Suicide Behaviour among a Nigerian Population (Psychiatry)

Amechi, A. (1973)

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Thesis

The aim was to collect epidemiological and clinical data and to tackle some of the methodological problems in the social epidermiology of attempted suicide using a Nigerian population in the city Lagos and to compare with a United States risk-population of black inhabitants of the city of New ward, New Jersey, and to produce recommendation for future social and clinical actions for preventive psychiatry or other interventions. Subjects: Subjects made up to 50 of suicidal behaviour seen in Lagos University Teaching Hospital between December 1971 and May 1972 were studied. A control group of 50 psychiatric patients seen in crisis in the emergency room of LUTH was used. Findings were compared with those of 460 cases of suicidal behaviour studied by the investigator at the New Jersey College of Medicine and Dentisty (NJCMD) in Network New Jersey in the USA – a community 80% Afro-American, having similar physical and other characteristics with Nigerians. Methods: Based on the reviews of literature the study tested 65 hypotheses illustrating the characteristics of Lagos suicidal patients, their environmental situation as well as the psychodynamics of suicidal behaviour in a Nigerian context. These suicide acts may be: (a) Declared attempt on one’s life or (b) Merely purposeful gestures without any death or. (c) The supposedly accidental act of drug overdose of self-poisoning. Findings and Comments: These are presented with 81 tables 1. In the study of demographic, psychosocial and temporal factor: 1.1 There was a tendency for suicidal behaviour in Lagos to be associated with (i) Sex: male/female ratio was 3:2 (ii) Age: younger age groups were overpresented (iii) interpersonal conflict mainly friendship problems (iv) tendency to blame other people for one's life problem. (v) Problem solving tendencies, (vi) relatives who were responsive to patients call for help. (vii) day of the week (viii) time of the day (ix) minimised gravity by Hospital staff (x) move by relatives to seek hospital assistance (xi) psychiatric diagnosis differentially affected by the patient’s sex: females being predominantly hysterical (xii) appreciable differences between initial and final diagnosis in hospital. 1.2 There was no observable tendency for suicidal behaviour in Lagos to be associated with (i) ethnicity (ii) marital status (iii) religion (iv) educational status (v) residence: mobility, overcrowding, number of friends, place of birth of nationality, (vi) parental deprivation (vii) season of the year (viii) hospitalisation because of continued suicidal threat, (ix) offering of trival psychiatric diagnosis by Emergency Room non-psychiatric staff. 1.3 The relationship between suicidal behaviour and the following could not be tested (i) number of children in the family (ii) occupation (iii) level of family income (iv) residence: urban versus suburban (v) social relationships (vi) involvement in social relationships (vii) frequency of request for psychiatric opinion on hospitalised patients. 2. In the study of the psychodynamics of suicidal behaviour in Lagos: 2.1 There was a tendency for suicidal behaviour to be associated with (i) low lethality of agents used (ii) case of discovery (iii) occurrence where people were accessible (iv) no serious physical effect (v) move to try to reverse the effect of act (vi) immediate call for help (vii) over lack of wish to die (viii) low lethality. 2.2 There was no observable tendency for suicidal behaviour in Lagos to be associated with (i) depressive illness (ii) appreciable discomfort before the attempt (iii) premeditation of the act (iv) drug dependence on contradistinction to drug misue (v) abuse of alcohol (vi) persistent suicidal thought as evidence of suicidalness of the patient (vii) persistent expressing of suicidal threat after the act. 3. 3.1 In the closer specific examination of the patient's relationship with significant people in the patient's life. 3.1 There was a tendency for suicidal behaviour to be associated with (i) recent observed objective stress (ii) the features of character disorder in contradistinction to those of psychosis (iii) prognosis viewed as good (iv) relative's upsurge of desire to give information (v) confirmed pathological relationship with significant people. 3.2 There relationship in suicidal behaviour could not be tested with regard to (i) lack of outside social contact because there was always some outside social contact. 4. in the investigation of the significant people's perception of the patient: (i) No Nigerian as was rated being socially isolated. (ii) patients overall functioning was not seen to be affected by any symptoms (iii) all the relatives tried to ensure recovery of the patient (iv) there was a tendency for relatives not to perceive the suicide attempter as a sick person. 6115. At a cross-cultural level many similarities were observed between Lagos, Nigeria and Neward, New Jersey in USA, especially in relation to demographic and psychosocial features while major differences as occurred at the psychodynamic level.

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