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Scope and prevalence of suicide in Nigeria from a psychological perspective

  • Abstract

    The rate of suicide in Nigeria is alarming. There is comorbidity between suicide, personality disorders, depression and addiction. Suicide is common among young adults and adolescents. This write up explores the meaning of suicide, factors influencing it, it's scope, types and other relevant information that provide insight into the pandemic phenomenon. In subsequent write-ups, more empirical knowledge about suicide such as the psychological evaluation including the theoretical framework behind suicide and interventions will be discussed.

    Introduction

    Suicide is not an affective disorder. Nor is it uniquely associated with depression. Nevertheless, it's a crucial topic and is more strongly related to depression than the other psychological state disorder. Suicide rates vary across countries. For example, Russia has an annual rate as high as 40 per 100,000 people, while Greece has as few as 4 per 100,000 (World Health Organization). They also vary over time and across genders. Among British women, for example, suicide rates have fallen since the early 1970s; among men, a decline in suicide rates between 1960 and 1975 has been followed by a steady increase over the subsequent ten years (McClure 2000). In 2000, the UK rates were 11.7 suicides per 100,000 men and 3.3. per 100,000 women – a substantial difference.These facts are from WHO, a reliable source. In Nigeria, suicide is prevalent among youths. Attempted suicide is particularly a common occurrence in young people: two-in 1997). Suicide is the third leading cause of death among American young people aged between 15 and 24 years (Anderson and Smith 2003), with particularly high rates among American Indian and Alaskan natives (Centers for Disease Control: www.cdc.gov/ncipc/wisqars)

    Only about half of those who commit suicide have an identified mental health problem, the most common being depression, substance-related disorders and schizophrenia. About 15 per cent of those with each disorder kill themselves (Meltzer 1998). Suicide is less strongly associated with severe than with moderate levels of depression, as those who are severely depressed may lack the volition to act on their feelings. Indeed, people who are depressed may kill themselves as their depression begins to lift because they are still hopeless but have some increased impulsivity and motivation.

    Bronisch and Wittchen (1994) reported that 56 per cent of their sample of people with a diagnosis of depression reported thinking about death, 37 per cent reported a wish to die and 69 per cent had suicidal ideas. Nigeria is reported to be the fifteenth highest suicide rate in the world (and seventh in Africa) according to the World Health Organisation’s age-standardised statistics, though comparing between countries is difficult given differing levels of reporting. News reports of suicides are common.

    However, these thoughts were not exclusive to depressed individuals: 8 per cent of a comparison group who had never been assigned a psychiatric diagnosis reported having suicidal ideas, and 2 per cent had made a suicide attempt. Suicide in people with schizophrenia is more often a result of demoralization than the result of hallucinations or delusions. Other risk factors include being male, single, living alone, poor sleep, impaired memory and self-neglect (Bronisch 1996). The psychological characteristics of individuals who attempted suicide often involve feelings of hopelessness (Stewart et al. 2005), worthlessness, guilt, despair, delusional depressive symptoms, inner restlessness and agitation (Wolfersdorf 1995).

    Individuals at risk are also more likely to have pre-morbid characteristics that include high levels of impulsivity, impaired executive functioning, irritability, hostility and a tendency to aggression, as well as a history of alcohol or substance abuse which can exacerbate these characteristics (Dumais et al. 2005). Gunnell et al. (2005) also found that men with low intelligence were at more risk of suicide than those of higher intelligence, perhaps reflecting a limited ability to solve problems while going through an acute life crisis or affected by psychological state problems. Also, people who have acquired coping skills are at lower risk of committing suicide. Acquisition of coping skills is a gradual process that is experienced through developmental process and socialization or through other health programs that train and sensitize people about their mental health, self-discovery and interpersonal skills. WHO supports this in their public health publication. Obviously, all these opportunities are rare in Nigeria; this explains why many youths resort to suicides.

    There is comorbidity between depression and suicide-thoughts of ending one's life emerge after the level of the depressive episodes has escalated. Prevalence of suicide and depression in Nigeria is alarming. This issue is common amongst teenagers and young adults. Some older adults are victims, but the rate is minimal compared to teenagers and young adults.

