Perceived Factor Influencing Suicidal Attempt Among Undergraduates

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Perceived Factor Influencing Suicidal Attempt Among Undergraduates


Abstract


Suicide and its risk factors form important global and local public health problems. Majority of undergraduate university students’ fall within the most affected age group. Empirical research in this crucial area of public health is generally lacking, especially among undergraduate university students in Nigeria. This study aimed to determine the prevalence of suicide ideation, its associated risk factors and risk factors that statistically predict suicide ideation among undergraduate students in University of Nigeria, Nsukka. The prevalence of suicide ideation among the undergraduate students of the University of Nigeria, Nsukka was 24.5%. Significant risk factors of suicide found in the study were relationship problems, academic stress, victimization, substance use and the presence of mental health disorders. Suicide ideation was predicted with statistical significance by the presence of mental health disorder (OR = 11), victimization (OR = 3), academic stress (OR = 2), and relationship problems (OR = 2). Combined efforts involving University faculties, Counselling unit and administration are necessary in averting suicide ideation and its dreaded squeal of completed suicide.


Chapter One


Introduction

1.1 Background of the Study

Suicide ideation is an important precursor to suicide (Pereira & Cardoso, 2015). It is impossible to complete suicide without previous suicide ideation (CDC, 2022). Therefore, regarding suicide ideation as a forerunner to the suicide attempt, then to completed suicide, it is necessary to prevent it as long as reducing suicide mortality is desirable. Suicide being the second most common cause of death among persons aged 1529 years, accounts for nearly 800, 000 deaths annually (W.H.O, 2019b). An increasing subgroup of this young population is University students. Organization for Economic Cooperation and Development (as cited in Mortier et al., 2017).

The University period posse several adjustment challenges to students with the potential to tip them into suicide ideation and possible death from suicide. Such mortality adversely affects the family and friends, community, and the nation as a whole. Suicide ideation sets off a cascade of harmful events which have an enormous potential of causing suicide death.

Not only does student suicide mortality thwarts University efforts in preparing young people intellectually, verbally and behaviourally to contribute meaningfully to society, it also robs the country of precious human capital and invested educational resources. University students are a vital group of people to gauge a country’s economic development and progress (Auerbach et al., 2018). This, emphasizes the need to study preceding events of suicide among University students. Also, there is the phenomenon of suicide contagion, copycatting, or the Werther effect, where exposure to suicides results in people attempting suicide. The impact of suicide contagion is more grounded among young people (CDC, 1994). This means preventing one suicide death in a young person, indirectly prevents more suicide deaths among his or her contemporaries.

Suicide ideation is an indicator of major mental health problems and is more common than attempted or completed suicide, it is the most important precursor to planning, attempting and completing suicide (Adelino & Francisco, 2015).

Researchers often study suicide ideation as a substitute for suicide because of the difficulty in studying suicide as an outcome, the strong association of suicide ideation with suicide and the ease with which ideation can be studied (Klonsky, May, & Saffer, 2016). It is, therefore, not surprising that the best interventions for suicide prevention is targeting ideation since suicide itself is not treatable (Subedi et al., 2015).

In 2010, a twelve-month prevalence of suicide ideation in the general global population was 2.1% and 2.0% in developed and developing countries respectively (Borges et al., 2010). Other studies by Nock et al. (2008a) estimate the prevalence of suicide ideation in a cross-national study to be 9.2%. In the United States of America, there has been an increase in the twelve-month prevalence of suicidal ideation among young adults from 5.1% in 2009 to 8.3% in 2015 (Han et al., 2018). Europe in 2006 had a lifetime prevalence of suicide ideation of 7.8% in the general population (Bernal et al., 2007).

Since suicide tendencies strongly predicts mortality by suicide (Brown, Beck, & Steer, 2000), which is a significant cause of overall global mortality (1.4%) (Varnik, 2012). These high prevalence rates of suicide ideation raise indirect concerns about achieving the third sustainable development goal which is ‘to ensure healthy lives and promote wellbeing for all at all ages’, especially target 4 which is to ‘reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being’.

Given the W.H.O’s plan to prevent suicides (WHO, 2014a), the paucity of data estimating suicide ideation, a precursor of suicide, is a serious impediment to the effective planning of locally-based and socially acceptable prevention strategies. Because suicide in its self is an end event and can only truly be prevented by preventing its risk factors t.

This study aims to contribute to the first goal of the World Health Organisation in suicide prevention by providing data on the prevalence of factors affecting suicide attempts among the most vulnerable group; that is, young adults.


