Psychological autopsy studies are the most accepted method of identification of risk factors for suicide. Repeated autopsy studies in developed countries revealed that at least 90 per cent of those who committed suicides had mental disorder. The second generation case-control psychological autopsy published on December 16, 2020 revealed a different picture in Bangladesh in relation to areas. Relatives of 100 suicides and 100 living controls from Dhaka city were interviewed following the study protocol in a13-month duration. The study found presence of a mental illness, immediate life events, previous self-harming tendency and sexual harassment as significant risk factors for suicide in Dhaka.
Of the 100 cases, there were 49 males and 51 females. The mean age was 26.30 years for the cases and 26.68 for the controls. Affair marriage was more common among suicide deaths. Hanging was the commonest method followed by poisoning, and the majority of the deaths happened at home. Of them 61 per cent had any form of psychiatric disorder, 44 per cent had depression, 0.9 per cent substance abuse, 14 per cent had a personality disorder. Among the deaths, 0.5 per cent with depression, 0.7 per cent with substance abuse, and 0.1 per cent with psychosis were previously diagnosed. The rest of them were diagnosed during the interview. Ninety-one per cent experienced life events, 89 per cent during the past 48 hours, 50 per cent during the past month and 26 per cent during the past year. The major life events include increased arguments with a family member, academic failure (important exam or course), breakup of engagement, increased arguments with spouse, sexual harassment, extramarital affair, loan, unfaithful conjugal relationship and death of a spouse. Relationship problem with spouses was more common among the cases in comparison to the controls, which was statistically significant. Extrapolation of opinions of respondents regarding the deciding factor of suicides revealed 57 per cent of the events are related to sexual issues such as extramarital affair of a spouse, pre-marital affair, sexual harassment, discord with family members, spousal discord, denial of a love relationship and forcible marriage.
Risk factors for suicide have been poorly researched in Bangladesh. This is the first systematic approach to identify the risk factors of suicide in Bangladesh that revealed a different picture in comparison to the Western countries but closely similar to China. The findings of the study would be a guide to formulate the national suicide prevention strategy. Escalation of mental health services, provision of educative material and distress, initiation of the specialised hotline, providing training to general practitioners and stopping sexual harassment has been identified as key areas of suicide prevention in the country. Culturally appropriate strategies in the low-resource setting should be identified and initiated for suicide prevention.
Preventive strategies should focus on increasing awareness of mental health and suicide, immediate distress coping, lessons for the general population with special attention to immediate distress management. Initiation of widely available hotlines, holistic approaches to stop sexual harassment, training of general practitioners to identify depression could be prioritised.
The writer is an assistant professor, Department of Psychiatry, Enam Medical College and Hospital, Savar