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The Arab Journal of Psychiatry (2008), Vol. 19, No .1, Page (1-24)
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Suicidality in the Arab World Part II: Community Studies
Elie G. Karam, Ranya V. Hajjar, Mariana M. Salamoun
Abstract
This paper reviews hospital and government based articles on suicidality in the
Arab world. A systematic search was conducted up to 2006 (Bahrain, Egypt,
Iraq, Jordan, Kuwait, Lebanon, Morocco, Oman, Palestine, Saudi Arabia, Su-
dan and United Arab Emirates). Results varied across countries and methods.
The Arab hospital studies, estimated annual rates of attempted suicide ranging
from 1.9/100,000 to 127/100,000. The Arab police and government records
reported annual completed suicide rates of 1.1/100,000 to 6.2/100,000. Several
risk factors were identified. While in hospital based studies, attempt was relat-
ed to being single, aged 15-25 years, primary to secondary level education,
students, housewives, unemployed, belonging to over-crowded large families,
and having a low socio-economic status. In addition, many psychiatric disor-
ders were identified as risk factors, most commonly depressive disorders, ad-
justment, personality, and drug dependence/abuse disorders. Completed sui-
cide victims were more frequently males, 20 to 40 years old, single, manual
workers and unemployed. In conclusion, accurate recording methodology in
hospitals and governmental institutions are needed to assess the prevalence and
risk factors of suicidal behaviours in the Arab World.
Key Words: attempt, deliberate self-harm, suicidality, suicide
Word count: 157.
Introduction
Studies that assess suicidality are rare
in the Arab world. Given the fact
that suicide and attempted suicide are
considered disgraceful acts prohibit-
ed by religion, condemned by society
and hampered by legal consequences,
suicidality remains a taboo in this
region of the world. The present pa-
per builds on a sister publica-
tion in a previous issue of the Arab
Journal of Psychiatry and reviews
hospital and government based re-
ports. More specifically, it reviews
the prevalence of suicide ideation,
attempts, completed suicide, the so-
cio-demographic, mental health and
other risk factors associated with sui-
cidality in the Arab world.
Suicidality in the Arab World
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Methodology
A search was conducted on PubMed,
PsycInfo and IDRAAC WEB/CD up
to 2006 using the following key
words: suicidality, suicidal behavior,
suicide ideation, suicide plan, suicid-
al gestures, attempted suicide, para-
suicide, deliberate self-harm, self-
harm, suicide and completed suicide.
This search included the Arab world
and Arab countries: Algeria, Bahrain,
Comoros, Egypt, Gaza, Iraq, Jordan,
Kuwait, Lebanon, Libya, Mauritania,
Morocco, Oman, Qatar; Somalia,
Sudan, Syria, Tunisia, United Arab
Emirates, West Bank, Yemen, and
Gulf, Middle East, and Arab. An ini-
tial list of 2750 abstracts were re-
viewed, and 32 articles were identi-
fied as relevant but only 22 articles
could be retrieved and reviewed after
several attempts to locate the original
authors. The articles tackled different
aspects of suicidality, such as suicide
attempt and completed suicide. Some
studies were hospital based (n= 17),
while others used police and gov-
ernmental records (n=5). Community
based studies are reviewed in a pre-
vious article.
Terminology
In the following review, non-fatal
self-injurious behavior is referred to
as attempted suicide, parasuicide and
deliberate self-harm. These terms are
used interchangeably and encompass
specific types of self-injurious behav-
iors such as deliberate self-poisoning.
In some studies, intent to die is as-
sessed not for the purpose to distin-
guish suicide attempt from suicide
gesture, but rather as a characteristic
of the suicide attempt itself. In addi-
tion, several studies included in this
review differentiated deliberate self
poisoning (by using household chem-
icals or poisons) from deliberated
drug overdose (by using prescribed
or non-prescribed medication), on the
basis of the type of substances in-
gested in order to attempt or commit
suicide. Other studies defined delib-
erate self poisoning as the ingestion
of household chemicals and drugs,
prescribed and non-prescribed, in
order to attempt or commit suicide.
Results
Bahrain In a study by Al Ansari et al.1 a case-
control study was intended to com-
pare socio-demographic, mental
health and psychosocial characteris-
tics of drug overdose in two different
age groups: adolescents (15-18 years)
and young adults (19-24 years) that
were consecutively admitted to Sal-
maniya Medical Centre, Bahrain De-
fense Force Hospital and Psychiatric
Hospital (June 1993-December
1994). One-hundred-and-nine cases
were admitted but only 100 cases
were included due to the expiration
of their residency. Both age groups
were assessed according to several
instruments: a semi-structured inter-
view, a special questionnaire (to
gather information about socio-
demographic characteristics and cir-
Elie G. Karam, et al
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cumstances that surrounded the act),
DSM III-R (to assess the presence of
psychiatric illness), the Beck Suicide
Intent Scale (in order to assess intent
to die) and Hollingshead and Rahae
scale in order to assess socio-
economic status. The most frequently
observed socio-demographic charac-
teristics were similar in both adoles-
cents (n= 57) and young adults (n =
43), with the most common charac-
teristics being female (77.2% and
72.1%, respectively), never being
married (91.2% and 65.1%, respec-
tively), having more than 7 years of
education (91.2% and 100%, respec-
tively), and belonging to lower socio-
economic class (70.2% and 74.4%,
respectively). Adolescents and young
adults differed in terms of employ-
ment status, adolescents were more
commonly students (82.5%) and
young adults were more commonly
unemployed (46.5%).Young adults
were significantly more likely to be
married (P<0.001) and unemployed
(P< 0.0001) in comparison to the ad-
olescent group. The most frequently
reported precipitating factors by both
groups were marital problems be-
tween their parents (70%), conflict
with parents (45%), work and school
problems (38%) and problems with
their significant other (28%). Adoles-
cents were significantly more likely
to have had problems with peers
(P<0.01) and social isolation as pre-
ceding the act (p<0.01), and to take
two or more drugs as compared to
young adults (p < 0.05). Young
adults were significantly more likely
to score higher on the Beck Suicide
Scale (P< 0.01). DSM III-R diagno-
ses were made in 48% of the total
sample, adolescents and young adults
being diagnosed with adjustment dis-
order (31.6% and 39.5%, respective-
ly), depression (1.8% and 7%, re-
spectively), and adolescents with
conduct disorder (3.6%). Out of the
total sample, 27% had a previous his-
tory of parasuicide (85% overdosed
and 15% injured themselves). Ado-
lescents who have had a previous
history of drug over-dose were more
likely (19%) to do so in the past year
in comparison to adolescents
(8.1%).The drug most commonly
used in more than half of the total
sample was the non-opiate analgesic
paracetamol (58%). Seventy-nine
percent attempted by using drugs that
were either present at home or that
had been prescribed to them or indi-
viduals in their family. There was no
significant difference between the
two groups in terms of where and
how the drug became available and
the type of drug used. Adolescents
were more likely than young adults
to request the aid of general practi-
tioners (29.8% vs.9.4%, respectively)
and social workers (12.4% vs. 2.3%,
respectively).