1.2 Problem Statement

Suicide is a major public health problem (W.H.O, 2019c). Suicide has a ripple effect on society. Affecting immediate family members, friends, classmates, teachers and other staff. Even those not closely related to the victim like the clergy and law enforcement are all affected. Approximately 115 people are affected with one completed suicide, with one in five reporting an experience of a major life disruption (Sandler, 2018).

Data on prevalence and suicide-related factors, particularly in Nigeria, are generally limited (Oppong Asante et al., 2017b). There are several anecdotal reports of suicide among students in the Nigeriaian Universities (Choicism, 2019; Nigeriaweb, 2019, 2022; Myjoyonline, 2017,2022) . In January 2019, a final year student in the Wa Campus of the University for Development Studies committed Suicide over poor grades (MyNewsGH, 2019). Another of such tragic events was a news report of that of a third-year medical student of the University of Nigeria that also completed suicide after posting several items indicative of suicidal ideation on social media (Now I put the phone down to do some actual studying; Some days I feel like a King; other days I wish for death, Need a new life, this one is broken, sometimes I feel like I’m fading away). This started after he had failed courses and was billed to repeat (Nigeriaweb, 2019). The list of similar unfortunate events such as these is increasing (Abdulai, 2022).

Students in the Korle Bu, Nurses and Midwifery training college reported a prevalence of 15.4% for suicidal ideation, 5.6% for plans and 2.3% for attempted suicides (Quarshie et al., 2019).

The counsellor of the UNN for Development Studies also recorded two cases of students with suicidal ideation in the one month (March 2022) which may just be a tip of the ice burg.

To the best of my knowledge and extensive internet searches, there is a dearth of published studies on the prevalence of suicide ideation among University students in Nigeria and the University for Development Studies is not an exception. Neither a national suicide prevention strategy or official suicide statistics exists in Nigeria (Andoh-Arthur et al., 2022). Because of the lack of information on suicidal behaviour in Nigeria, suicidal scientists and other stakeholders exploit opportunities to gather information on suicidal behaviour, motivated by the premise that additional knowledge of the nature and patterns of suicidal behaviour will increase understanding of the issue and lead to the design and implementation of culturally appropriate and effective predictions (Adinkrah, 2014). I share this vision.

As the absence of data in suicide ideation is a great obstruction to the designing, developing and implementing preventative strategies, the study seeks to find out the prevalence of suicide ideation among undergraduate students of UNN and to potentially inform University authorities, the Community as well as the country as a whole on intervention and preventive programmes. Establishing the magnitude of suicide ideation, therefore, is primordial to designing prevention strategies.


1.3 Research Questions

  1. What is the prevalence of suicide ideation among undergraduate students of UNN?
  2. What socio-demographic factors constitute significant risk for suicide attempts among undergraduate students of UNN?
  3. Which socio-demographic characteristics significantly predict suicide ideation among undergraduate students of UNN?

1.4 Purpose of the study

Perceived factor influencing suicidal attempt among undergraduates


1.5 General Research objective

  1. To estimate the prevalence of suicide ideation among undergraduate students of UNN.
  2. To identify socio-demographic factors that constitutes significant risk for suicide attempt among undergraduate students of UNN.
  3. To predict suicide ideation with significance based on the socio-demographic characteristics among undergraduate students of UNN.

1.6 Test of Hypothesis

H0 socio demographic factors does not affect suicide tendencies


1.7 Relevance of the Study

To inform preventive and socially appropriate intervention programme for suicide, there is the need to have locally based studies on the factors the prelude suicidal attempts, the primordial of which is suicidal ideation.

Interventions developed to impact suicide ideation would therefore automatically reduce planning and attempt of suicide. Within the context of the W.H.O Mental Health Action plan 2013-2022 which aims to reduce suicides by 10% across countries, it has been proposed to direct interventions on the entire spectrum of suicidal phenomena including suicide ideation (W.H.O, 2013), thus this study is an effort to support W.H.O with quality data to achieve a worthwhile goal. Furthermore, this study would provide a basis for the University authorities and the country in general to design well-suited suicide prevention and intervention strategy. Findings of this work would add to our understanding of the interplay of sociodemographic factors associated with suicide risk.


1.8 Justification of the Study

The World Health Organisation aims to reduce suicide and suicide-related behaviours through (1) improving availability and quality of data from vital registration, hospital based systems and surveys for effective suicide prevention, (2) restricting access to the means of suicide such as limiting access to pesticides and firearms or putting barriers on bridges through an understanding of the different methods preferred by different groups in society and through cooperation and collaboration of multiple sectors (W.H.O, 2014b). This study is, therefore, justified as it would contribute to the first aim by providing quality data on the prevalence and socio-demographic risk factors of an empirically established prerequisite (suicide ideation) to death by suicide.


