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Pattern of suicide: a review of autopsies conducted at the University Hospital, Kuala Lumpur

Nadesan K

Malays J Pathol, 1999 Dec;21(2):95-9.
PMID: 11068413

Suicide is one of the ten leading causes of death in the world, accounting for more than 400,000 deaths annually. The pattern of suicide and the incidence of suicide vary from country to country. Cultural, religious and social values play some role in suicide. Compared to the West and some of the countries in the Asian region the incidence of suicide is low in Malaysia. A three-year retrospective study of all the autopsies performed at the University Hospital, Kuala Lumpur was analysed and the cases that were definitely determined as suicides were further studied. 48.8% of all suicides were ethnic Indians though Indians formed only 8% of the Malaysian population. 38.1% of suicides were Chinese who formed 26% of the population while only 3.6% were Malays, who formed 59% of the population. The preferred methods of suicide were poisoning and hanging. The majority were in the age group 20-40 yr. The study may have missed some cases that would have been wrongly concluded as accidental deaths and a few others where the police would have released the bodies without postmortem examinations.

Matched MeSH terms: Suicide/ethnology
Is Hinduism ambivalent about suicide?

Vijayakumar L, John S

Int J Soc Psychiatry, 2018 08;64(5):443-449.
PMID: 29783869 DOI: 10.1177/0020764018777523

BACKGROUND: Hinduism is one of the oldest religions in the world and has over 1.1 billion adherents comprising about 16% of the global population living mainly in India and Nepal. The stand of Hinduism on suicide has been ambiguous through the ages, on one hand, condemning general suicides, while condoning religious suicides on the other. This ambiguity is reflected in contemporary India and among the Indian diaspora.
AIMS: To examine the stand of Hinduism as a religion in the context of suicide.
METHOD: A selected review of literature covering the major Hindu religious texts, cultural practices and suicide.
RESULTS: People who follow Hinduism have a suicide rate of about 21 per 100,000 population compared to the global average of 11.4. Hindu countries have higher rates of suicide compared to Islamic and Christian countries, but these rates are lower when compared to Atheist and Buddhist countries. This is reflected in the Indian diaspora as well with reports from Fiji, the Caribbean, Malaysia and the United Kingdom, indicating that suicide was disproportionately high among those of Indian origin. However, a strong faith in Hinduism acts as protective factor. The Hindu belief in karma fosters a sense of acceptance of the vicissitudes of life with equanimity, and the belief in the cycle of births and deaths renders suicide meaningless, as one's soul continues after death. Their religious beliefs makes the Hindus tolerate and accept hardships and calamities stoically.
CONCLUSION: In certain situations, the Hindu religion acts as a protective factor, whereas at other times, it may increase the risk of suicide. It is important to understand these different nuances in the Hindu religion in formulating a culturally appropriate suicide prevention strategy.

Matched MeSH terms: Suicide/ethnology*
Religious commitment, attitudes toward suicide, and suicidal behaviors among college students of different ethnic and religious groups in Malaysia

Foo XY, Alwi MN, Ismail SI, Ibrahim N, Osman ZJ

J Relig Health, 2014 Jun;53(3):731-46.
PMID: 23196328 DOI: 10.1007/s10943-012-9667-9

The variation in suicide patterns across ethnic groups with different religious background is a puzzling social phenomenon. This study sought to examine the impact of religious commitment and attitudes toward suicide on suicidal behaviors of college students across major ethnic and religious groups in a multicultural society of Malaysia. A total of 139 college students completed Religious Commitment Inventory-10, Attitudes Toward Suicide Scale, and Suicidal Behavior Questionnaire-Revised. Findings showed significant discrepancies in attitudes toward suicide, but not suicidal behaviors across ethnic and religious groups. Suicide acceptance significantly affected suicidal behaviors as well. Although religious commitment is not associated with suicidal behaviors, its deviation is reflected in students' acceptance of suicide. Additionally, college students' suicide risk, lifetime, and recent suicide ideation, as well as their likelihood of future suicide attempt can be associated with their acceptance of suicide. The influence of attitudes toward suicide and religion, therefore, should be taken into consideration while implementing suicide prevention programs as it helps shape the norms about suicide among youths.

Matched MeSH terms: Suicide/ethnology*
Self-poisoning by drugs and chemicals: variations in demographics, associated factors and final outcomes

Fathelrahman AI, Ab Rahman AF, Mohd Zain Z

Gen Hosp Psychiatry, 2008 Sep-Oct;30(5):467-70.
PMID: 18774431 DOI: 10.1016/j.genhosppsych.2008.04.004

OBJECTIVE: Drug overdose exposures were compared with chemical poisoning in terms of demographics, associated factors and final outcomes.
METHOD: Deliberate self-poisoning (DSP) cases admitted to Penang General Hospital during the years 2000-2004 were studied. Chi-square, independent t-test and binary logistic were used whenever applicable.
RESULTS: Indian patients were more likely to use household products, whereas Malay and Chinese patients were more likely to take drug overdoses (P=.001). Drug overdose victims experienced more socioeconomic problems (P=.05) and were more likely to be admitted to the intensive care unit (P=.052). Chemical poisoning patients presented earlier (P=.011), were hospitalized for shorter time (P=.001) and had a higher rate of mortality (P=.01).
CONCLUSION: The present study has identified a unique ethnic variation in the choice of suicide attempts from toxic substances. DSP associated with drug overdose showed significant morbidity, but increased mortality was seen in chemical poisoning.