Egypt Mabrouk and colleagues2 assessed
suicidal burns in the population of
patients who attended the burn unit
Suicidality in the Arab World
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of Ain Shams University (serves 4
million) from May 1995- December
1996. Seven-hundred-and-fifty-nine
cases were admitted to the Burn Unit,
23 were self-immolators (age range:
14-55) with a mean age of 23 years.
Self-immolators were mostly females
(91.4%), less than 20 years old (61
%), single (52%), illiterate or with
primary school level education
(56.5%), from low socio-economic
class (82.6%), housewives (52.2%)
and unskilled workers (31.4%). All
cases of self-immolation were exam-
ined by a psychiatrist and assessed
according to ICD-10 criteria; the re-
ported diagnoses were depressive
disorder (74%), borderline personali-
ty (13%), psychotic disorders (9%)
and unknown (4%). Twenty-two per-
cent had made a previous suicide at-
tempt and none had received prior
psychiatric treatment. Family con-
flicts were the “main” precipitating
factor among all self-immolators.
Even after extensive treatment, 74%
of self-immolator died. Kerosene was
used in all cases of self-immolation.
In a study by Okasha et al.,3 clinical
and social factors which predispose
individuals to attempt suicide in Cai-
ro were assessed in subjects who
were admitted for attempted suicide
to the casualty department of 3 dif-
ferent hospitals (catchment area: 4
million) during the first week of each
month, during a one year period
(1981-1982). Several instruments
were used to assess the different
characteristics of suicide attempters:
a semi-structured interview (to as-
sesses the characteristics of the at-
tempt, psychiatric symptoms and so-
cio-demographic characteristics);
suicidal feelings questionnaire (to
assess the presence of suicidal idea-
tion in attempters); Suicide Risk
Scale (to assess the risk of future sui-
cide); two psychometric tests ( the
Arabic version of Eysenck Personali-
ty Questionnaire and the Extreme
Response test); and the Hamilton
scale for depression and anxiety. The
attempter’s spouses were also given
personality tests to take. Ninety-one
attempters were recorded. A “higher”
prevalence of attempted suicide was
observed during May, June and July.
Suicide attempters were more signif-
icantly observed to be: female (69%),
single (71%), literate (71%), students
(37%) and unemployed (14 %),
which are all reported by the author
to be overrepresented in the sample
in comparison to the general popula-
tion. The most frequently observed
characteristics among attempters
were: being an adolescent or young
adult (60%); having children with a
mean number of 3.27 +/- 1.72 (93%);
belonging to overcrowded large
families (mean number 7.8 +/- 2.2);
living in a small mean number of
rooms (2.2 +/- 6.6); and belonging to
low socio-economic class (59%).
Eighty-three percent of all cases were
diagnosed with psychiatric disorders.
Of those diagnosed, the most com-
Elie G. Karam, et al
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mon were (27%) adjustment disorder
(32% of males and 25% of females),
(20%) personality disorder (18 % of
males and 2% of females), and (12%)
dysthymic disorder (16% of males
and 9% of females). Reported precip-
itating factors differed according to
gender, with females more likely to
report bereavement, romantic rela-
tionship problems and marital prob-
lems, and males were more likely to
report financial difficulties and con-
flicts related to work and school (no
numbers in article). Drug overdose
was the most commonly used method
(60%), while aspirin was the most
commonly used licit drug; violent
methods (cutting, piercing, burning
and jumping) were less commonly
used, but when used, they were more
often used by males. When suicide
attempters were compared with the
general population, attempters scored
higher on measures of psychoticism,
neuroticism and criminality. Male
attempters were more likely to be
classified as introverts in comparison
to female attempters. On the Extreme
Response test, suicide attempters
were reported to be more flexible and
less rigid in comparison to the aver-
age population. Male (6.3 +/-2.79)
and female (5.2+/-2.17) spouses of
suicide attempters had higher scores
for psychoticism than the average
population. Male spouses were re-
ported to be more extroverted (13.2
+/- 3.5) than the average population
and female spouses were more likely
to be introverted (11.9 +/- 4.3).
Okasha and Lotaif 4 investigated the
prevalence of attempted suicide and
the socio-demographic and mental
health characteristics of suicide at-
tempters in Cairo that were admitted
to the casualty department of Ain
Shams University Hospital during a
one year period (1975). One-
thousand-one-hundred-and-fifty-five
suicide attempters were recorded
which resulted in a reported approx-
imate annual rate of 38.5/100,000.
The sample was selected by choosing
the first 16 or 17 attempters admitted
during each month, resulting in a
sample of 200 cases. Interviews were
conducted with the use of the Ain
Shams case-taking sheet and ques-
tionnaire created for this study.
There was an observed increase of
attempted suicide during the months
of May, June and July. The highest
incidence of attempted suicide oc-
curred mostly in 15- 24 year olds
(60%), males (61.5%), single persons
(53%), those who practiced their re-
ligious beliefs (72%), students
(40%), the unemployed (23%), those
that completed secondary school
(35%) and individuals from middle
to low socio-economic class(no
numbers in article). One-hundred
percent of the total sample was diag-
nosed with a psychiatric disorder; the
diagnoses were (diagnostic method
not mentioned in article): 63% de-
pressive disorder (66% males), 13%
Suicidality in the Arab World
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hysterical reactions (77% females),
8.5% situational disorder (53%
males), 8% schizophrenia (94%
males), 5% personality disorders
(50% males) and 2.5% substance
abuse/ dependence (100% males).
