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Suicide rates in the national and expatriate population in Dubai, United Arab Emirates

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  • University of Ottawa Faculty of Medicine

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Background: Reports on suicide from the Gulf region are scarce. Dubai is a city with a large expatriate population. However, total and gender-specific suicide rates for the national and expatriate populations are not known. Aims: To investigate total and gender-specific suicide rates in the national and expatriate population in Dubai and to elicit socio-demographic characteristics of suicide victims. Methods: Registered suicides in Dubai from 2003 to 2009, and aggregated socio-demographic data of suicide victims were analysed. Suicide rates per 100,000 population were calculated. Results: Suicide rate among expatriates (6.3/100,000) was seven times higher than the rate among the nationals (0.9/100,000). In both groups, male suicide rate was more than three times higher than the female rate. Approximately three out of four expatriate suicides were committed by Indians. The majority of suicide victims were male, older than 30 years, expatriate, single and employed, with an education of secondary school level and below. Conclusion: Further research on risk factors for and protective factors against suicide, particularly among the expatriate population, is needed. Epidemiological monitoring of suicide trends at the national level and improvement of UAE suicide statistics would provide useful information for developing suicide prevention strategies.
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International Journal of Social Psychiatry
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DOI: 10.1177/0020764011430038
published online 13 December 2011Int J Soc Psychiatry Sonneck
Kanita Dervic, Leena Amiri, Thomas Niederkrotenthaler, Said Yousef, Mohamed O. Salem, Martin Voracek and Gernot
Suicide rates in the national and expatriate population in Dubai, United Arab Emirates
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E
CAMDEN
SCHIZOPH
Introduction
Dubai is a city in the United Arab Emirates (UAE) with
about 2 million inhabitants, of whom somewhat less than
20% are nationals (Dubai Statistic Centre, 2010). In the
large UAE expatriate population, the biggest group form
migrants from India who make up more than a fourth of all
UAE inhabitants (Rasheed, 2009).
Newspaper reports about suicides in the UAE and the
region are proliferating (Agarib, 2009; Al Najami, 2010;
Bashraheel, 2009), however, research on this phenomenon
is sporadic. Besides two published case reports (Benomran,
Masood, Hassan, & Mohammad, 2007; El Khafif, 1991)
we are only aware of the study of Koronfel (2002), which
reported suicides investigated at the Department of
Forensic Medicine in Dubai from 1992 to 2000. The abso-
lute number of suicides among expatriates was higher than
among nationals, and higher among men than women. A
total suicide rate of 6.2 per 100,000 population for Dubai
was reported, but the rates for national and expatriate pop-
ulations as well as gender-specific suicide rates were not
calculated (Koronfel, 2002).
Suicide rates from the Gulf countries are rarely reported.
Latest available statistics for Qatar, from 1995, stated zero
suicides (Pritchard & Amanullah, 2007), and Kuwait
reported a suicide rate of 2/100,000 in 2002 (World Health
Organization, 2010). Data for the autochtonous population
in these countries are even rarer; we are aware only of a
study from Bahrain where a suicide rate among the Nationals
Suicide rates in the national and
expatriate population in Dubai,
United Arab Emirates
Kanita Dervic,1 Leena Amiri,1 Thomas Niederkrotenthaler,2
Said Yousef,1 Mohamed O. Salem,1 Martin Voracek3 and
Gernot Sonneck4,5
Abstract
Background: Reports on suicide from the Gulf region are scarce. Dubai is a city with a large expatriate population.
However, total and gender-specific suicide rates for the national and expatriate populations are not known.
Aims: To investigate total and gender-specific suicide rates in the national and expatriate population in Dubai and to
elicit socio-demographic characteristics of suicide victims.
Methods: Registered suicides in Dubai from 2003 to 2009, and aggregated socio-demographic data of suicide victims
were analysed. Suicide rates per 100,000 population were calculated.
Results: Suicide rate among expatriates (6.3/100,000) was seven times higher than the rate among the nationals
(0.9/100,000). In both groups, male suicide rate was more than three times higher than the female rate. Approximately
three out of four expatriate suicides were committed by Indians. The majority of suicide victims were male, older than
30 years, expatriate, single and employed, with an education of secondary school level and below.
Conclusion: Further research on risk factors for and protective factors against suicide, particularly among the expatri-
ate population, is needed. Epidemiological monitoring of suicide trends at the national level and improvement of UAE
suicide statistics would provide useful information for developing suicide prevention strategies.
Keywords
suicide, nationals, expatriates, Dubai, UAE
1 Department of Psychiatry and Behavioral Science, Faculty of Medicine
and Health Sciences, United Arab Emirates University, UAE
2 Department of General Practice and Family Medicine, Centre for Public
Health, Medical University of Vienna, Austria
3
Department of Basic Psychological Research, School of Psychology,
University of Vienna, Austria
4Crisis Intervention Centre, Vienna, Austria
5Ludwig Boltzmann Institute, Vienna, Austria
Corresponding author:
Kanita Dervic, Department of Psychiatry and Behavioural Science,
Faculty of Medicine and Health Sciences, United Arab Emirates
University, PO Box 17666, Al Ain, UAE
Email: kanitadervic@uaeu.ac.ae
430038ISP0010.1177/0020764011430038Dervic et al.International Journal of Social Psychiatry
2011
Article
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2 International Journal of Social Psychiatry
of 0.6 per 100,000 was reported (Al Ansari, Hamadeh, Ali,
& El Offi, 2007). To our knowledge, there are no previous
reports on suicide rates for the UAE Nationals.
