reckless behavior or depression is getting worse, an intervention may be needed. Be there for your child. Always let them know that you are there to talk and that your love is unconditional.
2.2 Theoretical Framework
Theory has been described by Cookley (1990) as simple tools that assist one to ask important questions, interprete information as well as set goals and choose strategies for achieving these goals. They are usually based on the works of more than a single person and they are applicable to situations that transcend the experience of any one individual or group. Some of these theories have been examined in this study. They include:
2.2.1 Durkheim’s theory of social integration and social regulation
The philosophical foundation upon which prevalence of suicidal behaviour among undergraduates of universities in South Eastern States of Nigeria is built is the sociological and psychological theory of social integration and social regulation enunciated by Durkheim (1897; 1991 & 1993). The theory states that there is an inverse relationship between suicidal behaviour and the degree of integration an individual has with his or her social group. He proposed that suicide results, in part, from failure of social integration. The theory posits that an individual will not die by suicide unless he/she has both the desire to die by suicide and the ability to do so. He referred to social integration as the degree to which individuals in the society were bound by social ties and relationship, while social regulation referred to the degrees to which individuals have their desires and emotions controlled by the social values of the society. Durkheim held the view that suicidal behaviour would be more likely if social integration was too strong (leading to egoistic suicidal behaviour), if social regulation was too weak (leading to anomic suicidal behaviour), or if these two social forces were too strong (leading to altruistic and fatalistic suicidal behaviours respectively). This theory was re-emphasized in 1997 by Simpson; Durkheim; and Emile.. One of the clearest findings in the literature on suicide is that individuals who die by suicide often experience social isolation and social withdrawal before their death (Dieserud, Roysamb, Ekeberg, & Kraft, 2001; Koivumaar-Honkanen et al. 2001; Stravynski & Boyer, 2001; Waern, Rubernowitz, & Wilhelmson, 2003).
2.2.2 Johnson’s theory of social integration and social regulation
Johnson (1995) modified Durkheim’s theory predicting that suicidal behaviour would be more common if social integration and social regulation were weak. He maintained that the weakly integrated person in a solid social structure or the person caught up in a disorganized culture finds himself or herself in difficulty because there is not sufficient group control. The society with lessened or weak control increases the possibility of suicide. If the group control, on the contrary, is too much, suicide may also result. In fact, the potential for suicidal behaviour he maintained increases when once there is some imbalance or upset with respect to the relationship between the individual and the society. This aspect of Johnson’s theory suggests that those forces which bind the group together may turn negative and lead to what Kastenbaum (1991) called “sociocide.”
2.2.3 Hirschi’s theory of social bond
Hirschi (1999) propounded the social bond theory, which states four elements in the social bond between the individual and the society. These include: (1) attachment–which refers to the individual’s interest in sensitivity to, and caring for others, as well as concern for the wishes and expectations of others; (2) commitment–which refers to time, energy and effort in pursuing conventional pursuits in our society. If the individual has a stake in the society, then behaving defiantly endangers this; (3) involvement in conventional activities–a person who is involved in conventional activities in the society not only has less desire to engage in suicidal behaviour but he has less time. Finally, the social bond involves belief in the moral validity of the norms established by society for him. Those norms must be seen as both good and correct for society and as relevant to our own actions.
Hirschi found that high school students who felt close to their parents were less likely to engage in suicidal acts. Similarly, those who enjoyed and were successful in school were less likely to engage in suicidal behaviours. Students with high educational aspirations were less likely to commit delinquent acts. It is also likely that in Nigerian context, students who stay close to and imitate with their good and responsible parents are less likely to engage in suicidal behaviours. Similarly, those students with educational aspirations and were successful in school may less likely engage in suicidal behaviours.
2.2.4 Lester’s theory of social process
Lester (1990) proposed social process theory of criminal behaviour which focuses on the ties between the individual on the one hand and conventional groups in the society, other law– abiding individuals and the organizations and institutions of the society on the other. He postulated that those who have close relationships with parents, friends and teachers are more likely to have a positive self-image and to be able to resist the temptation of crime. Those who feel detached from conventional society are unaffected by its social functions. He called these theories, “social control theories”. He elaborated that social control may be internal or external. Internal controls involve such personality traits as a positive self–image and a strong internalized conscience. External controls involve positive close relationships with parents and teachers who are conventional and law-abiding.