1.9 Chapter Outline

This thesis is structured into six chapters. Chapter one has presented the introduction and the background to of study, the problem statement, the research questions, the study objectives (general and specific), the relevance of the study, the conceptual framework of the study and definitions of terms. In chapter two, I reviewed as much as possible the relevant and most up-to-date literature in relation to the study which provides the ‘giant shoulders’ on which my study stand. Chapter three presents the research methodology employed to rigorously assess statistically, the prevalence of suicide ideation and its associated socio-demographic risk factors. The chapter includes a brief profile of the University for Development Studies, a geographical description of the study area, the study type and design, the study population and unit, the sampling technique and method, as well as the primary data collection tool and ethical considerations. Chapter four displays the results whilst chapter five contains the conclusion, limitations and recommendation of the study.


1.10 Operational Definitions

Active Suicidal Ideation

Is defined as “desire to make an active suicide attempt.

Dummy Variable

Is a numeric value that is used to represent categorical data.

Non-Suicidal Self-Directed Violence

Is behaviour that is self-directed and deliberately results in injury or the potential for injury to oneself. There is absence of implicit or explicit evidence of suicidal ideation.

Passive Suicidal Ideation

Is defined as a desire to be dead without any intention of taking steps to end one’s life, for example, wishing to be dead.

Religiosity

State of being religious, that is, service and worship of God or a Supernatural.

Risk Factors For Suicide Ideation

Refer to qualities that are associated with suicide.

Self-Harm

The various methods by which individuals cause injury to themselves, such as self- mutilation, self-battering, taking overdoses or displaying intentional carelessness.

Social Bullying

Involves isolating individuals, making offensive gestures, excluding from activities, and manipulation.

Non-Suicidal Self

Directed violence is behaviour that is self-directed and deliberately results in injury or the potential for injury to oneself. There is evidence, whether implicit or explicit, of suicidal intent.

Suicidality

A term that encompasses suicidal ideation, plans, attempts and completed suicide.

Suicide Attempt

Is any non-fatal, self-directed behaviour with intent to die as a result. A suicide attempt may or may not result in injury.

Suicide Behaviour

Includes suicide ideation, suicide attempt and completed suicide.

Suicide Contagion

Is a phenomenon whereby vulnerable individuals are tipped towards suicidal behaviour as a result of having knowledge of other peoples’ suicidal acts.

Suicide Ideation

Is defined as thoughts of engaging in suicide-related behaviour.

Suicide

Is defined as death caused by self-directed injurious behaviour with intent to die as a result of the behaviour.

Suicide Plan

Is a thought regarding a self-initiated action that facilitates self-harm behaviour or a suicide attempt that will often include a systematically ordered way of engaging in suicidal behaviour such as a detailed description of a time frame and method.


1.11 Study Limitations

  1. Incomplete data from the records.
  2. Insufficient funds to carry out the research
  3. Time limitation
  4. Inaccessibility to all of the required respondents’ information,

Chapter Five


Conclusion and Recommendation

5.1 Conclusion

5.1.1 Lifetime Prevalence of Suicide

This study sort to measure the lifetime prevalence of suicide among undergraduate students of University of Nigeria, Nsukka and it associated socio-demographic characteristics. The overall lifetime prevalence was 24.5% which is higher than the prevalence from other studies in Nigeria.

5.1.2 Socio-Demographic Risk Factors of Suicide

The prevalence of suicide found was statistically associated with sociodemographic characteristics such as relationship problems, mental health disorders, university associated factors like as academic stress, and victimization. Although the prevalence of mental health disorders was low in this study, it should not be ignored, because having a diagnosis of a mental health disorder had the single most important predictive power of suicide.
The study did not find any significant differences between the programme of study, level of study, living alone, being in a romantic relationship and suicide. Thus, the study emphasizes the complex interacting pathways of risk factors for causing suicide behaviour. This study thus sets the stage for more studies in this important aspect of public health.

5.1.3 Significant Predictors of Lifetime Suicide

Relationship problems, victimization, non-heterosexual orientation, the presence of a mental health disorder and academic stress significantly predicted suicide. The presence of a mental health disorder is the single most important predictor of lifetime suicide.


5.2 Limitations of the Study

The results of this research should not be considered without regard to the plausible limits of the study. Because the questionnaires were filled anonymously, students with suicide could not be identified and given appropriate intervention. Also, because suicide behaviour in Nigeria is highly stigmatized (Quarshie et al., 2015), participants are likely to have provided socially desirable responses as opposed to reality. Again, the knowledge of suicide as a crime in Nigeria can be strong grounds for discouraging honest responses from participants.

