PSYCHOSOCIAL FACTORS RELATED TO SUICIDAL IDEATION AMONG STUDENTS IN A PRIVATE UNIVERSITY IN OGUN STATE, NIGERIA

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CHAPTER ONE

INTRODUCTION

1.1       Background to the Study

Suicide is a multifaceted self-annihilating behavior resulting from a complicated interaction of several factors on a personal and environmental level. As a result of a steady rise in suicide rates over the past 50 years, the World Health Organization established suicide as a key global public health concern. Suicide with a worldwide mortality rate of 16 per 100,000 otherwise translated to one death every 40 seconds’ totaling the death of almost one million people every year (WHO, 2011) and as such constitute an important public health concern. According to WHO (2014), it was estimated that about 804,000 suicide deaths occurred globally in 2012. It was also reported that a yearly worldwide age-standardized suicide rate of 11.4 per 100,000 population (8.0 for females; 15.0 for males) have been documented.

The concept of suicidal ideation depicts thoughts that one’s life is not worth living, it may range in intensity from passing thoughts to actual well figured-out plans for killing oneself or a total fixation with self-annihilation. Substance Abuse and Mental Health Services Administration (SAMHSA) of the United States of America, in 2013 gave estimates in a research of about 17.0% of students vigorously considering attempting suicide in the previous 12 months (22.4% of females and 11.6% of males); 13.6% of some students made plans about how they would attempt suicide in the previous 12 months (16.9% of females and 10.3% of males).

These suicidal behaviors and thoughts are common among young people. However, studies on suicidal behavioral patterns in Africa have been scarce which may be due to cultural beliefs that perceive suicide to be an abomination. Omigbodun, Dogra, Esan and Adedokun, (2008) conducted a study in Nigeria that indicates suicidal behavior is relatively common in Nigeria. The study reported that the one year prevalence of suicidal attempts among adolescents in southwest Nigeria is 12%. According to the WHO Mortality Database, about 75% of suicides in the world occur in low and middle income countries, although national-level data are unavailable for most of these countries (WHO, 2014), most of which are developing countries in Asia, Africa and South America. According to Randall, Doku, Wilson and Peltzer, 2014, the true scope of the issue in Nigeria and West Africa as a whole is hidden by incomplete surveillance and probable socio-cultural issues surrounding suicide and its related stigma.

Suicidal behaviors as with other disease outcomes are mediated by factors which could improve or degrade the quality of life of the individuals that are affected. The mental state of the individual is a function of psychology which may be influenced by several social associations between the individual and the components of the environment. This interaction is termed psychosocial and as such serve as factors (psychosocial factors) that affect the mental health of the individual. The term “psychosocial factors” is developed from two words “psychological” and “social”; by combining the Merriam-Webster’s dictionary (1997) definitions of psychological, “of or relating to the state of mind and behavior of an individual or a group”; social “of or relating to human society” and factor “an agent” or “something that actively contributes to a result”. The definition of psychosocial factors is then: an agent of the mind or behavior of an individual or group that actively contributes to a result. The concept of psychosocial factors is complex to grasp because it reflects the individuals’ perception, experiences and reflects many considerations unique to that particular individual. Some of these considerations refer to the state of mind of the individual i.e. psychology, while others relate to the social setting in which they find themselves hence the concept of psychosocial factors.

These factors either increase the risk of an individual developing a particular disorder that may be addictive (risk factors) or that reduce such risks (protective factors). Psychosocial interactions have been shown to be responsible for certain outcomes such as: anxiety, depression and substance abuse which are common among in-school adolescents (WHO, 2014). However, these outcomes are known risk factors for suicide. For the purpose of this study psychosocial factors would be represented by four variables: Optimism (life’s orientation towards life’s events), perceived social support, general self-efficacy and self-esteem; all of which are significant phenomena experienced by students especially when stressed by academic work load as well as the influence of significant others. Optimism depict individuals who are optimistic and express expectations that all things they will experience would be to their advantage. This facilitates to improving one’s mental health and wellbeing. Lack of optimism, would deplete the individuals’ mental health creating a situation that would establish depression; a risk factor of suicide.

Perceived social support offered by friends, peers and family members constitute a protective factor against suicidal ideation (Sanchez-Teruel, Garcia-Leon & Muela-Martinez, 2013). Feng, Li and Chen (2015), reinstated Bandura (1997), that self-efficacy is believed to give the individual confidence that he or she can cope and act effectively under stressful conditions, which is a trait of an individual with good mental health and wellbeing. Self-esteem is also a psychosocial factor that gives a sense of self-worth for an individual and depicts how much the individual values his or her life in present circumstances. It has been reported to be a mediator of suicidal ideation especially among students in the university (Eskin, 2012).

1.2       Statement of the Problem

Suicide has unique epidemiological characteristics that make it an important public health concern. It is the fourth leading cause of death globally among youths 15 to 19 years of age and the tenth leading cause of death for adolescents 10–14 years of age (WHO, 2014). However, these figures do not include suicide attempts, which are up to 20 times more frequent than completed suicide (WHO, 2011) which implies that suicidal ideation or thoughts would be more frequent than attempted suicide. People who experience suicidal ideation and those who make suicide plans are at increased risk of suicide attempts, and people who experience all forms of suicidal thoughts and behaviors are at greater risk of completed suicide (Handley, Inder, Kay-Lambkin, Stain, Fitzgerald, Lewin, Attia & Kelly, 2012). Considerably, the majority of young people who experience suicidal ideation will not go on to take their lives initially.

