SEPTEMBER TOWS- Suicide and Suicidal behaviour in children and adolescents- Dr Folorunsho Nuhu



Outline:

  • Introduction/definition

  • Epidemiology and trends in nigeria

  • Risk factors

  • Methods of suicide attempt

  • Prevention.

  • Questions and Answers.

Definition of Keywords:

Suicide: suicide is an act of taking one’s life, deliberately initiated and carried out by the person concerned with the intention of a fatal outcome (1)

Suicidal behaviour: This is a continuum of behaviours ranging from individual wishing himself/herself dead to the actual deeds of killing self

The continum ranges from Suicidal thoughts, Suicidal ideation, Suicidal intent, Suicidal plan, Suicidal attempts and possibly suicides.


Children: Individuals younger than 11 years of age

Adolesents: Individuals in the transition stage from childhood to adulthood. Usually from 11-19 years (1).


Epidemiology and trends of suicide and suicidal behaviour in Nigerian youths:

Concentrate on data from Nigeria we're all aware of the fact that Suicide is usually underreported for reasons like stigma, discrimination and misconceptions.

Introduction

A suicide estimate of 17.3/100,000 population across all age group has been reported (3)

A study in the South West Nigeria reported more than 20% Suicidal ideation and 12% Suicidal attempts amongst school children between the ages of 10 and 17 years (4).

From a recent newspaper reports (5), there has been an upsurge in suicide especially among young people in the last 12 months.


Newspaper reports reviewed by Daily Trust showed that no fewer than 51 persons comprising males and females took their own lives within the period.

The suicide cases were recorded in 22 states – Anambra, Bayelsa, Benue, Cross River, Delta, Edo, Ekiti, FCT, Imo, Jigawa, Kaduna, Kano, Katsina, Kwara, Lagos, Nasarawa, Ondo, Osun, Oyo, Plateau, Rivers and Zamfara.


It showed an increase of 17 when compared with the 34 suicide cases recorded in Nigeria in 2020.

The figure does not include the multitude of cases of suicide that have not been reported in the media because of many factors, among them the reluctance of family members to divulge information.

Eighty-five people reportedly killed themselves in Nigeria in 2019, up from 79 in 2018 and 66 in 2017.


It is noteworthy that among young people, suicides increase with age. For instance there's an increase from 0.6/100,000 among young persons, 14 years and below to 6.9/100,000 among adolescents 15-19 years (6). In addition SUPRIN has found that one-fifth of Suicidal cases reported in Nigeria were among the 13-19 years age group (7)


It's therefore pertinent to also consider young persons in the prevention, identification of Suicidal behaviours and Suicide not only among adults but also in children and adolescents population. Indeed they are supposed to be leaders of tomorrow!


Let's consider factors associated with Suicide in Young people


Risk factors:

Among children and adolescents, the risks of Suicidal Behaviours include;

  1. Physical and media bullying,

  2. Living in urban or semi-urban areas,

  3. Polygamous or disrupted families,

  4. Sexual and physical abuse,

  5. Parental over-involvement


Other risk factors especially in adolescents and adults are;

Depression, Anxiety, sexual violence, unemployment, substance use disorders, living alone, poverty, poor academic performance, parental neglect, forced marriage, chronic Medical conditions, chronic pain, stigmatizing conditions such as Epilepsy and HIV.

Other major Psychiatric disorders like schizophrenia, bipolar disorders, ADHD are also associated with increased Suicidal behaviours


Methods of suicide and suicidal attempts:

Children and Adolescents can use any readily available methods to attempt or commit Suicide;

Below are some of the methods usually employed?


1). Insecticides and poisons e.g sniper

2). Deliberate medication overdose

3). Hanging

4). Firearms (gun, knife, matchet)

5). Jumping from heights

6). Jumping in front of a fast moving vehicles or train


Above are fairly common from literature. However, pouring petrol and setting self-ablaze and jumping inside well have also been reported. However it's really not certain whether jumping inside well is actually deliberate or accidental. Some adolescents have also attempted Suicide by jumping down from a moving vehicle


In all cases of suspected Suicide attempts and especially among the at-risk individuals, prevention is the key. Previous attempts should be handled with all seriousness!


Prevention of suicide

There are challenges in the prevention of Suicide

1). Those at risk don't seek help because of stigma associated with mental illness

2). Poor awareness of Suicide being a public health problem

3). Taboo against discussing Suicide openly

4). Criminalization of suicide attempt

5). Limited quality data on Suicide globally

6). Beliefs that, mental illnesses which can predispose to Suicide are spiritual or secondary to ancestral misdeeds or witchcraft

7). Poor funding for awareness campaigns

8). Poverty. Mentally ill find it difficult to afford hospital and treatment bills.


Suicide Prevention Methods:

1). Reduce access to means of committing Suicide such as sniper, firearms, ropes, medication prescription

2). Reporting by media should be in a responsible way, media reporting seems to have a lot of effect, more reason reasonable reporting is advocated.

3). Introduction of alcohol policies to reduce harmful use of alcohol.

4). Early identification and prompt appropriate treatment of mental illness and substance use disorders.

5). Treatment of chronic pain and emotional distress

6). Adequate and appropriate treatment, psycho-education and support for persons with HIV and epilepsy

7). Abolition of sections treating Suicide attempt as a crime

8). Training of non-specialized health workers in the assessment and management of Suicidal behaviours

9). Follow up care for people who have previously attempted Suicide

10). Involvement of families and religious figures in care

11). Support groups and Community support


Suicide attempts if confirmed can receive jail term of up to one year.

Mentally ill rather than going to hospital are sometimes taken to non-Orthodox centers for treatment because of the beliefs about the causation, therefore there is need to decriminalize and de-stigmatize suicide in Nigeria so that persons who need help can easily speak up.

Prevention of suicide is Multidisciplinary and Multi-sectorial

Disciplines:

1) Doctors including psychiatrist, Pediatrician and other relevant physicians

2). Nurses

3). Clinical Psychologist

4). Medical Social Workers

5). Professional Counselors

6). Educators

7). Community Health Workers

8). Rehabilitation experts


Sectors:

1). Health sector

2). Education sector

3). Justice and Law

4). Defense

5). Politics

6). Media.

7). Families and Community.

8). Religious Leaders.

9). Labour and Business sector.

Conclusively, note that Suicide a public health concern, it may be more common than reported, young persons are not immune. Prevention is more important therefore, Intervention should be qualitative, comprehensive, evidence-based, well planned, multidisciplinary and multi-sectorial.

Warning signs:

  • Talking repeatedly about death.

  • Writing excessively about death.

  • Being suddenly socially withdrawn.

  • Manifesting clear symptoms of depression.

  • Impulsivity.

  • Inability to delay gratification.

  • Increasing use of alcohol and substances.

Questions & Answers:

Q: Which classification/authority defines children as individuals younger than 11years?

A: WHO classified as below 11 as children 11-19 adolescents.

Q: Are there some warning signs that may precede the suicidal attempt in children?

A: See as listed above.

Q: How can Religious leaders help?

A: Parents tend to seek help from their pastors and imams first before consulting other care providers. They believe everything case of mental illness or epilepsy is spiritual, religious leaders command a lot of respect. Some are however limited in knowledge of mental illness and it's presentation. They should be educated, respected and carried along because they are closer to the parents and their wards. In fact some parents won't accept medications for their children unless their pastors or imams give approval. So there is a need for collaboration with traditional and religious leaders as they are gate keepers in the community.