This study was done among undergraduate University students; thus, the generalizability of its results is limited. For ease of responding to the questionnaire, the study did not measure the risk factors with standardized scales such as the Beck depression inventory, Perception of student-professor/instructor bullying questionnaire for assessing bullying or victimization by the lecturer, or the peer-victimization scale for assessing peer bullying, Student-Life Stress Inventory and Academic Self-Efficacy Scale for measuring student academic stress. This was due to the complexities, size of the sample and logistic challenges. These risks were measured with single questions in a structured online questionnaire in order to make the questionnaire less arduous to respond to, however, these are prone to overestimation of the prevalence of suicide and the risk factors they sort to measure. Also, it is commonly argued to focus on strengthening protective factors rather than weakening of risk factors in preventive strategies. However, this study was more focussed on the elucidating risk factors.

This study focused on individual risk factors to the neglect of the administrative contextual factors which by themselves can affect suicide through decreasing socially abhorred behaviours such as substance use and promoting other healthy behaviours such as physical exercise (Giordano & Lindstrom, 2010). Despite these limitations, the study can be the first domino to propagate a series of research in this vastly under-researched but critical area in universities and public health in general.


5.3 Recommendations

5.3.1 A multidisciplinary approach to tackling suicide

Multidisciplinary approaches with concerted efforts are required in the prevention of suicide and thus, suicide. This would require forming an integrated unit comprising of all University faculties, administration, University Counselling Unit and medical team, and other players to combine efforts in curbing this menace.

5.3.2 Adopting a biopsychosocial approach to suicide

Despite the wealth of empirical evidence demonstrating significant linkages between depression and Suicide (Bantjes et al., 2016; Korb & Plattner, 2014b) as well the findings in this study that is strongly associating mental health disorders and suicide, it should not lead us to focus only on the medical model in suicide prevention but rather to integrate this with the public health approach and, encourage the University to weave into the design of any suicide prevention strategy, a scheme of diagnosing mental health disorder through identifying and dealing swiftly with distal socio-demographic risks factors for mental health disorders and suicide, as these two are almost inseparable. This can easily be done by adding mental status examination to the annual health screening form for freshmen. Students identified to be having ideation or significant risk factors such can be recommended to the counselling unit for the appropriate biopsychosocial interventions to be taken.

The study also recommends, a University instituted programme that enables periodic social check-ins by University staff and counsellors would help recognize, and assist high-risk students and promote a culture of help-seeking in the University for Development Studies.

De Luca et al. (2016), showed that extracurricular activities that increased the sense of belongingness such as cultural activities, fraternities or sororities, varsity athletics teams and social student government play a protective role in preventing suicide by increasing social connectedness and was associated with better academic performance. University departments can, therefore, increase student participation in extra-curricular activities by incorporating such activities into the main curriculum which would require students to be part of at least one of such social groups.

Hughes (2001) provides good examples for practice in dealing with bullying or victimization in higher education using qualitative methodology. These examples could be adopted and practised by staff and students to alleviate the effects of bullying or victimization in the University. The examples of good practice are; establishing good communication, taking immediate action in bullying or victimization cases, putting complaints into writing, moving students to other teaching groups and making students aware of their actions and boundaries of acceptable behaviour.

Approaches in cognitive, behavioural, and mindfulness are beneficial in controlling stress in university students. Universities, therefore, are advised to make these services readily accessible to students. Future research, however, should also focus on developing stress management programs which attract students of all demographic characteristics and address their needs (Regehr et al., 2013). Also, university students could be assigned academic mentors to help coordinate regular stress reduction activities.

Universities should build ways to promote higher social integration and acceptance of students that have a lesbian, gay, bisexual and transgender background. Policies should also explicitly state the measures to be followed or measures to address the victimization of students by both lecturers and colleagues.

Larger sample size in future studies may likely show statistical significance in the independent variables that did not show any significance in this study, hence more studies with bigger sample sizes are encouraged. Suicide is part of a continuum of the suicidal process that leads to suicide; so therefore, researchers conducting future studies could consider research into the other aspects of the suicide process such as suicide plans and attempts. I also recommend to future researchers to consider qualitative methods to probe into depth the phenomenon of suicidality.

It is my hope that this thesis will shed light on the suicide problem and inform the university, community, and national responses. By working together and focusing attention and resources, we can help students get through the University with the services they need to avert suicide risk without discrimination, maintain the wealth of human capital the country needs as well as achieve the Sustainable Development Goals.


Perceived Factor Influencing Suicidal Attempt Among Undergraduates


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