Places of worship must address suicidal behaviour
SUICIDAL behaviour needs to become part of the conversation in mosques, temples and churches, says Dr Naseema Vawda, who presented her pilot study “Suicide Attempts During Pregnancy in South Africa”, at the KZN Department of Health’s Research Day at Inkosi Albert Luthuli Central Hospital last week.
Vawda, who heads the psychology unit at King Edward VIII Hospital, said the aim of the study was to establish what percentage of suicide attempters were pregnant and to identify their clinical and socio-demographic characteristics.
“While doing clinical work and supervising interns, I would notice an increasing trend over the years in which pregnant women were coming in with suicidal trends. That worried me because it was a new thing,” she said, explaining her choice of research topic.
Vawda said research on suicidal behaviour indicated that males are four times more likely to commit suicide than females, but that women are more likely to have suicidal thoughts.
Whereas maternal and child health issues, with injury and violence, have been identified (among) the quadruple burden of diseases facing the South African healthcare system, research on self-injury, such as suicide attempts during pregnancy, is limited.
Vawda said this was due to the belief that pregnancy was a protection against suicide and suicidal behaviour.
Using a retrospective chart review over one year, Vawda found that out of 27 attempted suicide cases, 9 women, or 33% of the sample, were pregnant at the time of the suicide attempt. Their attempts at suicide were precipitated by:
Partner relationship problems.
Family relationship problems. Witnessing the murder of a significant other. Financial stress.
Past psychiatric history. Previous suicide attempts. “The cause of suicide among pregnant women can be anything from arguments with a boyfriend to being reprimanded by parents for falling pregnant. Having said that, there were a few of the women who had been diagnosed with major depressive disorder, which could also have been a precipitative factor.”
Vawda said she believed the conversation on mental health and suicide, in particular, must be deepened in order to kill the stigma. This will encourage people to seek help. “It is like HIV or termination of pregnancy. We had those conversations, and we are moving forward. Mental health, whether suicide, suicidal behaviour, suicidal ideation, suicidal attempts or suicide carried out successfully, needs to be part of the conversation in mosques, temples and churches in the community.
“We must create awareness of the resources available to people who feel like that. Once you start destigmatising it and bringing it out into the open, people will be more willing to communicate about it. That would enhance prevention efforts and increase the likelihood of them approaching organisations that can help. We must remember that when people feel pressured to hide their pain, that is when they feel unsupported and go ahead and act on their feelings.”
In her conclusion, Vawda acknowledged that her sample size was small, but points out that the findings indicate that suicide attempts are not rare in pregnant women. She also calls for the routine monitoring of pregnant patients for “stressors”, mental illness and previous suicide attempts.
“When admitted, pregnant suicide attempters should be co-managed holistically by obstetricians, physicians and mental health professionals throughout pregnancy and antenatally.
The goal should be the early identification of stressors and the prevention of suicide attempts, therefore ensuring viable foetal outcomes and the prevention of negative long-term outcomes such as child abuse.”