Migrants face many problems associated with migration,
their working and living conditions, or premorbid personal-
ity (Bhugra, 2004). A recent study of male migrant workers
in the city of Al Ain, UAE, revealed a prevalence of self-
reported depression of 25%, of suicidal ideation 6.5% and
of suicide attempts 2.5% (Al-Maskari et al., 2011).
Depression among male migrant workers was associated
with physical illness, working in the construction indus-
try, low salaries and working more than eight hours per
day (Al-Maskari et al., 2011).
Therefore, the aim of this study was to investigate sui-
cide rates per 100,000 among the national and expatriate
populations in Dubai, in total and by gender, using the most
recent statistics available.
Methods
Suicide data according to nationality and gender from
2003 to 2009 were obtained from Dubai Police General
Headquarters. In Dubai, all sudden, unexpected and vio-
lent deaths are investigated at the Forensic Medicine
Department, Dubai Police General Headquarters (Koronfel,
2002). Cases for post-mortem examination are referred by
the directors of the police stations and the Director of Public
Prosecution (Benomran, 2009). It is mandatory for a foren-
sic pathologist to examine the cases at the locus in order to
ascertain the manner of death, i.e. suicide vs homicide
(Benomran, 2009). Autopsies are only performed by a war-
rant of the Director of Public Prosecution following the
medical examiner’s request (Benomran, 2009). An autopsy
rate of about 7% was reported at the Forensic Medicine
Department in Dubai, which might also reflect cultural
undesirability of autopsies (Benomran, 2009). Furthermore,
aggregated data for the suicide cases with regard to age
group (younger than 18; 18–30 years; older than 30 years),
educational level (illiterate; can read and write (but without
formal education); elementary/preparatory school; sec-
ondary school; university degree and above) and occupa-
tional status (employed vs unemployed) were provided.
Population numbers for Dubai for the years 2003 to 2009
were obtained from the Dubai Statistics Center. Total and
gender-specific annual suicide rates per 100,000 population
for Dubai for the time period 2003–2009 were calculated.
Similarly, we calculated total and gender-specific
annual suicide rates per 100,000 separately for nationals
(autochthonous UAE population) and expatriates for the
period studied. Furthermore, mean suicide rates for the
time period 2003–2009 were calculated. Descriptive statis-
tics were used to explore socio-demographic characteris-
tics of suicide victims. The study was approved by the Al
Ain Medical District Human Research Ethics Committee.
Results
Five hundred and ninety-four (N = 594) suicides, 10 among
nationals (8 men and 2 women) and 584 among expatriates
(543 men and 41 women) were registered in Dubai from
2003 to 2009. The mean total suicide rate for the seven-year
period studied was 5.8 per 100,000 inhabitants (mean
male suicide rate 7.1/100,000, mean female suicide
rate 1.7/100,000; gender ratio 4.1:1). The mean suicide
rate for nationals was 0.9/100,000, and for expatriates
6.3/100,000 (ratio 7:1) (Figure 1). The mean suicide rate for
Figure 1. Suicide rates per 100,000 in Dubai – 2003–2009.
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Dervic et al. 3
nati onal males was 1.5/100,000, and for females 0. 4/100,000
(gender ratio 3.7:1). The mean suicide rate for expatri-
ate males was 7.5/100,000, and for females 2.1/100,000
(gender ratio 3.5:1).
As for other socio-demographic characteristics, 354
(59.6%) suicide victims were older than 30 years, and 234
(39.4%) were aged 30 and younger, out of which 3 (0.5%)
suicides were younger than 18 years; for 6 (1%) suicides no
age information was available. Furthermore, 554 (93.3%)
of suicides were employed and 40 (6.7%) unemployed.
Two hundred and eighty-nine suicide victims (n = 289,
48.6%) were single, 228 (38.4%) married, 20 (3.4%) wid-
owed/divorced, and for 57 (9.6%) cases the data were not
available. With regard to educational level, 9 (1.5%) sui-
cide victims were illiterate, 31 (5.2%) could write and read,
102 (17.2%) had elementary/preparatory school, 192
(32.3%) had secondary school, 48 (8.1%) were university
graduates/postgraduates; for 212 (35.7%) suicides data
were missing. Among expatriate suicides (n = 584), 93.8%
(n = 548) were from Asia; specifically, 78.6% (n = 431; 411
males and 20 females) were from India, and 15.2% (n =
117; 105 males and 12 females) were from other Asian
countries. The remaining 6.2% (n = 36; 27 males and 9
females) of expatriate suicides were committed by individ-
uals from other parts of the world. The proportion of sui-
cides committed by Indians (n = 431) among all expatriate
suicides in Dubai (n = 584) was 73.8%.
Discussion
The main finding of this study is that the suicide rate among
expatriates in Dubai was seven times higher than that
among the nationals. This corresponds with the findings
from another Gulf country, Bahrain, where expatriates
(12.6/100,000) also had a higher suicide rate than the
Nationals (0.6/100,000) (Al Ansari et al., 2007).