Matched MeSH terms: Suicide/ethnology*
The association of suicide risk with negative life events and social support according to gender in Asian patients with major depressive disorder

Park S, Hatim Sulaiman A, Srisurapanont M, Chang SM, Liu CY, Bautista D, et al.

Psychiatry Res, 2015 Aug 30;228(3):277-82.
PMID: 26160206 DOI: 10.1016/j.psychres.2015.06.032

We investigated the associations between negative life events, social support, depressive and hostile symptoms, and suicide risk according to gender in multinational Asian patients with major depressive disorder (MDD). A total of 547 outpatients with MDD (352 women and 195 men, mean age of 39.58±13.21 years) were recruited in China, South Korea, Malaysia, Singapore, Thailand, and Taiwan. All patients were assessed with the Mini-International Neuropsychiatric Interview, the Montgomery-Asberg Depression Rating Scale, the Symptoms Checklist 90-Revised, the Multidimensional Scale of Perceived Social Support, and the List of Threatening Experiences. Negative life events, social support, depressive symptoms, and hostility were all significantly associated with suicidality in female MDD patients. However, only depressive symptoms and hostility were significantly associated with suicidality in male patients. Depression severity and hostility only partially mediated the association of negative life events and poor social support with suicidality in female patients. In contrast, hostility fully mediated the association of negative life events and poor social support with suicidality in male patients. Our results highlight the need of in-depth assessment of suicide risk for depressed female patients who report a number of negative life events and poor social supports, even if they do not show severe psychopathology.

Matched MeSH terms: Suicide/ethnology
Suicidal Thoughts, Attempts and Motives Among University Students in 12 Muslim-Majority Countries

Eskin M, AlBuhairan F, Rezaeian M, Abdel-Khalek AM, Harlak H, El-Nayal M, et al.

Psychiatr Q, 2019 03;90(1):229-248.
PMID: 30498939 DOI: 10.1007/s11126-018-9613-4

There is a scarcity of research on suicidal phenomena in the Muslim world. Therefore, this study aimed at investigating the self-reported prevalence of suicidal thoughts, attempts and motives in 12 Muslim countries. A total of 8417 (54.4% women) university students were surveyed by means of a self-report questionnaire. Overall, 22% of the participants reported suicidal ideation and 8.6% reported attempting suicide. The odds of suicidal thoughts were elevated in Azerbaijan, Indonesia and Saudi Arabia, while reduced ORs were recorded in Egypt, Jordan, Lebanon and Malaysia. While odds of suicide attempts were high in Azerbaijan, Palestine and Saudi Arabia reduced odds ratios (OR) were detected in Indonesia, Iran, Jordan, Lebanon, Malaysia and Tunisia. Taking drugs and using a sharp instrument were the two most frequently used methods to attempt suicide. Only 32.7% of attempts required medical attention. Escape motives were endorsed more than social motives by participants who attempted suicide. Suicidal behaviors were more frequent in women than in men. Compered to men, fewer attempts by women required medical attention. Moreover, our results show that making suicide illegal does not reduce the frequency of suicidal behavior. Results from this comparative study show that suicidal thoughts and attempts are frequent events in young adults in countries where religious scripture explicitly prohibit suicide and the frequencies of nonfatal suicidal behavior show large variation in nations adhering to the same religion.

Matched MeSH terms: Suicide/ethnology*
Fulltext Associations between depression, anxiety, stress, hopelessness, subjective well-being, coping styles and suicide in Chinese university students

Lew B, Huen J, Yu P, Yuan L, Wang DF, Ping F, et al.

PLoS One, 2019;14(7):e0217372.
PMID: 31260454 DOI: 10.1371/journal.pone.0217372

Suicide is a major public health concern worldwide. This study aimed to predict the suicidal behavior of Chinese university students by studying psychological measures such as hopelessness, orientation to happiness, meaning in life, depression, anxiety, stress, and coping styles. In November 2016, a stratified-clustered-random sampling approach was utilized to select subjects from two large public medical-related universities in Shandong province, China. This sample consisted of 2,074 undergraduate students (706 males, 1,368 females; mean age = 19.79±1.39 years). The students' major risk factors for suicide were depression, anxiety, stress, and hopelessness, and the students' minor risk factors included orientation to happiness and coping styles (including self-distraction, self-blame and substance use). Notably, the presence of meaning in life had a positive effect on preventing suicide and acted as a protective factor, which suggests that it is important to identify risk factors as well as protective factors relevant to the target population group in order to increase the effectiveness of counseling and suicide prevention programs.

Matched MeSH terms: Suicide/ethnology