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Effect of social and family factors on rate of suicide among Iranian university students

 
AUTHORS

Seyyed Hadi Motamedi MD, Asghar Dadkhah PhD
University of Social Welfare and Rehabilitation science, Tehran

Abbas Tavallaee MD
Baghiatallah University of medical science, Tehran

Fatemeh Nasirzadeh
University of Social Welfare and Rehabilitation science


ABSTRACT

In all societies people of different ages and races commit suicide, and it is considered as one of the first ten causes of death. There may be several reasons for suicide and their recognition has always been of great importance for the authorities who are supposed to control it.

In fact, committing suicide among young people, especially university students, is a great social problem. It is also a matter of concern for mental health specialists. The aim of this study is to investigate the relationship between social and family factors and the idea of committing suicide among university students in Iran. 100 university students (50 male, 50 female) from the University of Welfare and Rehabilitation sciences were randomly selected and participated in the study.
A 59 question demographic questionnaire about family situation, personal features and the idea of committing suicide, and also a Beck questionnaire about depression and disappointment was administered. The questionnaires were filled out in a private interview.

The samples were taken randomly. It was found out that the singles were more inclined to commit suicide than the married students. Divorce, failure in education, and family background also increase the incidence. Among the other increasing factors old age and female sex was indicated.

Key Words: Social and family factors, suicidal idea and attempt, university students.

INTRODUCTION

The word suicide is a French word that consists of two parts: sui which means self and cide which means Killing (Dorckhime, 1999). .Pierre Moron indicates that suicide is an intentional act either consciously or unconsciously in order to destroy one's self (Moron, 1997). Aristotle believes that suicide is different to sacrifice. (Azkia, 1985) Freud believes that sexual relationships with others is an important factor (Roiters, 1994). According to Eric Frum the disintegration of social and traditional beliefs is an effective factor (khosravi, 1960). This theory is confirmed by Hallbwachs. (Shabani Fard Jahromi) Dorkhime claims that economical welfare decreases suicide. (Halbwachs,1930)Henry and Short confirm this idea with and put an emphasis on aggression. (Henry,1965) Gibbs and Martin emphasize the contrast of roles. (Gibbs,1965) Some people believe that social vacancy surrounding a person is the only cause of his/her suicide (Alec Ray). Sometimes suicides find an elevated value in society (Heidary,1997). Of course in this respect, the amount of suicides in the society and the social position of the people should be considered as determining factors (Jahan Pajuhesh). There are examples of the glorification of suicide in literature, such as the examples in Shakespeare's Works including the suicide of Juliet in Romeo and Juliet, that of Ophelia in Hamlet and that of Cleopatra in Anthony and Cleopatra and also suicide in the works written by Victor Hugo.

We can see even the suicide of some famous people, such as Ernest Hemingway.
It is estimated that 6% to 14% of people have suicidal ideas, and 10% to 14% of those, eventually committ suicide. Statistics shows that it is increasing, especially among young people all over the world (Mohseni ,1987). Researche shows that the number of women who have to stay in hospital because of attempted suicide is more than that of men (Burke,1978,7-11) and concerning the seasonal effects, it increases a bit in spring and autumn and decreases in winter.

Suicide is a great social pathology and is also a matter of concern for those who deal with mental health. This problem is worse especially when it concerns young people and university students who are the hope of our future. (Shopfropfer 2001) .
People of all different ages, races, and social classes may commit suicide. (Jilianeh and Jeifer 1993) . When the number of young people increases in a society, the number of suicides increases too. For example after the second world war with the large number of children, the problem was that a lot of young people committed suicide ( Caplan and Sadud 2000, Merk 2002) .