Approximately three out of four expatriate suicides in
Dubai were committed by Indians, which is consistent with
previous reports (Koronfel, 2002). Similarly, in neighbour-
ing Bahrain, Indian migrants had the highest suicide rate
among expatriates (Al Ansari et al., 2007). Thus, Indians
contribute largely to the Dubai expatriate suicide rate of
6.3/100,000. Regrettably, it was not possible to calculate a
separate suicide rate per 100,000 for Indians as the popula-
tion statistics contain only two categories, nationals and
expatriates, without specifying nationality. In their home-
land India, a suicide rate of 10.9/100,000 was reported in
2009 (National Crime Records Bureau, 2009). The differ-
ence between suicide rates in the home country and in
Dubai could reflect the healthy worker effect (Baillargeon,
2001), but also local differences in suicide registration pro-
cedures. In contrast, the suicide rate among Indian migrants
in Bahrain of 17.7/100,000 was higher than that in their
homeland (Al Ansari et al., 2007). The authors proposed
that the finding could be related to regional differences, as
the majority of Indian migrants in Bahrain are Hindus from
the Kerala state, which has a higher suicide rate than India
as a whole (Al Ansari et al., 2007); in 2009, Kerala state
had a suicide rate of 25.3/100,000 (National Crime Records
Bureau, 2009). Of interest, Patel and Gaw (1996) found that
suicide rates among the immigrants from the Indian subcon-
tinent were higher than among the autochthonous popula-
tion of the various host countries (i.e. from two times higher
in England and Wales to many times higher in Malaysia).
The total suicide rate in Dubai was shaped by the expa-
triate suicide rate, and by male expatriate suicides in par-
ticular. The majority of suicide victims were expatriate –
predominantly Indian – males, older than 30, single,
employed and with an education of secondary school level
and below. Regrettably, no information on reasons for sui-
cide was available for our study. In Koronfel’s (2002)
study, recent unemployment and depressive illness were
found to be major suicide triggers. Of interest, in India, the
highest number of suicides occurs among males in the age
group 30–44 years (Reddy, 2010). Moreover, a review
by Vijayakumar (2010) identified young male migrants
(within India) as a specifically vulnerable group, and stress-
ful life events, psychiatric illness, younger age and unem-
ployment as risk factors for completed suicide in India.
Notably, a psychological autopsy study of suicides in
rural India (Manoranjitham et al., 2010) found that psy-
chosocial stress and social isolation, rather than psychi-
atric morbidity, were risk factors for suicide. The authors
suggested that many Indian suicides are impulsive and
related to stress, which is alleviated through the wide-
spread belief that suicide is an option when faced with
severe personal suffering (Manoranjitham et al., 2007;
Manoranjitham et al., 2010).
Suicide rate among the nationals was very low, which is
common for Muslim countries as Islam strictly forbids sui-
cide. The UAE nationals’ suicide rate of 0.9/100,000 in
our study is comparable with that of Bahraini nationals
(0.6/100,000) (Al Ansari et al., 2007). However, previous
research has revealed considerably higher rates of undeter-
mined deaths in Muslim than in western countries, sug-
gesting that the culturally unacceptable suicides might
be hidden under this category (Pritchard & Amanullah,
2007). Indeed, under-reporting of suicides among the
UAE Nationals due to religious/cultural factors and
fear of stigma is possible. In Bahrain, suicides among
the Nationals are considered underestimated as sus-
pected suicides that occurred at home or those that could
be mistaken for accidents are not vigorously investigated
(Al Ansari et al., 2007). Similarly, Benomran (2009)
reported that many home deaths in Dubai are not referred
for medico-legal examination. Furthermore, a tendency by
medical personnel in Bahrain not to register suicides as
such but as accidents in order to spare the families of sui-
cide victims shame and humiliation was also described
(Al Ansari et al., 2007).
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4 International Journal of Social Psychiatry
The total suicide rate of 5.8/100,000 for Dubai in our
study is low in international comparison (World Health
Organization, 2010), and comparable with that reported
previously (Koronfel, 2002). The male–female ratio in
both the national and expatriate population corresponds
with international gender ratios for suicide (Hawton &
van Heeringen, 2000). A peak in the expatriate suicide rate
in 2008 was observed; further research might offer possi-
ble explanations.
Limitations
This study has several limitations. Under-reporting of sui-
cides is possible. Data on accidental deaths or undetermined
deaths were not available for this study; a mis-classification
of suicides under these deaths is not excluded. Furthermore,
a separate suicide rate for Indian migrants in Dubai could
not be calculated due to the lack of population figures for
specific nationalities. Next, there was no information about
suicide methods; previous reports indicated hanging as the
most common suicide method in Dubai (about 80% of all
investigated suicides) (Koronfel, 2002). Similarly, no data
on precipitants and circumstances of suicides were availa-
ble. Moreover, a review of suicides among immigrants
from the Indian subcontinent revealed higher suicide rates
for Hindus than for Muslims (Patel & Gaw, 1996); unfor-
tunately, information on religious affiliation of suicide
victims in our study was not available.
Conclusion
Public education on risk factors for suicide (i.e. depression,
substance abuse, previous suicide attempt) and about where
to obtain help in suicidal crisis (i.e. hotlines) (Sonneck,
2000) is needed in the UAE. Training of primary care phy-
sicians about early recognition of depression and manage-
ment of depressed individuals is an important suicide
prevention strategy (Hawton & van Heeringen, 2000).