    Suicide is an intentional termination of one’s life. This is preceded by serious mental distresses and pains. Human beings are known to struggle for existence that is; every human has a survival instinct which compels us to act in ways that sustain our lives. It is however daunting and controversial to see that these instincts in some people have totally become paralyzed and dysfunctional. Can we say suicide is a maladaptive expression of survival instinct or perhaps survival instincts no longer exist in people with suicidal ideation or intent?

    Related article: Conceptualizing human actions from a psychological perspective.

    Types of Suicide

    According to Emile Durkheim, these are different types of suicides on the basis of different types of relationship between the actor and his society.

    (1) Egoistic suicide:

    According to Durkheim, when a person becomes socially isolated or feels that he has no place within the society, he destroys himself. This suicide is prevalent in Nigeria. It results from the suicide's sense that s/he has no tether. This absence can give rise to meaninglessness, apathy, melancholy, and depression. Durkheim calls such detachment "excessive individuation". These set of individuals have no low or no sense of belonging to social groups; therefore they live without well-defined values, traditions, norms, and goals; due to this they have access to little social support or guidance, this predisposes them to suicidal ideation and or suicidal attempts. Social groups in Nigeria including families barely enable the formation of secure attachment. Many youths grew up in broken homes or home that anxiety was intense due to “incompetent” caregivers (who are neglectful, authoritarian, apathetic or too permissive) or domestic violence. Such youths are unable to learn coping skills and value system to successfully cope with life stressors environment. These youths are prone to suicide if a major crisis surfaces (death of a loved one, failed relationship, change of environment).

    (2) Altruistic suicide:

    This type of suicide occurs when individuals and the group are too close and intimate with their group norms and values. The excessive attachment of an individual to a social group could influence the occurrence of suicide, for example; Sati customs, Dannies warriors. This provides insight into suicidal bombers' Behavioral

    (3) Anomic suicide:

    This happens when a person is faced with some social sudden adversity such as failures in exams, failed businesses, bankruptcy etc. According to Durkheim, this happens when there are no restrictions to what can be or do, that is, a person's aspiration is not guided by some well-defined regulations that cause them to be more concentrated and faced with fewer opportunities to fail. When people have the freedom and in fact, some social pressures to expand their career and horizon, they as are more predisposed to distress which results from failures.  For instance, a person could commit suicide if he got none of the jobs he applied for tock market fails or one of his investments goes really bad. A person may be compelled to commit suicide if his business is evolving very slowly and he has failed to continue his Empowerment program due to financial constraints.

    (4) Fatalistic suicide:

    This type of suicide is due to strict rules and regulations in society. For example, a barren woman who commits suicide, another example is someone who has been trying to gain admission for so long but cannot due to unfavourable tight admission procedure. It is the opposite of anomic suicide and occurs in societies so oppressive their inhabitants would rather die than live on. For example, some prisoners might prefer to die than live in prison with constant abuse and excessive regulation. Lack of opportunities and brutal leadership in Nigeria trigger suicidal acts in many young graduates. Although this theory focuses excessively on social factors, it is vital to understand that.

    It interplay of certain factors such as lack of social support (and secure attachment that imbibe functional personality), social pressures and lack of opportunities (oppressive government cause suicide in Nigeria.

    Signs of Suicidal Intent

    About 80 per cent of people who complete suicide give warning signs, although the warnings may not be overt or obvious. These usually take the form of talking about suicide or a wish to die; statements about hopelessness, helplessness, or worthlessness; preoccupation with death; and references to suicide in drawings, school essays, poems, or notes.  In Nigeria, these people communicate through their wall posts and statuses expressing their hopelessness through reaction formation. Other danger signs include sudden, dramatic, and unexplained changes in behaviour and what is called “termination behaviours.” These behaviours include an interest in putting personal affairs in order and giving away prized possessions, often accompanied by statements of sadness or despair.

    A person who observes these signs should pay more attention to the person, show some care and  ask the person in question whether he or she is thinking about escaping the world due to the experienced difficulty. If so, the observer should refer the person to a trained mental health professional to reduce the immediate risk of suicide and to treat the problems that led the person to consider suicide. Most suicides can be prevented because the suicidal state of mind is usually temporary.

    Before we look at the methods of committing suicide why not check out this related article about how we acquire behaviours and habits.