It seems that the increase of suicide is the result of different factors including social environment, a change in the way we look at suicide, and availability of its tools (Hawthon and Kate 1997)

Among the other causes of suicide we can refer to great depression, misuse of drugs, and criminal behaviors ( Caplan and Saduk 2000, and Merk 2002) and (Sarason,1994). In this respect there are two groups of causes: those that make the victim inclined and those that make his/her tendency evident. In the first group we can refer to family background, mental disorders, physical problems, and also suicide attempts in the family, especially the parents. In the second group the crises of conformity, quarrel with parents, friends, and classmates, unemployment, divorce or separation, bereavement, and also all the stressful events of life.( Caplan , Saduk and Gereb, 1996). Men are more successful in suicide than women. In this respect China is an exception. Iran is the 58th country in the world in which out of each 100,000 people 6 attempt suicide. ( Table 1 shows the rate of suicide in some countries for the two sexes. )

It is reported that in 2001 there were 3000 suicides in Iran (65% men , 35% women) which is about 1% of total deaths. In developed countries this rate changes to %1 to 2% of total deaths. (Ganil, 2000). The number of suicidal attempts is more than successful suicides. For example in our country it is reported about 2 to 50 times more and this number changes in different provinces.

In different countries women usually attempt suicide 3 to 4 times more than men but men have successful suicides 3 times more than womem (Caplan and Saduk, 2000).
In Iran men usually have successful suicides; 2 times more than women. But in some provinces such as Ilam, Bushehr, Khuzestatn, kohkiluye and Boyerahmad, Fars, and Kerman the number of women who commit suicide is more than men. It is reported that the highest rate of successful suicide is in Ilam (26 in 100,000) and in Kermanshah (23 in 100,000) and the lowest rate is in Tehran and Sistan and Baluchestan. The oldest statistics about suicide in Iran can be taken from an article written by Dr. Mirsepasi in 1970 and published in a magazine about psychology. Manoochehr Mohseni 1884 announced 229 cases of suicide in Iran (1.3 in 100,000). In research made by Dr. Naghavi in 1994 it is reported that among the population of villagers, the rate of suicide is 5 in 100,000. Killing by fire is one of the most frequent ways of suicide among woman in some provinces. According to the study of Kamalzadeh and his colleagues the rate of suicide in Tehran has gone up three times higher in comparison with the last decade. Based on research in Kerman it is observed that women'sattempted suicide is 1.5 times more than men but successful suicide among men is 1.5 times more than women (Abbasizadeh,1999). Studies about this matter are so numerousthat it is not possible to deal with all the different aspects and texts, so some of the outstanding points will be given as follows:
Although the rate of suicide normally increases among middle-aged and old people (men after 45 and woman after 55), it is also increasing very rapidly among the young people especially boys between 15-24 years old (Tehran University, 1996). Depression and schizophrenia are the two main causes of suicide, and the background of its attempt shows how serious it might be (Caplan and saduk,1999). The idea of suicide is more common among men, old people, and single or divorced people (Caplan and saduk,1999). Suicide is more common in urban and industrial areas in contrast with rural and non-industrial areas. (Sheibani,1973) The matter of suicide is rarely observed among children, only in urban areas. (Mohseni ,1967,9-11) Higher social position and lower social rank are two other causes of suicide (Caplan and saduk,1999). The other cause is social disorder that leads to personal disorder. (Caran,1965) Suicide is very common among themedical doctors, especially female doctors and its main causes are depression and addiction. Psychiatrists and then ophthalmologists and anesthetists in contrast with the other specialists, have greater tendency to commit suicide). The unemployed people have a greater tendency. (Caplan and saduk,1999). And in general in high and low positions it is more common than in average positions. (Mohseni ,1987)T he rate of suicide among whites is more then blacks. (Caplan and saduk,1999). The acceptance of a person in the family is the basis of his/her physical and moral health and as a result decreases the danger of suicide. (Mohagheghi,1985) Marriage and having children decrease the rate of suicide enormously. It is observed that suicide among singles is two times more than married people and also among the divorced people is two times more than the singles. (Caplan and saduk,1999) Disintegrated families increase the rate of suicide especially among girls. (Ministery of the Interior, Iran , 1990) The Jews and Protestants commit suicide more than the Catholics, and the Moslems less than the others. (Mohseni,1987) Porterfield believes that impiety is closely related to suicide. (Caran,1965) Regardless of ethical, religious, and philosophical matters, psychologists investigated the subject of suicide based on clinical cases and their attempt to understand the reality of suicide. (Caplan and saduk,1999) There is a close relationship between physical health, sickness, and suicide. (%12 to %15 of suicides) (Mohseni,1987) Women are more likely to commit suicide during their monthly period, especially on the first day (Hassanpur , mashhad and Beca and colleaques, Spanish). But it rarely happens during pregnancy (Abbasizadeh,1999) Having children is one of the factors that 'immunize' women more than men against suicide (31). Imitation is one of the increasing factors but for a limited time. (Dorckhime,1999)

