Suicide among Ugandan university students: evidence from media reports for 2010–2020 (original) (raw)

• Journal List
• BJPsych Int
• v.18(3); 2021 Aug
• PMC8314982

BJPsych Int. 2021 Aug; 18(3): 63–67.

Mark Mohan Kaggwa

1Postgraduate Student, Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Uganda; and African Centre for Suicide Prevention and Research, Uganda. Email: moc.liamg@nahomkramk

Moses Muwanguzi

2Undergraduate Medical Student, Faculty of Medicine, Mbarara University of Science and Technology, Uganda

Elicana Nduhuura

3Undergraduate Medical Student, Faculty of Medicine, Mbarara University of Science and Technology, Uganda

Jonathan Kajjimu

4Undergraduate Medical Student, Faculty of Medicine, Mbarara University of Science and Technology, Uganda

Innocent Arinaitwe

5Undergraduate Medical Student, Faculty of Medicine, Mbarara University of Science and Technology, Uganda

Moses Kule

6Undergraduate Medical Student, Faculty of Medicine, Mbarara University of Science and Technology, Uganda

Sarah Maria Najjuka

7Medical Student, College of Health Sciences, Makerere University, Kampala, Uganda

Godfrey Zari Rukundo

8Senior Lecturer, Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Uganda; and African Centre for Suicide Prevention and Research, Uganda.

1Postgraduate Student, Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Uganda; and African Centre for Suicide Prevention and Research, Uganda. Email: moc.liamg@nahomkramk

2Undergraduate Medical Student, Faculty of Medicine, Mbarara University of Science and Technology, Uganda

3Undergraduate Medical Student, Faculty of Medicine, Mbarara University of Science and Technology, Uganda

4Undergraduate Medical Student, Faculty of Medicine, Mbarara University of Science and Technology, Uganda

5Undergraduate Medical Student, Faculty of Medicine, Mbarara University of Science and Technology, Uganda

6Undergraduate Medical Student, Faculty of Medicine, Mbarara University of Science and Technology, Uganda

7Medical Student, College of Health Sciences, Makerere University, Kampala, Uganda

8Senior Lecturer, Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Uganda; and African Centre for Suicide Prevention and Research, Uganda.

Received 2021 Jan 4; Revised 2021 Feb 26; Accepted 2021 Mar 1.

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, M.M.K., upon reasonable request.

Abstract

University students are in transition to adulthood and face multiple challenges that may lead to suicide. They are reported to have a higher risk of suicide by the World Health Organization. As there is no national suicide database in Uganda, we analysed student suicide using the press/media reports of suicides published between 2010 and 2020. A total of deaths by 23 suicide were identified: 19 were males, relationship problems were the main suicide reason (n = 6) and hanging was the most frequently used suicide method (n = 7). A strategic intervention to tackle suicide risk among university students is warranted.

Keywords: Suicide, media reporting suicide, university students, youth, students

Suicide is a global health concern, with 79% of the annual incidence occurring in low- and middle-income countries.1 However, suicide remains illegal in many African countries, including Uganda, and no suicide attempter would dare not to complete it for fear of the repercussions attached.2 Although suicide rates in Uganda decreased from 15.91 per 100 000 population in 2000 to 9.9 per 100 000 in 2017,3 the rates remained highest among the youth (approximately 700 000 are university students). University students are transitioning from adolescence to adulthood, a stage associated with many stressors (physical, psychological, social and spiritual) that overpower many, leading to suicide. Previous studies have demonstrated high numbers of suicides among university students.4–6 The year 2020 came with multiple unexpected challenges due to the COVID-19 pandemic that may have put many at risk of dying by suicide.7 Looking at past suicide cases may give us an insight into what to expect for better preparation and interventions. With no central database for suicide in Uganda, literature about suicide among university students is limited. This paper describes a study of press/media reports about suicide, its risk factors and the commonly used methods among university students in Uganda. We adopted an approach used by countries without suicide databases.5

Method

Data collected were from various Ugandan media reports of university students who completed suicide from 1 January 2010 to 31 December 2020. Our search used the keywords of suicide, ‘Yese’, suicide, university students, youth, students and obutwa. Records with the same date of death, name, age, gender and university were considered duplicates and one entry retained (Fig. 1). Only 23 reports were identified.

Flow diagram of case identification from the different media websites.

No ethical approval was required since the study had no direct contact with participants.