Lester postulated that the higher prevalence of non-fatal suicidal behaviour was more common among those who were highly, socially integrated (females, the young, students, and the lower class). He hypothesized that females and young people were likely to possess certain personality traits (low self-esteem, dependency, lack of self-confidence) that make them vulnerable to non-fatal suicidal behaviours. This theory was also supported by Orbach, BarJoseph, and Dior (1990); Simonds, McMahon, and Armstrong (1999) who postulated that females and young people who possess low self-esteem, dependency, and lack self-confidence were vulnerable to non-fatal suicidal behaviours. They added that suicidal persons tended to be avoidant, pessimistic, passive and rely on others for solutions to their problems. In our universities, those students who are passive and rely on others for solutions to their problems may be more easily deceived and cajoled into committing criminal acts and suicidal behaviours. All these theories are inter-related. They are all hinged on the relationship between the individual and the society. Durkheim and Hirschi's theories focus upon the social bond between the individual and the society and so fits into social control theory of Lester (1990); Orbach BarJoseph, and Dror (1990); and Simonds, McMahon, Armstrong (1991). Johnson (1995); Hirschi (1999); Lester (1990); Orbach Bar-Joseph and Dror (1990); and Simonds, McMahon, Armstrong (1999) theories are either amplifications or modifications of Durkheim (1991) theory of social integration and social regulation. Therefore, the present study was based on Durkheim’s theory of social integration and regulations.
Hence universities are social institutions with students as integral components; these theories can be applied to undergraduates of Nigerian universities. Applying these theories to undergraduates of universities in South Eastern States of Nigeria, one would like to find out to what extent the prevalence of suicidal behaviour is influenced by the students’ gender and year of study
2.3 Empirical Review
Information on non-fatal suicidal behaviours according to Canetto and Lester (2000) is available through time-limited local epidemiological surveys. No country, according to them, maintains an ongoing, nationally comprehensive record of non-fatal behaviours. Thus, the information on non-fatal suicidal behaviour is neither longitudinally or geographically comprehensive. The validity of these statistics have however been contested.
Kushner, (1999) argued that most of the official statistic collection procedure failed to account for intent. Consequently, individuals who unexpectedly survived a suicidal act were typically not counted in the official suicide rates. A study in Sri Lanka (Ganeshvaran & Rajawajaswaran, 2000), based on 1522 records from a single hospital, suggested that there might be as many as 14 non-fatal incidents of suicide for every fatal one. A larger study completed in 1999, tabulated patient admissions involving suicidal behaviours from the medical record of four large hospitals over a 5-year period (Kasturiartchi, de Silva & Ellawala, 1999). A total of 6086 cases were recorded; about 80 per cent of the patients survived. Of the total, 66 per cent of the patients were male, giving a male: female ratio of 2:1. About 60 per cent of the suicide-related admissions involved young people between the ages of 15 and 25. In that group of hospital admissions, ingesting poisonous substances or drug over doses accounted for more than 80 per cent of the suicide cases.
Centre for Disease Control (CDC-1999); Canino and Roberts (2001), reported that in 1999, 18.3 per cent of students studied nationwide had attempted suicide one or more times during the 12 months preceding the survey. The rate showed an increase from the previous study of 1997, in which 9.7 per cent of youths reported to have attempted suicide. Jacobson, Cook, Moser and
Aldana, (1999), ascertained the degree of suicidal ideation and attempt among 9th to 12th graders with United States’ state wide region. Twenty-five schools were randomly selected from all state school districts and 549 students were surveyed (290 females and 259 males), following active parental consent. Parental consent anonymity and confidentiality were stressed orally and adhered to as stipulated by the University Human Subject Review Board. Additionally, confidentiality of the participating schools was maintained. Dependent variables (thinking about, seriously planning, attempting and being treated for suicide) were calculated for the eight grade/gender combinations and analysed separately using analysis of variance (ANOVA) methods. Results of the analysis revealed a significantly higher probability of 9th and 10th grade girls in thinking about, seriously planning and attempting suicide. Further, all female respondents were significantly more likely than boys to think about and seriously plan suicide, of those who had been treated by a medical attendant for attempted suicide, no significant difference between grades or genders existed. It was concluded that parents and professionals most near the potential suicide victims became familiar with state and national adolescent suicidal behaviour.
Vega, Gil, Zimmerman and Warheit (2003), using data from a large school-based survey of Cuban, Nicaraguan, other Hispanic, African–American, and Anglo – American to ascertain the prevalence of suicidal ideation and attempts of male students in grades 10 and 12 reported that African-American had the highest prevalence of suicidal ideation in the previous six months of the study. Nicaraguans and other Hispanics had the highest levels of life-time suicide attempts. Roberts (2002) in a study of 252 cases of hospital admission of attempted suicides reported that the highest rates of suicidal attempts in the United States were among the adolescents.
