|Year : 2021 | Volume
| Issue : 3 | Page : 117-123
Prevalence and factors associated with suicidal behaviors in a cross-sectional sample of Nigerian young adults
Opakunle Tolulope M.B.B.S 1, Opakunle Olubukola M.B.B.S 2, Aloba Olutayo M.B.Ch.B 3
1 Department of Mental Health, State Specialist Hospital, Osogbo, Osun State, Nigeria
2 Department of Community Medicine, Uniosun Teaching Hospital, Osogbo, Osun State, Nigeria
3 Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
|Date of Submission||17-Dec-2020|
|Date of Decision||15-Feb-2021|
|Date of Acceptance||16-Feb-2021|
|Date of Web Publication||24-Sep-2021|
P. Box 2031, Osogbo, Osun State 234
Source of Support: None, Conflict of Interest: None
Objective: In this study, we intended to assess the prevalence of suicidal behaviors and their associated factors among Nigerian young adults. Methods: This is a cross-sectional descriptive study involving 1171 Nigerian young adults from the six geopolitical regions of Nigeria. They completed a study-specific sociodemographic questionnaire, Suicidal Behaviors Questionnaire-Revised Scale, Satisfaction with Life Scale, 10-item Drug Abuse Screening Test, Hospital Anxiety and Depression Scale, and Rosenberg Self-Esteem Scale. Results: The mean age ± standard deviation of the respondents was 24.92 ± 2.42 years. The lifetime suicidal ideation, plan, and attempt were 9.6%, 5.7%, and 2.6%, respectively. Of them, 7.1% had the 12-month suicidal ideation, and 4.8% were at risk of suicide attempt. Totally, 9.6% of the respondents had high suicide risk. The symptoms of depression and anxiety were present in 13.5% and 23.1% of the respondents, respectively. Suicidal behaviors among Nigerian young adults were significantly associated with dissatisfaction with life (p < 0.05), anxiety (p < 0.001), drug abuse (p < 0.001), and low self-esteem (p < 0.01). Conclusion: Suicidal behaviors were relatively high among Nigerian young adults, and were associated with dissatisfaction with life, anxiety, psychoactive substance use, and low self-esteem.
Keywords: anxiety, dissatisfaction with life, substance abuse, suicidality
|How to cite this article:|
Tolulope O, Olubukola O, Olutayo A. Prevalence and factors associated with suicidal behaviors in a cross-sectional sample of Nigerian young adults. Taiwan J Psychiatry 2021;35:117-23
|How to cite this URL:|
Tolulope O, Olubukola O, Olutayo A. Prevalence and factors associated with suicidal behaviors in a cross-sectional sample of Nigerian young adults. Taiwan J Psychiatry [serial online] 2021 [cited 2021 Oct 20];35:117-23. Available from: http://www.e-tjp.org/text.asp?2021/35/3/117/326574
| Introduction|| |
Globally, low- and middle-income countries (LMICs) such as Nigeria account for more than 90% of child and youth suicides in addition to more than 75% of all suicide-related deaths . Therefore, the World Health Organization has identified the different dimensions of suicidality as a major public health concern in LMICs . Sadly, the contribution of suicide to the global burden of disease is projected to be increased over the next decades, especially in those countries . This is because mental health services and treatments, especially among the youth population, are grossly inadequate and those that are available in LMICs are poorly organized and executed .
Suicidal behaviors refer to a spectrum that ranges from the concept of suicidal ideation (thinking about killing oneself), to planning suicide, to attempting suicide, and the act of completed suicide itself . The major factors associated with suicidal behaviors among the young adult populations include female gender, psychoactive substance use, mental disorders, poor social support in terms of weak family and peer relationships ,,. Suicide-related behaviors are closely linked to mental disorders such as depression and anxiety ,. Among the young adult populations, the presence of obvious depression and anxiety symptoms can increase the risk of suicide by more than 70% . Anxiety disorders are found in 3%–17% of young adults with obvious suicidal behaviors . Young adults who use psychoactive substances such as opioids, stimulants, or inhalants are likely to report suicidal ideations and are three times more likely to have made a previous suicidal attempt . Moreover, lower self-esteem and poorer satisfaction with life have been observed among young adults with suicidal behaviors ,.
Suicidal behaviors have been recently reported to be prevalent among the young adult populations . Globally, suicide is the second leading cause of death among those aged 15–29 years . In most African countries, the rate and factors associated with suicide-related behaviors among the young adult population are generally unknown because of paucity of research ,. Among the studies conducted in four African countries, suicidal behaviors are relatively common but also vary across countries . The prevalence of suicidal ideation in the young adult population has been 19.6%, 23.1%, 27.9%, and 31.9% in Uganda, Botswana, Kenya, and Zambia, respectively . In Tunisia, the prevalence of suicidal ideations and attempts among the young adult population has been reported to be 26.9% and 7.3%, respectively . But those young adult suicide rates may be underestimated .