Seventy-five percent of those diag-
nosed with depression attempted sui-
cide 4 months after the onset of their
depressive episode and the rest were
depressed for less than 8 months be-
fore making their suicide attempt.
Five percent sought psychiatric assis-
tance before attempting suicide. Thir-
teen percent made previous suicide
attempt, 5% made 1 previous at-
tempt, and 7% made 2 previous at-
tempts, and 1% made 3 previous at-
tempts. Seventeen percent of at-
tempters reported a family history of
suicide attempts. The most common
stressors and conflicts reported were
marital problems, unemployment,
work related problems, and financial
problems (numbers missing in arti-
cle). The methods used to attempt
suicide were: 80% overdose (61%
males), 10% used poisoning material
(85% females), 7% bodily harm
(100% males) and 3% intoxication
(100% males).
Iraq In order to identify the socio-
demographic and clinical characteris-
tics of self-poisoning, Al-Samarrai
and Hussein5 prospectively studied
all self-poisoning patients that were
brought to the emergency department
of University Hospital of Saddam
College of Medicine in Baghdad dur-
ing a 4 month period (January 1,
1998- April 30, 1998). With the use
of a semi-structured interview, 58
patients were diagnosed with parasu-
icide and self poisoning (age range:
15-59), which stand for almost
8.8/1000 total emergency cases. The
total sample mortality rate was
3.50%. Females (69%) constituted
the majority of cases, with a male to
female ratio of 1: 2.2. The average
age for the total sample was 28 years
(31 y for males and 25 y for fe-
males); females were significantly
younger than males (p< 0.05). The
most commonly observed socio-
demographic characteristics among
attempters were: 70.7% between the
ages 15-29 years (76% females),
48% single (61%females), 36% em-
ployed (52% males), 33% house-
wives, 72% lived in urban areas
(64% females) and 48% had univer-
sity or postgraduate level education
(75% females). Patients were almost
equally distributed among socio-
economic classes (upper, middle and
low). Only 8.6% were in the age
group 40- 59 years. No incidences
were recorded for older age groups.
A psychiatrist used a semi-structured
interview to assess parasuicide pa-
tients. Ten percent of the whole sam-
ple had a history of mental illness
and psychiatric treatment (diagnostic
method not mentioned in article).
Ten percent made previous suicide
attempts, 5% made one previous at-
Elie G. Karam, et al
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tempt and 5% made 2 or more sui-
cide attempts. The three most com-
monly reported motives for attempt-
ing suicide were to relieve stress
(27.5%), confused emotions (21%)
and desire to die (14%). The most
commonly reported precipitating fac-
tors were 27.6% family conflicts,
26% marital problems and 17.2% the
loss of someone important in their
lives as a result of death or separa-
tion. Self-poisoning was consistently
reported by attempters as an impul-
sive reaction during an argument or
fight in 78% of the total sample. The
most common drugs used in self-
poisoning were psychotropic medica-
tion (39% males and 52.5% females).
Only 26% were referred to a psychia-
trist and 39.6% were discharged
without follow up.
Jordan Abu-Hijleh 6 examined the effect of
life events in predisposing adoles-
cents to suicidal behavior in Jordan.
The study administered the Adoles-
cent Life Change Events Question-
naire (ALCEQ) and compared the
scores of adolescents (N=36; age
range = 14-19) who were admitted to
Jordan University Hospital (1995-
1997) for attempted suicide, with
those who were admitted for “neurot-
ic and anxious symptoms,” with a
control group selected from nearby
schools. There was no significant
difference in the total Life Change
Events score between neurotic and
suicidal adolescents; nonetheless,
there were significant differences on
particular life events: problems with
family (p < 0.001) and beginning to
have opposite sex friends (p < 0.05).
Losing a close friend was significant-
ly reported in both suicidal and neu-
rotic groups (p < 0.01).
In a retrospective study, Saadeh et
al.,7 examined all those who were
admitted for carbamate and organo-
phosphate poisoning to the Medical
Center of Princess Basma Hospital
during a 5 year period (January 1990
to January 1995) in order to assess
the incidence, socio-demographic
and clinical aspects of carbamate and
organophosphate poisoning in North
Jordan. Seventy adults were admitted
for carbamate and organophosphate
poisoning, 64% (56% females) were
assessed to be suicide attempts with a
total sample mean age of 23.25 +/-
8.2 years (the mean age of attempters
was not reported). The most common
characteristics observed in the total
sample were being young: 15-19
years old (43%), being single (67%),
being unemployed (43%) and living
in a rural area (57%).
In another retrospective study by
Saadeh et al.,8 the clinical and socio-
demographic characteristics of delib-
erate self- poisoning by drugs and
household products in Jordan were
assessed by reviewing the medical
records of all patients over the age of
15 years who were admitted for self-
poisoning at the medical department
of Princess Basma Teaching Hospital
Suicidality in the Arab World
8
(January 1990-1994). Using ICD-9
criteria, 709 cases were diagnosed as
being cases of deliberate self harm,
making a reported average annual
rate of approximately 127/100,000
with a mortality rate of 0.60%. Due
to missing data, only 647 cases were
included in the study. Cases of delib-
erate self-poisoning were frequently
observed to be female (58%), be-
tween the ages 15-24 (76%), single
(62%), students (41%), unemployed
(22%) and housewives (21%). The
estimated annual rate of self-
poisoning in 15-19 year olds was
416/100,000. The incidence of self-
poisoning decreased with increasing
age, resulting in the least amount of
incidences in the age group 35 and
over (5%). Medical doctors and a
psychiatrist diagnosed (method not
clear) 17% of the total sample with
mental disorders; the disorders were
depression (7%), drug abuse (4%),
schizophrenia (4%) and personality
disorders (2%). Previous suicide at-
tempts were reported by 10% of the
sample. Paracetamol (15%) and pre-
scribed drugs (15%) were two of the
most frequently used drugs in the
total sample. In 38% of cases, the
medicine used for self-poisoning had
been prescribed to the patient or to a
family member. Twenty percent were
immediately placed in intensive care
upon admission, while the rest stayed
in the hospital for a mean number of
2.7 days.