    Methods of committing suicide

    Methods of suicide vary from culture to culture. Hanging and poisoning are the leading method of suicide in Nigeria. Cases of using firearms are so rare due to limited access to guns. Some people jump down the bridge or tall building; this is also rare relative to hanging and poisoning. Poisoning and hanging appear affordable (when the impulse surfaces) plus social media contributes to the use of this due to the observed efficacy and efficiency. Researchers believe that a small proportion of fatal single-occupant automobile accidents are actually suicides.

    Factors influencing suicide

    Certain aspects of a person’s life increase the likelihood that the person will attempt or complete suicide. Studies have shown that one of the best predictors of suicidal intent is hopelessness. People with a sense of hopelessness may come to perceive suicide as the only alternative to a pained existence. People with mental illnesses, substance-abuse disorders such as alcoholism or drug dependence, and behavioural disorders also have a higher risk of suicide. In fact, people suffering from diagnosable mental illnesses complete about 90 per cent of all suicides. Physical illness also increases a person’s risk of suicide, especially when the illness is accompanied by depression. About one-third of adult suicide victims suffered from a physical illness at the time of their death.

    Other risk factors include previous suicide attempts, a history of suicide among family members, and social isolation. People who live alone or lack close friends may not receive emotional support that would otherwise protect them from despair and irrational thinking during difficult periods of life.

    Feeling down is a normal condition that every human experience once in a while. These painful feelings apparently exist to activate our problem-solving skills hence improve our functioning and personal development. Just as homeostasis indicates when there is an imbalance in the bodily functions when the thoughts are deviating, we tend to feel pains, it is expected that we regulate the functioning by replacing the faulty thought process with constructive ones. However when we fixate on these painful thoughts and feelings without making a conscious effort to alleviate them, the feelings persist and accumulate; consequently our mental wellbeing significantly deteriorates, that healing process takes so long or becomes complex and ineffective which may result into hopelessness and then suicidal thought. Two reasons exist for this, either we have no idea how to mitigate the painful thoughts or we choose to be careless (by not seeking or adopting the intervention techniques) hoping effortlessly without actively taking action to subdue the irrelevant stressful thoughts.

    All areas of our body are connected, that when an area (mental) is suffering, it gradually manifests impairment in other parts of the body, and could result in somatoform disorders. Some research have discovered that people with serious diseases (cancer, diabetes etc.) also have a history of mental problems (especially depression.). Depression does not necessarily indicate suicidal ideation until it reaches a significant point. These factors escalate depression or personality disorder to the point of suicidal ideation and or act:

    Stigma: Many Nigerians have reported depression usually through their observed actions. Mental problems in Nigeria is often stigmatized that many of the victims feel ashamed to intentionally report verbally or source for help.

    Ignorance: Lack of Insight is the major factor that influences ending one’s life. Many people are still ignorant of the fact that they are expected to seek intervention when they are experiencing psychological distress before it escalates, just like we visit hospitals when we feel feverish; many Nigerians are unaware of the effectiveness of therapies in ameliorating psychological problems. In fact, people underestimate the influence of their thought process on their living conditions and when they feel the pain they are quick to attribute the pain to available stimuli in the environment rather than to focus more inward which causes the painful emotion to disappear. Some people will attribute their mental pains and other dysfunctions they experience in their lives to spiritual causes, when in reality their thought, emotional and behavioural patterns are the major causal factors of the problems observed within individuals and in the society. People who experience psychological pains are not aware of the effective coping mechanisms to employ, very few people know these mechanisms but they are not within reach because people stay less conscious.

    Institution: This could also explain another form of ignorance whereby the government and leaders are not taking effective measure necessary to promote the mental wellbeing of the people. When people function optimally, it will contribute immensely to national development. The government needs to implement policies that will support mental health professionals and create awareness about mental health. In addition to this, the government should invest more in the health sector as regards both physical and mental because both are interdependent.