Indeed, every fourth male migrant worker, of whom about
95% were from the Indian subcontinent, was depressed in
the study by Al-Maskari et al. (2011). Al Ansari et al.
(2007) also suggested establishing teams of mental health
professionals within the existing mental health services
who can effectively communicate with the migrant popula-
tion. In this context, access of migrant workers to health
care services is crucial (Joshi, Simkhada, & Prescott, 2011).
A study conducted by the Dubai Health Authority revealed
that many Indian workers lacked health insurance
(Underwood, 2010). Addressing these issues, a 24-hour
helpline for Indian workers in Dubai was recently estab-
lished providing legal, financial and psychological counsel-
ling (Kannan, 2010). Moreover, Al-Maskari et al. (2011)
recommended strict implementation of current labour regu-
lations and guidelines in order to improve the working
conditions and mental health of migrant workers in the
UAE. Social workers and other gatekeepers should also be
educated on risk factors for suicide. Development of a
support network within the community would further
aid prevention (Jacob, 2008). Furthermore, media can
have both protective and negative effects on suicide
rates (Niederkrotenthaler et al., 2010), and an increased
media coverage on suicidal behaviour is observed in the
UAE. Prominent display of suicides and suicide hot spots
in the media and repetitive reporting combined with sensa-
tionalist content are associated with an increase in suicide
rates (Niederkrotenthaler et al., 2010; Sonneck, 2000). On
the other hand, articles on individuals who adopted coping
strategies rather than suicidal behaviour in adverse circum-
stances are associated with a decrease in suicide rates
(Niederkrotenthaler et al., 2010). Applying media guide-
lines for reporting on suicides is an effective prevention
strategy (Sonneck, 2000). Finally, epidemiological moni-
toring of suicide trends in the whole UAE and improve-
ment of UAE suicide statistics would provide useful
information for the development of suicide prevention
strategies (Sonneck, 2000). Further research on risk factors
for and protective factors against suicidal behaviour, par-
ticularly among the migrant population, is warranted.
Acknowledgements
The authors thank Dubai Police General Headquarters for provid-
ing the data on suicide. This study was supported by the seed
grant to Dr Dervic by the Faculty of Medicine and Health Science,
United Arab Emirates University.
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... [12] The PHQ-9 is a screening tool for depression, validated in different patients' population based on DSM-IV using a 4-point Likert scale. [13] Depression can be classified (on the cumulative score) into minimal (1-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderate-severe (14)(15)(16)(17)(18)(19), and severe (20-27). [12] PHQ-9 cutoff score of 10 was used for diagnosing clinically significant major depression. ...
... [17] Dervic et al. reported that suicide rates were seven times higher among the expatriate population, with 75% of those suicide were Indian nationals. [18] In our study we did not have clear incidence of preexisting mental illness as patients were first time presented to our hospital and none of them were on any psychiatric treatment. However, an undiagnosed mental illness could not be excluded, as found in other studies among expatriates. ...
... However, an undiagnosed mental illness could not be excluded, as found in other studies among expatriates. [18] The COVID-19 pandemic had significant implications on the expatriate population with movement restrictions by government sterilization (lockdown) program (for infection control), loss of employment, and departure to the home country. [19] We could not assess these factors and may have contributed to higher psychological distress and also a higher attrition rate at day 60 of the study. ...
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... These changes might have an impact on the phenomenon of suicide. Indeed, to our knowledge there have only been 2 studies that reviewed this risk in the Emirate of Dubai (5,6); however, these studies were done on cases of completed suicide and we are not aware of any studies that have addressed the characteristics of suicide attempters in the United Arab Emirates. ...
... We also noted a significant difference in the estimated annual rate for completed suicide in our study (2-3 per million) when compared with studies in Dubai, which ranged from 5.8 to 6.2 per 100 000 (5,6). This difference may be partially due to the limitation mentioned above; however, it is more likely to be related to the fact that most completed suicides (in the Dubai studies) were carried out by non-nationals of mostly Indian origin and in our study Indians constituted only 25% of the attempters. ...
... This is also in keeping with the statistics on attempted suicide from other countries, where it has been established to be higher in females (14). Conversely, studies on completed suicide in Dubai (5,6) showed much higher number of suicides in males, with a ratio of 4:1. The question remains whether men are less likely to reach the attention of the medical services before dying from suicide. ...
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Background: It is well established that attempting suicide significantly increases a person's risk of completing suicide. The risk is considered to be particularly high in the first year after the attempt. Epidemiological information on suicide is scarce in the Middle East and the countries of the GCC region and there is a need to establish a reference point to measure future changes. Aims: We examined the epidemiology of suicide attempters requiring inpatient care in Abu Dhabi to identify associated factors that could aid local suicide prevention strategies. Methods: This 4-year (2011-2014) study of suicide attempters in the city of Abu Dhabi included all attempters assessed by the consultation-liaison team and admitted to the 3 main governmental general hospitals. Results: We identified 364 suicide attempts with an annual incidence of 6 per 100 000 population. The mean age was 28.7 years. Females comprised 59.6% of the attempters and were more likely to be below age 30 years. Around 40% of the psychiatric diagnoses among attempters were related to stress and 17.9% to depression. Overdosing was the chosen method in 50.6% of the attempters, with 32.7% overdosing on paracetamol and females being more likely to use this method. Just over 13% of the attempters had made one previous attempt and 2.2% had made more than one. Conclusion: Females younger than 30 years were at higher risk of attempting suicide, with overdosing on paracetamol as the preferred method. Stress-related diagnoses were predominant in the attempters.