Results

All 23 individuals were undergraduate students, aged 19–25 years, and only 4 of them were female (Table 1). The majority (n = 10/21) were doing business-related programmes; the next most common programmes were in computer science (n = 3). The majority (n = 9/20) were in their second year of study; 7 were in their final year (the 3rd, 4th or and 5th year of study, depending on the programme offered).

Table 1

Characteristics of the participants

The majority of the students took their lives at night (n = 11/14). The most common methods were hanging (n = 7/18) and poisoning (n = 5). These incidents most commonly occurred in hostels (n = 13/20) and rentals near the universities (n = 5). The most commonly reported reasons for suicide were break-up of a romantic relationship (n = 6/21), family problems (n = 5) and betting/gambling (n = 5); academic failure was reported as a reason for only 1 student. Five students were reported to have had a mental illness at the time of the suicide, mainly depression (n = 3). None of the students was reported to have been using any substance of addiction.

Discussion

Risks associated with suicide

Gender

Completed suicide is consistently more common in males, but females attempt more;2,8 we attributed this to the culturally better coping skills of women, who grow up with their mothers as role models and learn from them how to handle most stressful situations. Additionally, most female students in Uganda are engaged with religious and spiritual groups/communities, which highly condemn suicidality and guide them.8,9 On the other hand, men are left alone because their primary role models (fathers) are busy and occupied with work and looking for money rather than mentoring their sons. Culturally, men are more determined not to fail; a failure makes them ‘less of a man’. So, when it comes to suicide, men use more lethal methods and make sure they complete. Some reports also attribute the high rates of suicide among men to their high-risk lifestyle of being involved in gambling and addictive substance use and being emotionally fragile.

Challenges/disappointments

Studies have found university students commonly to take their lives towards the end of their programmes;5,6 our investigation also found that only four students took their lives during their first year. This is possibly attributable to the compounding pressure as one progresses in school due to the various challenges that interplay. When it comes to students, academic disappointment may top the list of risk factors for suicide, but in our investigation, only one student was reported to have ended her life for this reason. Romantic problems are a frequent cause of suicide among Ugandan university students, with 6 out of 21 in our sample reported as having had such a challenge. These findings are consistent with previous studies among students.5,6,8 Throughout a student's education, mental preparation for academic challenges occurs, with exams at every step of academia. This is not the case for romantic relationship challenges. The transition to adulthood comes with many social expectations, and no student would want to fail in maintaining an emotional attachment that they have personally chosen. The bond formed with most individuals’ first love is so strong and we believe that some individuals cannot view their life without that person, and at times, some may opt for suicide. A break-up is one of the major and sometimes the first disappointment in these students’ lives. The exploratory nature of this stage of life makes many students try out numerous risks, such as betting/gambling. These easy schemes of money harvesting have made many students prey to systems owned by master tricksters. Many students in other parts of the world have taken their lives because of gambling.10,11

Substance use

Studies report use of addictive substances among university students as an etiological factor for suicide completion,12 attributing it to the psychotic symptoms experienced during intoxication or withdrawal.2,12 However, substance use was not identified in this study, and we attribute this mainly to the study design of using press/media houses, which rarely report such information in Uganda. For this same reason, mental illness, especially depression, a common cause of suicide, was not reported in most cases. Most media houses lack the expertise to deductively report the cause of suicide but do a great job in notifying the community about what is happening to the students.

The aftermath of student suicide

The majority of the suicides occurred in hostels, rentals or the home – places where students feel comfortable. Suicide is a signal or message to individuals important to the person,13 thus causing most people to carry out the act at home to inform an individual or the community about their stress. For this reason, some individuals leave a suicide note with specific messages, addressed to an individual. With the advancement in technology, communication is via social media; and the trend or tradition of written suicide notes is changing to social media posts or messaging to the target group.14

Despite advanced technology, some aspects of suicide may take long to change, such as the method used. As in other studies, hanging was the most commonly used method by the students.5,6 Despite many alternatives, many individuals still find this the best method of ending their lives. We suggest that this might be attributed to the unintentional advertisement of this method by showing a rope as a sign of suicide or social media emoji that communicate suicide with a rope sign.

The way forward

Despite all universities in Uganda employing qualified psychologists and counsellors to improve students’ well-being, students are still dying by suicide, leaving us questioning their effectiveness. Do we need a new approach? For a generation so absorbed in their gadgets, would the use of technology rather than human beings sitting in offices be a more acceptable – and more successful – way of improving mental well-being? We believe that, if possible, all the counselling services should be made anonymous, not face to face with a therapist, to increase their uptake by this generation of students. Many countries have opted for machine learning in an attempt to identify individuals at risk of suicide.15 Maybe this is the approach universities should employ to cut the suicide rate.