 

Regarding educational institutuions, collegians and students, according to the studies of Dr. Mohseni in 1973-76 in Tehran, it is observed that 17.5% of suicides were related to collegians and students. Failure in educational matters, especially in exams, increases the rate of suicide among university students. ( Alishiri,1991) Revolution doesn't affect the rate of suicide, but war decreases it. (Eslami Nasab,1992) Social complications increase it. (Eslami Nasab,1992) When the rate of homicide increases in a country, the rate of suicide decreases consequently. (Eslami Nasab,1992) Availability of the suicidal agent is very important in determining the type of suicide, for example in America the gun is a very common dagent. In winter, suffocation by gas, and in summer drowning in water are very common. (Elahi,1987) There are some other factors that increase the danger of suicide including social forces, sudden strong stressors, family problems and crises, death of a close relative, dismissal, the sense of failure, and also strong criticism by others. (Ghaem Magham,1985) Addiction to alcohol and drugs can be added to the list (Oryan,1998). The community supposes that poverty increases the risk of suicide, but the fact is exactly the opposite. (Dorckhime,1999). Of course in some countries such as India and Uzbekistan, it is observed that there is a close relationship between economic crisis and poverty with suicide. (Sotudeh ,1994). Studies confirm the same point even in Iran. (The Entekhab newspaper). Although the relationship between modernity and suicide has not been proved (Sotudeh ,1994) old studies and statistics express the point that the movement of society toward modernity increases the rate of suicide. (Shabani Fard Jahromi). In Iran increasing immigration of villagers to cities is considered as another cause. (Hesamian,1984).

Finally we are going to have a look at different causes of suicide in Iran. In Lorestan, it is primarily addiction and poverty; in Ilam, depression, poverty, and accusation regarding someone's chastity; in Gilangharb, sexual privation, limitations, and chastity affairs (Hesamian,1994); in Kermanshah, family problems and psychological and mental problems (Province council of Kermanshah,1997), in Mazandaran, family conflicts (Province council of Mazandaran,1997) and in Kerman, family problems, and cultural poverty (Province council of Kerman , 1997) Based on the studies about women, we can classify some of the causes of suicide among women in this way: husband's addiction, great difference between the ages, maladjustment, the existence of several wives for a man, lack of ability to make decisions, the interference of others in the family affairs, marriage at an early age, and also considering divorce as a very undesirable act (Asgari ,1997). It is interesting to know that in Iran suicide is very popular among the young married women while in western countries it is popular among the old unmarried men. (Asgari, 1997). There are several bodies of research about different causes of suicide in Iran: According to a research undertaken in 1994, the causes are mentioned respectively as loneliness, age, irremediable disease, and failure in life and love (Gudarzi, 1994). In other research, the causes are pointed out as marital problems, undesirable condition of family life, psychological problems, failure in love, mental and personal disorders, poverty, joblessness, addiction, urban and industrial life and disintegration of social groups (Sotudeh, 1994). Based on other research the factors are mentioned respectively as marital problems, undesirable condition of family life, poverty, joblessness, addiction, psychological problems, personal and mental disorders, failure in love, and urban and industrial life (Mohseni, 1987).

MATERIALS & METHOD

The students of bachelor level at the university of Welfare and Rehabilitation in Thehran were the basis of statistical research. A sample group of 100 people (50 male, 50 female) was taken randomly from the same society.

