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

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 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.

Full text

http://isp.sagepub.com/
International Journal of Social Psychiatry
http://isp.sagepub.com/content/early/2011/12/13/0020764011430038
The online version of this article can be found at:
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
Published by:
http://www.sagepublications.com
can be found at:International Journal of Social PsychiatryAdditional services and information for
http://isp.sagepub.com/cgi/alertsEmail Alerts:
http://isp.sagepub.com/subscriptionsSubscriptions:
http://www.sagepub.com/journalsReprints.navReprints:
http://www.sagepub.com/journalsPermissions.navPermissions:
What is This?
- Dec 13, 2011Proof >>
by guest on December 15, 2011isp.sagepub.comDownloaded from

International Journal of
Social Psychiatry
0(0) 1 –5
© The Author(s) 2011
Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav
DOI: 10.1177/0020764011430038
isp.sagepub.com
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
by guest on December 15, 2011isp.sagepub.comDownloaded from

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.
by guest on December 15, 2011isp.sagepub.comDownloaded from

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).
by guest on December 15, 2011isp.sagepub.comDownloaded from

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.
References
Agarib, A. (2009). Debts, depression major causes of suicide.
Retrieved from www.khaleejtimes.com
Al Ansari, A., Hamadeh, R. R., Ali, M. K., & El Offi, A. (2007).
Suicide in Bahrain in the last decade. Crisis, 28, 11–15.
Al-Maskari, F., Shah, S. M., Al-Sharhan, R., Al-Haj, E.,
Al-Kaabi, K., Khonji, Bernsen, R. M. (2011). Prevalence
of depression and suicidal behaviors among male migrant
workers in United Arab Emirates. Journal of Immigrant and
Minority Health, DOI: 10.1007/s10903-011-9470-9.
Al Najami, S. (2010). 100 suicides a year in UAE, police say.
Gulf News, 18 January, Retrieved from http://gulfnews.com/
news/gulf/uae/crime/100-suicides-a-year-in-uae-police-say-
1.569543?localLinksEnabled=false
Baillargeon, J. (2001). Characteristics of the healthy worker
effect. Occupational Medicine, 16, 359–366.
Bashraheel, L. (2009). Suicide cases in Kingdom at a worrying
rate. Arab News. Retrieved from www.arabnews.com
Benomran, F. A. (2009). The medico-legal scene in Dubai:
2002–2007. Journal of Forensic and Legal Medicine, 16,
332–337.
Benomran, F. A., Masood, S. E., Hassan, A. I., & Mohammad, A. A.
(2007). Masking and bondage in suicidal hanging: A case
report. Medicine, Science and the Law, 47, 177–180.
Bhugra, D. (2004). Migration and mental health. Acta Psychiatrica
Scandinavica, 109, 243–258.
El Khafif, H. (1991). Unusual cases from Dubai, United Arab Emir-
ates. American Journal of Forensic Medicine and Pathology,
12, 187–190.
by guest on December 15, 2011isp.sagepub.comDownloaded from

Dervic et al. 5
Hawton, K. & van Heeringen, K. (Eds) (2000). Suicide and
Attempted Suicide. Chichester: John Wiley & Sons.
Jacob, K. S. (2008). The prevention of suicide in India and the
developing world: The need for population-based strategies.
Crisis, 29, 102–106.
Joshi, S., Simkhada, P., & Prescott, G. J. (2011). Health prob-
lems of Nepalese migrants working in three Gulf countries.
BMC International Health and Human Rights, 11, 3, DOI:
10.1186/1472-698X-11-3.
Kannan, P. (2010). Helpline for Indian workers taking 800 calls
a week. The National, 20 December. Retrieved from http://
www.thenational.ae/news/uae-news/helpline-for-indian-
workers-taking-800-calls-a-week
Koronfel, A. A. (2002). Suicide in Dubai, United Arab Emirates.
Journal of Clinical Forensic Medicine, 9, 5–11.
Manoranjitham, S., Charles, H., Saravanan, B., Jayakaran, R.,
Abraham, S. & Jacob, K. S. (2007). Perceptions about suicide:
A qualitative study from southern India. The National Medi-
cal Journal of India, 20, 176–179.
Manoranjitham, S. D., Rajkumar, A. P., Thangadurai, P., Prasad, J.,
Jayakaran, R., & Jacob, K. S. (2010). Risk factors for suicide
in rural south India. British Journal of Psychiatry, 196, 26–30.
National Crime Records Bureau. (2009). Accidental Deaths &
Suicides in India – 2009. Retrieved from http://ncrb.nic.in/
CD-ADSI2009/ADSI2009-full-report.pdf
Niederkrotenthaler, T., Voracek, M., Herberth, A., Till, B.,
Strauss, M., Etzersdorfer, E., Sonneck, G. (2010). Role
of m edia reports in completed and prevented suicide:
Werther v. Papageno effects. British Journal of Psychiatry,
197, 234–243.
Patel, S. P. & Gaw, A. C. (1996). Suicide among immigrants
from the Indian subcontinent: A review. Psychiatric Services, 47,
517–521.
Pritchard, C. & Amanullah, S. (2007). An analysis of suicide
and undetermined deaths in 17 predominantly Islamic coun-
tries contrasted with the UK. Psychological Medicine, 37,
421–430.
Rasheed, A. (2009). 1.9 m increase in population since last offi-
cial census. Gulf News, 6 October. Retrieved from http://
gulfnews.com/news/gulf/uae/general/1-9m-increase-in-popu-
lation-since-last-official-census-1.541758
Reddy, M. S. (2010). Suicide incidence and epidemiology. Indian
Journal of Psychological Medicine, 32, 77–82.
Sonneck, G. (2000). Krisenintervention und Suizidverhütung.
Vienna: Facultas Universitätsverlag.
Underwood, M. (2010). 75% of Indian workers lack health insur-
ance. The National, 28 June. Retrieved from http://www.
thenational.ae/news/uae-news/health/75-of-indian-workers-
lack-health-insurance
Vijayakumar, L. (2010). Indian research on suicide. Indian Journal
of Psychiatry, 52, S291–S296.
World Health Organization. (2010). Country Reports and Charts.
Retrieved from http://www.who.int/mental_health/prevention/
suicide/country_reports/en/index.html
by guest on December 15, 2011isp.sagepub.comDownloaded from