... [19] Dervic et al. investigated suicide rates in the national and expatriate population in Dubai city of the United Arab Emirates and found that suicide rate among expatriates was 6.3 per 100,000 population which was seven times higher when compared to the nationals (0.9 per 100,000 population). [20] Male suicide rate was more than three times higher when compared to females. [20] Nearly 94% of the cases were from Asia; specifically, 79% were Indians, and 15% were from other Asian countries. ...
... [20] Male suicide rate was more than three times higher when compared to females. [20] Nearly 94% of the cases were from Asia; specifically, 79% were Indians, and 15% were from other Asian countries. [20] The majority were above 30 years of age, single, and employed and with an education of secondary school level and below. ...
... [20] Nearly 94% of the cases were from Asia; specifically, 79% were Indians, and 15% were from other Asian countries. [20] The majority were above 30 years of age, single, and employed and with an education of secondary school level and below. [20] Spallek et al. demonstrated that migrants from countries having higher suicide risk bring along the risk to country of settlement at least for the initial period of migration. ...
Article
Background: Suicide is a complex phenomenon involving several risk factors. We aimed to describe the frequency, pattern, and outcomes of patients with traumatic injuries following suicide attempts admitted to a level 1 trauma center. Methods: We conducted a retrospective analysis of data obtained from Qatar National Trauma Registry and mortuary database. The study included all patients with traumatic injuries following suicide attempts, admitted to the Hamad Trauma Center (HTC) from April 2008 to March 2018. Results: During this 10-year period, 206 patients were admitted to the HTC for injuries associated with suicide attempts. The majority were males (76%), young age (mean age 31 years), and expatriates specifically from South Asia (55%). The most common injury was due to self-inflicted cutting and piercing (51%) followed by jumping from height (30%). Females chose jumping from high place more often as a method of suicide attempt (59% vs. 20%), while males chose self-stabbing or cutting their throat (59% vs. 25%) (P = 0.001). Most of the patients had head injuries (30%) that was severe in terms of abbreviated injury scale score (3.6 ± 0.9). More than half (54%) of the patients required psychiatric consultations. The in-hospital mortality was 8% which was comparable in both genders. Conclusions: The present study revealed that 1.8% of trauma admissions at HTC were related to suicidal attempts. Better understanding of risk factors is important in devising preventive strategies.
... A recent study carried out in Dubai found that suicide rates were seven times higher among the expatriate community than the nationals where 78% of the suicide cases were Indian. Suicide rates were higher amongst single, expatriate, and employed males (Dervic et al. 2012). ...
... The profile of suicide cases in UAE showed that they were mostly males, single, employed, older than 30 and expatriates. The suicide rate was seven times higher in expatriates compared to nationals (Dervic et al. 2012). Review of the police records in Kuwait (Al-Waheeb and Al-Kandary 2015) showed that the most common method of suicide was hanging (60%) and the majority were expatriates (87%). ...
... Review of the police records in Kuwait (Al-Waheeb and Al-Kandary 2015) showed that the most common method of suicide was hanging (60%) and the majority were expatriates (87%). A similar pattern was also reported in Kingdom of Saudi Arabia (KSA) (Elfawal 1999;Helaly et al. 2015), Bahrain (Al Ansari et al. 2007) and UAE (Dervic et al. 2012;Koronfel 2002). A review of the Arab studies using police and government records (Karam et al. 2008) reported that the annual rate of completed suicide ranged from 1.1 to 6.2 per 100,000 population where they were mostly males, 20-40 years old with hanging as the most common method in UAE and KSA while in Jordan and Lebanon the methods used were mostly gunshots in males and self-immolation or pesticide poisoning in females. ...
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The aims of this study were to retrospectively assess the profiles of subjects with suicide attempts and self-harm in Doha, Qatar; and whether the available data were complete. We reviewed all the records of fatal and non-fatal suicides together with accidental self-ham cases seen in the major Emergency Department in Doha, over a one-year period. There was 37 completed suicide, mostly male expatriates in mid 30 s who died by hanging. In cases with suicide intent (N = 270), more males were admitted to Psychiatry than women. Overdose was the common method and the majority had mood disorders. In self-harm cases with no suicide intent (N = 150) the majority were not seen by Psychiatry. The profiles of suicide cases in Qatar are similar to those reported internationally. However, there is a major need to establish a comprehensive system to register and assess all self-harm patients in Qatar.
... A reluctance to seek help due to stigma and scepticism regarding the efficacy of conventional Western medical treatment has also been reported [27][28][29]. A few studies have focused specifically on UAE migrant/expatriate samples, reporting higher rates of suicide among adult expatriates compared to UAE nationals [30], and an increased frequency of risky behaviors among adolescents [31]. ...
