Ugandan Men's Perceptions of What Causes and What Prevents Suicide

Article excerpt

Suicidal behavior is a continuous challenge around the world and the World Health Organization (2001) estimates that about one million people kill themselves every year. However, this challenge has not yet been taken up in all parts of the world. For instance, most parts of Africa lack official suicide preventive initiatives. As in many other developing countries there are no public statistics on suicidal behavior in Uganda and the scope of the problem is thus uncertain. The Support to the Health Sector Strategic Plan Project estimated a 15.5 percent lifetime prevalence of nonfatal suicidal behavior in the 14 districts covered by the study (Kinyanda et al., 2004). However, big differences between the districts were observed, with figures varying from 4.9 percent in Yumbe to 16.1 percent in Adjumani. The authors assumed that underlying ecological factors operating at district level might explain these variations. Other studies have found much higher rates. Bolla (2002) estimated a suicide rate of 99/100 000 and a suicide attempt rate of 518/100,000 in Adjumani district. Ovuga et al. (2005) found a suicide rate of 16.7/100,000 in Adjumani District whereas Kinyanda et al. (2009) found a suicide rate of 15-20/100,000 among a post-conflict population in Northern Uganda. From 1986 to 2006 this part of the country was severely affected by civil conflict between Uganda Government armed forces and rebel groups (Dolan, 2009). Underlying ecological factors must therefore be taken into consideration and we would therefore expect differences in suicidal behavior between the conflict area of Adjumani and the capital Kampala, where the informants of the present study come from, differences that might affect men's perceptions and attitudes. In a recent study from Kampala, 8 percent of Ugandan psychology students reported having experienced suicide within their family, 53 percent knew of someone outside their family having killed themselves, and 24 and 61 percent, respectively, knew someone in or outside their family who had engaged in suicidal behavior (Hjelmeland et al., 2008). Other than this, only limited research has recently been published on suicidal behavior in Uganda (Hjelmeland et al., 2006; Hjelmeland et al., 2008; Kinyanda et al., 2004, 2005a, 2005b, 2005c; Ovuga et al., 2005). However, the studies conducted indicate that suicidal behavior is a considerable public health problem within this country. It is, however, impossible to elaborate on trends over time due to the lack of baseline data. Since there are no reliable suicide statistics in Uganda, the exact sex ratio of suicide is unknown. However, based on the studies cited above there is reason to believe that more men than women engage in suicidal behavior in this country. For completed suicide, a male:female ratio of 4.4:1 (Kinyanda et al., 2009) and for nonfatal suicidal behavior 1.7:1 has been reported (Kinyanda et al., 2004).

Despite the growing recognition of suicide as a severe health problem there is a paucity of literature on attitudes towards suicide in Africa in general and Uganda in particular. Only few studies exist on attitudes towards suicide in Africa (e.g., Lester & Adebowale, 2001; Peltzer et al., 2000; Eshun, 2006). These studies are all quantitative, which limits explorations of the decisive social and ideological context (Denzin & Lincoln, 2005; Gergen & Graumann, 1996). Some qualitative studies on attitudes towards suicide in Uganda (Mugisha et al., in press) and Ghana (Osafo et al., in press) are, however, underway. To the best of our knowledge, theoretical reflections on suicide in Africa are non-existing. Being highly context-dependent, it does not seem meaningful to transfer theoretical models developed to fit other cultural settings.

The aim of the present study was to examine Ugandan men's perceptions of what causes and what prevents suicide as well as their attitudes towards suicide and suicide prevention. Knowledge about this is important as the country is now planning suicide prevention strategies and men seem to be a particularly vulnerable group. …