In a study by Daradkeh,9 characteris-
tics of individuals who committed
suicide in Jordan were assessed by
reviewing all suicide deaths recorded
at the Department of Public Security
during the years 1980-1985. Two-
hundred-and-nineteen completed sui-
cides were recorded, the author re-
porting an estimated average annual
rate of 2.1/100,000 attempts. Males
had a mean age of 31 years and fe-
males had a mean age of 28 years.
Fifty-nine percent were males
(2.55/100,000), who were between
the ages of 15 to 24 (3.35/100,000)
and 25-34 (3.73/100,000). Female
suicide victims were also observed to
reach a peak of incidence between
the ages 15-24 (3.38/100,000) and
25-34 (2.53/100,000). The frequency
of suicide was observed to be less
common in the age range 65 years
and older for both males
(2.58/100,000) and females
(2.06/100,000). Police investigators
labeled 63% of the total sample as
mentally ill (diagnostic method not
mentioned in article). Males were
more likely to be single (70%), man-
ual workers (35%), unemployed
(22%), used insecticides (26%), or
self-shooting (26%) to commit sui-
cide. Females were more likely to be
married (51%), housewives (41%),
students (29%), and unemployed
(27%), and used the methods self-
immolation (41%) and insecticides
(37%) to commit suicide.
Elie G. Karam, et al
9
Kuwait A retrospective hospital based study;
bang et al.10 assessed the various
characteristics of those who died due
to burns during a period of 16 years
(1982-1997) at 3 different hospitals
in Kuwait. During the study period,
234 patients died as a result of their
burn injuries (mean age = 30y),
11.5% were the result of self-
immolation. Kuwaiti nationals con-
stituted 37.2% of the total sample.
Out of those deemed to be suicidal
deaths, the highest incidences were
among Kuwaiti citizens and non-
Kuwaiti Arabs (numbers not in arti-
cle), females (9.4%) and married
(9.8%). Psychological disorders were
found to be present in 56% of those
that died as a result of suicidal burns
(diagnostic method not mentioned in
article). Benzene was the most com-
monly used accelerant in cases of
self-immolation.
In another retrospective study, Emara
and colleagues11 investigated all re-
ported cases of attempted suicide by
drug overdose admitted to the medi-
cal wards of the Mubarak Teaching
Hospital during a 3 year period from
1983-1985 (serves 240,000).Two-
hundred-and-twenty-seven cases of
attempted suicide were recorded (age
range: 14-48), and two died (mortali-
ty rate of 0.88%). Kuwaiti nationals
constituted 36% of the total sample.
Out of the total sample, the most
common socio-demographic factors
were being female (77%) and under
the age of 25 years (68%). In the
total sample, females were signifi-
cantly younger (22.5 +/- 6.1 years)
than males (26.05 +/- 7.2 years) (p <
0.005). Forty-nine percent of cases
were assessed using ICD-9 criteria,
34.8% were diagnosed with a mental
illness. Those with a diagnosis:
21.4% had depression (14.8% of
males and 23.5% of females), 10.7%
drug dependence (33.3% of males
and 3.5% of females), 0.89% schizo-
phrenia (4% males) and 2% mental
retardation (4% of males and 1% of
females). Previous suicide attempts
were recorded in 13.2% of the total
sample, 7% had one, 5% had two and
1.5% had three previous attempts.
Attempters with a history of drug
dependence were significantly more
likely to have made multiple previ-
ous suicide attempt (p =0.0013), in-
gested fewer tablets (p = 0.9934), and
utilized an unidentified variety of
drugs (p = 0.0389). The most com-
monly used drugs were paracetamol
(36.5%), aspirin (19%), tranquilizers
and antidepressants (14.5%). The
majority of cases used only one type
of drug (64%) and took a dose of up
to 20-40 tablets (45.3%). Expatriates
were significantly more likely to take
larger doses than Kuwaiti nationals
(p=0.0107).
Suleiman et al.12 investigated the psy-
chosocial profile of 92 parasuicide
patients (age range: 14-44) brought to
the Mubarak Al-Kabir Teaching
Hospital in Kuwait (serves 449,000)
Suicidality in the Arab World
10
during a 1 year period (December
1984- November 1985). Kuwaiti citi-
zens comprised 41.7% of the total
sample. Females were younger than
males with a mean age of 22.2 +/-
5.03 vs. 27.2+/- 7.3, respectively.
Females outnumbered males with a
ratio of 6:1 and they were significant-
ly more likely to feel regret over their
suicide attempt (P< 0.003). Attempt-
ers that were 30 years and younger
were significantly more likely to use
self-poisoning and jump from high,
while those 30 years and older were
more likely to use sharp tools to at-
tempt suicide (P < 0.005). Males
were significantly more likely to use
sharp tools, while females were more
likely to use self-poisoning (P >
0.002). Non-Kuwaiti Arabs were sig-
nificantly more likely to use self-
poisoning, while non-Kuwaiti non-
Arabs were more likely to use sharp
tools and jump from high (P<0.001).
Those with more than eight years of
education were significantly more
likely to use self-poisoning, whereas
patients with 8 years or less of formal
education were more likely to use
sharp tools to attempt suicide (P <
0.0001). Using ICD-9 criteria to as-
sess the presence of psychiatric dis-
orders, the most frequently made di-
agnoses were 25% depression, “acute
situational distress” and “personality
disorders” (numbers not available in
article). Kuwaitis were more likely
to report family conflict (P < 0.05)
and educational problems ( P <
0.007) as precipitating factors, while
non-Kuwaiti non-Arabs reported that
work conflicts ( P < 0.001) and al-
tered work conditions ( P < 0.0001)
most often preceded suicide attempt.
