Suicides: A growing concern

The issue of suicide is very under-researched in Bangladesh. The World Health Organisation (WHO) has estimated that, about 10,000 people are killing themselves every year in the country. Some studies by local non-governmental organisations have claimed that the number could be much higher than this.

Suicide is the fourth leading cause of overall injury-related deaths and second important cause of injury associated death in age groups of 20-39 years in Bangladesh. Still, national suicide surveillance and nationwide study on suicide are absent due to a number of underlying reasons.

One of the primary reasons is that suicide is still a criminal offence in the legal system of the country. According to psychiatrists and mental health experts, this has been the main barrier at identifying the reasons behind and solving the suicide problem in Bangladesh as victims and their families are afraid to seek help. As a result, channelising suicide as accidental death is somewhat a common phenomenon in the country.

Religious factors also play an important role to hide suicides. In addition, strong social stigma on suicide in families affects social status, social acceptance and nuptial events, specially affecting the girls of the affected family.

Sometimes patients with suicidal tendencies are referred to other hospitals to avoid adverse problems. Every now and then, guardians take their patients to hospitals that do not have suicide register in order to hide any probable incident from the legal system. Due to all these reasons, getting quality data on suicides in Bangladesh has been a real challenge for researchers.

There is no suicide database in the country. WHO reported that the suicide rate for 2012 in Bangladesh was 7.8 per 100,000 people including 8.7 females per 100,000 people and 6.8 males per 100,000 people. A similar rate of 7.3 per 100,000 people was found during a cross-sectional study in 2003 by WHO.

A recent study by Economic and Social Commission for Asia and the Pacific (ESCAP) found the suicidal rate to be about 30 per 100,000 of young adults every year in rural Bangladesh. A community-based study conducted by Feroz et al. in 2012 had revealed that the suicidal rate was 128.8 per 100,000 populations per year in a specific district of Bangladesh.

Suicides were happening more in rural areas of Bangladesh especially in the poverty-stricken districts of Chuadanga, Jenaidah, Kushtia, Meherpur, Jashore, and Chandpur.

A study conducted by Shah et al. in 2018 has found that 70 per cent of suicides are being carried out by women. A similar research by Shah et al in 2017 found that 58 per cent of suicides were by women. Social scientists presumed that the female dominance in suicides might be the effects of complex interactions between patriarchal social structure, perceived self-status of females, passive gender role, little to no educational qualifications, early marriage and early conception, lower economic freedom, discord with husband and other enduring socio-cultural factors.

Previous researches had found that the third decade of life was the most vulnerable period of life. Also, more married people are committing suicides in Bangladesh which is different from the global observation where single people commit more suicides.

The risk factors behind suicides tend to vary. A community-based study conducted by Feroz et al. in 2012 found that about 63 per cent of suicides were proximally related with emotional events noticed within the family. Another review unveiled that the most common risk factor of suicides was marital discord followed by quarrel among the family members.

Another study, that assessed news items on online media portals, found emotional risk factors to be major issues. For example, affair related complicacies were the risk factor for 14 per cent of suicides while marital and familial discord was reason behind 22 per cent suicides. Other reported risk factors also related with strong emotions include sexual harassment, failing in exams, loved ones not fulfilling demands, extra-marital relationship issues, early marriage, death of partner, death of children, verbal abuse by teacher, domestic violence, and more.

However, repeated evidences stated that, approximately 90 per cent of persons who died by suicide had been suffering from no less than one mental illness and depression has been considered as the main culprit accounting for about 60 per cent of deaths. Conversely, psychiatric illness as a risk factor of suicide is under focused and has not been considered as an important risk factor in the country.

Some initiatives have been taken, mostly through private endeavours, to prevent suicides or curb its number.

Among them, suicide prevention clinic has been dealing with people diagnosed with mental health issues. The crisis resolution hotline 'Kan Pete Roi' has also been helpful. But the number of such initiatives in the country is still inadequate compared to the number of people affected.

Across the globe, numerous prevention strategies have been tested and were found to be effective at preventing suicides. However, no single strategy has been found as universally effective and superior than others. As a significant portion of risk factors are related to immediate emotionally charged events, Bangladesh should look for strategies that can support the distressed person immediately.

The available hotline can be an effective option to ventilate the emergencies though it is yet to gain popularity across the country. Mass awareness campaigns can help in this case. Multilateral research is necessary to identify the risk factors, relationship of risk factors with existing bio-psychosocial aspect of suicide.

National suicide database and suicide surveillance need to be considered. Changes in the legal system should be given priority. Decriminalisation of suicide can also help to destigmatise the problem, increase proper help seeking behaviours for suicidal tendencies while eliminating the scope of undue legal harassments.

Dr. SM Yasir Arafat is a mental health physician and psycho-social researcher with Bangabandhu Sheikh Mujib Medical University
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