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Background Most mental health issues develop during adolescence, therefore identifying youth mental health needs and pathways to care is critical to improve prevention. To date, studies have typically focused on Western samples, while the impact of cultural diversity on perception of health and illness, and pathways to care, remain poorly understood. To address the shortage of studies conducted in the Arab world, and particularly in the United Arab Emirates (UAE), the present investigation aims to identify the characteristics of youth accessing mental health services in Dubai. Methods Data was collected retrospectively from patients’ records at Rashid Hospital Child Psychiatry Service. Information collected included demographics, life stressors, symptoms duration, main diagnosis, and presence/absence of psychotic features in patients’ symptomatology. The relationship between demographic and clinical variables was explored using Chi-square tests and negative binomial regression models. Results The sample included 99 treatment-seeking young patients (mean age 15.3; SD = 1.7); 47.5 % were Emirati (UAE national) and 52.5 % were non-Emirati patients. In our treatment-seeking youth sample Depressive disorders represented the most frequent diagnosis, followed by Bipolar and related disorders, Anxiety and stress related disorders, and Schizophrenia and psychotic disorders. Compared to Emirati patients, non-Emirati patients were more likely to report relationships with friends as a source of stress. Female help-seekers, compared to males, were more likely to report stressful relationships with family members, and to receive a diagnosis of Depressive disorders. The duration of symptoms before seeking help was significantly predicted by family stress, gender, self-harm behavior, a symptomatology with psychotic features, and a diagnosis of Anxiety disorders. Conclusions The present study contributes to characterizing youth accessing mental health services at Rashid Hospital’s Child Psychiatry service in Dubai. An overall prevalence of poor family functioning among help-seeking youth, and the importance of peer support for expatriate youth were highlighted. Gender differences in perceived stressors, diagnoses and help-seeking behavior suggest the need to promote help-seeking among young boys. While presentation with psychotic features seems to lead to quicker access to medical care, self-harm and anxiety appear to delay help-seeking. The potential implications of our results for promoting youth wellbeing in the region are discussed.
... A recent systematic review of all studies related to migrant mental health in the Persian Gulf identified fewer than a dozen articles published between 2002 and 2010 [22]. These limited studies offer quantitative evidence of a high rate of suicide [23][24][25][26] and psychiatric symptoms [27,28]. A small number of studies have used depression scales to quantify burdens and covariates of mental illness among migrants [29,30]. ...
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Background Temporary labor migration is an increasingly important mode of migration that generates substantial remittance flows, but raises important concerns for migrant well-being. The migration and health literature has seen a growing call for longitudinal, binational surveys that compare migrants to relevant non-migrant counterfactual groups in the sending country, in order to answer the basic question “Is migration good for health?” This study compares the health of male international migrants, internal migrants, and non-migrants using a unique representative panel survey of the Matlab subdistrict of Bangladesh. Methods and findings A cohort of 5,072 respondents born 1958–1992 were interviewed in 1996–1997, and reinterviewed in 2012–2014. Extensive migrant follow-up yielded a 92% reinterview rate. We explored health and income outcomes for respondents who at the time of the follow-up interview were current international migrants (n = 790), returned international migrants (n = 209), internal migrants (n = 1,260), and non-migrants (n = 2,037). Compared to non-migrants, current international migrants were younger (mean 32.9 years versus 35.8 years), had more schooling (7.6 years versus 5.8 years), and were more likely to have an international migrant father (9.7% versus 4.0%) or brother (49.1% versus 30.3%). We estimated multivariate ordinary least squares and logistic regression models controlling for a wide range of control variables measured as far back as 1982. Results show that current international migrants had substantially better health status on factors that likely relate to self-selection such as grip strength and self-rated health. Current international migrants had no excess risk of injury in the past 12 months compared to non-migrants (adjusted mean risk = 6.0% versus 9.3%, p = 0.084). Compared to non-migrants, current international migrants had roughly twice the risk of overweight/obesity (adjusted mean risk = 51.7% versus 23.3%, p < 0.001), obesity (6.9% versus 3.4%, p = 0.012), and stage 1 or higher hypertension (13.0% versus 7.0%, p = 0.014). Compared to internal migrants, current international migrants had significantly higher levels of overweight/obesity (adjusted mean risk = 51.7% versus 37.7%, p < 0.001). Current international migrants showed above average levels of depressive symptoms on a 12-item standardized short-form Center for Epidemiologic Studies Depression Scale (+0.220 SD, 95% CI 0.098–0.342), significantly higher than internal migrants (−0.028 SD, 95% CI −0.111, 0.055; p < 0.001). Depressive symptoms differed significantly from those reported by non-migrants when restricting to items on negative emotions (international migrant score = 0.254 SD, non-migrant score = 0.056 SD, p = 0.004). Key limitations include the descriptive nature of the analysis, the use of both in-person and phone survey data for international migrants, the long recall period for occupational and mental health risk measures, and the coverage of a single out-migration area of origin. Conclusions In this study, we observed that international migrants had comparable or lower injury and mortality risks compared to respondents remaining in Bangladesh, due in part to the high risks present in Bangladesh. International migrants also showed higher levels of self-rated health and physical strength, reflective of positive self-selection into migration. They had substantially higher risks of overweight/obesity, hypertension, and depression. Negative health impacts may reflect the effects of both harsh migration conditions and assimilation into host population conditions. Our results suggest the need for bilateral cooperation to improve the health of guest workers.
