OMEGA, Vol. 62(2) 169-186, 2010-2011
A QUALITATIVE STUDY OF ATTITUDES
TOWARD SUICIDE AND SUICIDE PREVENTION
AMONG PSYCHOLOGY STUDENTS IN GHANA
BIRTHE LOA KNIZEK
Norwegian University of Science and Technology, Trondheim
CHARITY SYLVIA AKOTIA
University of Ghana, Legon
Norwegian University of Science and Technology, Trondheim,
and Norwegian Institute of Public Health, Oslo
The purpose of the present study was to investigate attitudes toward suicide
and suicide prevention among psychology students in Ghana by means of
a qualitative analysis of open-ended questions about causes of suicide and
how suicide best can be prevented. The students mainly saw the causes as
intra-personal and almost all of them believed that suicide can be prevented.
The results indicated a huge impact of religion on the attitudes toward suicide
as well as some lack of distinction between their religious and professional
roles and responsibilities.
Suicidal behavior is a continuous challenge around the world and the World
Health Organization (WHO) estimates that about one million people kill them-
selves every year (2005). However, this challenge has not been taken up in all
parts of the world yet. For instance, most parts of Africa lack official suicide
? 2010, Baywood Publishing Co., Inc.
publicstatistics,thesizeof theproblemisunknown inthiscountry butestimations
done by Hjelmeland and colleagues (2008a) indicate that the problem is large
enough to necessitate suicide preventive efforts. Their estimations were based on
comparisons of experiences of suicidal behavior among students in Ghana and
Uganda with analogous experiences among students in a country with reliable
suicide statistics: Norway. These estimations are still not substantiated by proper
epidemiological studies, but we have reasons to believe that suicidal behavior
can be considered a serious public health problem in Ghana. This calls for suicide
Attitudes are important when action is to be taken. For instance, attitudes
toward suicide may affect health care workers’ will to intervene in suicidal
crises or to treat those who deliberately have harmed themselves (Bagley &
Ramsey, 1989). Research has shown that suicide is perceived negatively in
African countries (e.g., Eshun, 2003; Hjelmeland et al., 2008a; Lester & Akande,
1994; Peltzer, Cherian, & Cherian, 1998). In Ghana, suicidal behavior is
considered criminal and thus carries legal as well as social sanctions. In
some families/clans cleansing rituals are required. Eshun (2003) has shown
that Ghanaian college students have significantly more negative attitudes toward
suicide than their American counterparts and has recommended qualitative
studies in future research in order to get more detailed or informative results
(Eshun, 2006). The same trend of negative attitudes was found in a study by
Hjelmeland and colleagues (2008a), where Ghanaians saw suicide more as a
taboo compared to Ugandans and Norwegians. The difference between Ghana
and Uganda was interesting in so far as the vast majority in both countries are
very religious (Gifford, 1999), but the impact of religion on attitudes toward
suicide seems to differ in students from these two countries. Religious people
are found to be considerably more intolerant toward suicide than less religious
people (see Koenig, McCullough, & Larson, 2001, for an overview), and
to believe more in suicide prevention (Bascue, Inman, & Kahn, 1982). In
contrast to this, Hjelmeland et al. (2008a) found that the Ghanaians seemed
more reluctant than the Ugandans to help suicidal persons. We therefore
wanted to study the Ghanaian psychology students’ attitudes more in-depth.
Another reason for this is that a Mental Health Bill is under preparation in
order to improve the mental health services in Ghana (WHO, 2007). It is
likely that these future gatekeepers will be involved in this one way or the
other and may, for instance, be able to influence the construction of suicide
prevention programs. The purpose of the present study was thus to investigate
psychology students’ negative attitudes toward suicide more in-depth as well
as these attitudes’ relation with their religious/spiritual viewpoints. This was
done by qualitative analyses of the students’ responses to open-ended ques-
tions regarding the most important causes of suicide and how suicide could
170/ KNIZEK, AKOTIA AND HJELMELAND
Instrument and Procedure
The Attitudes Toward Suicide questionnaire (ATTS) developed by Salander
Renberg and Jacobsson (2003) was employed in the study. This questionnaire
consists of a number of questions to be scored quantitatively on issues such as
experiences of suicidal behavior, attitudes toward suicide and suicide prevention,
and life-satisfaction. In addition, two open-ended questions are included, namely
“What is the most important cause of suicide?” and, “What do you think can be
done to prevent suicide?” The questionnaire is presented in detail by Salander
Renberg and Jacobsson (2003). In the present study we report the results of the
qualitative analyses of the open-ended questions, whereas some of the quanti-
tative findings have been reported previously (Hjelmeland et al., 2008a). In this
previous publication, qualitative studies are recommended in order to improve
the general knowledge but also to develop the ATTS into a more culture sensitive
instrument. The present study is a contribution to such an endeavor.
