‘Suicide in the Africa region must be taken seriously’

Suicides among university students, in particular medical students, have raised concerns about a mental health crisis that is tearing through Egyptian higher learning institutions and necessitates action.

In October and September 2022 six students died, three of them in the medical field (two pharmacy and one medicine student). Last year local media also reported that six university students committed suicide – three medicine and one dentistry student, as well as one engineering and one law student. They were from various universities.

These deaths come at a time when there is growing concern about the mental health of students in Africa and beyond – and calls from experts on higher education institutions to help to tackle the enormity of the problem.

One academic who would like to see support for mental wellness improve is Joseph Osafo, a professor of clinical/health psychology and the head of the department of psychology at the University of Ghana.

“Suicide in the Africa region must be taken seriously,” he told University World News.

“Universities must invest in mental health support systems for their students. Governments in Africa must reduce the stigma [of suicide] by investing in mental health services and challenging negative attitudes towards persons in suicidal crises.

“This will help to identify and report persons in suicidal crisis on time and provide help,” said Osafo.

Osafo is the lead author of the 2020 study ‘Suicide Prevention in the African Region’.

Echoing Osafo’s view, Professor Annette Beautrais, a suicidologist at the University of Canterbury in New Zealand, told University World News that the loss of students under difficult circumstances was a tragedy and that medical students need guidance on good mental health from the outset.

Beautrais is the author of the 2020 editorial article ‘Stress and suicide in medical students and physicians’.

Factors contributing to mental distress

Osafo is clear: medical training is stressful and students require psychosocial support right from the start of their studies.

“They must be constantly screened to identify those who may be experiencing difficulties, and immediate support must be given to them, especially between the third and fifth years,” Osafo suggested.

“Additionally, students who are underperforming should not be ignored and only threatened to raise their game. They must be a group of interest.

“Even those who are performing should not be assumed to be well, simply based on their good scores, but must be constantly engaged to find out what their challenges and distresses are.

“Religious beliefs and practices can ameliorate psychological distress for medical students who are religious,” Osafo pointed out.

Expanding further on ways of preventing suicide incidents among medical students , Beautrais said: “Encourage a culture of self-responsibility for well-being and self-care from the day of entry to medical school and throughout their professional working lives.

“Destigmatise, de-penalise and encourage help-seeking for mental health problems amongst medical students and physicians and ensure mental health is taught early and comprehensively to medical students so that they are able, early, to recognise distress in fellow students.”

This will help to “intervene early by knowing how and where to refer them for appropriate help along with encouraging proactive physical, mental, spiritual health actions, and social connections and support throughout medical school,” said Beautrais.

Suicide risks among medical students

Several factors have been considered as risks for suicidality among medical students,” Osafo added.

According to him these include the pressure to pass examinations, failure in examinations, feeling detached from other social activities and spending almost all the time studying, as well as the shame of not progressing well in their studies, hopelessness, depressions, having access to lethal substances or weapons, and more, Osafo indicated.

Expanding further, Beautrais said the reasons for suicide among medical students are usually similar to those in the general population of the same age. Generally, suicide is caused by the convergence of multiple risk factors – the most common being untreated or inadequately managed mental health conditions. Suicide is often preceded by losses of some sort.

“However, physicians have higher rates of burnout, depressive symptoms, and suicide risk than the general population, and medical students may share some of these additional occupational-related risks,” Beautrais added.

“Both physicians and medical students can experience high degrees of mental health distress and are less likely than other members of the public to seek mental health treatment.

“Physicians and medical students report several barriers to seeking mental health care, including time constraints, hesitancy to draw attention to self-perceived weaknesses, and concerns about reputation, confidentiality and career progression,” Beautrais pointed out.

“At the time of their death, compared to people in the general population, physicians are less likely to be receiving help for mental health problems. Risk for suicide increases when mental health conditions go unaddressed,” Beautrais said.

Egyptian studies warn about a crisis

The importance of addressing mental health in general, and that of medical students specifically, has been emphasised by various studies done in Egypt during the last few years.

Egypt has had an alarming increase in suicide mortality, which reached a rate of three people per 100,000 in the population. 2,584 suicides were officially reported in 2021, according to a September 2022 article ‘Suicide prevention in Egypt’.

The article indicated that “screening for depression in schools and universities through incorporating a depression detector application into education platforms could be a part of the solution as a safe and stigma-free method of raising awareness around mental health issues”.

The Egyptian society has also realised the escalation of the phenomenon, especially among the youth category, according to the March 2022 report ‘About the phenomenon of suicide in Egypt’.

The 2021 Egyptian study ‘Stress and Burnout among Egyptian Undergraduate Medical Students’ warned of the prevalence of stress and burnout among Egyptian medical students which “may cause a great impact on the students’ personal lives and affect their academic achievements and, may reflect on their psychological health.”

The study indicated that “a considerable concern should be given to medical students through the anticipatory care services provided by family health clinics, finding different ways to relieve the total stress”. Additionally, “further studies should be done to discuss different ways to critique the overcrowded medical curricula and to mitigate the academic stress as adding an extra entertainment curriculum e.g., sports, arts, and handicrafts are simple examples,” the study concluded.

Furthermore, a 2020 study ‘Depression among medical students in Alexandria, Egypt’ indicated that the prevalence of moderate and severe depression was high among medical students, calling for actions to help those students and to prevent new cases.

In addition, a 2019 study ‘Prevalence and Predictors of Burnout Syndrome among Medical Students of Cairo University’ indicated that “tremendous efforts ought to be applied to investigate stressors faced by the students and to embrace burnout preventive and interventional measures accordingly”.

Furthermore, a 2016 Egyptian study ‘Forensic analysis of suicidal ideation among medical students of Egypt: A crosssectional study’ indicated that medical students are at a higher risk of suicide than their peers. The study found that suicide ideation has been linked to a lack of family support systems and, therefore, sheds light on the importance of support systems for Egyptian medical students with a high stress on family support.

Beyond Egypt

Studies across different countries worldwide have consistently demonstrated high rates of several psychiatric disorders among medical students including suicide ideation and depression, which are strong predictors of attempted suicide among medical students.

African examples of these studies have been carried out in
Morocco, Nigeria, Ethiopia, Zambia and Sudan.