In Nigeria [Figure 1], the national or systematic mortality data collection systems are practically nonexisting . This is notwithstanding the reported observation that Nigerian youths have one of the highest rates of suicidal ideation and attempts globally . In Nigeria, the true scope of suicidal behaviors among young adults is veiled by incomplete surveillance and sociocultural issues surrounding suicide and its related stigma . The few suicide studies in Nigeria have been focused on adolescents , and general adult population in the southwestern geopolitical region of Nigeria . No study has specifically examined the prevalence and factors associated with suicidal behaviors in a geopolitically representative sample of Nigeria young adults.
|Figure 1: Nigeria (area = 924,000 km2, population = 206.6 million, and number of psychiatrists ≤ 500) is a country in West Africa bordering Niger in the north, Chad in the northeast, Cameroon in the east, and Benin in the west. Its southern coast is on the Gulf of Guinea in the Atlantic Ocean. It is a federal republic comprising 36 states and the Federal Capital Territory, where the capital, Abuja, is located. Lagos is the most populous city in the country and the African continent, as well as one of the largest metropolitan areas in the world. Osun State is located about 200 km in northeastern direction of Lagos (photo courtesy: Encyclopædia Britannica, Inc., copyrights 2002; used with permission, reprinting of the map is permitted)|
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In this study, we intended (a) to determine the prevalence of suicidal behaviors among young adults from the six geopolitical regions of Nigeria, and (b) to explore the associated factors with suicidal behaviors among our study sample. We hope that the findings of our study will contribute to the extant literature and facilitate evidence-based data, planning and rollout of culture-specific suicide prevention services among the Nigerian young adult population.
| Methods|| |
This descriptive cross-sectional study was conducted among Nigerian young adults from different cultural backgrounds, who freshly graduated from various tertiary institutions (universities, colleges, and polytechnics) across the six geopolitical zones of the country and are attending the mandatory one-year National Youth Service Corps (NYSC) program. The NYSC is characterized by a three-week program in which the participants reside in a designated camp. After the three-week program, they are allocated to work temporarily in different governmental and nongovernmental establishments for one year. Participation in this program is a prerequisite for obtaining permanent employment.
We prepared a copy of sociodemographic questionnaire to collect respondents' sociodemographic variables such as the age, gender, marital status, and geopolitical region.
Suicidal Behaviors Questionnaire-Revised Scale
The Suicidal Behaviors Questionnaire-Revised (SBQ-R) Scale consists of four items . Item 1 is to check lifetime suicide ideation and/or attempt while item 2 is to assess the frequency of suicidal ideation over the past 12 months. In addition, item 3 is to assess the threat of suicide attempt, and item 4 is to evaluate self-reported likelihood of suicidal behaviors in future . The aggregate score on the SBQ-R Scale is ranged from 3 to 18, with higher scores reflecting greater risk for suicidal behaviors . The psychometric properties of the SBQ-R in its reliability, validity, and screening characteristics have been described among Nigerian young adults, and a cutoff score of eight indicates high suicide risk .
Satisfaction with Life Scale
The Satisfaction with Life Scale is a five-item scale designed to measure global cognitive judgments of one's life satisfaction . Participants indicate how much they agree or disagree with each of the five items using a seven-point Likert scale that is ranged from 7 (strongly agree) to 1 (strongly disagree). The possible range of scores is 5–35. A score of 20 represents a neutral point on the scale. A score from 5 to 9 means that the respondent is extremely dissatisfied and a score from 31 to 35 indicates that the respondent is extremely satisfied . For the purpose of this study, the scores were recoded as a range of 5–19, 20, and 21–35, and were regarded as dissatisfied, neutral, and satisfied, respectively.
Hospital Anxiety and Depression Scale
The Hospital Anxiety and Depression Scale is a 14-item scale with two subscales (each consists of seven items). It quantitatively assesses anxiety and depressive symptoms . Each item is rated on a four-point Likert scale (0–3). The cumulative score on each subscale ranges from 0 to 21. Its psychometric properties have been reported to be adequate in different populations in Nigeria .
Drug Abuse Screening Test
The Drug Abuse Screening Test (DAST) is a 10-item self-reported brief measure that provides a quantitative evaluation of the extent of the consequences associated with drug abuse. The 10-item DAST is an abridged version of the 28-item instrument . The higher the cumulative score on the DAST, the greater the likelihood that the respondent is abusing one or more drugs. A score of 0 implies no drug abuse, 1–2 means low level, 3–5 signifies moderate level, 6–8 score is substantial level, and 9–10 indicates severe level of drug abuse . The DAST-10 is further classified based on suggested actions as 0, 1–5, and 6–10 to indicate no drug abuse (no action), low–moderate (monitoring/further investigation), and substantial–severe levels (intensive assessment) of drug abuse, respectively .
