There is no widely accepted definition for suicide, even though it has been documented since time immemorial. The word is derived from the Latin for 'self-murder', and it is often a fatal act that represents the person's wish to die. (1) Few acts have such deep roots in social and human conditions, or such far-reaching consequences. (2)
Suicide is currently the 8th leading cause of death in the world and among the top 3 causes of death among 18-24-year olds. (3) It accounts for 1-2% of global mortality. In 1995 the annual world-wide incidence of successful suicide was 16/100 000 persons; this means that globally 1 in every 600 persons commits suicide every year. (3)
Attempted suicide and deliberate self-harm (DSH) are terms used to describe acute self-infliction of physical harm or ingestion of poisonous substances that does not result in death. (4)
In Canada the rate of DSH has been estimated at around 304/100 000, (5) and in the US National Institute of Mental Health's Epidemiological Catchment Area Study (1980-1985) it was found that 2.9% of respondents had made a suicide attempt. (6) Maniam and Morris did a computerised search of the literature on suicidal behavior and ethnicity in Malaysia dating back to 1966, supplemented by other relevant published and research material. (7) They found that the Indian population was over-represented among people who attempted suicide, with young women from the lower socio-economic groups being at particularly high risk. Forty-eight per cent of all individuals who had attempted suicide had used detergents or insecticides, pesticides or other agrochemicals. The authors commented on the easy availability and lethality of chemicals such as paraquat. (7)
Suicide and DSH are a tragic and potentially preventable public health problem, as both are conscious acts. Identifying protective factors could play a major role in their prevention and management. Maniam and Morris found very few studies of preventive approaches to DSH, (7) especially in our region. Studies on psychosocial factors contributing to DSH have been conducted in many states in peninsular Malaysia, but Sabah is in East Malaysia, where there are limited psychiatric resources. In view of this lack and the history and diverse ethnic background of the people of Sabah, we considered that a study of DSH in this region was indicated.
It has been hypothesised that religious beliefs, responsibility to family and coping skills help prevent suicidal behaviour. We therefore compared DSH and control groups using psychosocial tests to assess these characteristics. We defined DSH as intentional but not fatal self-poisoning or self-injury, irrespective of the apparent purpose of the act. (8) DSH ranges from behaviours with no suicidal intent but aiming to communicate distress or relieve tension, to suicide. The term is preferred to 'attempted suicide' or 'parasuicide' because the motives or reasons for this behaviour include non-suicidal intentions.
The study was conducted in Kota Kinabalu, capital of Sabah, a Malaysian state located on the northern part of the island of Borneo. (9) The official population estimate for the year 2006 was 2 997 000. (10) Hospital Mesra Bukit Padang (a psychiatric hospital) and Queen Elizabeth General Hospital cater for the psychiatrically ill population of Kota Kinabalu.
The study was a cross-sectional comparative analysis of religious beliefs, coping skills and responsibility to family as factors protecting against DSH. The DSH patients were 42 consecutive male and female individuals aged 13-60 years, consecutively admitted or directly referred to Queen Elizabeth General Hospital or Hospital Mesra Bukit Padang following an episode of DSH during the period December 2006--April 2007. Inclusion criteria were ability to give written informed consent, availability of a consenting parent or legal guardian for those below 18 years or incompetent to give consent, (11) and ability to read and write in English or Bahasa Malaysia. …