Drugs used for self-poisoning were
more often taken from free clinics or
belonged to a relative or family
member (P < 0.001). Kuwaitis were
more likely to take a combination of
drugs and the most frequently used
drugs were non-opiate analgesics (P
<0.0001). The attitudes of the at-
tempter’s families were assessed too
regarding the patients suicide at-
tempt: Kuwaiti patients were signifi-
cantly more likely to report that they
were met by “aggressive attitudes”
from family members (P <0.0001).
Lebanon In 1994, Alyahfoufi13 retrospectively
assessed the prevalence of attempted
suicide in Lebanon by using the files
of 6 different hospitals in different
areas of Beirut with a reported
catchment area of 800,000. One-
hundred-and-forty-seven attempters
were documented, making an annual
rate of approximately 21.4/100,000
attempts. Attempters were more fre-
quently single (76.92%), females
(65.31%) and between the ages of
16-25 (57.14%). Psychological prob-
lems were assessed by medical doc-
tors (diagnostic method not men-
tioned in article), depression reported
to be present in 23.9% of all attempt-
ers. The most common precipitating
factors or reasons given for attempt-
Elie G. Karam, et al
11
ing suicide were family problems
(63.8%), and the two most common-
ly used methods for attempting sui-
cide were drug overdose (59.8%) and
self-poisoning (27.2%).
Abou- Daoud14 investigated the prev-
alence of completed suicide in the
Beirut area over a 5 year period
(1968-1972) by using the register of
deaths in the Municipal Health De-
partment of the city of Beirut with a
reported catchment area of
1,000,000. One-hundred-and-twenty
completed suicides were recorded, a
reported estimate of about
2.4/100,000 completed suicides an-
nually. Lebanese citizens constituted
the majority of the sample (61%).
Out of the total sample, suicide vic-
tims were frequently male (58%), in
the age group 10-29 years (52%), of
the Muslim religion (64%), and sin-
gle (54%). Parathion poisoning was
the most frequently used method in
the total sample (20%) and among
females (28%), while fire-arms were
the most commonly used method for
males (20%). Cases of completed
suicide appeared to successively de-
crease from 31 cases (1968) to 19
cases (1972).
Oman In a retrospective study by Zaidan
and colleagues,15 information about
the demographic characteristics, pre-
cipitating factors, and substances
used for deliberate self-poisoning
(DSP) were taken from the files of
deliberate self poisoning cases who
were brought to the Accident &
Emergency clinics of 4 different hos-
pitals in Urban Muscat during the
years 1993-1998 (serves 557,500).
Suspected cases deliberate self poi-
soning was assessed according to
ICD-10 criteria. One-hundred-and-
twenty-three cases of deliberate self
poisoning cases were recorded (age
range: 12-56) with a mean age of
23.5 years (SD = 6.86), of which
77.2% were Omani citizens. Out of
the total sample, deliberate self poi-
soning was more common in persons
20-30 years old (54.1%) and persons
less than 20 years old (30.3%). Oma-
ni patients were mostly females
(83%), single (63%), students (36%),
unemployed (26%), and received up
to secondary school education (72%).
Among the total sample, 20% were
diagnosed with psychiatric disorders,
(11.4%) depression, personality dis-
orders (4.1%), substance abuse
(2.2%), a history of seizures (1.6%)
and a history of criminal activity
(1.6%). Twelve percent of the total
sample reported previous instances of
deliberate self-harm, with an average
of 3.28 months in between attempts.
Family conflicts (30.9%) and social
problems (15.4%) were the most fre-
quently reported precipitating factors
among the total sample. The most
commonly used substance for self-
poisoning among the total sample
were non-steroidal analgesics
(40.7%). The majority of cases
(75.6%) were admitted to the general
Suicidality in the Arab World
12
medical ward, 8.3% were treated in
the psychiatric ward, and a minority
(7.3%) experienced complication and
had to be admitted to the ICU. A rise
in reported instances of deliberate
self-poisoning in Omani citizens was
observed from 1995 (1.9/100,000) to
1998 (12.8/100,000).
Saudi Arabia In a retrospective study by Al-Jahdali
et al.,16 cases of intentional drug
overdose admitted to the King Fahd
National Guard Hospital (catchment
area: 250,000) from 1997 to1999
were assessed by reviewing patient’s
charts in order to ascertain socio-
demographic and mental health char-
acteristics of intentional drug over-
dose in Saudi Arabia. Seventy-nine
cases were studied (age range: 15-40
years old) with a mean age of 22
years (SD 4.6 yrs). Saudi nationals
constituted 96% of attempters. Inci-
dences of suicide attempts were ob-
served to increase in September
(20%). Out of the total sample, inten-
tional drug overdose patients were
frequently female (80%) with a fe-
male to male ratio of 4:1, single
(75% of males and 44% of females),
unemployed (60%), with a high
school education (41%), and from a
family of 5 or more members (59%).
Upon admission and prior to dis-
charge, a psychiatrist interviewed
each case, 25% were assessed to have
had an unspecified psychiatric disor-
der and 5% had a history of drug
abuse. The most frequently reported
precipitating factors were family con-
flicts (60%), while school perfor-
mance was an important precipitating
factor in school aged patients. The
most commonly used drug was acet-
aminophen (30%); one type of drug
was used in the majority of cases
(80%); and patients were most likely
to have been prescribed the drugs
that they used to overdose on (53%).
Twenty-three percent made previous
attempts, of which 39% made one
previous attempt, 22% made 2 at-
tempts, and 39% made 3 previous
attempts. Out of the total sample,
63% had either normal or negative
drug levels, 15% were admitted to
the intensive care
unit, staying for a mean number of
1.5 days (SD 0.5), while the rest of
the patients were admitted to the reg-
ular ward for a mean number of 5
days (SD 3) .
AbuMadini and Adel Rahim,17 pro-
spectively assessed characteristics of
deliberate self-harm subjects by us-
ing two structured questionnaires to
collect information about socio-
demographic characteristics and de-
liberate self-harm characteristics for
each deliberate self-harm patients
attending the Accident & Emergency
at the King Fahd University Hospital
from 1994 to 2000. Three-hundred-
and-ninety-eight cases were recorded
(age range 13-74), only 362 cases
were included in the study (drop out
rate of 9%) with a mean age of 26.3
(SD 9.5). Saudi nationals comprised
Elie G. Karam, et al
13
the majority of the sample (76.2%).