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Nurses are front line workers in the healthcare services. A heavy workload as a career can leave them overworked and stressed which gives high risk of developing negative mental states like depression. For individuals with depression, the severity of depressive symptoms increases and their ability to function is affected as well. A high standard of nursing care is only possible if nurses can maintain sound physical and mental health. In the United Arab Emirates, there are no published data regarding the prevalence of depression among nurses. Hence, this study sought to identify the prevalence of depression among nurses working in the Ministry of Health (MOH) hospitals in Ras Al Khaimah, United Arab Emirates, and to assess the association of demographic variables with the prevalence of depression. The selected MOH hospitals were Saqr Hospital, Ibrahim Bin Hamad Obaidullah Hospital, and Obaidullah Geriatric Hospital. A cross-sectional descriptive study design was used and the data was collected from 136 nurses through a self-administered Beck Depression Inventory-II (BDI-II). The overall prevalence of depression, according to the BDI-II, was 17.6% in the present study, mild depression was 6.6%, moderate depression was 8.8%, and severe depression was 2.2%. Overall results showed that the prevalence of depression among nurses working in the MOHAP hospitals of Ras Al Khaimah were low. A significant association (p<0.05) with nationality, work experience, marital status, and financial dependence of family members of the nurses were found with depression. In order to conclude the prevalence of depression among nurses working in MOHAP hospitals of Ras Al Khaimah, the findings provided useful baseline data for policymakers regarding decisions that can positively affect the health of nurses and patients. Encouraging nurses' mental wellbeing will help optimize patient health outcomes too.
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Abstract Background Qatar is a high-income country with 90% of the population being economic migrants from low income countries. Due to this unique population composition, it has been suggested that Qatar may not follow suicide trends of high-income countries. Additionally, there is paucity of information on suicidal trends and rates due to social and cultural reasons. The Covid-19 pandemic has additionally impacted mental health of migrants differently form native Qataris. Objectives This study explores suicidal behavior trends among individuals attending the main Emergency Department in the state of Qatar for mental health emergencies. The study also compared these trends for pre-pandemic period to early post pandemic period. Methods A cross-sectional study of individuals attending the main emergency department of the country from 1st December 2019 to 30th June 2020 was carried out using a composite data collection form. This identified 799 individuals presenting with mental health emergencies. Suicidal behaviors, relevant sociodemographic data, along with factors known to be associated with suicidal behaviors were collected for this group. Results 24.9% (n = 199) of the sample presented with suicidal behaviors. Younger age (31.16 ± 9.497), current hopelessness (70; 54.7%), history of suicidal thoughts (50; 47.2%), history of suicidal attempts (43; 34.7%), history of self-harm thoughts (35; 39.3%), history of self-harm attempts (41; 37.6%) were highly significantly associated with suicidal behavior (p
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Suicide is a public health issue that impacts a nation's resident and non-resident populations alike. Singapore has one of the largest non-resident (work permit holder) populations in the world, yet very little attention has been given to examining suicide in this population. The current study examined the case materials of all 303 non-resident completed suicides in Singapore in the period January 2011 to December 2014. Their basic profiles were compared with that of the 1,507 resident cases in the same period. A sample of 30 death notes written by non-residents were randomly selected and thematically analyzed to supplement the descriptive findings and discussion. Results showed that suicides were highest among males, those aged 21-35 years old, and South Asians. Most non-resident suicide cases did not have known physical or mental health issues, prior suicide attempts, or suicide notes. Suicide decedents from South Asia and Europe most frequently used hanging, while jumping was most common among decedents from other regions. Relationship and health problems emerged as the top two suspected triggers for suicide based on our analysis of the suicide notes. The unique situation of working abroad may increase non-residents' vulnerability in general, while adverse life events such as relationship and health issues may be too overwhelming to bear, especially when support services are not readily available and accessible. The results have implications for suicide prevention among this neglected group of people who choose to work in foreign lands.
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The suicide rate in India is 10.3. In the last three decades, the suicide rate has increased by 43% but the male female ratio has been stable at 1.4 : 1. Majority (71%) of suicide in India are by persons below the age of 44 years which imposes a huge social, emotional and economic burden. Fifty four articles on suicides have been published in IJP. Several studies reveal that suicidal behaviours are much more prevalent than what is officially reported. Poisoning, hanging and self immolation (particularly women) were the methods to commit suicide. Physical and mental illness, disturbed interpersonal relationships and economic difficulties were the major reasons for suicide. The vulnerable population was found to be women, students, farmers etc. A social and public health response in addition to a mental health response is crucial to prevent suicidal behaviour in India.
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Migrant workers comprise 80% of the population of the United Arab Emirates, but there is little research on their mental health. To determine the prevalence and correlates of depression among workers living in labor camps, we conducted a cross-sectional survey in labor camps in Al Ain city. The Depression Anxiety and Stress Scale (DASS-42) was used to assess depression and suicidal ideation among the study participants. Off the 319 contacted workers agreed to participate, however 239 fully completed the DASS-42. The prevalence of a score >=10 ("depression") was 25.1% (60/239). Depression was correlated with physical illness (97/301), (adjusted odds ratio-AOR = 2.9; 95% CI 2.26-5.18), working in construction industry (prevalence 124/304), AOR = 2.2; 95%CI 1.56-3.83), earning less than 1,000 UAE Dirham per month (prevalence 203/314), (AOR = 1.8; 95%CI 1.33-3.16), and working more than 8 h a day (prevalence 213/315), (AOR = 2.7; 95%CI 1.19-6.27). 20/261 (6.3%) of the study participants reported thoughts of suicide and 8/265 (2.5%) had attempted suicide. People with suicidal ideation were more likely to have a physical illness (AOR = 8.1, 95%CI 2.49-26.67), earn less than 1,000 UAE Dirham per month (AOR = 5.98, 95%CI 1.26-28.45), and work for more than 8 h a day (AOR = 8.35, 95%CI 1.03-67.23). The study identified self reported indicators of a substantial burden of depression, and thoughts of self-harm among laborers surveyed. Policy level intervention and implementation, is needed to improve working conditions, including minimum wages and regulation of working hours is recommended.