THE MEASUREMENT DEVICE

Demographic questionnaire obtaininginformation and two Beck questionnaires, about hopelessness and depression, were filled out respectively in a private and face - to - face situation. At the same time all the questions of the samples were answered.

THE TYPE OF RESEARCH

This is retrospective research

THE VARIABLES OF RESEARCH

The independent variables are social and family factors and the dependant variable is suicide.

STATISTICAL METHODS

The software SPSS (9.5) is used in this research and then the method of one sample T test is used in which the relationship between the main variables and those that affect the number and rate of depression (which determines the rate of suicidal thought ) is considered . The important point is the meaningful level that is about 0.0005 in the four cases of divorce, failure in education, marital status, and family background.

RESULTS

50 men and 50 women took part in this test. Their ages were between 17 and 26 and the highest percent belonged to the age of 22 which was 23% of the whole. 15% of the samples were married, 58% stayed at the dormitories and 42% lived at home. 8% of the samples had experienced failure during their education. 32% of the samples had the idea of suicide and 6% attempted unsuccessful suicides. 28% had experienced the loss of a close relative in the last 6 months. In the family of two subjects there was a background of suicide. Among the samples, there was a significant relationship between depression and divorce, failure in education, marital status, and family background. Of course the relationship between depression and family background was stronger than the others (Table 2). About the marks of hopelessness we can conclude that they were from 1 to 15. Most of these were between 2 and 8. The highest percents were for mark 3 by 17%, mark 2 by 16%, and mark 5 by 10%.

DISCUSSION AND CONCLUSION

For many years in Iran nobody paid attention to comprehensive research about suicide (Mohseni ,1987) and the students rarely made such research. Studies about educational matters in America and especially at some universities such as Yale, Kernel, and Harvard support the fact that in these cities the university students commit suicide more than other groups of people. According to the research of Dr. Mohseni about suicide in Tehran (1973-74), it is observed that 17.5% of suicides were related to collegians and students, which supports the above- mentioned point. In this research, some factors such as failure in exams, lack of educational success, and family conditions, are considered as the main causes of suicide (Alishiri ,1991). Based on research in Kermanshah (97-98) 3% of suicides were because of failure in education (Province council of Kermanshah ,1997). In our sample test, 8 people had experienced some failure and two of them had suicidal thoughts . Separation from family is another reasonfor suicidal thoughts, especially among girls and the reason is that they are dependant of their families for social, economical, and emotional matters (Ministry of the Interior, Iran , 1990). Research in Tabriz (1978-79) shows that the death of close relatives is the main cause of suicide (Karbasi) and other research made in 1994 supports the same point in the whole country (Gudarzi ,1994). In our test, 28 people had experienced the separation of a close relative in the last 6 months and 19 of them had thought of suicide and 3 of them committed suicide.

Among the samples there were also 58 students who lived in the dormitories far from their families, from which 21 students had thought of suicide. Research shows that the rate of suicide among unmarried people is two times thar of married ones (Caplan and saduk, 1999). In our research there were 85 singles and 15 marriedstudents, and 30 of the singles (35%) and 2 of the married students (13%) had thought of suicide. Also from the 6 students who committed suicide, 5 were single. Of course in Iran marriage can be considered as a controlling factor especially for men (Asgari, 1997) and as a result, marriage decreases the amount of suicide (Mohagheghi, 1985). Research shows that suicide has increased in extended families in comparison with nuclear families (Ministry of the Interior, Iran, 1990). In ourresearch, there were backgrounds of suicide attempts in only the family of 2 samples, but neither of them had tendency to the same. Of course the problem is that our statistical society is limited. Most of the research confirms that family problems are the main causes in Iran ( between 54% and 80%) (Mohseni ,1987, Province council of Kermanshah ,1997 , Malek ,1994). The immunity of women against suicide is more than men (Malek, 1978). According to old research women committed suicide more than men in Iran (Asgari ,1997) but new research shows the opposite situation. (Asgari ,2004) In our recent study 32 people out of 100 had thought of suicide (19 women and 13 men ) and of course 6 of them committed suicide ( 4 women and 2 men) .Increasing age is also an important factor (Tehran University, 1996) Suicide is increasing very fast among the men of 15 to 24 years old (Tehran University, 1996). In our recent study we observed that there is a direct relationship between increasing age and suicidal thoughts. The results of this study proved all of our hypotheses: there is a significant relationship between suicide (thought and attempt) and divorce, failure in education, marital status, and family background. Age and sex also have a significant relationship with suicide (thought and attempt).