The Rosenberg Self-esteem Scale
In this study, the Rosenberg Self-esteem Scale (RSES) was used for respondents to complete. RSES is a copy of 10-item questionnaire with items scored on a four-point Likert scale from strongly agree to strongly disagree . Items 2, 5, 6, 8, and 9 on the scale are reversedly scored. The higher the scores on the scale, the higher the subjective perception of self-worth. Satisfactory reliability and validity have been demonstrated in Nigeria .
The ethical approval for the study was obtained from the State Specialist Hospital Health Research Ethics Committee of the Hospitals' Management Board, Osogbo (study protocol number = HREC/27/04//2015/SSHO/0106 and final date of approval = December 11, 2020) with the stipulation to obtain signed informed consents from the study participants.
The State Board of the NYSC also gave permission for the study. The inclusion criteria included those aged between 18 and 30 years, and those who gave their consent. Excluded were youths (a) who refused to sign consent, (b) who had a current or previous history of a psychiatric disorder, and (c) who were receiving treatment for a chronic medical illness (i.e., hypertension, diabetes mellitus, and sickle cell disease).
The youths were consecutively recruited according to their platoons. A platoon had an average of 120 youths. Those who agreed to participate in the study were given the questionnaire booklet after the objectives of the study had been explained to them. Out of the 1,252 in camp, 1,202 gave consent to participate in the study, thereby giving a response rate of 96%. In addition, 31 copies of questionnaire booklets were not properly filled, hence only 1,171 were available for data analysis.
Descriptive statistics such as the mean ± standard deviation (SD) and frequency (%) were used to depict the respondents' sociodemographic variables as well as scores on the SBQ-R Scale and other study measures. The dependent variable was suicidality as measured with the SBQ-R Scale while the other study measures were the exploratory variables. The continuous and categorical variables were tested for significance level using t-test and Chi-square, respectively.
We evaluated the directions and strengths of the relationships between SBQ-R score and the other study measures with correlational analyses. We did multivariate linear analysis to identify the variables that significantly predicted the SBQ-R scores among the study respondents.
Statistical analyses were done using the Statistical Package for the Social Science software version 21 (SPSS Inc., Chicago, Illinois, USA). The differences between the groups were considered significant if p-values were less than 0.05 (two-tailed).
| Results|| |
[Table 1] shows that the mean age ± SD of the respondents was 24.92 ± 2.42 years. The majority of the respondents belonged to the male gender. The lifetime suicidal ideation, plan, and attempt (according to the SBQ-R score) were 9.6%, 5.7%, and 2.6%, respectively. The 12-month suicidal ideation was 7.1%, and the respondents at risk of suicide attempt were 4.8%. High suicide risk group was constituted by 9.6% of the respondents (based on SBQ-R score of > 8). The symptoms of depression and anxiety were present in 13.5% and 23.1% of the respondents, respectively.
|Table 1: Respondents' sociodemographic and study measure characteristics (n = 1,171)|
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[Table 2] shows that more females were significantly classified as belonging to the high suicide risk group (p < 0.01). No significant differences existed among the respondents from the six geopolitical zones in relation to the suicide risk categorization.
|Table 2: Association between sociodemographic characteristics and suicide risk among the respondents|
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[Table 3] indicates that the SBQ-R score was significantly to have positive correlation with that of depression, anxiety (p < 0.01), and drug abuse, while it was significantly to have negative correlation with satisfaction with life and self-esteem (p < 0.01).
|Table 3: Correlational analyses (Pearson's) between Suicidal Behaviors Questionnaire-Revised Scale and other study measures (n = 1,171)|
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In [Table 4], respondents in the high suicide risk category had significantly lower mean scores on the life satisfaction (p < 0.001) and self-esteem scales (p < 0.001), as well as had significantly higher mean scores on the depression (p < 0.001), anxiety (p < 0.001), and drug abuse scales (p < 0.001).
|Table 4: Comparison of the mean scores of the study measures between the respondents with low suicide risk (n = 1,058) and those with high suicide risk (n = 113)|
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[Table 5] shows that significant more dissatisfaction with life (p < 05), anxiety (p < 0.001), drug abuse (p < 0.001), and poorer self-esteem (p < 0.01), cumulatively accounted for about 12% of the total variance in the SBQ-R score.