Deliberate self-harm patients were
frequently females (64.4%), single
(48.9%), between the ages of 20-29
years (53.3%), and unemployed
(37.6%). In comparison to males,
females were significantly more like-
ly to be less than 20 years old (p <
0.0001), unemployed (p <0.0001)
and students (p < 0.01). The majority
of deliberate self-harm patients re-
ceived a psychiatric admission
(53.6%) and had a family history of
psychiatric disorders (51%). ICD-10
diagnoses were made for 87% of the
total sample; the most common diag-
noses were personality disorder
(32%), adjustment disorder (30.1%)
and depressive disorder (8.6%). The
most frequently reported precipitat-
ing factor among deliberate self-harm
patients was family problems
(50.3%). Females were significantly
more likely to have a personality dis-
order (p<0.01), an adjustment disor-
der ( p < 0.01), to have had acute on-
set of mental illness (p< 0.0001), to
report stressful life events ( p <
0.0001) and family conflicts (p <
0.00001) as preceding their attempt,
and to describe their attempt as a way
to get back at others ( p < 0.001).On
the other hand, males were more sig-
nificantly diagnosed with substance-
related disorders (p < 0.0001), schiz-
ophrenia (p < 0.01), depressive dis-
order (p<0.01), delusional disorders
(p < 0.01), having psychotic symp-
toms (p < 0.001), difficulty with law
enforcement individuals(p < 0.0001),
to report internal conflicts (p <
0.00001) as a precipitating factor and
to report serious intent to die (p <
0.0001) as their main motive. The
methods most used in all cases of
deliberate self-harm were drug over-
dose (78.7%) and self cutting (26%),
and the most used drug was parace-
tamol (80%). Drug overdose was
significantly observed in females (p
< 0.0001), while self-cutting was
more frequent in males (p < 0.001).
One previous attempt was reported
by 21.5%, two previous attempts
were reported by 19.9%. Females
were significantly more likely to
have made the attempt in the pres-
ence of others (p < 0.0001), to have
made more than one previous attempt
(p< 0.5) and to have been admitted to
the ICU (p < 0.01). Males were more
likely to be admitted to the surgical
ward (p< 0.0001).
By examining all cases of recorded
suicide in the Medical Legal center in
Dammam, Saudi Arabia from 1986-
1995, Elfawal18 was able to ascertain
the different methods used to commit
suicide and the frequency with which
such methods were employed in the
different age, gender and racial
groups in Saudi Arabia. Two-
hundred-and-twenty-one cases were
recorded, producing an annual esti-
mated population rate of 1.1/100,000.
Saudi nationals constituted 23%
(84% males and 17% females) of the
total sample. Suicide victims were
Suicidality in the Arab World
14
more likely to be: males (82%), be-
tween the ages of 30-39 years old
(44%), single for males (59%) and
married for females (65%). Low in-
cidences (3.2%) of suicide were ob-
served in the age group 60 years and
older. The most commonly used
methods among Saudi nationals were
hanging (39%) and gunshot injuries
(37%). The two most frequently used
methods by females were hanging
(55%) and drug overdose (23%)
There was no significant difference
in the number of suicides among in-
dividual months of the year.
In a study by Osman and Ibrahim,19
cases of deliberate self-harm attend-
ing the Accident and Emergency De-
partment at the King Fahd University
Hospital were assessed by psychia-
trists during a period of 9 months
(April 1994- December 1994). Fifty-
five deliberate self-harm cases were
recorded (18.2% males and 81.8%
females), 65.5% were Saudi nation-
als. Saudi female attempters were
younger (mean age: 20.8 y) than
Saudi male attempters (mean age:
29.7 y). Saudi attempters were more
frequently females (89 %), single (78
%) with secondary education or less
(89 %). Expatriates were significant-
ly more likely to be older (p < 0.05),
married, to have previously seriously
considered attempting suicide and
were less likely to have made previ-
ous attempts (p < 0.005). Psychiatric
disorders and previous deliberate
self-harm each occurred in 29 % of
the total sample. The majority of de-
liberate self-harm patients denied
suicidal intent (88 %) and reported
family conflict as the main precipitat-
ing factor that preceded the act
(50.9%). Out of the total sample, the
most frequently used methods were
self-poisoning (80%) and jumping
from high (22%). Serious cases were
more likely to be expatriates, males,
older age groups and those with pre-
vious suicide attempts.
In a retrospective study, Malik et al.,
20 reviewed the files of all drug over-
dose patients that attended Asir Cen-
tral Hospital during a 5 year period
(1985-1993). Fifty-seven cases of
drug overdose were recorded, 81%
were suicide attempts and the rest
were accidental in nature. Results
indicated that the frequency of drug
overdose had increased over the 5
year study period, from 2 cases in
1989 to 22 cases in 1993. The ma-
jority of attempters were Saudi citi-
zens (89%). The most common char-
acteristics among all cases of drug
overdose were: less than 40 years
(95.6%) with a mean age of 23.6 +/-
9.1 years, single (57.8%), and have
between 6-12 years of education
(82%). ICD-9 psychiatric disorders
were diagnosed in 74% of intentional
drug overdose patients, the most
common diagnosis were depressive
disorder (39.5%) followed by per-
sonality disorder (34.9%). In 60% of
the total sample, family and interper-
sonal problems were reported as cen-
Elie G. Karam, et al
15
tral precipitating factors. The most
frequently used drugs were analge-
sics and non-steriod anti-
inflammatory drugs (25.9%). Illicit
drugs were not detected in any cases
and only one patient was found to
have consumed alcohol. Illiterate pa-
tients and male patients were signifi-
cantly less likely to be referred for a
psychiatric evaluation (P < 0.05). No
mortalities were recorded.
In another study, Daradkeh and Al-
Zayer21 investigated the social and
clinical characteristics of parasuicide,
retrospectively and prospectively,
among the Arabian-American Oil
Company (ARAMCO) employees
(n=31,814) and their dependents (n=
127,614) who were qualified for
treatment in ARAMCO’s medical
services, specifically Dahran Health
Center (1985-1986). In the retrospec-
tive part of the study (1985), 30 Sau-
di citizens were admitted for parasui-
cide, with a mean age of 23.4 years.