    Family and interpersonal dynamics: Apparently, the standard for measuring wellbeing in Nigeria is inferior, that dysfunctional attitude has formed the norms. Many homes constitute abuses (physical, domestic, sexual etc) and victims tend to nurture victims. Many children are raised by parents who are neurotic due to certain inner conflicts. Many children are not allowed to express their thoughts and feelings or maybe humiliated for reporting any form of abuse. The learning process for many children is faulty that children get to receive more negative stimuli (consequence) and are left to figure out the right behaviours on their own and when they do, there is little or no cue that suggests approval of such behaviour. So many homes are not well structured that roles of family members are not well defined, there is no consensus, and also values are not well communicated nor defined through interaction right from childhood. Adolescents have very few trusted persons (who barely knows how to resolve the relative problem) if at all any exists. Also, parents and loved ones barely give room for the heart to heart discussion.

    Socio-Economic Crises: Lack of financial resources and other societal problems render many people helpless, concluding that there is help nowhere. Some individuals refuse to go for help because they have no money for the service. These crises also prevent passionate mental health advocator and psychologists to create concrete and sustainable projects that focus on people with depression/addiction.

    Lack of Resources: There are very few passionate mental health professionals and facilities in Nigeria. When people finally decide to help themselves, it is often difficult to find the right mental health professional that is ready to offer effective intervention. When mental pains manifest physical symptoms, many people visit medical hospitals, these doctors out of either their incompetence or selfishness continue to only give drugs that address the superficial symptoms without mitigating the root problems (psychological impairment and dysfunctional cognition)

    Lack of Social Support: The reassurance and affections experienced from relatives and friends are vital to mental wellbeing. This quality support is scarce in Nigeria because apparently many other people are struggling to cope with the many stressors in their own lives too. These people have limited or no assistance to render to solve the problems.

    Check out the following article that explores human personality types and susceptibility to substance abuse.

    Prevalence and Scope

    Many people who commit suicide experience considerable anxiety and about 20% suffer from psychotic delusions-unshakable false beliefs. Some are variations on the theme of worthlessness: “It would be better if I had not been born. . . I am the most inferior person in the world” (Beck, 1967, p. 38). Specific cognitive deficits, including disrupted attention and working memory, also accompany depression that leads to suicide. Moreover, depressed patients often exhibit physical manifestations that can include a loss of appetite and weight, weakness, fatigue, poor bowel functioning, sleep disorders, and lack of interest in sex. It is as if both bodily and psychic batteries have run down completely.

    Depression accompanied by suicides is not tied to any particular age or life stage. It is most common in adolescence through middle adulthood, but depression can also emerge in children and in the elderly (Garber & Horowitz, 2002; Kessler, Keller, & Wittchen, 2001). Depressed adolescents show most of the symptoms we have described, but some of their symptoms may come in the distinctly teenage form. Their despair often leads them to substance abuse; their apathy about life shows up in the number of classes they miss; their irritability emerges as belligerence and defiance. To be sure, all these behaviors can occur without depression, but any or all of them, together with other symptoms of depression, can indicate profound emotional problems.

    In Nigeria, there are a number of reasons to feel depressed considering the numerous socio-economic problems. People still seek to know which precedes which, that is, is the country suffering due to the impaired mental states of so many people or do people experience pains as a result of the socio-economic problems. Research have revealed that developed countries comprise of a high number of people who have healthy mental states. This implies that the mental wellbeing of people must be emphasized and focused on to foster development in Nigeria because people make up a society and nation. Their decisions, choices, leadership style, attitude, behaviours and actions manifest occurrences within the society.

    The reported data on the internet seems inadequate but then we will employ it being the only source for data. There are questions as to why suicide is currently on the rise, could it be due to the challenges in the country, low level of personal development relative to the rapid civilization the country is “forcefully” manifesting, or could it be that the issue has always been in existence but people remained silent to avoid shame on the family and now people are becoming more enlightened and then the internet facilitates circulation of information.

    Suicide in Nigeria is more associated with youths who are in the university, have just completed either university degree or NYSC or someone who has issues in their relationships. Research by a graduate of the University of Ilorin in 2017 revealed that 72% of the participants reported symptoms of moderate depression (precisely low self-esteem) and these symptoms were associated with the excessive use of the Internet. Also, it appears that many victims of suicides are learned people who are familiar with the internet.

