CHAPTER ONE
Introduction
Background to the Study
Every society is dynamic and has its peculiar problems. However, when these problems, overwhelm the young ones who have no coping ability, they may start thinking of risky behaviour of suicide or attempt suicide. Suicide among teens and young adults is a complex and distressing problem (Tellioglu, 2006). To contemplate suicide at any age is awful. When it involves a teenager who has a life full of potentials ahead of him, it is almost too awful (Behning, 2006).
In recent years the rate of suicide among adolescents has risen to alarming proportions (Goldman, 1988). Worldwide, suicide is among the top five causes of mortality in the 15 to 19 years age group in many countries, suicide ranks first as a cause of death among both boys and girls in this age group (World Health Organization (WHO), 2000). In persons between the ages of 15-34years, it is the third leading cause of death (Vijayokumar, Nagaraji, & John, 2004). However, incidence and pattern of suicide varies from country to country depending on social, cultural, and religious values (Saeed, Bashir, Khan, Igbal, Rajo, & Rehman, 2002). It is considered a sin or immoral act in many religions and a crime to help someone commit suicide in some countries. On the other hand, some culture have view it as an honorable way to exit certain shameful or hopelessness situations (Columbia University Press, 2003).
Suicide is the act of taking one’s life voluntarily and intentionally (Saeed, Bashir, Khan, Igbal, Rajo, and Rehman, 2002). Suicide is a self-execution, an act in which one deliberately and intentionally kills himself, is gradually seen as extreme and complex behaviour, involving all aspects of human experience, the biological, psychological, social, and environmental aspect of life (Moscicki, 1994). It is the act of deliberately taking one’s life. Suicidal behaviour is any action with potentially life threatening consequences, such as taking a drug overdose (Taylor, 2003).
Suicide attempts or completed suicide have bearing in suicidal thoughts or ideas. When a person has ideas or thoughts about suicide, it is called suicide ideation. Ideation is the collective representation of thoughts and ideas, recalled from memory, or projected into the future, singly or combined (Segen, 2002). Ideation is also viewed as knowledge or understanding of something without being certain about it, belief or opinion, a purpose or reason for doing something (Procter, 1995). According to Wordnet (2007), ideation is the process of forming and relating ideas. When these ideas are related to suicide, it is termed suicide ideation.
A host of life events, personal and social variables must be involved when people have thoughts about suicide and when they actually make attempts. Such an extreme and unusual occurrence reflects the combined effect of these variables, which are difficult to study because of their complexity (Reich, Newsom, & Zautra, 1996). However suicidal ideation is maladaptive and realistic precursor in many cases of suicide attempt (Hawton, 1986).
Suicide ideation is the capacity for or the act of forming or entertaining ideas that are suicidal in nature (Wikipedia, 2007). According to National Centre for Health Statistics (2007), suicidal ideation is having thoughts of suicide or thinking of taking action to end one’s life. Suicidal ideation includes all thoughts of suicides, both when thoughts include a plan to commit suicide and when they do not include a plan. This means that suicidal ideation will include the wish or the plan to commit suicide.
Suicidal ideation, given its specificity to cognitions, is consistent with a cognitive behavioral focus (Kendal & Hollon, 1981), and may be viewed as a domain of self-statements. It extends from vague wishes that do not exist (extremely mild ideation) to thoughts quite specific to the act of suicide such as thinking about how and when one will kill himself or herself.
Suicidal ideation is a common medical term for the mere thoughts about and of plans of committing suicide, not the actual following through or act itself. People who undergo suicide ideation do not commit suicide. The range of suicidal ideation varies greatly from fleeting, detailed planning, role-playing, and half-hearted attempt. Fleeting as applied to suicide ideation refers to someone having an idea about intention to commit suicide, but this idea soon fades away and starts again. Planning refers to the process of outlining the activities to be carried out in a purposive manner including the methods to be used in committing suicide. Role-playing is attempting or acting out the activities outlined under planning to explore the possibility of how it will work. Finally, half-hearted attempt is concerned with field testing or trying the plan of committing suicide but not with the actual intention to commit the action (suicide) (Wikipedia, 2007).
Suicide ideation can be active and this involves a current desire and plan to die. Suicidal ideation can be passive, involving a desire to die but without a plan to bring about one’s death (Shields & Barton, 2005). Suicidal ideation is often the precursor of later and more serious, suicide related behaviour (Konick & Gutierrez, 2005). Wikipedia, (2007) indicated that, regardless of what percentage of people with suicidal ideation that commit suicide, it is still risk factor for suicide. Andrews and Lewinsohn, (1992), Dubow, Kausch, Blum, Reed, and Bush (1989), explained that many adolescent suicide attempters express high levels of suicide ideation, however, many suicide ideations never attempt suicide. Rohde, Seeley, and Mace (1997), further indicated more importantly that adolescents who make one suicide attempt have an elevated risk for future attempts and completed suicide.
Suicidal ideation, which includes thinking about the reasons for and ways of killing oneself, and suicide attempts are related to variety of life events in childhood and adolescence. For instance, confusion and frustration in coming to terms with gender identity, gender role, as well as sexual orientation may lead to a feeling of depression and suicidal ideation (Frisch & Frisch, 1998). This view is also supported by (Allan, Kashani, Dahlmeier, Taghizadeh, & Reid, 1997), that there appears to be a dramatic rise in suicidal behaviour as children make the critical transition from childhood to adolescence and young adult. Suicidal thoughts become abnormal in children and adolescents when the realization of those thoughts seems to be the only way out of their difficulties. There is then a serious risk of attempted suicide or suicide (WHO, 2000).
