ABSTRACT
Contemporary socio-economic problems such as overpopulation, poverty, and poor health care system have increased the number of adolescents and young adults that are susceptible to depression and suicidal ideation. In Nigeria, there are few studies on the prevalence and causes of depression and suicidal ideation among adolescents, and particularly family-induced ones. This study, therefore, examined the relative contributions of certain socio-demographic variables (age, gender, and class in senior secondary school) and family variables (family size, family type, and birth order) as factors associated with depression and suicidal ideation among young people in FCT, Nigeria.
Emotional security and emotion regulation theories provided the framework, while a cross- sectional survey design was adopted. One thousand young people were randomly selected from four Local Government Areas (LGAs) to represent urban LGAs (FCT North and FCT North West) and semi-urban LGAs, (Ido and Akinyele) in Abuja, Nigeria, through cluster sampling and stratified sampling techniques. Ten Senior Secondary Schools were randomly selected from each of the four LGAs. Participants completed a structured questionnaire that contained items on socio-demographic and family variables, a depression subscale of Trauma Symptom Checklist 40 (𝖺= 0.67), and Positive and Negative Suicide Ideation Inventory (𝖺= 0.77). Data were analysed using Analysis of variance and t-test for independent samples at p≤0.05.
The participants’ mean age was 14±1.52; 44.3% were males and 55.7%. About 15.0% of the respondents were in Senior Secondary School Class 1, 39.3% were in Senior Secondary School Class 2, and 45.7 % were in Senior Secondary School Class 3, 62.6% were below seven in family, 37.4 % were seven or more in family; 67.3% were from monogamous families while 32.7% were from polygamous families, 69.7% were low birth order, while 30,3% were higher birth order. Depression was reported by 21.2% while 38.3% reported suicidal ideation. Adolescents in urban LGAs reported higher suicidal ideation and depression than those in semi- urban LGAs. There was significant variation of depression on family size (F (3, 995) = 6.39), those adolescents from family with 10 or more members significantly reported higher depression than adolescents from family with 4-6 and 7- 9 members. Family size also significantly influenced suicidal ideation (F (3, 995) = 11.04), those adolescents from family with seven or more members significantly reported higher level of negative suicidal ideation than adolescents from family with below seven and seven and above members. Higher birth order significantly influenced level of depression (F (4, 994) = 6.76), and negative suicidal ideation (F(4, 994) = 3.39). Adolescents within 16th - 20th birth order were more depressed than 1st born, 2nd - 5th, 6th - 10th, and 11th - 15th. Adolescents from polygynous family were significantly higher on depression (t (996) = 4.40) and negative suicidal ideation (t (996) = 4.03) than adolescents from monogamous families.
Large family size, polygamous and higher birth order influenced depression and suicidal ideation among sampled young people in FCT, Nigeria. Mental health professionals and parents/care givers should therefore consider these factors in mental health services.
Keywords: Young people, Family size, Family type, Suicidal ideation
Word count: 497
CHAPTER ONE
INTRODUCTION
1.2 Background to the Study
Contemporary socio-economic problems such as overpopulation, poverty, and poor health care system have increased the number of adolescents and young adults that are susceptible to depression and suicidal ideation. In Nigeria, there are few studies on the prevalence and causes of depression and suicidal ideation among adolescents, and particularly family-induced ones. This study, therefore, examined the relative contributions of certain socio-demographic variables (age, gender, and class in senior secondary school) and family variables (family size, family type, and birth order) as factors associated with depression and suicidal ideation among young people in FCT, Nigeria.
Suicidal Ideation is considered to be a significant antecedent to later attempt and accomplished suicides (Brent, Johnson, Bartle, Bridge, Rather, Matta…Constantine, 1993; Gili-Planas, Roca- Bennasar, Ferrer-Perez, and Bernardo-Arroyo, 2001) moreover it is of main public health consequence. Nationwide investigation estimates that 11.4% of college students extremely reflected on attempting suicide in the previous years, 7.9% concluded a suicide plan, and 1.7% tried suicide (Barrios, Everett, Simon, and Bremner, 2000, Olley, 2006). Suicidal behaviour (SB) denotes a range of behaviours that comprises thought of suicide (or ideation), scheduling for suicide, threats of suicide, trying of suicide and suicide itself. The annexation of ideation in suicidal behaviour is a multifaceted matter around which there are evocative constant academic discourse (Thompson, et al 2012).
