Suicidal behavior among young people in Singapore

Abstract

The purpose of this study was to investigate suicidal behavior among young people in an Asian community. Tracing records of all patients below 21 years of age who attempted suicide and were managed in a teaching hospital, the authors found the incidence increased sixfold between 1991 and 1995. Young females of Indian origin were found to be a risk group. Differences in suicidal behavior among the three main ethnic communities appear to be influenced by various sociocultural factors. The most common diagnosis was adjustment disorder stemming from interpersonal losses and conflicts. Schizophrenia, alcohol, and other substance abuse were rarely reported.

Introduction

Suicidal behavior contributes significantly to the psychiatric morbidity of young people. It is comparatively rare in adolescents under the age of 14 1, 2, 3, 4. However, among the 15 to 24-year age group, the suicide rates have been increasing over the past 30 years in nearly all European countries and in the United States 5, 6.

Diagnostically, young people who attempt suicide are not a homogenous group. They differ widely in social backgrounds, methods of self-harm, the nature of their psychosocial stressors, and outcome. Most have a recognizable psychiatric abnormality, with adjustment reactions being the most common. Hawton [7] was able to demonstrate that among adolescents who overdosed on medications, those who had long-standing problems together with the manifestation of behavioral disturbances (e.g., truancy, drug taking, violence) had the worst prognosis, often requiring a significant period of inpatient treatment with many developing serious personality disturbances.

Female adolescents tend to take overdoses whereas males have a higher preponderance to self-injure. About 10% of the male suicide attempts eventually commit suicide compared with 2.9% of females 3, 8.

Suicidal behavior in young people has been associated with substance abuse 9, 10, 11, major depression 12, 13, disordered family functions 14, 15, lower socioeconomic class [10], antisocial behavior 16, 17, and academic difficulties [18].

Research papers on suicidal behavior originating from the Far East have been few and far between. The majority of their studies were published more than 15 years ago and were research reports on completed suicide 19, 20, 21, 22. Data on attempted suicide are often difficult to obtain and often do not accurately reflect the true prevalence of suicide attempts. It has been estimated that at least 30% of patients who attempted suicide are not hospitalized [22]. Tsoi [23] has established the parasuicide rate in Singapore to be 55 per 100,000; this figure has since been revised to 92 per 100,000 in 1986. More recently, Habil et al. [24] studied patients admitted to a teaching hospital in Kuala Lumpur, Malaysia, following a suicidal attempt and found that 45% of the group were from social class IV and V with patients of Indian ethnic origin being overrepresented in the study population. Except for a study report on adolescent suicide attempters from Hong Kong [25], we know very little about the suicidal behavior of young people in the Asian region.

Geographically the Republic of Singapore consists of the main island and 58 other smaller islets. Covering 616 square kilometers in land area, it is located at the southern tip of Peninsula Malaysia. Culturally the population of 2.8 million is almost completely urbanized, with the vast majority living in high-rise apartments. The population is multiracial with the main ethnic groups being of Chinese, Malay, and Indian origin. The various ethnic groups are fairly evenly distributed throughout the island.