LIMITATIONS
  1. Lack of ability to apply this research to the whole society because the selected people may not represent the society.
  2. Limitation and small size of the selected society that is considered as a pilot study .
 

 

Table 1. The rate of suicide in different countries for the two sexes ( in 100,000 people )

Number

Country

Suicide rate women

Suicide rate men

1

Canada

5.4

21.5

2

Norway

6.9

17.7

3

The United States

4.5

19.8

4

Sweden

9.2

21.5

5

Australia

4.7

21

6

France

10.7

31.5

7

Finland

11.8

43.4

8

Germany

8.7

32.2

9

Denmark

11.2

42.2

10

Italy

4

12.7

11

Spain

3.7

12.7

12

Chile

1.4

10.2

13

Costa Rica

1.8

8

14

Poland

16.7

50.6

15

Venezuela

1.9

8.3

16

Mexico

1

5.4

17

Colombia

1.5

5.5

18

Cuba

14.9

25.6

19

Latvia

15.6

79.1

20

Thailand

2.4

5.6

21

Iran

3.4

3.8

Source: the report of human expansion 1999 (undp)

back to text

 

Table 2. The rate of correlation between depression and the four Hypotheses

 

Number

Correlation

Meaningful level

average

Standard marks

Meaningful level 2- Tailed

1.divorce and depression

100

- 0.10

0.31

1.46

0.78

0.000

2. Failure in education and depression

100

- 0.29

0.01

1.66

0.71

0.000

3. Marital status and depression

100

- 0.42

0.67

0.89

0.70

0.000

4. Family background and depression

100

- 0.003

0.97

1.7

0.64

0.000

In this table the variables are considered in pairs and there is a significant relationship between depression and the four hypotheses. The important point in this table is the positive correlation between depression and family.
1-     The relationship is significant. 2-     The relationship is significant. 3- The relationship is significant. 4- The relationship is significant.

 