Strength and limitations

Owing to the lack of an official database, the use of press reports was the best available approach to tracking suicide among university students. The study had limitations: the press may not have reported all student suicides and the number of cases identified was too few to make any generalisations.

Data availability

The data that support the findings of this study are available from the corresponding author, M.M.K., upon reasonable request.

Author contributions

M.M.K. and S.M.N. conceived the study; M.M.K., G.Z.R. and E.N. designed the concept and protocol; I.A., M.K., S.M.N., M.M.K., J.K. and M.M. did the literature search; and M.M.K. and E.N. drafted the initial manuscript. All authors contributed to critical revision for the intellectual content of the manuscript.

Funding

The research received no specific funding from any organisation, public or private.

Declaration of interest

None.

References

2. Kaggwa MM, Nuwamanya S, Ashaba S, Rukundo GZ, Harms S. An adolescent's use of veterinary medicines: a case report exploring addiction. J Psychoactive Drugs [Epub ahead of print] 12 Jan 2021. Available from: 10.1080/02791072.2021.1873466. [PubMed] [CrossRef] [Google Scholar]

4. Rasheduzzaman M, Al Mamun F, Faruk MO, Hosen I, Mamun MA. Depression in Bangladeshi university students: The role of sociodemographic, personal, and familial psychopathological factors. Perspect Psychiatr Care [Epub ahead of print] 13 Jan 2021. Available from: 10.1111/ppc.12722. [PubMed] [CrossRef]

5. Griffiths M, Mamun M, Misti JM. Suicide of Bangladeshi medical students: risk factor trends based on Bangladeshi press reports. Asian J Psychiatr2020: 48:101905. [PubMed] [Google Scholar]

6. Karbeyaz K, Toygar M. Çelikel A. Completed suicide among university student in Eskisehir, Turkey. J Forensic Leg Med2016; 44: 111–5. [PubMed] [Google Scholar]

7. Manzar MD, Albougami A, Usman N, Mamun MA. COVID-19 suicide among adolescents and youths during the lockdown: an exploratory study based on media reports. J Child Adolesc Psychiatr Nurs [Epub ahead of print] 3 Apr 2021. Available from: 10.1111/jcap.12313. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

8. Mamun MA, Siddique AB, Sikder MT, Griffiths MD. Student suicide risk and gender: a retrospective study from Bangladeshi press reports. Int J Ment Health Addiction [Letter] 19 Mar 2020. Available from: 10.1007/s11469-020-00267-3. [CrossRef] [Google Scholar]

9. Mugisha J, Hjelmeland H, Kinyanda E, Knizek BL. Religious views on suicide among the Baganda, Uganda: a qualitative study. Death Stud2013; 37: 343–61. [PubMed] [Google Scholar]

10. Reith G, Wardle H, Gilmore I. Gambling harm: a global problem requiring global solutions. Lancet2019; 394: 1212–4. [PubMed] [Google Scholar]

11. Mamun MA, Griffiths MD. A rare case of Bangladeshi student suicide by gunshot due to unusual multiple causalities. Asian J Psychiatr2020; 49: 101951. [PubMed] [Google Scholar]

12. Schneider B. Substance use disorders and risk for completed suicide. Arch Suicide Res2009; 13: 303–16. [PubMed] [Google Scholar]

13. Synnott J, Ioannou M, Coyne A, Hemingway S. A content analysis of online suicide notes: attempted suicide versus attempt resulting in suicide. Suicide Life Threat Behav2018; 48: 767–78. [PubMed] [Google Scholar]

14. Luxton DD, June JD, Fairall JM. Social media and suicide: a public health perspective. Am J Public Health2012; 102: 195–200. [PMC free article] [PubMed] [Google Scholar]

15. Naghavi A, Teismann T, Asgari Z, Mohebbian MR, Mansourian M, Mañanas MÁ. Accurate diagnosis of suicide ideation/behavior using robust ensemble machine learning: a university student population in the Middle East and North Africa (MENA) Region. Diagnostics2020; 10(11): 956. [PMC free article] [PubMed] [Google Scholar]

Articles from BJPsych International are provided here courtesy of Royal College of Psychiatrists