Many adolescents who are suicidal are also depressed or in a state of extreme demoralization as in the case with adults (Beck, Kovacs, & Weissman, 1975; Beck, Steer, Kovacs, & Garrison, 1985). Suicidal adolescents often feel an overwhelming sense of hopelessness (Garfinkel, Froese, & Hood, 1982; Robbins & Alessi, 1985). However, hopelessness appears to be experienced by many adolescents, not just those who think about or attempt suicide (Spirito, Slark, Fristad, Hart, & Owens-Stively, in press). Adolescents frequently find themselves under tremendous stress. Problems most often occur when stressors at home, school, and with peers occur within a context of minimal social and emotional support. These problems are further exacerbated when there is lack of coping strategies or when behavioral deficit or dysfunction exists.
For the purpose of this study, suicidal ideation refers to an individual who has thoughts to die, which involves the process of fantasizing, planning and motivation to commit suicide.
Research has shown that adolescents are at greatest risk when they are experiencing a major negative life event, having a lot of “hassles” and having little social support (Reynolds & Waltz, 1986). Other investigators have also noted the relationship between high life stress and suicidal ideation and behavior in young adults (Schotte &Clum, 1982) and adolescents (Smith & Crawford, 1986).
Apart from the home, school, and peers contributing to suicide behaviours, suicidal behaviour tends to differ on the basis of gender, age, and grade or class and location. Factors of gender have been suspected to be associated with suicide ideation, and Frisch & Frisch (1998), maintained that there are significant gender differences in rates of adolescents suicide, while more females admit having suicidal ideation and more attempts at suicide; more males actually succeed in completing suicide. These differences have been found to be related to gender feelings of loneliness and experiences of substance abuse in males than female adolescents.
Many adolescents including secondary school students are involved in chronic drug use, which leads to drug abuse and addiction. For example, marijuana is a drug commonly used in Nigeria since after the civil war. This substance has been linked with acute psycho toxic reactions, withdrawal symptoms like restlessness, anxiety, sweating, and hyperactivity. Adolescents who are found under these conditions may think of committing suicide. The high incidence of armed robbery, assassinations and other crimes are often as a result of drug abuse. When some of these adolescents commit some of these crimes, some of their accomplices are caught, those who escape may think of committing suicide while, others commit suicide. The society frowns at adolescents’ misbehavior, rebellion, riots and other crimes. When they are napped in these vices, there is a tendency for them to think of taking their lives to escape from the shame.
Mohr (2003) stated that it is often hard for parents and teachers to detect the warning signs of suicidal behaviour. He documented the signs of suicide to include statements such as “I won’t be around for you to yell at” or “you won’t have to worry about me much longer” (p.673). Lack of emotional responsiveness, social withdrawal, inability to enjoy previously enjoyed activities, drug or alcohol abuse, threat making, and giving away of possessions and certain cheerfulness after being depressed, may not be common to adolescents but some may be present, for example, lack of emotional responsiveness, social withdrawal and drug misuse or abuse.
Attempted or completed suicide may to a large extent be preceded by suicidal ideation. These situations may not always be uncommon with adolescents as those in the present study. Situations which may give rise to suicidal thoughts in Nigeria abound. According to WHO (2007), lack of reliable information at local/regional/national levels significantly undermines the problem of suicidal ideation or attempted suicide. In the case of suicides, considerable under reporting and misclassification occurs in data gathering. Hospital information systems do not include suicides and these are often listed under “injuries and accidents” or occasionally under “mental health problems”. Adolescents’ suicidal ideation or behaviour is widely deemed to be under reported, because many deaths of this type are inaccurately classified as unintentional or accidental (WHO, 2000).
WHO (2000) indicated that in some countries there is an alarming increase in suicide among children aged less than 15, as well as in the 15-19 year age group. Therefore, the identification of adolescents’ severity of suicide ideation serves as a variable proactive approach for the identification of youth at risk of suicide. This explains why this study is pertinent especially in Taraba State.
Investigations have continued to focus on suicidal ideation as an important aspect of suicidal behaviour in adolescents and young adults. Schotte and Clum (1982) noted the importance of research on suicidal ideation “especially since there is demonstrated relationship between the frequency of suicidal ideation and the likelihood of suicide attempting” (p.690). Furthermore, they asserted that “with adult attempters, suicidal ideation and depression explained the greatest proportion of the variance in adolescent suicide behaviour; the more serious the suicidal ideation, the more likely was the adolescent to have attempted suicide” (p.491).
In Taraba State, for instance, four cases of adult suicide were recorded in the last 4 years (Taraba State Police Command, 2007). No record of adolescent case of suicide was reported following investigation with the Federal Medical Centre (FMC) of the State, the State Police Command and the State Social Welfare Office. In addition, to the knowledge of the researcher, no study has been carried out to identify adolescents with suicidal ideation who may be at risk of suicide attempts or complete suicide, in Jalingo Local Government Area of Taraba State. This reason makes the study necessary.
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