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ISSN: 2161-0711
Journal of Community Medicine & Health Education

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Prevalence of Suicidal Thoughts among a Sample from Baghdad

Ameel Alshawi1*, Riyadh Lafta2 and Ahmed Al-Nuaimi3

1College of Medicine, Mustansiriya University, Iraq

2University of Washington, Seattle, WA, USA

3Department of Community Medicine, College of Medicine, Baghdad University, Jadriyah, Baghdad, Iraq

*Corresponding Author:
Ameel Alshawi
College of Medicine
Mustansiriya University, Iraq
Tel: +251-910-35-25-15
E-mail: [email protected]

Received date: January 14, 2015; Accepted date: February 17, 2015; Published date: February 20, 2015

Citation: Alshawi A, Lafta R, Al-Nuaimi A (2015) Prevalence of Suicidal Thoughts among a Sample from Baghdad. J Community Med Health Educ 5:334. doi: 10.4172/2161-0711.1000334

Copyright: © 2015 Alshawi A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

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Abstract

Background: The Iraqi people witnessed and are still witnessing the painful and terrible consequences of mass violence and military operations which are reflected on their general life condition. Objective: To estimate the prevalence of suicidal thoughts among a sample from Baghdad city and highlight some of the probably associated factors. Methods: This cross-sectional study was conducted in Baghdad city during the period from January 2013 through January 2014. A multistage sampling technique was adopted to choose 13 primary health care centres and eight colleges from three universities in Baghdad. The questionnaire included some demographic variables, history of alcohol drinking and of sedative, narcotic, and psychotic drug usage. Suicidal thoughts were measured via a modified item 9 of Patient Health Questionnaire (PHQ-9). Results: Suicidal thoughts were reported in 155 (15.5%) of the participants, 4.2% reported alcohol drinking and 4.8% had a history of using sedative drugs. the prevalence of suicidal thoughts is higher among females (19.31%) compared to males (10.36%). Conclusions: suicidal thoughts are not uncommon in the Iraqi population as a consequence of the continuous and accelerating situation of violence that they are experiencing; these thoughts are strongly related to female gender (especially housewives), low level of education and drug usage.

Keywords

Suicidal thoughts; Prevalence; Baghdad; Iraq

Introduction

Suicide is a global phenomenon in all regions of the world; 75% of global suicide occurred in low- and middle-income countries in 2012. Suicide accounted for 1.4% of all deaths worldwide, making it the 15th leading cause of death in 2012 [1]. Studies have indicated that people are more likely to have suicidal thoughts when they are depressed and have physical symptoms concomitantly [2].

Suicidal thoughts are considered as a subtype of suicidal behaviour, which also includes: attempted suicides-also called ‘‘Para-Suicide’’ or ‘‘deliberate self-injury’’ and completed suicides, all fall under the category of self-directed violence [3].

Mental disorders (particularly depression and alcohol use disorders) are a major risk factor for suicide in Europe and North America; however, in Asian countries impulsiveness plays an important role, generally suicide is a complex matter with psychological, social, biological, cultural and environmental factors 1

Iraq and violence: For more than three decades, the Iraqi nation as a whole has been suffering from wars, sanctions and urban violence [4,5].

The Iraqi people witnessed and are still witnessing the painful and terrible consequences of car bombing, mass violence, and military operations [6]. However, few reports demonstrated the effect of exposure to wars and conflicts on the mental health of Iraqi population [7,8]. A survey conducted by the International Organization for Migration found that there are more than 177000 internally displaced families because of direct threats to life (61%), generalized violence (47%), and fear (40%). An estimated one million of Iraq’s displaced persons were without adequate access to shelter and food, and 300000 are without access to clean water [9]. These stressful conditions make people more vulnerable to psychological problems, PTSD and suicidal thoughts. Studies on suicide in Iraq and other Arab countries are scarce. The objective of this study is to estimate the prevalence of suicidal thoughts among a sample of adults in Baghdad and highlight some of the associated factors.

Methods

This cross sectional study was conducted in Baghdad city; the centre of Baghdad (the capital of Iraq) during the period from January 2013 through January 2014. The target population age between 18-59 years. The source of data collection was from:

Primary health care centres (PHCCs)

A multistage random sampling technique was used. Baghdad is divided into 16 health sectors, out of these; five sectors were chosen by a simple random technique, the total number of PHCCs in these five sectors was 60 with a mean number of 12; three PHCCs were chosen from each large sector (contains more than 12 PHCCs) and two from each small sector (with less than 12 PHCCs) through a simple random sampling to achieve equity of choosing PHCCs according to the density of its distribution. So, 13 PHCCs from the two main sides of Baghdad city were collected that represent central and peripheral sectors. Each PHCC was visited for 2-3 weeks to collect data from daily attendants, through a systematic random sampling technique by including every fourth one.

