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Conference spotlights Kazakhstan’s youth suicide problem, search for solutions

18 july 2013, 12:22
1

Twenty-one-year-old Aknur Sakhanova had just entered the hallway to her Almaty apartment when she came across a grisly sight.

The Almaty State University student’s neighbor, who was about 25, was hanging dead from a rafter, having committed suicide.

The young man had a wife, a 1-year-old baby and a mother to care for – but no job. After months without work, he could no longer face a world that he felt was closing in on him.

What Aknur saw three years ago is all too common in Kazakhstan, which has the highest suicide rate in the former Soviet Union and one of the highest in the world: 20.7 suicides per 100,000 people.

The country’s suicide rates among 20- to 29-year-olds are even higher – 25.3 per 100,000 among those 20 to 24 and 31.2 per 100,000 among those 25 to 29. The teen suicide rate is also high – 17.5 per 100,000 youths 15 to 19.

The good news is that Kazakhstan’s government made suicide prevention a national priority a year ago – and when other countries have done this, their suicide rates have declined.

That prioritization led to the government creating its first suicide-prevention action plan. It covers the years 2012 to 2014.

Kazakhstan’s suicide problem, and ways to address it, were the focus of a recent international conference at Nazarbayev University sponsored by the Ministry of Health and the United Nations Children’s Fund, or UNICEF.

In an interview after the conference, Jun Kukita told me that when he came to Astana in 2011 to head UNICEF’s Kazakhstan office, he “looked at the data relevant to children” to determine what issues his team should focus on.

Youth suicide stood out, so Kukita offered to work with the government to study the scope of the problem and find ways to prevent young people from taking their lives.

Senator Svetlana Dzhalmagambetova noted in her welcoming address to those attending the conference on May 14 that Kazakhstan has made significant progress on many health issues, particularly heart disease and cancer.

“This year we’re very much concerned with the suicide rate,” she said. “This is about how to prevent the loss of lives of our children.”

To address a problem, you must first understand its scope, of course – but “suicide has not been well studied” in the former Soviet Union, Kukita said at the conference.

So UNICEF and the Ministry of Health developed a research program to help understand its dimensions in Kazakhstan, he said.

“The results will help us take evidence-based joint action for prevention of suicide among youth,” Kukita said.

“Suicide prevention requires a coordinated effort – families, schools, government officials, police and the media,” he said. “This conference is an important milestone (in the prevention effort) in Kazakhstan and the CIS (Commonwealth of Indpendent States),” he said.

A key component of the UNICEF/Ministry of Health suicide research program was a multi-pronged study of the problem in five province.

UNICEF asked Dr. Marco Sarchiapone of the University of Molise in Italy to administer the study and analyze its results. He’s the first vice president of the International Association for Suicide Prevention.

The study, conducted in 2012 and 2013, included:

1. An analysis of the 108 suicides in five province from 2009 to 2012. One statistical finding was that four times as many men committed suicide as women. The research included talking with families and friends of victims to seek clues about the reasons for the suicides. Those interviews led to the finding that 24 percent of the victims had told others that they were considering taking their lives.

2. An analysis of 24 suicide attempts in the province. This included interviews with those who tried to kill themselves about why they made the attempts.

3. A survey of 2,970 students 14 to 16 to identify factors that increase the risk of suicide. An example of a high risk factor is previous suicide attempts. That’s because studies have shown that many of those who have tried to kill themselves are likely to try again. Forty-three of the 2,970 students surveyed in East Kazakhstan Province had tried to commit suicide in the previous two weeks, putting them in the highest risk category. Other risk factors ranged from depression to impulsiveness to substance abuse to being victims of bullying.

The Ministry of Health plans to use the results of the study to help achieve “early detection of those who might want to attempt suicide,” said Azhar Tulegalieva, director of the ministry’s Department of Medical Care Arrangements.

Sarchiapone’s study included four preliminary recommendations, two of them dealing with the mental-health problems that underlie many suicides. More recommendations are expected after further analysis of the study.

One preliminary recommendation was that Kazakhstan promote the importance of mental health. Another was that it take steps to reduce the stigma that prevents those with mental-health issues from seeking help – a problem across the former Soviet Union.

“The attitude toward psychiatrists here remains the same – very negative,” noted Sagat Altynbekov, director of Kazakhstan’s National Mental Health Center, which was a partner with UNICEF in the five-province study. “This was the way it was in Soviet times,” but Kazakhstan is in a new era “and we need to address this,” he said.

Another recommendation of Sarchiapone was that Kazakhstan develop prevention programs that are based on evidence, that are multidisciplinary – that is, involve the government, schools, mental-health professionals and others – and that are culturally relevant.

A final recommendation was that Kazakhstan work not only on reducing suicide risk factors but also on identifying – and bringing into play -- factors that help prevent suicide.

Dr. V.A. Rozanov, coordinator of the European Union’s programs on youth-suicide prevention in Ukraine, struck an optimistic note by explaining that a number of countries have reduced their suicide rates through national prevention programs.

For example, Sweden halved its suicide rate from 22 per 100,000 people in 1970 to 11 per 100,000 in 2010. Finland reduced its rate from a peak of 29 suicides per 100,000 in 1990 to 11 in 2011, and Norway from a peak of almost 17 in 1988 to less than 12 in 2012.

Finland's suicide rate dropped dramatically after it instituted a national prevention program.

Finland's suicide rate dropped dramatically after it instituted a national prevention program.

A key component of a national suicide prevention program should be training those with whom young people interact to detect the warning signs of suicide, Altynbekov said.

For example, students and teachers should be trained in how to detect changes of behavior that could indicate a youngster is considering suicide, he said.

By making the public more aware of the suicide problem, news organizations can be a big help in a national prevention program, Altynbekov said. But they should be trained in the proper way to report the problem, he said.

One danger of reporting suicides is that the coverage will prompt other young people to try to kill themselves – the so-called copycat effect. Those who worry about this effect contend that the media “can put the idea” of suicide in young minds, particularly if young people see suicide as glamorous.

Altybekov said Kazakhstan also needs the kind of suicide-prevention hotline that developed countries have. The hotline, which would be manned 24 hours a day, seven days a week, would allow those contemplating suicide to call specialists with whom they could talk anonymously.

It’s telling, Altynbekov said, that 89 percent of those who kill themselves in Kazakhstan do so by hanging.

“Hanging is not an impulsive act – it is well thought out,” he said. “This means that most people who commit suicide here probably conveyed it in some way to family members or friends before doing it.”

And that, in turn, means the suicide could have been prevented.


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