De­pres­sion, among top killers in Bhutan

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Among the risk fac­tors con­tribut­ing to sui­cide in Bhutan, de­pres­sion had the high­est im­pact. Other risk fac­tors in­cluded men­tal health disor­ders such as bipo­lar dis­or­der and schizophre­nia.

Some of the ma­jor fac­tors which lead to sui­cides are psychosis, im­pul­sive be­hav­iors, cry­ing for help, philo­soph­i­cal de­sire to help and by mis­take.

In Bhutan, sui­cide ranks in top six lead­ing causes of death af­ter the al­co­hol liver dis­eases, other cir­cu­la­tory dis­eases, can­cers, res­pi­ra­tory dis­eases, and trans­port deaths.

To­day, Bhutan has 361 sui­cide deaths were doc­u­mented with the Royal Bhutan Po­lice in a five-year re­view of sui­cide cases from 2009 to 2013.

Although the global sui­cide rate has seen a dropped, how­ever, Bhutan wit­nessed a rise in the oc­cur­rence of sui­cide case. Dr. Dam­ber K. Nirola, Psy­chi­a­trist with na­tional re­fer­ral hospi­tal, writes in his blog spots, “Sui­cide rates in Bhutan have re- mained steady and rather in­creased par­tic­u­larly in the re­cent years.”

Be­sides, some of the ma­jor con­tribut­ing so­cial fac­tors iden­ti­fied were lack of job op­por­tu­ni­ties, the per­cent­age of bro­ken fam­i­lies, and a high rate of do­mes­tic vi­o­lence.

Ac­cord­ing to Dr. Dam­ber K. Nirola, there are sev­eral risk fac­tors that may con­tribute to thoughts of sui­cide, at­tempted sui­cide, and ac­tual sui­cide in­clud­ing pre­vi­ous sui­cide at­tempts, sub­stance abuse, be­ing ex­posed to sui­ci­dal be­hav­ior, fam­ily his­tory of sui­cide, poor job se­cu­rity or low lev­els of job sat­is­fac­tion and be­ing di­ag­nosed with a se­ri­ous med­i­cal con­di­tion, such as can­cer or HIV among oth­ers.

Dr. stated that peo­ple who have sui­ci­dal thoughts are of­ten so over­whelmed by feel­ings of sad­ness and hope­less­ness that they think they have no other op­tion. “If your friend or loved one isn’t in im­me­di­ate dan­ger but is hav­ing sui­ci­dal thoughts, then you can sim­ply speak to them about the chal­lenges they may be fac­ing.”

He also writes that bio-psy­choso­cial, en­vi­ron­men­tal and so­cio­cul­tural are the causes for in­creased sui­cide risk. “En­vi­ron­men­tal fac­tors that in­crease the risk for sui­cide of­ten oc­cur due to a stress­ful life event.”

Dr. Dam­ber K. Nirola added that one of the main so­cio-cul­tural causes of sui­cide is the feel­ing of be­ing iso­lated or of not be­ing ac­cepted by oth­ers. “Feel­ings of iso­la­tion can be caused by sex­ual ori­en­ta­tion, re­li­gious be­liefs, and gen­der iden­tity.”

The re­ported sui­cide cases are be­tween the age group of 15 to 40 years, which con­sti­tutes about 87 per­cent in the coun­try. The pro­por­tion at a higher risk for sui­cide was higher in men than in women above 45 years.

It is es­ti­mated that about 88 per­cent has oc­curred in ru­ral agri­cul­tural ar­eas among mar­ried at 66 per­cent with less ed­u­ca­tion and low in­come.

In Bhutan, for ev­ery 4.5 sui­cide deaths, there is one sui­cide at­tempted case recorded, in­di­cat­ing gross un­der-re­port­ing of the at­tempted cases.

Pol­icy ac­tion must take these state-level dif­fer­ences into ac­count to con­trol this po­ten­tially ex­plo­sive pub­lic health sit­u­a­tion. The gov­ern­ment di­rected to con­duct the study on sui­cide cases in the coun­try and im­ple­mented the sui­cide preven­tion pro­gram in the min­istry of health.

The Health Man­age­ment In­for­ma­tion Sys­tem (HMIS) of the health min­istry has been col­lect­ing data on “in­ten­tional self-harm” since 2010.

The cases of in­ten­tional self-harm re­ported in the health fa­cil­i­ties ranged from 502 to 682 cases while only 3 to 5 deaths due to in­ten­tional self­harm. Dr. Dam­ber K. Nirola stated that shows sui­cide at­tempt cases end up in health fa­cil­ity care. “Sui­cide at­tempts re­sult in an enor­mous cost to the health­care, fam­ily and in­di­vid­u­als due to in­jury and dis­abil­ity.”

Rais­ing com­mu­nity aware­ness and break­ing down the taboo is im­por­tant for coun­tries to make progress in pre­vent­ing sui­cide. To give aware­ness, the Min­istry of Health ob­serves the world sui­cide preven­tion day on 10 Septem­ber an­nu­ally.

Ac­cord­ing to the data pub­lished by the World Health Or­ga­ni­za­tion, about 800,000 peo­ple die due to sui­cide ev­ery year, which is one per­son ev­ery 40 sec­onds. Sui­cide is the sec­ond lead­ing cause of death among 15 to 29-year-olds glob­ally.

Sui­cide ac­counted for 1.4 per­cent of all deaths world­wide, mak­ing it the 18th lead­ing cause of death in 2016. 79 per­cent of sui­cides oc­curred in low and mid­dle-in­come coun­tries in 2016.

The coun­tries with the high­est sui­cide rates in 2018 ac­cord­ing to World Pop­u­la­tion Re­view are Sri Lanka with 35.3 sui­cides, South Ko­rea in East Asia with 28.3 sui­cides, Eastern Euro­pean coun­try of Lithua­nia with 32.7 sui­cides per 100,000.

A num­ber of other eastern Euro­pean coun­tries have high sui­cide rates, in­clud­ing Be­larus, Poland, and Latvia, all at around 22 sui­cides per 100,000.

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