In the prospective part of the study
(1986), 36 incidences of attempted
suicide were presented, 92% were
Saudi nationals with a mean age of
24 years (24.9 years for males and
23.2 years for females). In the pro-
spective sample, the rate of attempted
suicide among Saudi employees and
their dependents was estimated to be
20.7/ 100,000. Out of all cases of
Saudi nationals in both groups, the
most frequently observed socio-
demographic characteristics among
the retrospective and prospective
sample were: female (87% and 73%,
respectively), married (63% and
55%, respectively), housewives (50%
and 36%, respectively) and students
(33% and 33%, respectively). The
most frequently reported motives by
Saudi nationals in both samples (ret-
rospective and prospective) were a
desire to die (47% and 30%, respec-
tively) and attention seeking (33%
and 36%, respectively). Among Sau-
di nationals, ICD-9 diagnoses were
made for the retrospective (77%) and
prospective (85%) samples, the most
frequently made diagnoses were
acute reaction to stress (40% and
55%, respectively) and depressive
disorder (20% and 18%, respective-
ly). The most commonly used meth-
od in the retrospective and prospec-
tive samples was drug overdose
(67% and 70%, retrospectively) and
the drugs most commonly used drugs
were non-opiate analgesics (43% and
52%, respectively). In the prospec-
tive sample, the most frequently re-
ported precipitating factors were
marital problems (30%) and disa-
greements with parents (36%), and
the majority attempted without a plan
(88 %). Twenty- one percent of the
prospective sample reported a previ-
ous suicide attempt.
United Arab Emirates In a study by Koronfel,22 all deaths
confirmed as suicides for the years
1992-2000 by the Forensic Medicine
Department in Dubai were examined
in order to ascertain specific charac-
Suicidality in the Arab World
16
teristics related to suicide deaths in
Dubai (population covered: 650,000).
Three-hundred-and-sixty two cases
were recorded, with a reported annu-
al rate of about 6.2/100,000. Dubai
citizens constituted the minority of
cases (6%). A non-significant in-
crease of suicide was recorded during
November, along with a decrease
during July. Fridays were observed to
have a non-significant low incidence
of reported suicide, along with a non-
significant difference between Mus-
lims and non-Muslims. Out of the
total sample, the majority of suicide
victims were males (85%), expatri-
ates (94%), in the age group 21-40
(81.5%) and chose to commit suicide
in their homes (63%). A peak of in-
cidence was observed during the ages
26-30 (29%) with a decline in vic-
tims 50 years old and older (2.7%). A
significant increase was observed in
the prevalence of teenage girls (P =
0.024), especially among teenage
female citizens (P = 5.8E-06), and in
non-Indian expatriate females (P=
0.007). Hanging was the most com-
monly used method to commit sui-
cide among the total sample (75 %),
in the age group 21-40 year old
(62%), in males (79%), and in Dubai
citizens (71%). Females and non-
Indian expatriates showed a signifi-
cant inclination for jumping from
high and self-poisoning (P =0.008).
The most commonly used substances
for self-poisoning were corrosives
(23%). Information about the vic-
tim’s mental health history (diagnos-
tic method not mentioned in article)
and life stressors was only available
in 9.7% of the total sample. Of the
latter, 34 % were being treated for
depression, 9% suffered from drug
addiction, 23% had work or financial
problems, 11% were having family
problems, and 1.65% had made pre-
vious suicide attempts.
Discussion
The lack of national epidemiological
studies in the Arab world and the dif-
ferences in methodologies used, ren-
der it difficult to compare results and
make generalizations. In addition,
properly defined catchment areas for
the distribution of health care ser-
vices are practically non-existent in
Arab countries; thus, making it unre-
liable to make regional estimates of
attempted suicide by using hospital
based studies. Therefore, results
should be interpreted with caution. It
has been observed that official rec-
ords of suicide and attempted suicide
are filled with inconsistencies and
missing information which create an
incomplete picture of suicidal behav-
ior in several Arab countries.
In the reviewed hospital based sui-
cide studies, authors reported esti-
mated annual rates of attempted sui-
cide that widely ranged from
1.9/100,000 to 127/100,000. Obvi-
ously these estimates we presume are
not very reliable for several reasons
(accuracy of catchment areas, report-
ing etc.). Suicide attempters were
Elie G. Karam, et al
17
most frequently: females, between
the ages of 15-25 y , single, with
primary to secondary level education
, students, housewives , unemployed
, belonged to over-crowded large
families , lived in crowded living
conditions , and were from low so-
cio-economic status. Male attempters
were frequently older than female
attempters and were more commonly
unemployed or unskilled workers.
The psychiatric diagnoses ranged
from 10% -87%. The most frequently
diagnosed psychiatric disorders were
depressive disorder, dysthymic dis-
order, adjustment disorder, personali-
ty disorder, “acute reaction to stress,”
and drug dependence/abuse disor-
ders. The most commonly reported
precipitating factors among suicide
attempters were: family conflicts,
work/school problems and financial
problems. Suicide attempters fre-
quently reported low intent to die.
Previous suicide attempts were not
consistently reported in all Arab hos-
pital based studies, but when they
were, they ranged from 5% to 31%.
The two most common methods used
to attempt suicide were drug over-
dose and self-poisoning.
The Arab suicide studies that used
police and government records re-
ported annual completed suicide rates
of 1.1/100,000 to 6.2/100,000, again
keeping in mind the caveats of re-
porting. The most frequently ob-
served characteristics among suicide
victims were: male gender; between
the ages 20 to 40 years old, single,
manual workers and unemployed.
Female suicide victims were fre-
quently younger than male attempters
and were either students or house-
wives. Information about mental dis-
orders, previous suicide attempts and
precipitating factors were typically
not recorded on death registrations.
With this in mind, depression was the
most recorded psychiatric disorder,
and family problems were the most
recorded precipitating factor. The
most commonly used methods to
commit suicide, across all Arab sui-
cide studies, were hanging and self-
poisoning, males being more likely to
self-shoot and females to self-poison
and self-immolate.
