SUICIDE is a complex, multi-causal, global preventable public health problem and it an under researched phenomenon in Bangladesh. The World Health Organization estimated that, about 10,000 deaths by suicide occur annually in Bangladesh. It 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. However, national suicide surveillance and nationwide study on suicide are yet to be initiated. Furthermore, it is still considered a criminal offence that is major barrier for people seeking help in this regard.
Challenges of quality data and suicide rate
LIKE other developing countries, getting quality and scientific data is a major challenge in Bangladesh. There is no suicide surveillance and national suicide database. Reliable and meticulous source of suicide data is out of reach of researchers, policy makers. There is also the challenge of getting suicide cases properly reported. Since our legal system considers suicide as a criminal offense there is a common tendency to hide or report suicides. To avoid legal harassment, people try to avoid reporting it. Sometimes, relatives claim suicides as homicides without any firm evidence and start legal proceedings. This is somewhat a common phenomenon when suicide happens in in-law’s residence. Religion is also a factor here as suicide is discouraged in Islam and about 90 per cent citizens of Bangladesh are Muslims. In addition, social stigma exists around suicide and mental health. Families of the patients often try to pressurise health care providers to hide the real cause of death or illness to avoid stigmatization. This is particularly true when the patient is a woman. Hence, suicide is largely under reported and getting accurate data is a real challenge in Bangladesh. Available information is mainly drawn from police reports forensic reports, media sources and limited other sources of reports such as hospitals, Thana and courts. Therefore, it is also a challenge to get an accurate suicide rate for Bangladesh. According to WHO report, the suicide rate was 7.8 per 100,000 population in 2012 which appears lower. However, the Economic and Social Commission for Asia and the Pacific suggested a different rate that was 30/100,000 of young adults every year in rural Bangladesh. A community-based study conducted by Feroz et al. in 2012 revealed the suicidal rate was 128.8 per 100,000 populations per year in a specific district of Bangladesh. Undoubtedly, the country needs a proper system to record suicide cases in Bangladesh.
Media and suicide
RECENTLY, some media research has been done to see how suicide cases are reported in media. One such study scrutinized the printed paper contents to analyse the demography and risk factors of suicide (Shah et al. 2017). Another study dissected reported cases of suicide published in online portals and looked for the demography and risk factor of suicide (Arafat et al. 2018). The quality of published reports revealed poor media reporting. Unnecessary details of the victims, methods, life events and mono-causal explanations were declared very frequently. Educational approaches were fundamentally absent.
Risk factors and preventive initiatives
MULTIPLE studies revealed somewhat similar risk factors in Bangladesh. In 2012, a community-based study shows about 63 per cent of suicides were proximally related with emotional turmoil within the family. Another study conducted in rural area revealed about 65.5 per cent suicides was related with emotional factors and again the factors were found within the family. Another review unveiled that the most common risk factor of suicide was marital discord. A study analysing the newspaper contents found that about two-third of the risk factors are familial. Suicide among supporters of favorite sports teams is also not so uncommon in the country. Other reported risk factors were related to cases of sexual harassment, failing in exam, extra-marital relationship issues, early marriage, death of partner, death of children, verbal abuse by teacher, domestic violence, and divorce. However, previous reviews revealed psychiatric morbidities are the vital issues in suicide as a risk factor globally. Repeated evidences stated that, approximately 90 per cent of persons who died by suicide had been suffering from no less than one mental illness. A systematic review revealed only 7 per cent of the suicide victims had depression.
Despite urgent need for suicide prevention support very little is there in Bangladesh. Recently few initiatives are taken to support people with suicidal behavior. Suicide prevention clinics have been dealing with the clinical populations whereas the crisis management hotline, Kan Pete Roi has been listening to the people in need. There are globally acceptable suicide prevention strategies that are proved effective. However, one cannot talk about one particular strategy that is universally effective. Bangladesh should really look for strategies that will address the problem of its population.
Preventing suicide in Bangladesh
Suicide is an under attended problem in Bangladesh where the actual rate of suicide is unknown. Systematic research is needed to explore the reasons behind suicides in Bangladesh. It is a demand of the time. National suicide database and suicide surveillance is an important consideration in this regard. A change in the legal system is also necessary. Public health policy makers must consider the issue of decriminalizing suicide in the country. In many Asia and developed countries suicide is decriminalized. Decriminalisation would help to destigmatise the problem, encourage people with suicidal behaviour to seek help in times of crisis. The government also needs to identify the appropriate prevention strategy for the country. Multisectoral collaboration within the country among clinicians, social scientist, researchers, media professionals, social workers, voluntary organisations, non-governmental organisation, funders and government to prevent suicide.
Dr S M Yasir Arafat is a psychiatrist and suicidologist and assistant professor of psychiatry at CARE Medical College.
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