Universities

A multistage random sampling technique was adopted by selecting three universities out of the five that are present in Baghdad through a simple random sampling technique, then some colleges were selected from each university and one grade from each college again by a simple random technique; all students of that stage, who were available at the time of data collection, were included in the sample. Teachers were also included in the sample for they are available, cooperative, and of wide spectrum of age.

Instruments

Study instruments

A well-structured questionnaire was developed by the researchers, translated to Arabic (local language), and validated. The questionnaire inquired about demographic information: age, current education level, marital status, and occupation, history of alcohol drinking and history of sedative, narcotic, psychotic drug usage. Suicidal thoughts were measured via a modified item [9] of Patient Health Questionnaire (PHQ-9) [10] Thoughts that “would be better off dead, or of hurting themselves” in some way during last week. Suicidal thoughts are considered positive when there is history of frequent thoughts. Responses ranged from “not at all “to “most of time 5-7 days.”

The questionnaire was filled through a direct interview with participants after explaining to them the meaning of some questions that might be difficult for them to understand, the time of the interview ranged between 10-15 minutes.

Ethical issue

This is a very sensitive issue (considering the Iraqi culture), The questionnaire form was anonymous and self-administered to avoid causing any embarrassment to the respondents. The researcher explained to the respondents the aim and concept of the research, assuring them that the information inquired in the questionnaire will be kept strictly confidential, restricted exclusively to the researchers, and will not be used for other than research purposes. The subjects were given the choice to participate or not. The interview was conducted in a separate place to achieve privacy.

Data Analysis

Data entry followed by descriptive and analytic statistics were performed using the Statistical Package for Social Science (SPSS-version 21). Chi square was used to measure the association between variables. P value of less than 0.05 was considered as a cut-off point for statistical significance.

Results

A total of 1040 subjects were surveyed and 1000 were responded making a response rate of 96.2 %. The respondents' age ranged from 18 to 59 years with a mean of 32.08±11.169, females constituted a higher proportion (58.3%) of the study sample, 603 (60.4%) of the participants had University/Diploma as highest level of education, 59.3% of them were married, other demographic characteristics are summarized in Table 1. In respect to substance usage; 4.2% reported alcohol drinking and 4.8% had a history of using sedative drugs (Table 2).

  N=1000 N %
1 Gender    
  Female 583 58.3
  Male 417 41.7
  Total 1000 100
2 Age group (years)    
  18-29 498 49.9
  30-39 227 22.7
  40-49 177 17.7
  50-59 96 9.6
  Total 998* 100
3 Highest level of education    
  Primary school 135 13.5
  Intermediate 127 12.7
  Secondary 122 12.2
  University/Diploma 603 60.4
  Post graduate 12 1.2
  Total 999* 100
4 Marital status    
  Single 362 36.5
  Married 588 59.3
  Divorced 12 1.2
  Widowed 29 2.9
  Total 991* 100
5 Occupation of participants    
  Governmental employee 327 32.8
  Non-Governmental employee 6 0.6
  Private work 118 11.8
  Student 317 31.8
  Housewife 210 21
  Unemployed 10 1
  Retired 10 1
  Total 998* 100

Table 1: Socio-demographic characteristics of the study sample.

Thoughts that they would be better dead, or hurting themselves in some way were reported in 155 (15.5%) of the participants (Table 3).

  N=1000 N %
1 Alcohol drinking habit    
  Never drank alcohol 949 95.8
  Ever drank alcohol 42 4.2
  Total 991 100
2 Being on sedative drugs    
  No 837 95.2
  Yes 42 4.8
  Total 879* 100

Table 2: Frequency distribution of substances usage.

Thoughts  Frequency %
None or little thoughts 840 84
Have frequent thoughts of death 155 15.5
Total 995 99.5

Table 3: Frequency of thoughts of death among the participants.

As shown in Table 4 the prevalence of suicidal thoughts is higher among females (19.31%) compared to males (10.36%) with a statistically significant association between gender and suicidal thoughts (P<0.0001). No significant association was found between suicidal thoughts and age or marital status of the participants.

