A taboo subject in most societies, suicide is often the last act of a desperate individual struggling in vain with problems such as depression or drug abuse. Determined to end the pain, two doctors are carrying out the nation's first in-depth study of the issue. AL AIN // In her personal life, Dr Leena al Amiri has first-hand experience of the pain that someone attempting to take their own life can cause those around them.
When she was a child, a friend's mother attempted suicide many times to escape a troubled marriage. The impact on her friend was, she says, "devastating". "Her mother used to get taken away in an ambulance in the middle of the night," says Dr al Amiri. This insight is now influencing Dr al Amiri in her professional life. A child psychiatrist and lecturer at UAE University in Al Ain, she is leading the country's first comprehensive study into the prevalence of suicide, information which it is hoped will eventually form the basis of a national prevention policy.
Dr al Amiri, one of two doctors heading up the research, is focusing on the incidence of suicides among children and adolescents, an area she says is neglected. Work on the study began a year ago, and the project has no set deadline. When it is complete, however, it will provide the first in-depth look at the extent of suicides in the UAE and supply full and detailed statistics, broken down by sex, nationality, age and emirate.
What little information is available at the moment is patchy, and there are no statistics concerning the number of attempted suicides in the country. Dr al Amiri, an Emirati who lives in Dubai, is working with a university colleague, Dr Kanita Dervic, an associate professor who is the principal investigator, gathering information on suicides from hospitals, health bodies and the police. The pair are looking at all aspects related to suicidal behaviour, including the causes leading to it, the methods used, and how it is handled by the authorities, police and families.
"Research on risk factors for suicidal behaviour and protective factors against suicide on the national level is needed," says Dr Dervic. "The research results will offer important information and create a basis for development and implementation of suicide prevention strategies," says Dr Dervic. Dr Dervic began studying suicide 10 years ago at the Vienna Medical University, and says that general research has shown that one third of children have suicidal thoughts at some point in their lives.
"It's vital that there is greater awareness from people such as parents, peers and teachers about the major risk factors for suicidal behaviour in this age, such as depression, substance abuse and family and school problems. Family support and religious anchorage are the two strongest preventative factors against suicide here," she says. Dr al Amiri, an assistant professor at UAE University who treats children in the psychiatry department at Tawam Hospital in Al Ain, says that the major causes of suicidal behaviour - bullying, sexual abuse and substance abuse - must be addressed.
At the clinic, she says she sees many Emirati children who are wrongly said to have a condition such as attention deficit hyperactivity disorder, when in reality they are concealing more serious problems. Little is known about the prevalence of suicide in the country. There were 86 cases in Dubai in 2009, according to the police, and the Health Authority Abu Dhabi (HAAD) says there were 66 cases in the capital in 2008.
Doctors tell their own stories. Dr Essam Emam, the head of psychiatry at Tawam Hospital, where patients are Emirati, says he sees several cases of attempted suicide every week, primarily women. They are referred to him from the emergency room, where they receive primary medical attention. "The majority of these people are not always serious about killing themselves, but it is a cry for help, a cry for attention. They want to escape a situation or avoid a social problem such as a bad marriage or domestic violence," he said.
Most people who attempt suicide, he said, use weapons or try to overdose on medications. The patients are usually adolescents or young adults in their 20s. Dr Emam, who has been at the hospital for five years, says he and his colleagues see more females than males, and that the number of cases increase during periods of stress, such as examination times in schools and colleges. Suicide remains a taboo subject in the country, and the social stigma surrounding it is perhaps the main hurdle to prevention.
"There is a problem of denial, especially if there's police involvement," says Dr Emam, who previously spent 20 years working in Saudi Arabia and says suicide is a region-wide problem. "It's inside the homes, so people try to cover it up and they don't want to speak about it. However, with a good approach, we can gain the support of the family and they are more open to help." He believes the key to success is increasing public awareness.
Dr Ali al Numairi, the vice president of the Arab Medical Union and a former president of the Emirates Medical Association, agrees. He contends that all sections of society must be educated in order to help build a successful suicide prevention and identification strategy. "From the mosques, churches, temples, the people of religion, the educational people, NGOs, clubs and most importantly, the family, they must all contribute.
"A helpline would at least give someone to help them get to the root of their problem, which is something when they reach this point they cannot do alone. Even those people who are merely attempting suicide and using it as a cry for help must have social support." In spite of the lack of research in the area, Dr al Numairi says that suicide is still relatively rare in the UAE because of the importance of Islam.
"Killing yourself is the biggest crime a man can commit," he says. "In Islam, we believe there is a good life beyond death." Dr Justin Thomas, a specialist in mental health and depression from the UK who is now based at Zayed University in Abu Dhabi, says that while practising Islam can help prevent people from attempting suicide, in order to really tackle the problem the country must institute open discussion about the issue and conduct thorough research into its causes.
"It is premature to create a prevention strategy before we presuppose it's a problem," he says. Dr Thomas recently carried out a survey of more than 400 students at Zayed University and found psychological problems and depression to be as common as in countries such as the UK or the US. Between five and eight per cent of the students surveyed were suffering from severe depression. A further 20 per cent had moderate depression.
Dr Thomas also found that the students at the university were suffering from depression at a much earlier age than the global average, with the onset of symptoms starting at 19, compared to a more common age of 25. "Research has shown that a lot of money is wasted in the UAE, investigating and treating somatised symptoms, whereby a patient says they have a bad back, a migraine, when really, they are covering up depression," he says. "Ninety per cent of people who attempt suicide have mental health problems, so by tackling mental health, we are preventing suicide." mswan@thenational.ae
? Nationwide research ? Implementation of a national suicide-prevention programme ? A campaign to educate the media about responsible coverage of suicide cases ? Restricting access to guns, medications, poisons and other items that can be used to attempt suicide ? Better awareness. For example, in schools and workplaces, training people to look for common warning signs, such as mood swings, social withdrawal, sudden behavioural changes, expressions of death-wishes ? A national hotline for people who need somewhere to turn for help * Melanie Swan
