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Nigerian Psychiatric Hospitals record more patients

On July 18, 2013, Ruth Amusan, 45, allegedly jumped into the lagoon by Leventis Bus-Stop on the Lagos Island. She drowned and her body was later recovered by people around the lagoon. Though Amusan’s reason for committing suicide is still unknown, some people suspect she might have been robbed since the bag she left by the lagoon contained some bank documents.

A relative of Amusan, who spoke to Saturday PUNCH on the phone, but did not want to be named, said he was “sad and embarrassed by the incident.” He added that Amusan had some form of mental illness but that family members never knew she had suicidal tendencies.

In the first week of 2014, the death of a part-time student of The Polytechnic, Ibadan, Oyo State, Timilehin Ogundare, who allegedly committed suicide made the news. It still remains unclear what could have led the teenager to kill himself.

About a month before his death, Ogundare posted a picture of himself and a lady holding each other on the Sultan Beach, Lagos, on his Facebook page. The couple were all smiles.

A day before Ogundare’s suspected suicide, he had attempted to jump into a river before he was stopped by some security men, who handed him over to his family. Ogundare allegedly hanged himself with his belt in his room in Abeokuta, Ogun State, the following day while his family members were at home.

He left a short note, apologising to his family for disappointing them.

A World Health Organisation  report for 2000 estimated that approximately one million people died from suicide, with 10 to 20 times more people attempting suicide worldwide. This represented one death every 40 seconds and one attempt every three seconds, on the average.

According to the organisation, suicide has become one of the three leading causes of death among people aged 15 and 34 years in all countries.

In Nigeria, there are also indications that the rate of suicide is on the increase, even though there have been no recent community-based surveys to substantiate this. However, the current hospital-based data from the Federal Neuro-Psychiatric Hospital, Yaba, Lagos, shows that more Nigerians are seeking help at the Psychiatric hospital with  an average of 15 new cases of psychiatric disorder being presented daily.

A Consultant Psychiatrist and Head of Emergency at the hospital, Dr. Increase Adeosun, said from his experience, the number was on the increase. He, however, warned that a survey done in the community would best describe the true situation rather than the one carried out in hospitals. He said the increase in number of psychiatric cases in hospitals could also mean that more people are becoming aware of the need to take patients to hospitals.

“Unlike in the past when patients would not go to the hospital and family members would chain them up, that is changing because of the awareness and exposure to information. The perception is also changing since more people now know that the best place is the hospital,” he said.

Meanwhile, experts have identified increasing rural-urban migration, unemployment, economic recession and insecurity as some of the factors that could be responsible for the growing number of patients in psychiatric hospitals.

Adeosun said, “More migration from rural to urban areas has reduced the cohesiveness in communities. Such support systems are protective factors that assist people to cope when they are going through issues, but such systems are being weakened now. It has also weakened family values and the extended family system.

“There are more factors like joblessness, economic recession, a lot of people commit suicide during economic recession, we can then speculate because we know that these are factors that can trigger suicide, but we don’t have data to prove that. We know that unemployment and insecurity are on the increase. They can trigger psychiatric problems. Children who have witnessed the atrocities in the northern part of the country may not remain the same again.”

Also according to Adeosun, global statistics show that one out of five people has depression.

He said, “From our database, an average of 15 new patients come to this hospital on a daily basis with various cases ranging from depression to schizophrenia. The situation is rising compared to some years back. “I don’t have the statistics, but I can tell you that the rate is increasing rapidly. Over the years, there is an upsurge in presentation to psychiatric tendencies and even psychiatric emergencies. One out of every three patients that come in has schizophrenia, one out of six has depression and about one out of 10 has substance use disorder.

“This may suggest to a lay man that schizophrenia is the most common disorder in the society but that is not the case. The most common psychiatric disorders are depression and anxiety. The best statistics to show the true situation is a survey done in the community rather than a hospital-based data.

“The studies that we have internationally and which have been verified in most countries show that about one out of five people has depression, which is about 20 to 25 per cent of the population. Anxiety is also common and can even be higher.”

Adeosun identified depression, schizophrenia, bipolar and substance use disorders as the major psychiatric disorders responsible for suicidal tendencies, with depression taking the lead. He said hospital records show that about 45 per cent of persons with suicidal tendencies are diagnosed with depression.

Statistics from the Neuropsychiatric Hospital, Aro, Abeokuta, over a four-year period, show that the annual number of new patients to the hospital had a steady decline from 2009 to 2011, but picked up in 2012, to hit the highest figure.

The hospital had 2,331 new patients in 2009; 2,298 in 2010 and 2,204 in 2011, but the figure rose to 2,515 in its 2012 record. Between 2011 and 2012, the number of old patients received by the hospital also rose from 28,625 to 30,213.

However, cases of patients who had depression rose from 1,981 in 2009 to 2,251 in 2011. Also the data of patients who were schizophrenic show a slight decline from 10,302 in 2009 to 10,012 in 2010,but rose to 11,900 in 2011. Curiously, the hospital records show that more women suffer from depression and schizophrenia.

At the same hospital, while 659 men were diagnosed with depression in 2012, 1,385 women had the same problem in the period.

In his 2009 overview of depression, which involved a survey carried out in 20 states of the country, Oye Gureje, a professor of Psychiatry at the University of Ibadan, found out that suicide attempts had increased “18-fold among persons with depression, six-fold among persons with substance use disorders and four-fold among persons with anxiety disorder.”

Ogundare’s suspected suicide generated some buzz on the social media, with some people asking why he was so desperate to die after a failed attempt.

Also, a man identified as Afeez, was sighted climbing an electric pole on Olaitan Street, Masha, Surulere, Lagos, September 1, 2012. He was said to have earlier complained to his friends that he was tired of life.