Reynolds and Mazza (2000) assessed suicidal behaviour in a sample of 2412 junior and senior high schools students in eight states of USA. The highest rate of history of suicidal attempts was found for Native American adolescents (25.5 %), and the lowest rate was among African- American youths. Hispanic youths also reported a high rate (16.3 %) of lifetime suicidal attempts.
Garrison, Addy, Jackson, McKeown, and Waller (1999), studied a sample of 860 female inhabitants (430 Whites and 430 Blacks) from a statewide survey in South Carolina to ascertain the prevalence of suicidal plans, ideations and attempts among the Whites and the Blacks. They found that while suicide attempts were higher for Whites than for Blacks, Black females reported the highest frequency of attempts requiring medical treatment. Blacks were less likely to report plans, but significant ethnic differences were not found for suicidal thoughts. The gender ratio reported in most studies of non-fatal suicidal behaviour showed a female: male ratio of 2:1 for suicidal behaviour. A study of 1165 people on causes of attempted suicide by WHO/EURO Multicentre Study on Para suicide (Kerkhof, 2004), revealed that suicidal behaviour was more prevalent among young women, (30 %); people with low education levels, (25 %); the unemployed, (20 %); the disabled, (10 %); the divorced, (10 %); and the separated, (5 %). The picture that emerged was that of powerless groups or those with little chances to improve themselves, facing troubles in finding a place in society and having many emotional and relationship problems as well. It then means that suicidal behaviour is the result of both social conditions and individual maladaptation.
Langhirnrichsen–Rolhing, Sanders, Crane and Monson (1999), reported that there were differences in the forms and types of methods which men and women prefer when they engage in suicidal behaviour in United States. Specifically, according to them, American women engage in non-fatal suicidal behaviours using less lethal weapons more frequently than American men. America men, however, were more likely to engage in suicidal behaviours using more lethal weapons that resulted in death. This view was supported by McIntosh (1999) who found out that American women engaged in less lethal weapons like over doses of drugs and wrist cutting for attempting suicide; while American men use more lethal weapons like guns and explosives for attempting suicides. National Centre for Health Statistics (2004) studied the methods of suicidal behaviours among the Americans and reported that the men used more lethal weapons like guns, hanging, and explosives to end their lives; while the women used less lethal weapons like slitting of wrists, and over doses of drugs to attempt ending their lives.
Vega, Gil, and Warheit (1999) studied the prevalence of suicidal ideation and attempts among 1152 Cuban-American, Nicaraguan, and African-American students in USA. They reported that African-American students had the highest prevalence of suicidal ideation in their school based survey of Cuban-American, Nicaraguan, and African-American. Roberts and Chen (2000) examined suicidal ideation and attempts in large sample of 6084 European-American and Mexican-American middle school students. Mexican-Americans had rates of ideations almost twice as high as those of their European-American counterparts, while the European-Americans had the highest suicidal attempts. Adjusting for the effects of gender, Mexican-American adolescents still had 1.7 times the risk of suicidal ideation.
Roberts (2002) studied the prevalence of suicidal ideation and attempted suicide among the students nationwide in USA in 1999 using 2750 undergraduates. He reported that during that period, 8.3 per cent of students studied in USA had attempted suicide one or more times. He also found out that 11.7 per cent of the students had seriously contemplated and planned suicides. Some even wrote suicide notes and threats.
Walter et al. (2005) investigated the rate of ethnic suicidal behaviours in 4 middle schools in New York City. They revealed that 14 per cent of Latinos reported suicidal behaviours compared to 12.8 per cent of African–Americans and 12 per cent for ‘other’ ethnicities in a survey (n=3738) of four middle schools in New York City. They also reported that female students were more likely to attempt suicides than the males but the males were more likely to complete suicide than the females because the males use more lethal weapons such as firearms. Investigating gender differences in the prevalence of suicidal behaviours, Garrison et al. (1999) had earlier found that the prevalence of suicidal attempts was about equal for African – American male and female adolescents. Contrary to this, Woods et al. (1999) had also reported earlier 2.4 per cent suicidal attempts for females and 3.4 per cent for males. CDC (2000) also had reported that African–American girls were more likely than males to think seriously of attempting suicide (18.8 % and 11.7 %) respectively, and to have attempted suicide (7.5 % and 7.1 %) respectively.