    The conclusion of the study was that many people often use the internet as an escape route for their mental pains when in reality it tends to aggravate the problems and mitigate their self-esteem because of people’s sense of failure and incompetence increases while interacting with others who appear to be accomplished. Also, it appears that the society demands so much of youths that socialization did not imbibe nor make provision for. Another study testing self-actualization amongst university students in Nigeria revealed that a number of the students regardless of their status, level, course, and tribe reported a low level of fulfilment and majority thought they epitomized failure. All of these show that ineffective socialization and lack of coping skills (bring about incongruence that) influence distorted thoughts leading to suicides.

    Many people suggest that the availability of job opportunities and economic stability within the country will mitigate the rate of suicides. This appears logical but then we must critically examine the situation and realize that some people who commit suicides have jobs or are financially independent, some of them apparently have a good career and strong social support. This implies that there is a major problem going on that is more subjective and can only be examined and understood by mental health professionals. We must identify constant factors that are common to all the victims. So far, report has shown that the following are common predictors of suicide: literacy, social media, distorted thoughts - fixation on past and future; fear and worry; disparity of reality and expectation; unhealthy socialization, ignorance of human inner modus operandi, vague definition of values and wrong metrics for measurement, impulsivity and past history of lack of delay gratification (zealous about pleasure). More information about the causes will facilitate the intervention and recovery process.

    Nigeria apparently has a faulty interpersonal system, the learning process is vague, and there are a number of incompetent people becoming caregivers. This set of people have a less developed executive control system (frontal lobe) due to their own past experiences too, many adults act majorly in response to their impulses, they can barely delay gratifications, adopt self-control inculcate in children or model appropriate patterns of behaviours for them to emulate because even they don’t know how to. The cognition of children due to the input from immediate relatives and the environment as a whole is not well developed nor functional; therefore, their perceptions about the world are distorted. As a result of this continuous process (which basically has formed the norm and no one is interested in questioning it nor mitigating it), a number of people grow up becoming helpless in the face of adversity, they do not believe that they are capable of restoring their lives through restructuring their thoughts subsequently they exhibit symptoms of PTSD, which becomes aggravated and leads to suicide if not alleviated. In addition to this many children are socialized not in preparation to solve problems nor delay gratification nor to take responsibility for the consequences of their responses and reactions.

    More on suicide in Nigeria will be explored and explained in my subsequent writings.

    References

    Anderson, R., & Smith, B., (2003). Deaths: Leading causes for 2001. National Vital Statistics Report, 52 (9)

    Beck, A. T. (1967). Depression: Clinical, experimental and theoretical aspects. New York. Google Scholar

     Bronisch, T., & Wittchen, H.-U. (1994). Suicidal ideation and suicide attempts: Comorbidity with depression, anxiety disorders, and substance abuse disorder. European Archives of Psychiatry and Clinical Neuroscience, 244 (2), 93–98. https://doi.org/10.1007/BF02193525

    Dumais, A,  Lesage, Martin, A., Guy, R., Dumont, M., Nadia C., Monique R., John, M., Cawki B., Gustavo T., (2005). Risk factors for suicide completion in major depression: a case-control study of impulsive and aggressive behaviors in men. American Journal of Psychiatry 162 (11), 2116-2124, 2005

    Durkheim, E., (1979). Suicide: A Study in Sociology."Trans. Spaulding, John A. New York: The Free Press.

    Garber J, Horowitz JL (2002) Depression in Children. In: Gotlib IH, Hammen CL (eds) Handbook of depression. Guilford, New York. Google Scholar, pp 510–540.

    Gunnel, D., Julia,S., & Deborah, A., (2005) Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials. Bmj 330 (7488), 385, 2005

    Hawton, K., Fagg, J., Simkin, S., et al (1997) Trends in deliberate self-harm in Oxford, 1985–1995. Implications for clinical services and the prevention of suicide. British Journal of Psychiatry, 171, 556–560.

    Meltzer (1998). Suicide in schizophrenia: risk factors and clozapine treatment. The Journal of clinical psychiatry 59, 15-20, 1998

    McClure  (2000). Changes in Suicides in England and Wales 1960-1997. British Journal of Psychiatry. 176-64-67

    World Health Organization (2019). Suicide. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/suicide

    Wolfersdorf. M, et al. (1998.) [Depression and aggression. A control group study on the aggression hypothesis in depressive disorders based on the Buss-Durkee Questionnaire]. Med.

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