According to a publication of The Youth Coalition of the ACT (2016), from the result of focus group discussions it could be inferred that young people are typically reluctant to seek professional help for mental health problems and as suicidal ideation increases, their intention to seek help decreases further, thus the difficulty in detecting individuals with suicidal thoughts. However, any report of suicidal ideation should be taken seriously. When suicidal ideation is mild, and is only discussed casually between peers, it can be found to be associated with significant symptoms of depression which is common and some other psychological outcomes which includes substance use or abuse that may be easily overlooked. Furthermore, young people experiencing persistent, severe suicidal ideation are at increased risk of attempting suicide.

Evidence from literature provides that suicidal ideation and attempts among young persons in schools, homes or communities are mediated by several psychosocial factors (Sanchez-Teruel, Garcia-Leon & Muela-Martinez, 2013; Feng, Li & Chen, 2015). According to the American association of suicidology, (2014) depression which is one of the outcomes of psychosocial interactions, is associated with about 50% of suicide worldwide. However, literature search for studies conducted in Nigeria are yet to elucidate predisposing issues (suicidal ideation), its’ dynamics, the factors responsible or how it may have led to suicidal plans, attempts or suicide itself which is said to be under-reported. At this rate, interventions cannot be effectively carried out as any concept without a framework would lack empirical support for any intervention to be effective. This study intends to assess psychosocial factors (Optimism, Social Support, General Self-efficacy and Self-esteem) related to suicidal ideation among students of Babcock University, Ilishan-Remo, Ogun state.

1.3       Objective of the Study

The main objective of this study is to assess the psychosocial factors related to suicidal behaviour and suicidal ideation among students of Babcock University, Ilishan-Remo, Ogun State.

The specific objectives are to:

  1. determine the level of suicidal ideation across socio-demographic factors among the students;
  2. assess the level of Optimism (level of attitudinal disposition of students towards life events) among the students;
  3. evaluate the level of Perceived social support among the students;
  4. measure the level of General Self-efficacy among the students;
  5. determine the level of Self-esteem among the students and
  6. identify which of the psychosocial factors play a significant role in determining suicidal ideation among the students.

1.4       Research Questions

  1. Is there a significant difference in the level of suicidal ideation across socio-demographic factors of the students?
  2. What is the level of Optimism (level of attitudinal disposition of students towards life events) among the students?
  3. What is the level of Perceived social support among the students?
  4. What is the level of General self-efficacy among the students?
  5. What is the level of self-esteem among the students?
  6. Which of the psychosocial factors play a significant role in determining suicidal ideation among students?

1.5       Justification for the Study

Research on suicidal ideation is particularly scanty in Nigeria. However, a previous study aimed to assess the prevalence and correlates of suicidal behaviour done in Nigeria showed a 20% prevalence of suicidal behaviour among a sample of adolescents aged 10-17 (Omigbodun, Dogra, Esan & Adedokun, 2008). This validates that suicidal behaviour constitutes a course for concern among public health professionals regarding vulnerability of youths to poor mental health outcome and mortality. Hence, this study intends to provide a better understanding of the behavioural pattern called suicidal ideation and the influence of its related psychosocial risk factors.

Generally, research on suicidal behaviour has been conducted amiss conceptual frameworks based on behavioural theories to identify human actions or inactions and associated factors that contribute to suicidal behaviour. This study would attempt to assess, using a well-structured instrument, common psychosocial risk factors leading to suicidal ideation among university students based on behavioural theories that would provide understanding for primary preventive measures or primordial care against suicide. Also, measures would be taken to elucidate protective factors that may prevent suicide or suicide attempts even though suicidal ideation may be evident among students of Babcock University, Ilishan, Ogun state.

At the end of this study, the findings would provide a better understanding for the dynamics of psychosocial factors known to be associated with suicidal ideation. The study may provide rationale as to why in-school students experiencing suicidal ideation would rather not commit suicide despite its burden on their mental health. This would go a long way to provide basis for an intervention to promote mental health for students experiencing suicidal ideation and also improve their living conditions by enabling them make conscious decisions to prevent suicide.

This study would enlighten health workers or professionals alike in understanding factors responsible or that influence suicidal ideation and show where the need for an intervention would be required among students. The results would also be useful for other researchers interested in understanding mental health or setting up health programs for mental health.

1.6       Hypotheses

The study hypothesizes that;

H1: There is a significant relationship between Optimism (the level of attitudinal disposition of students towards life events) and suicidal ideation among the students.

H2: There is a significant relationship between Perceived social support and suicidal ideation among the students.

H3: There is a significant relationship between Self-efficacy and suicidal ideation among the students.

H4: There is a significant relationship between Self-esteem and suicidal ideation among the students.

1.7       Operational definition of terms

Suicidal Ideation

Suicidal ideation refers to thoughts that life is not worth living, ranging in intensity from fleeting thoughts through to concrete, well thought-out plans for killing oneself, or a complete preoccupation with self-destruction.

Psychosocial Factors

For this study; psychosocial factors refer to variables of optimism, perceived social support and self-efficacy that may influence the development of suicidal ideation culminating into distinct suicidal behavior.

  1. Optimism: Optimism is the generalized positive outcome expectancy of the student towards life’s events.
  2. Perceived social support: It is the student’s subjective view of how other people, in particular families or peers, are available to meet and/or assist with meeting the individual’s needs for comfort and support.
  3. General Self-efficacy: It is the student’s assessment and subsequent ability to respond to life events and/or changes in the environment.
  4. Self-esteem: It is the student’s reasoning regarding self-worth either negatively (low self-esteem) or positively (high self-esteem).

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