However, on that day, some eyewitnesses begged Afeez to get down, which he did. But some of those present reportedly slapped him and rebuked him for attempting to take his life.

On that night, Afeez allegedly committed suicide after drinking a poisonous substance.

A consultant psychiatrist at the Neuropsychiatric Hospital, Aro, Abeokuta, Dr. Lateef Sakeeb, said the risk of committing suicide increases up to three times for every failed suicide attempt.

He said, “If someone has made an attempt in the past but not successful, then there are two to three -fold risk of completing it if not prevented. The person will complete it in the nearest future, except the underlying causes are addressed and treated.”

Sakeeb said in Ogundare and Afeez’s cases, a mental health team should have been involved to “diagnose the problem and intervene.”

“It will involve a lot of observation and finding out the family dynamics of the person, the social circumstances (both immediate and remote) and the recent adverse life events. The patient could also be screened for emotional disorders and if the patient is an adult, he could be screened for mental disorders and substance abuse,” he said.

Sadly, Ogundare and Afeez did not get the help they needed before they succeeded with the attempts that finally ended their lives.

Aside from Ogundare and Afeez, there have been a surge in the number of reported suicide cases in the country.

On January 1, 2014, 30-year-old Daniel Ogunsona was found hanging from the hook of a ceiling fan in an uncompleted building at Hilltop Estate, Ikorodu , Lagos. Ogunsona was found by his younger brother who traced him to the building after reading the note he left at home. The Architecture graduate from Obafemi Awolowo University, Ile-Ife, Osun State, allegedly killed himself because his girlfriend’s father turned down his offer to marry his daughter.

About two months earlier, the lifeless body of Patrick Essien was found hanging in the toilet he shared with co-tenants at his residence in Benin, Edo State. Essien had just been dismissed from his job at a transport company. He was survived by a wife and three children.

In Ijebu-Ode, Ogun State, 35-year-old motorcycle technician, Kayode Onabamiro, allegedly committed suicide after leaving a note, saying he had taken the action because of his wife’s infidelity. Onabamiro was said to have sent his son on an errand and locked the door before hanging himself.

Also in Ijebu-Ode, a 25-year-old housewife and mother of a five-year-old boy, Sakirat Abdullahi, of 33, Ereko Street, Ijebu-Ode, Ogun State, allegedly committed suicide by mixing shaving powder with her meal.

On October 1, 2013, Asampete Usman sent a suicide message to some of her friends on Facebook, hinting them of her intention to “end it all”. Her friends did not take her threat seriously.

A week later, Usman’s corpse was found by her family members after a suspected suicide.

Much like Usman’s case, a 30-year-old man from Delta State, Diano Ovie-Richy, also announced his intention to commit suicide to his friends on Facebook. Ovie-Richy allegedly committed suicide on Christmas Day in 2011 after reportedly telling his friends that it was his “Xmas gift” to them.

Ovie-Richy’s final year thesis was reportedly rejected by his project supervisor, preventing him from graduating with his classmates. As of the time of Ovie-Richy’s death, his girlfriend was pregnant with their first child. He said he did not want his unborn child to see him suffer and appealed for love for his baby. He, however, declared his hatred for God in his last message, blaming Him for allowing demons destroy his hard work.

Meanwhile, Afeez’s experience and public comments have shown a general aversion to suicide in the country.

Many of the comments that the suicide reports generated on the social media outright condemned the acts and faulted the victims.

For instance, Aminu Muhammad, who commented about Usman’s death on the social media, wrote, “I cannot say rest in peace because the messenger of Allah said any Muslim that kills himself because of worldly things should consider his soul as a kafir (an infidel) because he’s going to hell fire.”

Another person, Christy Tanko, wrote, “Why did you take a life you never gave to yourself? While others are lying on the hospital bed, begging for God’s healing and not to die untimely, others are snuffing lives out of themselves.”

‘Suicide attempters are ill’

But experts have described majority of people who attempt or commit suicide as suffering from psychiatric disorder and require medical help. Therefore because of the misconception, experts say many people associate the illness with spiritual attacks.

Sakeeb said, “Many people don’t realise that these people (who attempt to, or commit suicide) are ill and need medical help. There are some things we call ‘correlates,’ that is, factors that can predispose somebody to depression. It could be psychological, social or political. Age and sex also affect the rate of suicide; suicide rate is higher among the elderly, above 60 years and the adolescents.

“Many factors can contribute to it. It could be that the individual could not cope with the challenges of adolescent period. Males can be predisposed to alcohol abuse, which is associated with suicide. In female, fear of pregnancy or pregnancy can predispose them to try to attempt suicide.”

Adeosun said, “When things happen, it’s not what actually happens but how it is perceived. People have selective attraction or negativity syndrome, which is when you focus more on a particular aspect of an issue rather than the bigger picture.”

However, he added that not  everybody who commits suicide can be established to have a psychiatric disorder, saying that people could have social and environmental problems without having psychiatric disorder.

“Especially when it’s impulsive. for instance, somebody who just lost his job, and without thinking about it, just quickly commits suicide or somebody who doesn’t want a secret to be exposed and therefore, commits suicide,” he said.

Confirming the situation, Adeosun said that women have a higher tendency of committing suicide than men, but that men only tend to have more completion rate.

He said, “There are high expectations of females. They play the gender role of being the mother, the wife, housekeeper and so on. So, there is so much pressure on women. If a 40-year-old man is not married, he might not face as much pressure in the society as the woman.

 “It’s the woman that suffers the stress of pregnancy and labour and so there is a lot of stressors for women. So, because of this, women have higher rates of contemplating suicide. But when men contemplate suicide, they are more likely to complete it because they usually use more dangerous methods.”

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