Noorullah, Aisha

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Pakistan Journal of Neurological Sciences (PJNS) Volume 16 Issue 3 Article 5 9-2021 Suicide, A Convoluted Challenge in Covid-19 Era Aisha Noorullah Aga Khan University Pakistan Follow this and additional works at: https://ecommons.aku.edu/pjns  Part of the Neurology Commons Recommended Citation Noorullah, Aisha (2021) "Suicide, A Convoluted Challenge in Covid-19 Era," Pakistan Journal of Neurological Sciences (PJNS): Vol. 16 : Iss. 3 , Article 5. Available at: https://ecommons.aku.edu/pjns/vol16/iss3/5 of suicides need to be improved. Urgent need to revisit decriminalization of suicide. Feeling connected toeach other is vital human need and is desired today more than ever. Making sure people have regular check invirtually, no one lacks ties with society. Promoting the new availability of vaccines and proved timelimitations of these pandemic may overall result in optimistic outcome. It is the right moment for doingthe root cause analysis of this global public health problem. We can utilize this adverse pandemic situationinto an opportunity for policy implications, not the proposed policies but the implemented oneeverywhere and for every one because the mental health really matters!SUICIDE, A CONVOLUTED CHALLENGE IN COVID-19 ERA!Aisha Noorullah,11Senior Instructor, Department of Psychiatry, Aga Khan University Hospital, Karachi Correspondence Author: Aisha Noorullah Affiliation: Senior Instructor, Department of Psychiatry, Aga Khan University Hospital, Karachi  Email: aishasid01@gmail.comDate of submission: April 28, 2021 Date of revision: September 15, 2021 Date of acceptance: September 22, 2021The enigmatic, precarious, and menacing Coronavirus-19 pandemic has flooded almost all corners of theworld globally revealing its devastating effects in multiple spectra of life. The famous notion that no healthcan ever be achieved without mental health is the best fit in today’s emerging mental health needs morethan ever. The psychological effects of pandemic are expeditiously unfolding making it compulsory for allthe professionals to live on the qui vive globally but specifically in low- and middle-income countries likePakistan where mental health is still a struggling discipline for service users and service providers.Suicide is the tenth [1] leading cause of death worldwide. Media reports numerous cases of suicide duringthis COVID-19 era. A man [2] in Islamabad who was suspected to suffer from some psychiatric illness,committed suicide. Approximately one month after this, a father took his life [3] due to starvation of hischildren in quarantine. Another case in Karachi worth investigation is of a lady who committed suicide [4]after killing her children. A post-doctoral student [5] committed suicide who was being harassed by hersupervisor and had multiple rejections of her thesis. Pakistani national data on suicide and deliberate self harmis not available due to diverse reasons [complexities surrounding societal, religious and legal system]so these reported cases at various media forums are important indicators that the frequency is escalatingrapidly. A multitude of conventional predisposing, precipitating and perpetuating pre-pandemic risk factors ofsuicide may be exacerbated in COVID-19 compounded with new emergence of devastating bio-psychosocial circumstances which may further escalate the risk of suicide. Let’s piece together etiological partssurrounding COVID-19 which may mount these cases. The most congruous research findings of proximal risk factors of suicide state the large majorities of those who die from suicide [6] have some form of psychiatric disorders. People who are already diagnosed with some psychiatric disorders are lost to follow up, have relapse of symptoms or non-compliance with medications due to fiscal financial realities. The new unattended and undiagnosed cases are also heading towards poorer prognosis due to longer duration of untreated illness. The rates of suicide are known to be higher in the unemployed cohort [7], in the current situation, economic depression [8] is leading to higher rates of unemployment. The domestic violence has increased in this pandemic globally which poses a high risk of suicide. Rising trends of divorce stemming from domestic abuse of various sorts may also confer additional risk. Durkheim, has emphasized the importance of social disintegration [9] as a precipitating event in tolling the cases of suicide. When societies undergo major transformations, those who feel detached from society may commit suicide. Social fragmentation in today’s scenario is enough to precipitate this event. In Pakistan a culture of “men don’t cry”, escalate the risk for men by not seeking professional help for mental health problems. Physical illnesses always pose higher risk for suicide, the morbidity in the short and longterm stemming from COVID-19 is a risk factor of suicide. The high mortality from COVID-19 leaves behind caregivers who may develop complicated grief, acute stress disorder and post-traumatic stress disorder. High rates of suicides have been reported among doctors,[10] front-line professionals[11] in this humanitarian emergency are also subsumed under red umbrella to be at the high risk of suicide. Many of the above-mentioned factors may lead to hopelessness which independently increases the risk of suicide.               