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Nepal is one of the largest suppliers of labour to countries where there is a demand for cheap and low skilled workers. In the recent years the Gulf countries have collectively become the main destinations for international migration. This paper aims to explore the health problems and accidents experienced by a sample of Nepalese migrant in three Gulf countries. A cross-sectional survey was conducted among 408 Nepalese migrants who had at least one period of work experience of at least six months in any of three Gulf countries: Qatar, Saudi Arabia and United Arab Emirates (UAE). Face to face questionnaire interviews were conducted applying a convenience technique to select the study participants. Nepalese migrants in these Gulf countries were generally young men between 26-35 years of age. Unskilled construction jobs including labourer, scaffolder, plumber and carpenter were the most common jobs. Health problems were widespread and one quarter of study participants reported experiencing injuries or accidents at work within the last 12 months. The rates of health problems and accidents reported were very similar in the three countries. Only one third of the respondents were provided with insurance for health services by their employer. Lack of leave for illness, cost and fear of losing their job were the barriers to accessing health care services. The study found that construction and agricultural workers were more likely to experience accidents at their workplace and health problems than other workers. The findings suggest important messages for the migration policy makers in Nepal. There is a lack of adequate information for the migrants making them aware of their health risks and rights in relation to health services in the destination countries and we suggest that the government of Nepal should be responsible for providing this information. Employers should provide orientation on possible health risks and appropriate training for preventive measures and all necessary access to health care services to all their workers.
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Media reporting of suicide has repeatedly been shown to trigger suicidal behaviour. Few studies have investigated the associations between specific media content and suicide rates. Even less is known about the possible preventive effects of suicide-related media content. To test the hypotheses that certain media content is associated with an increase in suicide, suggesting a so-called Werther effect, and that other content is associated with a decrease in suicide, conceptualised as a Papageno effect. Further, to identify classes of media articles with similar reporting profiles and to test for associations between these classes and suicide. Content analysis and latent class analysis (LCA) of 497 suicide-related print media reports published in Austria between 1 January and 30 June 2005. Ecological study to identify associations between media item content and short-term changes in suicide rates. Repetitive reporting of the same suicide and the reporting of suicide myths were positively associated with suicide rates. Coverage of individual suicidal ideation not accompanied by suicidal behaviour was negatively associated with suicide rates. The LCA yielded four classes of media reports, of which the mastery of crisis class (articles on individuals who adopted coping strategies other than suicidal behaviour in adverse circumstances) was negatively associated with suicide, whereas the expert opinion class and the epidemiological facts class were positively associated with suicide. The impact of suicide reporting may not be restricted to harmful effects; rather, coverage of positive coping in adverse circumstances, as covered in media items about suicidal ideation, may have protective effects.
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The relative contributions of psychosocial stress and psychiatric morbidity to suicide are a subject of debate. To determine major risk factors for suicide in rural south India. We used a matched case-control design and psychological autopsy to assess 100 consecutive suicides and 100 living controls matched for age, gender and neighbourhood. Thirty-seven (37%) of those who died by suicide had a DSM-III-R psychiatric diagnosis. Alcohol dependence (16%) and adjustment disorders (15%) were the most common categories. The prevalence rates for schizophrenia, major depressive episode and dysthymia were 2% each. Ongoing stress and chronic pain heightened the risk of suicide. Living alone and a break in a steady relationship within the past year were also significantly associated with suicide. Psychosocial stress and social isolation, rather than psychiatric morbidity, are risk factors for suicide in rural south India.
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The body of a 35-year-old man was found hanging in a relatively isolated place outdoors. A vest was wrapped over his head, neck and lower part of the face. The hands were loosely tied in front of the body. The vest was tucked between the neck and the ligature, to act as a pad. Thorough scene examination and post-mortem examination excluded any evidence of foul play. Although bondage is usually associated with autoerotic practices in asphyxiation deaths, it was established that this case was a suicide. DNA was used as a supportive measure to determine that the handkerchief and vest belonged to the deceased.
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Very high rates of suicide have been reported from India and the developing world. However, much of the debate on suicide prevention focuses on individuals, methods, site-specific solutions, or particular suicide prevention strategies. This article argues for population based approaches that focus on improving the general health of populations (e.g., macroeconomic policies that aim for social justice, schemes to meet basic human needs, organizing local support groups within vulnerable sections of society, developing and implementing an essential pesticide list, addressing gender issues, and increasing public awareness through the mass media) rather than medical, psychiatric, and other strategies that target individuals (e.g., treatment of mental illness, counseling, etc.) in order to reduce high suicide rates in India and developing countries. Individual approaches will help people in distress and prevent individuals from committing suicide, but will not reduce population suicide rates.
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Dubai is one of the small countries of the United Arab Emirates located on the shores of the Persian Gulf in the Middle East. This report deals with two deaths: one an unusual method of suicide by hanging and the other, a death under investigation into whether it was accidental or suicidal.