As the world marks the 15th World Suicide Prevention Day on 10 September, the rising number of suicides among North African students and university graduates is turning the spotlight onto the role of universities in supporting vulnerable students and raising awareness around mental health issues.
"Universities should play a major role by screening and raising awareness of mental health and stigma – not only for their students but for the public at large," according to Dr Ali H Mokdad, lead author of a study entitled “Intentional Injuries in the Eastern Mediterranean Region, 1990–2015: Findings from the Global Burden of Disease 2015 Study”.
The research, published recently in the International Journal of Public Health, showed an increase in suicides among populations in North Africa.
According to Mokdad's article, suicides in the Eastern Mediterranean area, which includes the African countries of Tunisia, Egypt, Somalia, Libya, Sudan, Djibouti and Morocco, are increasing much faster in North Africa than in any other region in the world.
Universities should "teach more about mental health … and how to diagnose and treat [these problems] but, most importantly, how to prevent [them]," Mokdad told University World News.
A 2016 report entitled The Phenomenon of Suicide in Egypt, published by the Egyptian Coordination for Rights and Freedoms, indicates that there were 34 cases of suicide among Egyptian students out of a total of 157 in the period January to August 2015. Egyptian students top the list for the number of suicides, representing about 22% of suicides, or 1.9 student suicides per month.
And in Algeria, a study shows that 20% of suicides in that country are committed by university students or pre-university educated persons.
According to a report on Suicides in the Arab World, “study failure” and unemployment are among the main factors leading youth to end their lives, while local news reports have pointed to the correlation between suicide rates and the release of academic results.
The causes of suicidal behaviour among university students are multifactorial, according to experts.
Mehmet Eskin, professor of clinical psychology at the faculty of medicine at Adnan Menderes University in Turkey, said such factors include the social exclusion of students who are different, for example, ethnic or sexual minorities. This creates a heavy mental burden for the afflicted person which, combined with a pressurised academic schedule, may create burn-out and despair.
"For instance, research shows that stressful events and all sorts of violence are highly potent risk factors for suicidal behaviour and diminished psychological well-being," said Eskin who is the author of a 2016 article entitled "Cross-national Comparisons of Attitudes towards Suicide and Suicidal Persons in University Students from 12 Countries”, which argues that while suicide ideation, suicide attempt and psychological distress are common in university students, their rates vary depending on the sociocultural context.
According to Mehdi Ben Khelil from the faculty of medicine of the University of Tunis El Manar in Tunisia, high suicide risk among university students was partly explained by a lack of opportunities and an imbalance between the number of specialised students and job market opportunities. This was compounded by a lack of support.
Khelil, who is the author of a 2016 article entitled "Impact of the Tunisian Revolution on Homicide and Suicide Rates in Tunisia”, universities could lower this suicide risk among students by establishing psycho-social support services, as well as sensitising university staff on detecting suicidal behaviour and the management of affected students.
Universities should think about offering spaces to students to gain life skills, enhance their coping mechanisms in adverse situations, rethink the fit between course offerings and market needs, and offer postgraduate support, said Khelil.
"Universities could also help by offering new opportunities such as national and international internships, options to switch field of study as well as the possibility to play an active role in the governance of the institution and to work in partnership with the institution on social entrepreneurship projects, which would raise the self-confidence of students and their intrinsic capacities,” said Khelil.
According to Samar Ahmed, director of the Forensic Psychiatry Research Initiative at Ain Shams University, Egypt, “the competitive nature of universities and the limited opportunities to succeed and excel are a contributing factor to the increased psychological stress that students are subjected to".
Ahmed said medical curricula in particular were built on a competitive basis and an individualistic excellence approach.
"There is very limited room for peer support and team work in medical curricula which makes students lonely within the programme and in an individual competition that many times ends in frustration,” she said.
"Universities attracting high achievers like medical students have to be alert to the high probability of suicide thoughts and ideation among students particularly in the early years of study when students are still transitioning from school life to university life," said Ahmed, who is the author of a 2016 article entitled "Forensic Analysis of Suicidal Ideation among Medical Students of Egypt: A cross-sectional study”.
"Students in the early years tend to feel overwhelmed and are in increasing need of academic counselling and support. More focus has to be placed on students who are residing in hostels and have little family support," Ahmed said.
Ahmed suggested that universities with high-achieving students should have a suicide detection protocol and a response team for reporting suicidal students.
"We have a problem in the culture of psychological support and academic advisors. Both parties need to have dedicated protocols to support students with academic struggles," Ahmed said.
According to Eskin, three steps are needed to prevent suicide and build a safe learning environment for all students.
The first step would be tackling stigma and social exclusion, while the second would focus on empowerment and building resilience and problem-solving among students, said Eskin. The third step would involve providing quality mental health care for students.
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