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Suicide: an Overview Stephanie P 11 SUICIDE: AN OVERVIEW STEPHANIE P. HUTCHESON & R. MACHELLE MAJOR The family of an 18-year-old girl is in shock after she was found dead, hanging from the rafters of the apartment she shared with her mother on Sunday afternoon. Police say the evidence sug- gests that Keisha Thurston, a recent graduate of CC Sweeting, committed suicide and expect to close the investigation in the next few days.1 omestic violence, child abuse, and gun violence are clear and often public acts of violence, but this chapter explores a violence that may be less obvious, violence against oneself – specifically the act of suicide. D The global phenomenon of suicide represents a desperate and violent act against the self with the intent to end life. A 2011 World Health Organization (WHO) report estimated that more than 800,000 persons worldwide died by suicide.2 In May 2013, the WHO took a decisive step in addressing the global trend of suicide through the adoption of the Mental Health Action Plan.3 This Mental Health Action Plan marked a new thrust on at least two levels: it was an historic first step in constructing a comprehensive international mental health plan. Further, a significant feature of the Mental Health Action Plan was the focus on and inclusion of, suicide prevention to reduce the global burden of suicide and the sequelae associated with suicide.4 International statistics indicate that the highest rates of suicide occur in Eastern European nations with the lowest rates in Latin American and Muslim countries.5 Worldwide, suicide is reported as the eighth leading cause of death for those countries where data are available.6 In the 15-34 age group, re- search indicates that suicide is the third leading cause of death.7 Suicide is a well-researched area in the field of psychology and sociology. Studies have examined suicide in several domains: the influence of Internet and Internet sites endorsing suicide, the impact of unemployment and economic downturns, the profile of suicides in youth, cultural differences, methods of suicide, racial differences, epidemiology, international trends, and gender differences.8 Even though the magnitude of the problem of suicide is reflected in international statistics, gaps exist when one examines the incidence of suicide in non-European countries and western cultures. In regions such as the Caribbean and The Bahamas, there has been less research. This is probably because traditionally, suicide was not considered a major problem in the English- speaking Caribbean. In Barba- dos, the literature tends to report suicide attempts or “self-harm” with subsequent hospitalizations rather than completed suicide. Recent regional research paints a picture of suicide in the Caribbean for countries such as Jamaica with an alarming trend clinically reported for Guyana.9 Other reports include Bermuda, St. Lucia, Guyana, The Bahamas, and Grenada. Mahy has contributed a largely descriptive picture of suicide in various Caribbean nations. He traces the historical and geopolitical context of suicide.10 Mahy demonstrated that overall suicide rates in the Caribbean appear lower than those in other countries globally. However, a profile of a steadily rising rate of suicide in the region does emerge – noted through admissions to hospital of those who attempt suicide. 171 Violence in The Bahamas Early reports (from the 1960s) from Jamaica and Trinidad & Tobago indicated more completed suicides in females as opposed to males with numbers hovering around 190 per year. Demographic factors provide a profile of suicides in the Caribbean region that include age, sex, and ethnicity. East Indians in Trinidad & Tobago have higher numbers of suicide and suicide attempts than people of African descent. In terms of method and lethality, Mahy’s paper points to the popularity of ingesting agricultural pesticides in countries where agro-pesticides are readily available (e.g.: pesticides in Guyana and poisoning using benzodiazepines in Barbados). This contrasts with hanging as the method of choice elsewhere in the Car- ibbean. A history of mental illness was implicated in those who attempted or completed suicide. Mood disorder was by far the most noted diagnosis of those admitted for suicidal behaviour. Mahy articulates the socio-psychological perspective on suicidal behaviour as a cry for help rather than intent to die. He does not consider religion a significant factor in predicting suicides in the Caribbean. As this factor has not been examined to any great degree in the literature, it is probably a future area of research given the strong Christian influence