Every single suicide is a catastrophe that distresses families, communities and whole countries and has enduring impacts on the individuals left behind. Suicide can ensue at all age and remained the second prominent source of death amongst 15–29-year-olds universally in 2012 (World Health Organisation, [WHO], 2014). According to WHO (2014), over 800,000 individuals die by suicide each year – about one individual each 40 seconds, with 75% of suicides taking place in low- and middle-income nations.
Suicide is an obdurate public health problem; besides it is avertible with appropriate, evidence-based and time and again inexpensive interventions. Meant for nationwide retorts to be in effect, a wide-ranging multi-sectoral suicide deterrence scheme is required (WHO, 2014). Suicidal behaviours (SB) characterize a foremost economic and societal encumbrance for contemporary societies. In spite of continuous research designed at recognizing demographic and clinical risk elements, active deterrence of SB remains a foremost encounter (Husky, McGuire, Flynn, Chrostowski, and Olfson, 2009).
The concern of suicide is a multifarious one and deterrence efforts against it oblige interdisciplinary teamwork amid health care specialists. The psychological and social impact of suicide on the family and society is massive. On the average, a single suicide grievously upsets at least six additional individuals. If a suicide ensues in a school or workplace its side effect impacts on hundreds of other individuals. The burden of suicide can be projected in terms of DALYs (Disability-Adjusted Life Years), DALY is a measure of total disease burden, specified as the amount of years lost owing to ill-health, disability or early death (WHO, 2016).According to this indicator, in 1998, suicide was accountable for 1.8% of the total burden of diseases worldwide, fluctuating between 2.3% in high- income countries and 1.7% in low-income countries. This is equal to the burden due to wars and homicide, roughly twice the burden of diabetes, and equal to the burden of birth asphyxia and trauma. (WHO, 2000)
Suicidal predisposition or Adolescent Suicidal Behaviour (ASB) and depression are weighty civic wellbeing glitches and energies have been strengthened to comprehend suicidal ideation and depression among Young people. Suicidal ideation occurs on a continuum from suicidal ideation to completed suicide (Evans, Hawton, and Rodham 2004; Thompson, Proctor, English, Dubowitz, Narasimhan and Everson, 2012) whereas the continuum of depression exists from mild to profound (American Psychiatric Association, [APA], 2013). Depression among adolescents is an uncommon and habitually unrecognized matter in pediatrics. Children and adolescents conversely agonize from both depression and concomitant symptoms (Chinawa, Manyike, Obu, Aronu, Odutola, Chinawa, 2015, Gureje, Ademola and Olley, 2008).
According to Chinawa et. al. (2015) it is recognised and documented that adolescents do undeniably suffer from both depressive symptoms and depressive disorders and they further stated that, adolescence is a critical period for the development of depressive disorders. Depressive symptoms among adolescents are often attributed to the normal stress seen at this stage of life. This is often misdiagnosed as primarily conduct or substance abuse disorders. Neglecting depression among adolescents can have a awful and deleterious the consequence. Depression appears as a factor related to suicide. Early in the 20 century, it was alleged that children as well as adolescents could not suffer from depression. Later in the century, psychologists have come to the knowledge that children can get depressed; though, numerous findings established that childhood depression is different from adult depression (Clarizio, 1989). Some typical symptoms of depression in adolescents are melancholy, suicidal ideation, aggressive behaviour, sleep disturbances, changes in school performance, diminished socialization, and changes in appetite (Clarizio, 1989, Gureje, Ademola and Olley, 2008.).
A foremost cause or trigger of depression in adolescents is assumed to be distress. A predisposition to depression may be implicated; even so, the additive stresses of everyday adolescent life often appear to trigger depression (Clarizio, 1989). According to Pfeiffer, (1989) “There is a complex relationship between depression and suicide. Many depressed patients are suicidal, and, conversely, most but not all suicidal individuals manifest depressive mood and symptoms if not depressive illness”. In a study by Rubenstein, Heeren, Housman, Rubin, and Stechler (1989), 300 high school students out of 1,124 in grades nine through twelve participated in a study that intended to differentiate risk and protective factors in suicidal and non-suicidal high school students. Depression and life stress were found to be risk factors for suicide. It was determined that family interconnection can counterweight life stressors. They also found that moderate to severe levels of depression posed an internal risk factor for suicidal ideation in adolescents. Further, those who scored high in the clinically depressed range on the Beck Depression Scale were at a greater risk for suicidal ideation.
