Taking a locally sensitive approach to student suicide

The prevalence of suicidal behaviour among pre-university students and university students presents a major challenge to African higher education institutions and calls for culturally-appropriate and locally-tailored interventions, according to experts.

"In addition to school-based strategies to deal with the suicide issues when they start, higher education institutions can play a significant role in offering targeted suicide prevention initiatives for newcomer students to serve their psycho-social needs and offer further support to students who are in need," according to Asaduzzaman Khan, associate professor at the School of Health and Rehabilitation Sciences of the University of Queensland, Australia, and lead researcher of The Lancet Child and Adolescent Health (LCAH) study slated for publication in April.

"The vast majority of available interventions are developed and tested in high-income countries and we are not sure about the appropriateness of these interventions to young people in resource-limited settings," Khan told University World News. "We are in need of interventions tailored to the local context, and strategies that are culturally appropriate.”

The population-based study, which used data from the Global School-based Student Health Survey of schoolchildren aged 13-17 years between 2003 and 2015 in 59 low-income and middle-income countries across six World Health Organization regions, shows that pre-university students in Africa have the highest prevalence of suicidal thoughts and planning rates among developing countries.

Among the African countries surveyed, one in four teenagers reported suicide planning. The highest prevalence was in Zambia, where about two in every five adolescents reported having made a suicide plan.

The LCAH study indicated that across all low- and middle-income countries, about 17% of adolescents had suicidal thoughts, plans or attempts during a 12-month period, considerably higher than levels in developed countries such as Australia, where only 5.2% of adolescents had suicidal plans and 2.4% made suicide attempts.

Variety of reasons

On the reasons behind the high prevalence in Africa, Khan said: "There could be a variety of reasons such as poverty, political tensions, violence, human rights violations, adolescent pregnancies and vulnerability to sexual and reproductive ill-health, which can have direct or indirect effects on the psycho-social wellbeing of adolescents."

The LCAH study is supported by a number of other country-specific studies related to university students. For example, a 2018 study entitled "Suicidal thoughts among university students in Ethiopia” indicated that one in five students reported suicidal thoughts as a result of mental distress, family history of mental illness, low social support, financial distress and substance use.

Nearly 20 university students across Kenya committed suicide between 2014 and 2018, according to a 2018 local news report. In 2015, a journal article on suicide among university students in Kenya pegged the prevalence of suicidal behaviour and physical fighting at 16.4%.

In South Africa 25% of university students have expressed suicide ideation, at least 12% suffer from depression and a further 15% grapple with anxiety, according to the website of the South African Depression and Anxiety Group.

University students at risk

Jason Bantjes, a psychologist and senior lecturer in the Department of Psychology at Stellenbosch University, South Africa, told University World News: "We know that rates of non-fatal suicidal behaviour (thoughts of suicide, plans and suicide attempts) appear to be higher among university students than the general population. This seems to be true in many parts of the developed and developing world."

"We do not have accurate longitudinal data about rates of completed suicide among university students so we can’t say too much about ‘suicide’ in this population other than it needs more research and anecdotal evidence suggests that rates might be increasing," said Bantjes, who is co-author of a 2018 global study entitled "Suicidal Thoughts and Behaviors among First-Year College Students: Results from the WMH-ICS Project.”

"We need to collect accurate epidemiological data about fatal and non-fatal suicidal behaviour on campuses across the continent, so that we can understand the extent of the problem and identify at-risk groups," Bantjes added.

"Accurate epidemiological data will also give us a baseline against which we can measure the effectiveness of interventions and thus build an evidence base for context-sensitive and culturally appropriate suicide prevention in Africa," he said.

Socio-cultural factors

"We know that suicidal behaviour, like all complex human behaviours, has a social, political, economic, historical and cultural context," Bantjes said. "Suicide has a particular situated meaning which is very much framed by socio-cultural factors."

"This makes it impossible simply to import suicide prevention interventions from other Western industrialised countries and assume that they will be effective in all parts of Africa."

"We have some work to do in tailoring existing evidence-based interventions so that they are culturally appropriate and context sensitive. But this does not necessarily mean we have to re-invent the wheel," Bantjes said.

"Many of the established universal principles of suicide prevention, such as promoting access to effective and appropriate mental health services, will apply to universities in Africa as much as they do to settings in other parts of the globe."

"To develop effective culturally appropriate and context sensitive interventions, we will need to understand more about the lived experience of students in Africa who engage in suicidal behaviour, as well as understanding the cultural context in which this behaviour occurs along with the particular factors that contribute to students’ suicidal behaviour.

"Importantly, this may entail shifting from a purely biomedical view of suicide (which frames suicidal behaviour as a symptom of mental illness) to embracing other theories of suicidal behaviour which take more account of context and systemic factors.”

Campus-based services

According to Bantjies, there is a need to strengthen campus-based mental health care services and promote access to these services, which might entail addressing issues such as stigma and attitudes to help-seeking.

"To reduce rates of suicidal behaviour at universities, we will need to build campus communities in which students can find connection and belonging, feel secure, imagine a future for themselves, and access support when they need it.

"Suicide can be prevented – we have the knowledge but now we need political will and the commitment of university authorities to address this issue."