Thoughts of Death
    Total None or little thought % frequent thoughts of death  % P* value
Gender Female 580 468 80.69 112 19.31 0
  Male 415 372 89.64 43 10.36  
Age group (years) 18-29 497 416 83.7 81 16.3 0.578
  30-39 226 190 84.07 36 15.93  
  40-49 176 148 84.09 28 15.91  
  50-59 94 84 89.36 10 10.64  
Marital status Single 362 309 85.36 53 14.64 0.579
  Married 585 493 84.27 92 15.73  
  Divorced 11 8 72.73 3 27.27  
  Widowed 29 23 79.31 6 20.69  
Educational Primary level 104 77.4 31 22.96 0.035  
  Intermediate 126 103 81.75 23 18.25  
  Secondary 120 105 87.5 15 12.5  
  University/Diploma 601 516 85.86 85 14.14  
  Post graduate 12 12 100 0 0  
Occupation Governmental employee 322 283 87.89 39 12.11 0.005
  Non-Governmental employee            
  Private work 118 105 88.98 13 11.02  
  Student 317 264 83.28 53 16.72  
  Housewife 210 161 76.67 49 23.33  
  Unemployed 10 10 100 0 0  
  Retired 10 10 100 0 0  
*P value of Chi square test

Table 4: Relation of thoughts of death to demographic variables.

Regarding level of education; the prevalence of suicidal thoughts is significantly higher among those with primary school education (22.96%) compared to other categories of education. There is also a statistically significant association between occupation and frequency of suicidal thoughts, the housewives registered the highest prevalence of such thoughts (23.33%).

Table 5 revealed a statistically significant association between suicidal thoughts and history of drug usage (P<0.0001), but not with history of alcohol drinking.

  Thoughts of death
Total None or infrequent thoughts % Frequent thoughts of death % P* Value
Alcohol drinking habit Never drank alcohol 944 800 84.75 144 15.25 0.27
  Ever drank alcohol 42 33 78.57 9 21.43  
Being on addictive drugs No 835 717 85.87 118 14.13 0.003
  Yes 41 27 65.85 14 34.15  

Table 5: Relation of suicidal thoughts to substances usage.

Discussion

Health outcomes in Iraq generally were the poorest among the region, and well below the levels found in comparable income countries [11]. Iraqis have witnessed a depletion of social capital, which led to social deprivation in most sectors of the society [12].

In the current study; females constituted a higher proportion of the sample at the time of data collection, this could be attributed to the general condition of the country which led to some demographical changes as violence was a leading cause of death in men during the period following 2003 invasion [13]. In addition to the continuous abroad migration of males especially from Baghdad [14], many reasons were there particularly security problems.

Frequencies of alcohol drinking (4.2%) and of drug usage (4.8) among the participants are higher than what was reported in Iraqi Mental Health Survey (IMHS) (0.7% and 0.2% respectively) [15] this might be attributed to the differences in the methods, questionnaires and in the sampling techniques; however, there is a sort of underestimation in the prevalence of substance abuse among the Iraqi population as researches that dig for that are scarce and limited [16], besides, reporting such information is considered as a sensitive issue in the Iraqi culture.

Thoughts that “they would be better dead or hurting themselves in some way” were reported in 15.5%, this gives a hint about the level of deterioration in the psychological conditions and general frustration/ depression that is affecting the Iraqi individuals after repeated and continuous accumulation of stress during the last decades. This finding is higher than what was reported among household heading women in Baghdad (8.6%) [17].

Females have more thoughts of suicide compared to males, this finding is consistent with what was reported in the literature as females are more predisposed for mental health problems [18] and being a female is considered as one of the internal characteristics of vulnerability factors for adverse effect of trauma exposure [19,20]. Many studies have pointed out a strong relationship between gender and mental illness, with female gender being more vulnerable and more likely to admit having mental illness, yet more reluctant to seek help from mental health professionals [21]. Regarding the occupation; housewives registered the highest frequency, this might be attributed to the fact that a high quota of women in Iraq is housewives, besides; many women suffered a triple burden of fear, difficult security and economic condition in addition to frequent loss of a husband or a son, this makes them more vulnerable to have suicidal thoughts [22].

A non-significant association was found between suicidal thoughts and history of alcohol drinking while a positive association was found with drug usage, many factors could be playing a role in drug usage such as effect of peer relationships - it is well known that peers, especially friends, play an important role in adolescents’ psychosocial development; peers may affect adolescents’ behaviours and emotions through socialization processes, a phenomenon more generally referred to as peer influence [23]. Literatures revealed that stressful social events have an important role in suicide [24].

It can be concluded from this study that suicidal thoughts are not uncommon in the Iraqi population as a consequence of the continuous and accelerating situation of violence that they are experiencing, these thoughts are strongly related to female gender (especially housewives), low level of education and drug usage. Yet; we think that there is an element of underestimation (due to underreporting) as this issue is highly sensitive in our culture and could be considered as a religious or social stigma.

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