The association between adolescent depression, suicide ideation and familial factors has been noted by a number of investigators (Bayatpour, Wells, and Holford, 1992; deWilde, Kienhorst, Diekstra, and Wolters, 1992; Pfeffer, Lipkins, Plutchik, and Mizruchi, 1988; Clarizio, 1989; O’Connor, 2011a; 2011b), but models of the process that links these two public health problems have not yet been adequately tested. Consideration of the epidemiological characteristics of depression and suicide ideation brings into sharp focus the need to understand that process. Although depression and suicide has more often been considered a problem pertaining primarily more to adults, both mental health conditions are now known to have substantial applicability to adolescents (Clarizio, 1989; Centre for Disease Control and Prevention [CDC], 1995), Suicide is the second most frequent cause of death among adolescents (CDC, 1995).
1.2 Statement of Problem
Alarming statistics, from 2003-04 suicide rates showed that suicide rate among females. between ages 10-19 and males between ages 15-19 increased significantly (CDCP, 2006). Between 1970 and 1990, suicide rates tripled among children between the age of 5 and 14 years. Overall suicide rate of children and adolescents have increased to over 300% since the 1950s. More adolescents die by suicide than from cancer, AIDS, birth defects, stroke, pneumonia, influenza and lung disease combined. During the year 2000, almost 4000 adolescents aged 15 to 24 years killed themselves ( …….). Ninety percent (90%) of adolescents who die by suicide usually suffer mental health problems, especially depression, substance abuse or both. It would be important to examine whether familial factors have ability to influence depression and suicidal ideation among adolescents in FCT, Abuja, Nigeria. Familial factors could be trigger of significant risk factors for mental health of adolescents (Clarizio, 1989; CDC, 1995), it is not known whether theses variables would influence depression and suicidal ideation in FCT, Nigeria.
Adolescence marks a complex period of transition between childhood and adulthood (Story, Neumark-Sztainer, and French, 2002) Despite these needs, youths with suicidal ideation are especially unlikely to seek help (Husky, McGuire, Flynn, Chrostowski, and Olfson, 2009) and their suicidal ideation is often not recognized by others in their lives (Thompson, Dubowitz, English, Nooner, Wike, Bangdiwala,…Briggs, 2006). It is important, therefore, to better understand the factors that indicate risk of suicidal ideation among youths. (Thompson, et al 2012). General population epidemiological surveys of adolescents indicate that such acts occur more frequently than is suggested by hospital statistics (Choquet and Ledoux, 1994; Hawton, Rodham, Evans, and Weatherall, 2002). Such studies can also define the characteristics of adolescents who self-harm, or have suicidal ideas, which can assist in the early identification of adolescents at risk and inform both prevention and intervention strategies. A large number of factors which may contribute towards the occurrence of suicidal phenomena have been identified, including individual characteristics, such as depression, low self-esteem, family and social factors (O’Connor, 2011a; 2011b).
According to WHO (2014), globally, the availability and quality of data on suicide and suicide attempts is poor. Only 60 member states have good-quality vital registration data that can be used directly to estimate suicide rates. This problem of poor-quality mortality data is not unique to suicide, but given its sensitivity and the illegality of suicidal behaviour in some countries, – it is likely that under-reporting and misclassification are greater problems for suicide than for most other causes of death. Suicidal ideation and depression among Young people remains an important clinical problem and the major cause of death among youths (Amitai and Apter, 2012). Given the challenge of depression and suicidal ideation therefore, linking familial factors would be substantial step forward, helping to update knowledge, of the impact of familial factors and thus improving the ability to treat the maladaptive behaviour of depression and suicidal ideation.
1.3 Research Questions
The following research questions were posed:
1. Will young people from urban LGAs significantly report more depression than those in semi urban LGAs in FCT, Abuja, Nigeria?