Ways Forward:Suicides are preventable and they should be prevented. The seriousness of this subject isreflected in the national and international initiatives for suicide prevention. Availability of moreaccessible, affordable and cost-effective psychiatric services is a viable option including tele mental healthservices. Concept of mental health help lines is already emerging, need to expand with regard to specificsuicide help lines. Establishing supportive psychological services for front-line workers who are sufferingfrom deteriorating psychological well-being may also help. At a national level reporting and registration4 3P A K I S T A N  J O U R N A L  O F  N E U R O L O G I C A L  S C I E N C E S V O L .  1 6  ( 3 )  J U L Y - S E P  2 0 2 1C O M M E N T A R Yof suicides need to be improved. Urgent need to revisit decriminalization of suicide. Feeling connected toeach other is vital human need and is desired today more than ever. Making sure people have regular check invirtually, no one lacks ties with society. Promoting the new availability of vaccines and proved timelimitations of these pandemic may overall result in optimistic outcome. It is the right moment for doingthe root cause analysis of this global public health problem. We can utilize this adverse pandemic situationinto an opportunity for policy implications, not the proposed policies but the implemented oneeverywhere and for every one because the mental health really matters!4 4P A K I S T A N  J O U R N A L  O F  N E U R O L O G I C A L  S C I E N C E S V O L .  1 6  ( 3 )  J U L Y - S E P  2 0 2 1        Figure # 01- Interconnected Web of Etiological Factors of Suicide                                                                             Covid-19 Era Psychiatric Disorders Deterioration & emergence of new cases !Economic depression Unemployment Increase poverty/financial issues Serious physical illness Long term morbidity Health care professionals Sudden mortality Complicated grief/Acute Stress Disorder/PTSD in caregivers Hopelessness Social Isolation  Domestic Violence Conflict of interest: Author declares no conflict of interest.Funding disclosure: NilAuthor’s contribution:Aisha Noor ullah; data collection, data analysis, manuscript writing, manuscript review4 5P A K I S T A N  J O U R N A L  O F  N E U R O L O G I C A L  S C I E N C E S V O L .  1 6  ( 3 )  J U L Y - S E P  2 0 2 1References:1. Hawton K, Saunders KE, O'Connor RC. Self-harm   and suicide in adolescents. The Lancet. 2012 Jun   23;379(9834):2373-82.2. ShakeelQarar, MunawerAzeem. Man, Self    Immolates Outside PM secretariat in Islamabad.   Dawn. 2020 Apr 04. Available from: https://www.dawn.com/news/1546155 3. Newstrack.Father Committed suicide after  watching condition of children. 2020 May 15. Available from:       https://english.newstracklive.com/ news/father-committed-suicide-after- watching-children-condition-pakistan- ramadan-lockdown-sc103-nu612-ta612- ta277-1092497-1.html4. Omair Kamran. Woman poisons children and    commits suicide in Karachi. Blogs Siasat.  2020 Aug 13. Available from:     https://blog.siasat.pk/woman-poisons- children-suicide-karachi/5. Web Desk . Doctoral Student Commits Suicide in   Karachi.Daily Times.2020 Aug 17.Available from :   https://dailytimes.com.pk/655245/doctoral- student-commits-suicide-in-karachi/6. Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM.   Psychological autopsy studies of suicide: a    systematic review. Psychol Med. 2003  Apr 1;33(3):395.7. Blakely TA, Collings SC, Atkinson J. Unemployment   and suicide. Evidence for a causal association? J   Epidemiol Community Health .2003  Aug 1;57(8):594-600.8. Rasheed R, Rizwan A, Javed H, Sharif F, Zaidi A.   Socio-economic and environmental impacts of    COVID-19 pandemic in Pakistan—an integrated   analysis. Environ Sci Pollut Res. 2021 Jan 6:1-8.9. Course Hero. "Suicide: A Study In Sociology Study   Guide." March 20, 2020.  Accessed from:       https://www.coursehero.com/lit/Suicide- A-Study-In-Sociology/book-2-chapter-5-summary/10.Kingston AM. Break the silence: physician  suicide in the time of COVID-19. Mo Med. 2020 Sep;117(5):426. 11.Jahan I, Ullah I, Griffiths MD, Mamun MA.    COVID-19 suicide and its causative factors among   the healthcare professionals: Case study evidence   from press reports. Perspectives in psychiatric  care. 2021 Feb 5.

Suicide, A Convoluted Challenge in Covid-19 Era

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Suicide, A Convoluted Challenge in Covid-19 Era

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