REFERENCES
1: Dorckhime, Emil " Suicide " translated by : Salarzadeh Amiri, Nader. Tehran : Allame Tabatabaee University publication, 1999 .
2: Alec Ray , M . B. "Family history of suicide in Affective disorder patients". J.clin psychiatry.
3: Heidary, Senobar " Suicide and its Survey in Iran" Ph.D. thesis in psychiatry, Iran University of Medical science , Tehran, 1997.
4: Moron, Pierre " Suicide , formation and causes and treatment" translated by: Sahand, Maziar, Tehran : Rasam Publication, 1997.
5: Azkia, Mostafa " A Survey of causes of suicide in Tehran" Etelaat Publication , 1985.
6: Roiters, George " Sociological theses " translated by : Gharavizad , Ahmad Reza, 1st ed ., Tehran : Jahad Daneshgahi Publication , 1994.
7: Khosravi , Khosro " Suicide in Iran " Bachelor thesis , Faculty of social science , Tehran University , 1960.
8: Halbwachs , M. , " les causes da suicide K. " Paris Alcon, 1930.
9: Shabani Fard Jahromi , Ali Akbar , " The pathology of suicide " .
10: Henry , A., and Short , J. , " suicide and Homicide " , New York : The free press , 1965.
11: Jahan Pajuhesh Institute , " A contrastive survey of suicidal rate in Iran and industrial countries".
12: Gibbs , J., and Martin , W. " Status Integration and Suicide ; A Sociological Study" , V.O. Oregon books , 1965.
13: Mohseni , AliReza " A survey of the rate and causes of suicide in Ilam."
14: Caran , R. , " suicide " , New York : Ressell and Ressell , Inc, 1965.
15: Caplan and saduk , " A synopsis of psychiatry " , Rafiee , Hassan . Arjmand Publication , Tehran , 1999.
16: Mohseni , Manuchehr , " Social Deviations , Motives and causes of suicide " Tehran : Fadaee Publication , 1987.
17: Abbasizadeh, Masumeh," The report of suicide " ,The office of the social injured, Teharn , 1999.
18: Sarason, Iron J. and Barbara R., Sarason, " Pathological Psychology " , Dr. Najarian, Bahman, Dr. Asghari, Mohammad Ali; Dehghani, Mohsen, Roshd Publication , Tehran , 1994.
19: Elahi, Faeze , " The Pattern of suicidal attempt for people " , Bachelor thesis , The Faculty of Social science , Allame Tabatabaee University ,Teharn , 1987.
20: Eslami Nasab, Ali, " The Crisis of Suicide " , 1st ed., Tehran , Ferdos Publication, 1992.
21: Alishiri , Behruz , " A Survey of social and psychological causes of suicide in Tehran" , Master thesis , Azad University of Tehran, 1991.
22: Mohagheghi, Fariba , " The causes of suicide among women in Torkaman Sahra after revolution", Bachelor thesis , Azad University of Tehran, 1985.
23: " A survey of effective causes of suicide in Lorestan from 1986 to 1990" , The department of political , Social , and security assistance in the Ministery of the Interior, Iran , 1990.
24: W.H.O. "Suicide and Attempted Suicide", Geneva : W.H.O. 1974. P.15, 83, 89.
25. Burke, A.W. "Attempted Suicide Among Immigrants in Birmingham". International Journal of psychiatry . Vd.24 No. 1. 1978. P.P.7-11.
26: " The schedule of analysis of suicide in Tehran" The Faculty of Health , Tehran University, 1996.
27: Sheibani, A., " Statistics of suicide " , Tazehaye Ravanpezeshki magazine , No.1 , 3 rd year , 1973.
28: Mohseni , Manuchehr . " Suicide : the problem of our century" Mehre Khanevade, No. 1, 1967, P. 9-11.
29: The Entekhab newspaper , " Social crises and suicide in Izeh, Khuzestan."
30: Hesamian, Farokh, " Urban life in Iran " , Tehran , agah Publication , 1984.
31: Asgari , Samie , " Women : the main victims of suicide in Iran " , Farhang va Tose'e Magazine, 1997.
32: Gudarzi , Faramarz , " The book of Medical Jurisprudence", Tehran , Einstein Publication, 3 rd ed , 1994.
33: Shariati Rudsari, Mostafa , " The causes of suicide " , Tarbiat Magazine , 10 th year, Tehran, 1994.
34: Province council of Kermanshah , administration of social affairs, " A survey of the rate and causes of suicide in Kermanshah" , Iran, 1997.
35: Province council of Mazandaran, administration of social affairs , " A survey of the rate and causes of suicide in Mazandaran", Iran, 1997.
36: Province council of Kerman , administration of social affairs , " A survey of the phenomenon of suicide from 94 to 97", Iran, 1997.
37: Sotudeh , Hedayatollah , " Social pathology , sociology of deviations ", Tehran , Avaye Noor publication , 1994.
38: Ghaem Magham, Faraht , "Psychological disease, suicide " , Tehran , The Publication of Distribution and Human Culture Organization , 1985.
39: Oryan, Behzad , " Suicide is the only alternative " , women Rights social Periodical , No . 7 , 1998.
40: Asad Beigy, Hossein , " suicide and intervention in it " , Tehran , 2004, P. 56.
41: Malek , Ayoob , " A survey of suicide in 1991 in Sina hospital and Emam hospital", Ph . D. thesis , Tabriz, 1994.
42: Karbasi, Foroogh , " A Research about Suicide " P. 100.