2. Will young people from urban LGAs significantly report more suicidal ideation than those in semi urban LGAs in FCT, Abuja, Nigeria?
3. Will Family size significantly influenced depression levels among young people in FCT, Abuja, Nigeria?
4. Will Family size significantly influenced suicidal ideation levels among young people in FCT, Abuja, Nigeria?
5. Will birth order significantly influence depression levels among young people in FCT, Abuja, Nigeria?
6. Will birth order significantly influence suicidal ideation levels among young people in FCT, Abuja, Nigeria?
7. Will young people from monogamous family significantly report more depression than those from polygamous family in FCT, Abuja, Nigeria?
8. Will young people from monogamous family significantly report more suicidal ideation than those from polygamous family in FCT, Abuja, Nigeria?
1.4 Purpose of Study
The main purpose of this study is to examined the relative contributions of certain socio- demographic variables (age, gender, class in senior secondary school) and family variables (family size, family type, birth order) as factors associated with depression and suicidal ideation among young people in FCT, Abuja, Nigeria. Specific objectives toward realizing this goal include:
1. To examine whether the young people from urban LGAs will significantly report more depression than those in semi urban LGAs in FCT, Abuja, Nigeria.
2. To examine whether the young people from urban LGAs will significantly report more suicidal ideation than those in semi urban LGAs in FCT, Abuja, Nigeria.
3. To investigate if family size will significantly influenced depression levels among young people in FCT, Abuja, Nigeria.
4. To investigate if family size will significantly influenced suicidal ideation levels among young people in FCT, Abuja, Nigeria.
5. To enquire whether birth order will significantly influence depression levels among young people in FCT, Abuja, Nigeria.
6. To enquire whether birth order will significantly influence suicidal ideation levels among young people in FCT, Abuja, Nigeria.
7. To explore whether young people from monogamous family will significantly report more depression than those adolescents from polygamous family in FCT, Abuja, Nigeria.
8. To explore whether young people from monogamous family will significantly report more suicidal ideation than those adolescents from polygamous family in FCT, Abuja, Nigeria.
1.5 Significance of the Study
The focus of this present study will facilitate the scaling up of comprehensive quantitative data on suicidal ideation and depression among young people in FCT, Abuja, Nigeria. This study will be relevant in contributing data to the identification of young people at risk of suicide attempt based on the familial factors under consideration. Many of the available epidemiological studies which suggest high prevalence of adolescent depression and suicide attempts were based on samples of hospitalized adolescents; in view of this, they have a number of limitations.
First, the generalisability of findings to community samples cannot be assumed. Second, previous studies have relied on retrospective report, whereas only prospective research (such as this study) would provide information about the extent to which characteristics precede, and predict a future suicide attempt among adolescents (Andrews and Lewinsohn, 1992).
The findings of this research will contribute to emerging empirical literature on depression and suicidal ideation among young people in FCT, Abuja, Nigeria. The scientific relevance of this study is of advantage to the practice of clinicians when the knowledge would be applied in preventing the condition of distress among young people.
Furthermore, the outcome of this study will be useful in subsequent quantitative and qualitative research on depression and suicidal ideation among young people.
The findings of this study will also avail researchers, clinicians and teachers insights into further research areas on depression and suicidal ideation among young people. It is noteworthy that Nigeria is among the United Nations countries lagging behind in comprehensive data for suicide behaviour (WHO, 2014).
1.6 Limitation of the Study
The use of a community-based sample may have helped to avoid the bias inherent in clinical based research since all of the information gathered was based on retrospective reporting, a potential problem for lifetime diagnoses and for the disclosure of information regarding familial factors. However, a review by Rutter and Maughan (1997) suggests that retrospective self-reports regarding some variables are more likely to be biased towards under reporting than exaggeration. These potential limitations, notwithstanding, the current study has contributed to research in depression and suicidal ideation among non-clinical populations by using young people for the study. It has therefore contributed to the understanding of the dependent variables. Other studies are required to replicate these findings and work out intervention modalities. The use of longitudinal studies in further studies will also help to unravel the causal directions between these factors. Further research in this area can also explore or consider intervening variables and or the protective factors.
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