The questionnaire was handed out in class to psychology students at all
levels of the study. Because of a very large number of students at the first four
levels, a stratified sampling (by gender) was conducted in these classes, while all
students from the fifth level filled in the questionnaire. The data were collected in
2002. The questionnaire was in English, which is the medium of instruction in
schools in Ghana. The study was approved by the relevant ethical bodies both
in Norway and in Ghana.
The total number of participants of the study was 570: 274 women (48%),
290 men (51%), 6 nondisclosing gender (1%). The response rate was 100%.
One hundred and ninety-six (34.4 %) of the participants had responded to at least
oneof theopen-ended questions. Asoneperson cangivemorethanonestatement,
our entire data material for the qualitative analysis was 476 statements from 196
students for the question on causes and 311 statements from 190 students on the
question about prevention.
As reported in Hjelmeland et al. (2008a), 2% (N = 11) of these students had
attemptedsuicide during the last year, whereas 3% (N = 19) had attemptedsuicide
earlier in life. Ten percent (N = 53) had experienced attempted suicide and
almost 2% (N = 9) had experienced suicide in their family, while 37% (N = 192)
had experienced attempted suicide and 17% (N = 91) had experienced suicide
The analyses were first conducted by the first author (who is Danish) and a
preliminary category system was developed. Both the category system and the
ATTITUDES TOWARD SUICIDE AND PREVENTION IN GHANA/171
Gifford, P. (1999). African Christianity. Its public role in Uganda and other African
countries. Kampala: Fountain Publishers.
Goldney, R. D., & Bottrill, A. (1980). Attitudes to patients who attempt suicide. The
Medical Journal of Australia, 2, 717-720.
Hjelmeland, H., & Bjerke, T. (1996). Parasuicide in the county of Sør-Trøndelag, Norway.
General epidemiology and psychological factors. Social Psychiatry and Psychiatric
Epidemiology, 31, 272-283.
Hjelmeland, H., & Knizek, B. L. (2004). The general public’s views on suicide and suicide
Archives of Suicide Research, 8, 345-359.
Hjelmeland, H., Akotia, C. S., Owens, V., Knizek, B. L., Nordvik, H., Schroeder, R. et al.
(2008a). Self-reported suicidal behaviour and attitudes toward suicide and suicide
prevention among psychology students in Ghana, Uganda, and Norway. Crisis, 29(1),
Hjelmeland, H., Knizek, B. L., Kinyanda, E., Musisi, S., Nordvik, H., & Svarva, K.
(2008b). Suicidal behavior as communication in a cultural context. A comparative
study between Uganda and Norway. Crisis, 29(3), 137-144.
Kinyanda, E., Hjelmeland, H., Musisi, S., Kigosi, F., & Walugembe, J. (2005). Repetition
of deliberate self-harm as seen in an African population in Uganda. Archives of
Suicide Research, 9, 333-344.
Kirmayer, L. J. (2007). Cultural psychiatry in historical perspective. In D. Bhugra &
K. Bhui (Eds.), Textbook of cultural psychiatry (pp. 3-20). Cambridge: Cambridge
Knizek, B. L., Hjelmeland, H., Skruibis, P., Fartacek, R., Fekete, S., Gailiene, D., et al.
(2008). County council politicians’ attitudes toward suicide and suicide prevention.
A qualitative cross-cultural study. Crisis, 29(3), 123-130.
Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of religion and
health. Oxford: Oxford University Press.
Lang, W. A., Ramsey, R., Tanney, B. L., & Tierney, R. J. (1989). Caregiver attitudes in
suicide prevention: Help for the helpers. In R. F. W. Diekstra, R. Maris, S. Platt, A.
Schmidtke, & G. Sonnek (Eds.), Suicide and its prevention: The role of attitude and
imitation (pp. 260-272). Leiden: Canberrs, Brill.
Lester, D., & Akande, A. (1994). Attitudes about suicide among the Yoruba of Nigeria.
Journal of Social Psychology, 134, 851-853.
Moxnes, K. (2002). Children coping with parental divorce. In A. M. Jensen & L. McKee
(Eds.), Children and the changing family: Between transformation and negotiation
(pp. 76-168). London: Routledge.
Mbiti, J. S. (2006). African religions and philosophy (2nd ed.). Oxford: Heinemann.
Neimeyer, R. A., Fortner, B., & Melby, D. (2001). Personal and professional factors and
suicide intervention skills. Suicide and Life-Threatening Behavior, 31(1), 71-82.
Peltzer, K., Cherian, V. I., & Cherian, L. (1998). Attitudes toward suicide among South
African secondary school pupils. Psychological Reports, 83, 1259-1265.
Penn, C. (2008). Ghana—Marriage, family formation, and childbearing. Accessed at
Phillips, M. R., Yang, G., Zhang, Y., Wang, L., Ji, H., & Zhou, M. (2002). Risk factors
for suicide in China: A national case-control psychological autopsy study. The
Lancet, 360, 1728-1736.
ATTITUDES TOWARD SUICIDE AND PREVENTION IN GHANA/ 185
Prince, R. (1968). The changing picture of depressive syndromes in Africa. Canadian
Journal of African Studies, 1, 177-192.
Salander Renberg, E., & Jacobsson, L. (2003). Development ofa questionnaire onattitudes
towards suicide (ATTS) and its application in a Swedish population. Suicide and
Life-Threatening Behavior, 33, 52-64.
Samuelsson, M., & Åsberg, M. (2002). Training program in suicide prevention for
psychiatric nursing personnel enhance attitudes to attempt suicide patients. Inter-
national Journal of Nursing Studies, 39, 115-121.
Stark, R., Doyle, D. P., & Rushing, J. L. (1983). Beyond Durkheim: Religion and suicide.
Journal for the Scientific Study of Religion, 33, 110-121.
Steady, F. (2005). An investigative framework for gender research in Africa in the
new millennium. In Oyenouke Oyewumi (Ed.), African gender studies: A reader.
New York: Palgrave Macmillan.
Suokas, J., & Lönnqvist, J. (1989). Work stress has negative effects on the attitudes
of emergency personnel towards patients who attempt suicide. Acta Psychiatrica
Scandinavica, 79, 474-480.
Vijayakumar, L. (2004). Suicide prevention: The urgent need in developing countries:
World Psychiatry, 3, 158-159.
Vijayakumar, L., John, S., Pirkis, P., & Whiteford, H. (2005). Suicide in developing
countries (2). Risk factors. Crisis, 26(3), 112-119.
World Health Organization (WHO). (2005). Suicide statistics, international statistics.
Available from http://www.befrienders.org/info/index.asp?PageURL=statistics.php
World Health Organization (WHO). (2007). Ghana: A very progressive mental health
Yang, G.-H., Phillips, M. R., Zhou, M. G., Wang, L.-J., Zhang, Y.-P., & Xu, D. (2005).
Understanding the unique characteristics of suicide in China: National psychological
autopsy study. Biomedical and Environmental Sciences, 18, 379-389.
Zhang, J., Conwell, Y., Zhou, L., & Jiang, C. (2004). Culture, risk factors and suicide
in rural China: A psychological autopsy case control study. Acta Psychiatrica
Scandinavica, 110, 430-437.
Direct reprint requests to:
Birthe Loa Knizek
Department of Psychology
Norwegian University of Science and Technology
7491 Trondheim, Norway
186/ KNIZEK, AKOTIA AND HJELMELAND
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