Ugandan Men's Perceptions of What Causes and What Prevents Suicide
Knizek, Birthe Loa, Kinyanda, Eugene, Owens, Vicki, Hjelmeland, Heidi, Journal of Men, Masculinities and Spirituality
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. We decided to study men only in order to focus on the inherent logic in men's beliefs rather than to compare them with women. The social and ideological context for men and women seems to be different (Kinyanda et al., 2005) and needs to be taken into account both for comprehending the internal logic in their understanding and for planning prevention efforts. When action is to be taken, attitudes become central since it is generally assumed that attitudes towards suicide are of great importance. Such attitudes affect the will of people as well as health care staff, helping persons in a suicidal crisis or those who have deliberately harmed themselves (Bagley & Ramsey, 1989). Suicidal behavior is illegal in Uganda. It is also considered a bad omen for the clan, necessitating cleansing rituals. Hence, suicide carries enormous stigma (Hjelmeland et al., 2008). Uganda is also considered to be a very religious country (Uganda Bureau of Statistics, 2002). This is important as we know that religious people are considerably more intolerant towards suicide than less religious people (see Koenig et al., 2003, for an overview). Suicide is thus perceived negatively in African countries (Lester & Akande, 1994; Peltzer et al. 1998), which also was found in a study in Uganda and Ghana by Hjelmeland et al. (2008). However, it also has been shown that among religious people there is a greater belief that suicide should be prevented (Bascue et al., 1982).
To understand the men's perceptions and attitudes it also is necessary to look at the social conditions in Uganda since they constitute the framework for their statements. With recent rebel activity, the HIV/AIDS pandemic (which has led to the death of more than 1 million people in more than 20 years of the epidemic), and a large number of deaths caused by malaria annually, Uganda has considerable challenges, not only on the economic and political scene, but also in the daily lives of its population. Ugandans are squeezed by poverty, unemployment, high rates of premature death, and insecurity regarding prospects for the future. According to the World Health Report (WHO, 2001), people in East Africa are some of the poorest in the world. Almost every Ugandan is affected by the situation of family instability and/or poverty and struggles for a decent living. This also affects Ugandan men as many of them have problems in finding adequate jobs and maintaining their traditional position as the breadwinners of the family (Dolan, 2002; Kinyanda et al., 2005). Barker and Ricardo (2005) point at the same problem when they underline that young men perceive multiple and sometimes conflicting ideas about what it means to be a man and generally perceive that they are constantly judged and evaluated for their actions as men. These pressures--arising from the clash of ideologies, Westernization trends, socioeconomic change and the challenges to traditional masculinity--may lead to feelings of humiliation, both in a man's sense of self, as well as in his sense of how he is perceived by others (Dolan, 2002) and might impact on Ugandan men's suicidal behavior and attitudes towards suicide.
Given the complexity of the phenomenon and the fact that little is known about suicide and Ugandan masculinity, we chose to mainly use qualitative methodology and focus only on men. With such an approach we try to handle the problem that theories are often gender biased with male suicide generally perceived as a rational choice and a reaction to external, impersonal factors, whereas female suicide is connected to emotional, personal factors (Canetto, 1997). Whether this is true across cultural settings is an important research question.
Responses to the two open-ended questions: "What is the most important cause of suicide?" and, "What do you think can be done to prevent suicide?" were analyzed qualitatively. Also, some quantitative analyses were conducted in order to illuminate the qualitative analyses further where relevant. This is described in detail below.
Altogether, 329 men from the following groups participated in the study: medical …
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Publication information: Article title: Ugandan Men's Perceptions of What Causes and What Prevents Suicide. Contributors: Knizek, Birthe Loa - Author, Kinyanda, Eugene - Author, Owens, Vicki - Author, Hjelmeland, Heidi - Author. Journal title: Journal of Men, Masculinities and Spirituality. Volume: 5. Issue: 1 Publication date: January 2011. Page number: 4+. © 2009 Journal of Men, Masculinities and Spirituality. COPYRIGHT 2011 Gale Group.
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