Dear Editor,
Policy makers and social activists felt relieved in early 2022 when the reported suicide rate declined (by 21.7%) between 2016 (23.4 per 100,000) and 2021 (18.3 per 100,000), partly in response to initiatives linked to the Government’s National Suicide Prevention Strategy 2015-2020 (NSPS), and National Mental Health Action Plan, 2015-2020, as well as to the work of NGOs, but the suicide problem persists and remains significant. When “suicides” are combined with “suicide attempts” (e.g., for every suicide, there are 7 attempts), not to mention suicidal ideation (which ranges from 14% to 40%), the picture of the suicide problem is altered considerably.
The combined data on “suicide” and “suicide attempt” show that females have a higher rate than males, even though fewer females die of suicide than males. Suicidal acts of women are often spontaneous and are more likely than men to take less potent substance (such as kerosene, OTC drugs, and sleeping tablets) as well as lower dosage of toxins. Blocking the access to poisonous substance like gramoxone or carbon tablets to men who plan their suicidal act makes some of them turn to hanging. Using sample data (2014), the “suicide attempts” were combined with “suicides” and a different picture of what has been usually portrayed, emerges: the rate among Indo-Guyanese and Afro-Guyanese was almost similar (Indo-Guyanese had a rate of 36.33 per 100,000 compared with 36.2 per 100,000 for Afro-Guyanese). The data also show that for Indo-Guyanese, suicide attempts were 6.7 times more than suicides, while for Afro-Guyanese the attempted suicide rate was 7.9 times more than suicides.
Data on suicide attempts for 2018, though deficient, indicate similar trend in two areas: females continue to have a higher rate of attempted suicide than men (1.52 times), and 2/3 of all suicide attempts were reported for regions 2 and 6. Data on other relevant variables like proportion in each ethnic group, were lacking. The difference in ‘suicides+suicide attempts’ rates between Afro-Guyanese and Indo-Guyanese is statistically not significant at <.05 level (X=2.7526). These data show that using proportions (%) alone provides an incomplete picture of the suicide problem, especially from a comparative perspective. Rate is a better barometer of suicidal behaviour. While data (2018-2021) on suicide attempts are grossly under-reported, partly because of constraints imposed by Covid-19, nevertheless whatever exists reinforces the historical trend in few areas such as gender disparity, ethnic proportion, and youthful age, but the reports are devoid of other important analytic information such as regional distribution and methods used.
The suicide problem is much deeper than what is usually portrayed in reports on suicides. Suicidal ideation, a process by which persons develop and harbour suicidal thoughts, either active or passive, is a major growing concern. Active ideation could result in suicide or suicide attempts, while passive ideation remains at the thought level. A report by Charlotte Shaw et al indicates that suicidal ideation is more pronounced in females than males. While data on suicide attempts and suicidal ideation could lead to analytic refinement, what appeals most to people are not abstract data but the real-life stories of suicide victims and how families and communities are impacted. The gruesome murder-suicide in a village on the East Coast Demerara as well as another brutal murder-suicide on the Essequibo Coast have rocked their villages as well as the country. Several months before, a university lecturer died by suicide. These and other suicide stories point to the nagging underlying conditions like marital conflicts, family/domestic problems, infidelity, hopelessness, depression, loss of status that result in suicidal behaviour.
Studies on suicide show that proportionately (i) more Indo-Guyanese (80%) die of suicide than any other ethnic group; (ii) the youthful population are at greater risks of suicide than the older folks; (iii) males have a higher rate than females; (iv) more suicides occur in rural areas; (v) a higher proportion of Hindus die of suicides compared with other religious groups: of the 101 suicide cases in which religious affiliation was identified, Kay Shako reports that Hindus comprised 49.5%, Muslims 8.9%, Christians 35.6%, and Others 5.9%. (The Hindu rate of 23.9 per 100,000 was 1.4 times higher than the Muslim rate of 17 per 100,000 and 1.5 times higher than the Christian rate of 15.5 per 100,000); (vi) poisoning and hanging were the most common methods used in the suicidal act. Data on suicide for 2017-2021 as well as on suicide attempts alter the conventional profile of suicides among Guyanese. The national proportion of Indo-Guyanese that died of suicide fluctuated from 65.2% in 2018, to 50.7% in 2019, to 63.9% in 2020 and to 73.1% in 2021. There have been significant changes in age structure of persons of all ethnic groups who died of suicide.
In 2018, the age group 79+ had the highest rate (40.84 per 100,000), in 2019 for the 65-69 age group had the highest rate (57.82 per 100,000); in 2020, the age group 70+ had the highest rate (44.93 per 100,000); and in 2021 the age group 65-69 had the highest rate (43.37 per 100,000). The suicide hotspots have been thought of as in regions 2 and 6, but Region 5 had surpassed them in
suicide rate in 2017, 2018, 2019, and 2020. Also, the method used in suicide and attempts are changing. In 2010, 28% of Afro-Guyanese (suicides and suicide attempts) used kerosene compared with 6.3% for Indo-Guyanese. In 2011, the proportion of Afro-Guyanese that used kerosene was 29.9% compared with 7.1% for Indo-Guyanese. Malathion, a common method in the 2000s, has given way to gramoxone, carbon tablets, other toxins and hanging. At an annual average (2017 and 2021) the proportion of persons that died of suicide from poison was 55% while the annual average proportion for hanging for the same period was 37.7%. Isolation, genetic, poor health, over regulation, hopelessness, faulty socialization, and depression, are some of the underlying reasons for ‘suicides,’ ‘suicides attempts’ and ‘suicidal ideation.’
However, analysis of case studies shows that just one component (such as rejection, alcohol/drugs, witchcraft/obeah, shaming, poor health, hopelessness, and depression) could trigger the suicidal behaviour. A comparative study of suicidal behaviour with Trinidad & Tobago (T & T) could generate insightful explanations on causes or correlations. Although TT and Guyana have a similar demographic structure and a common history, the existing suicide rate (18.34 per 100,000) of Guyana is 2 times higher than that of TT (9.12 per 100,000). Is the differential level of modernization between the two countries an important variable in suicidal behaviour? The long-term study by Columbia University is expected to determine the magnitude, pattern, causes, intervention techniques, and preventive measures relative to the suicide problem. The new National Suicide Prevention Strategy (2020-2025) and the National Mental Health Action Plan (2020-2025) are likely to include the Gatekeepers, the Safety (poison) Box program, and a National Suicide Prevention Commission. The result of the Columbia University study could be incorporated into these Health Plans whenever this becomes available. Suicidal behaviour deserves priority attention by the government, and it should continue to engage the national consciousness.
Sincerely,
Dr. Tara Singh