in The Bahamas. In The Bahamas, research on suicide is not so robust. Between 2008 and 2010 public awareness of suicide peaked when a spate of suicides and suicide attempts were reported in the Bahamian media.11 The ensuing alarm by public and mental health officials decried this seeming rise in suicides. And even though the WHO reported a suicide rate of 1.0 per 100,000 for the year 2002 for The Bahamas, a definitive picture of suicide in The Bahamas is not available.12 Local work in The Bahamas depends upon Spencer’s work from the 1960s and more recently an unpublished report by a Bahamian government-convened task force to study suicide.13 Spencer’s work reviewed deaths classified as suicides via the Coroner’s Court records – covering an 11-year span (1959- 1969). A notable feature of his study was the analysis of suicide in the Bahamian population including ex- patriate residents and visitors, although he was cautious as to how successful this distinction was. Results revealed 35 Bahamian suicides during the period, a rate of 2.8 per 100,000 annually. For males the rate was 5 per 100,000 and for females 1 per 100,000. The rate of suicide in New Providence (3.3 per 100,000) was higher than that in the other islands (2.2 per 100,000). Additionally, the suicide rate was higher for males in New Providence as opposed to males in the other islands. The profile of suicides in non-Bahamians (visitors and expatriate residents) was also included in Spencer’s work. The rate of suicides in this population was relatively high, ranging from 12.8 in males to 6.4 in females. Spencer noted the challenges of definitively speaking to these figures as he describes them as “rough approximations.”14 Still, the figures provide utility in delineating differences in suicide in these groups. In terms of other demographic data, suicides were most common in the modal age group, 31-40. More than 35% of the suicides had a psychiatric history. Methods of suicide included poisoning, shoot- ing, hanging, and drowning. Shooting was more common in males while poisoning was more common in females. Spencer surmised that overall, the Bahamian suicide rate was fairly low in comparison to the rate in other communities. Although Spencer’s data relate to the 1960s, they provide a useful baseline to appreciate changes, if any, which have occurred in relation to suicides since that time. In 2013, a task force to study suicide in The Bahamas was struck as a public health response to re- curring reports of suicides.15 Data from the task force provide a contemporary understanding of suicides in The Bahamas. Data were derived primarily from police constabulary sources and cover the period from 1990 to 2013. Between 1990 and 2013, 136 suicides were recorded. The yearly mean was 5.67, with a standard er- ror of 0.642. The overall number of suicides per 100,000 was 1.81. Table 11.1 shows the number of suicides by year as well as the population and the number of suicides per 100,000. 172 SUICIDE: AN OVERVIEW Table 11.1: Number of suicides and estimated suicide rates per 100,000, recorded in The Bahamas 1990-2013 Year Counts Estimated Population Suicides per 100,000 1990 0 256,338 0 1991 4 261,102 1.53 1992 3 266,097 1.13 1993 8 271,105 2.95 1994 8 275,820 2.9 1995 5 280,050 1.79 1996 4 283,678 1.41 1997 5 286,845 1.74 1998 2 289,926 0.69 1999 5 293,442 1.7 2000 10 297,759 3.36 2001 6 303,005 1.98 2002 3 309,039 0.97 2003 3 315,624 0.95 2004 2 322,400 0.62 2005 5 329,088 1.52 2006 4 335,622 1.19 2007 7 342,049 2.05 2008 11 348,340 3.16 2009 12 354,492 3.39 2010 8 360,498 2.22 2011 6 366,331 1.64 2012 11 371,960 2.96 2013 4 377,374 1.06 Total 136 M/year 5.67 1.81 Population data: Source: World Bank: http://databank.worldbank.org/data/views/reports/tableview.aspx Suicide data: Suicide Task Force of The Bahamas, unpublished data. During this period, a simple linear regression indicates that the number of suicides per year has increased; the slope was 0.191, standard error, 0.086, which is significantly different to zero (p = .036), which indicates that the number of suicides is related to time. However, this is influenced by the fact that in 1990, no sui- cides were recorded. When we look at the suicides per 100,000, there is no evidence to suggest that overall, the data deviate from the long-term mean of 1.81/100,000 (Kolmogorov-Smirnov z = .76, p = .61, N = 24). So despite there being some higher values between 2007 and 2013, this seven-year period includes two years when the suicide rate was below the long-term average. A runs-test again suggests that there is no long-term deviation from the underlying mean, p = .173.
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