|Table 5: Multiple linear regression showing the factors that are associated with Suicidal Behaviors Questionnaire-Revised among the respondents (N = 1,171)|
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| Discussion|| |
In this study, we set out to investigate the prevalence and the factors associated with suicidal behaviors in a cross-sectional sample of Nigerian young adults that is inclusive of respondents from all the six geopolitical zones of the country. As shown in [Table 1], the prevalence of lifetime suicidal ideations and attempts was 9.6% and 2.6%, respectively. In addition, the 12-month suicidal ideation and suicide risk prevalence among our respondents [Table 1] was 7.1% and 9.6%, respectively. These results correspond with the findings of the World Mental Health Survey . But the suicide rates reported in our study are lower than what have been reported in other young adult population studies across different Western countries and cultures ,,. These differences among those studies may be attributable to the variations in the young adult age range and other methodological variations. There could also be the plausibility of underreporting because of the cultural beliefs and practices associated with suicidal behaviors in Africa ,. There is a dearth of studies regarding suicidal behaviors specifically among the Nigerian young adult population, hence a comparison with the findings in our study was rather difficult. Nevertheless, what we noted in this study regarding suicidal behaviors among Nigerian young adults is comparative to the observations that have recently been reported among Nigerian adolescents . As shown in [Table 1], the prevalences of depressive and anxiety symptoms were 13.5% and 23.1%, respectively. Those findings are similar to what have been previously reported among the Nigerian young adult population ,.
There are gender differences in suicidal behaviors among young adults . In our study [Table 2], we found that significantly more females (12.0% vs. 7.5%, p < 0.01) were categorized as high suicide risk. In developed countries, young adult females are twice more likely to indicate having suicidal ideation and to engage in suicide attempt behaviors . As suggested by Vijayakumar in 2015 , the higher susceptibility of young adult females to suicidal behaviors may be attributable to their vulnerability to certain psychopathological processes and social stressors.
As shown in [Table 3], we found that suicidality was significantly to have positive correlation with depression, anxiety, and drug abuse (p < 0.01). These findings are expected as depression is a major risk factor associated with suicidal behaviors, and youths with anxiety disorders display more dysregulation in their expression of worry, sadness with anger, and less adaptive emotion coping mechanisms ,. In addition, substance use increases psychological distress and dangerousness and causes poor cognitive judgment which may inadvertently lead to an increased suicidality .
In [Table 4], respondents in the high suicide risk category had significantly lower mean scores on the life satisfaction (p < 0.001) and self-esteem scales (p < 0.001) and had significantly higher mean scores on the depression (p < 0.001), anxiety (p < 0.001), and drug abuse scales (p < 0.001). Our findings are consistent with those of studies from developed countries that reported that youths and young adults with high risk for suicidal behaviors are less satisfied with life and had lower self-esteem ,,,. Youths and young adults who exhibit suicidal behaviors, have relational difficulties and feelings of insecurities and inappropriately tend to use suicidal behaviors as a major mode of communicating their internal worries ,.
On regression analysis [Table 5], significantly more dissatisfaction with life (p < 0.05), more anxiety (p < 0.001), poorer low self-esteem (p < 0.01), and more drug abuse (p < 0.001) were found in study variables that were cumulatively accounted for about 12% of the variance [Table 1] of the score on the SBQ-R Scale. This variance suggests that more studies are still needed among the Nigerian young adult population to identify the other factors that are associated with suicidal behaviors. Nonetheless, in our study, the highest variance in suicidality score was attributed to dissatisfaction with life. But an observation has also been reported in a cross-sectional section study on Chinese young adults . Young adults who express dissatisfaction with life, have poor strategies to cope with and adapt to life changes, hence they are predisposed to suicidality and other factors that could tilt them toward suicidal behaviors .
As suggested by Ialongo et al. in 2002 , suicidality among young adults is attributable to the fact that the young adult years are marked with huge developmental transitions and many other life-changing challenges. To do suicide prevention among young adults is apparently more challenging in Nigeria, where psychiatrist manpower is scarce .
The main strength of our study is that it is the first one to examine the prevalence and associated factors with suicidality among Nigerian young adults derived from all the six geopolitical zones of the country. But the readers are warned not to overinterpret the study findings because this study has three major limitations:
- The study is cross-sectional in nature. As a result, the direction of causality between suicidality and the other variables cannot be ascertained among the respondents.
- The measures of suicidal behaviors and other variables were based on self-report, hence respondents in this study might have been subjected to both recall and reporting bias regarding the study instruments.
- No other study with the same design, has ever been carried out in Nigeria. We need more studies to duplicate the study results and to strengthen the study findings.
This study has shown that suicidal behaviors are relatively high among Nigerian young adults, and those suicidal behaviors are associated with dissatisfaction with life, depression, anxiety, psychoactive substance use, and low self-esteem. We believe that the findings in this study will serve as an encouraging step toward the conduction of further studies among this population, and that this study may have the potential to provide the variables in developing young adult mental health interventions targeted specifically toward the prevention of suicide among Nigerian young adults.
| Acknowledgment|| |
We thank the Youth Corps members who participated in the study and the management of the NYSC Program in Osun.
| Financial Support and Sponsorship|| |
| Conflicts of Interest|| |
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]