“Doctor, please don’t say he died by suicide”: exploring the burden of suicide survivorship in a developing country

Abstract

Background: Annually, 800, 000 die from suicide worldwide. However, suicide is believed to be rare in our environment. Suicide causes significant life disruptions in people bereaved by it. These disruptions result from associated complicated grieving pattern characterised by stigma, feeling of shame, responsibility, guilt, etc. People therefore usually want to be certain that their relation indeed died from suicide. Being certain can in part help survivors achieve closure. A pathologist is often called upon to diagnose the actual cause of death in suspected suicide. The aim of this paper is to highlight the perception and attitude of survivors to suicide in our environment. Methods: This is a prospective study carried out in Enugu State University Teaching Hospital, Enugu, Nigeria. Data was obtained by audio-recording and transcription of face-to-face interviews of 8 groups of relatives who had presented to the pathologist for autopsy of their relation suspected to have committed suicide. Transcribed data was double checked for accuracy and analysed. Informed consent was obtained from participants. Ethical clearance was obtained from the Ethical Committee of the hospital. Results: There were 8 cases of suspected suicide over a 7-year period accounting for 0.6% of all violent deaths in the period. The central attitude of survivors in all the cases was denial of the event. At all the meetings survivors desired the pathologist to report cause of death differently than suicide. Also, in all cases, the extended family felt affected by the event. The following six themes in descending order of importance were identified to underlie survivors' attitude to suicide: fear of stigma and its consequent isolation, fear of economic repercussions, a conflict of choice of cause of death stemming from religious beliefs about the afterlife, feeling of shame and anger against the deceased and fear that acknowledging the event may bring a repeat in the family. Conclusion: There is profound fear of stigma and associative concerns which leads to outright suicide-denial. There is a need to educate the society about the reality and dynamics of suicide. This will make a bereaved person open to receiving requisite care.

Suicide in Nigeria: observations from the content analysis of newspapers

“…Deaths by suicide are perceived as sinful, a taboo and caused by evil forces, so the family are often times stigmatised and denied social opportunities. 10 People prefer to hide the mode of death, declaring suicides as accidental deaths or as homicides. 10 11 Many of the reported cases rely on police and hospital records, neither of which are comprehensive and might have been influenced by the bereaved.…”

“… 10 People prefer to hide the mode of death, declaring suicides as accidental deaths or as homicides. 10 11 Many of the reported cases rely on police and hospital records, neither of which are comprehensive and might have been influenced by the bereaved. 7 10 Suicide is still a crime in Nigeria according to section 327 of the country’s Criminal Code.…”

Sociocultural perspectives on suicidal behaviour at the Coast Region of Kenya: an exploratory qualitative study

“…Consequently, bereaved families would often misreport the cause of death to avoid judgement and blame, as well as to spare discriminatory practices towards the body of the deceased and the family. An exploratory study by Ohayi 30 similarly found that bereaved suicide survivors would often deny and misreport suicide as cause of death because of fear of stigma. This misreporting contributes to underestimation of suicide statistics, especially those highlighted in LMICs 31…”

Suicidal ideation and attempts among Nigerian undergraduates: Exploring the relationships with depression, hopelessness, perceived burdensomeness, and thwarted belongingness

“… 7 Also, family members prefer not to disclose the mode of death, reporting suicides as accidental deaths or as homicides at the hospitals or police stations. 8 In Nigeria, methods of engaging in suicidal behavior among youths include the use of chemicals, self-cutting, burning with kerosene, hanging, and firearms. 9 – 11…”