Despite the difficulty in making
comparisons to western countries, yet
we can say, with great caution, that
data from North America23 point to
higher annual rates of attempted sui-
cide (500/100,000) and completed
suicide (14/100,000) than the rates
depicted in the Arab hospital based
studies on attempted suicide that we
reviewed.
On the other hand, the reviewed Arab
government based studies on com-
pleted suicide agree with other west-
ern reports24 on the higher prevalence
among males, but still point to lower
rates in the Arab world as compared
to western countries (Canada, Den-
mark, France, Germany, United
Kingdom, etc.)
Suicidality in the Arab World
18
Many have hypothesized that the rel-
atively low prevalence of suicidal
behavior in the Arab world, as com-
pared to western industrialized coun-
tries, is related to underreporting by
all socioeconomic classes, to improp-
er record keeping by official institu-
tions involved in this essential pro-
cess, and in part to legal and confi-
dentiality issues. Others have ex-
plained that the low prevalence of
suicide, especially among the elderly
population, is related to the social
environment of this part of the world,
where irrespective of region, the still
strong family cohesiveness shields
against suicidal impulses.
Still some Arab studies found a re-
cent increase in the rate of suicidal
behavior15,18, 20 and this is thought to be
due to economic and social changes
which are the result of rapid modern-
ization and urbanization in the re-
gion, such rapid changes creating a
growing rift between younger and
older generations, with the resulting
dissonance and intensifying conflicts
between Arab youth, the conservative
society and homes they live in. It is
possible though that there no real in-
crease in the rates of suicidal behav-
ior, but an increase in the effort to
record it.
An interesting issue has come to light
with our review and due to the popu-
lation distributions in a number of
Arab countries such as Saudi Arabia
and Dubai, where citizens represent
only a segment (at times a minority)
of the entire population: the preva-
lence and correlates of suicide and
attempted suicide were difficult to
distinguish from the expatriates re-
siding in those countries. In this re-
view, we attempted to report mainly
on the citizens of Arab countries.
However, it is difficult to overlook
the much higher prevalence of sui-
cide in expatriates living in Arab
countries in comparison to those re-
ported for the local citizens
A limitation to this review is that not
all Arab countries are represented
here (although we did not exclude
any from our search) and it is possi-
ble we might have missed important
studies in spite of our best attempt to
locate the authors and retrieve the
articles.
In conclusion, national epidemiologic
studies and proper book keeping
methodology in hospitals and gov-
ernmental institutions are needed to
assess suicidal behaviors in the Arab
World. This could help in developing
prevention programs and awareness
activities locally against suicidality.
The Arab Journal of Psychiatry (2008), Vol. 19, No .1, Page (1-24)
19
ل يض ا ح دزاسبدان رساجع ر انقبنخ كم أجس ذ له لا بد انز زح بز ي انل بنى انلسث
ذنك لج س جج ساب ثح ن يج حز ل بو . انشسطخ اندائس انحكياخ أ يسجالد ي انسزشفبد،
انجحس، يص س، انل سا ، ادز،، انك ذ، نج ب، ان سة، س هاخ ل ب، يهس ا، انهك خ ) 2002
بد أظ سد اندزاس . رلد،د انزبئج يقب نهجهدا اناس انزاجل خ . (،ا ا يبزادانلسثاخ انسل،اخ، انس
1.1/100,000زح بز ي ب ث انل دااد انس اخ نحبن خ ا أانز أجس ذ ي انسزش فبد
خرشس انسجالد ند انشسطخ اندائس انحكياخ ي انجهدا انلسثاخ جن يلدااد سا. 121/100,000
انلد د ي انلاي م انز رل سا نق د ر ىا رحد د . 2.2/100,000جن 1.1/100,000زح بز ي نإل
. زح بز نإل زح بز ن ب لالب خ ثلاي م ل داح انسزش فبد رج ا أ يح باد ا اندزاس بد انز أجس ذ ي
ز دائ جن ثجس خ، انس ز اندزاس ي 25جن 15ك انفس، غس يسرجط، انل س ز سام ي : يب
جزبب جن لبئالد كجسح، يس ز رح، زثخ يزل، لبطم ل انلم، ا ثب، رالي بزص ب، ج-جز بل
خ انز رلزج س كلاي م ر ، جن ض اساثبد انفس اض بيخ جن ذن ك، ب انكل س ي ا ثب . ي ضف
أياب ثبنس جخ جن . ضدزادكزئبة، انزكاف، انشضصاخ، ا ،يب له انضاساثبد ا جزحبز خصصب ا
س خ، غ س ي سرجا، 00 20يى له ادغهت ذكز، لسى ي ب ث ألشضبص انر ازحسا يلالن
ا بل دا أل بطه ل انل م ا س رس جم ،بق خ ي انسزش فبد ن، ب حبج خ ضبر خي ان. ل
.ي انلبنى انلسث ،اخ جننلايم انزحبز ااخ ي أجم رقى سجخ انسه ا اندائس انحكي
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Acknowledgement
This project was partially funded by the Institute for Development, Re-
search, Advocacy and Applied Care (IDRAAC), the Lebanese Ministry of
Public Health and the World Health Organization (WHO, Lebanon). The
authors wish to thank Ms. Lynn Farah for editing the manuscript and Ms
Dania Younes for helping in the literature review.
Table 2: Hospital based studies on attempted suicide in the Arab world
Country /
Author /Year
N Age (years)
and Gender
Characteristics of the
sample
Mental disorders Meth-
ods of
attempt
Bahrain
Al Ansari et al.
(1997)
2 groups:
Adoles
cents n=
57 Young
adults n=
43
Adolescents:
15-18
Young adults:
19-24
F>M
Never married (Adoles-
cents: 91.2%, Young adults:
65.1%)
Students: Adolescents:
82.5% , Unemployed:
Young adults 46.5%
Low SES (Adolescents:
70.2%, Young adults:
74.4%)
adjustment (31.6%
adolescents, 39.5%
young adults)
depression (1.8%
adolescents; 7%
young adults);
conduct (3.6% adoles-
cents)
Drug
overdose
(only)
Egypt
Mabrouk et al.
(1999)
759
(23
suicidal
burns)
Mean 23
F>M
52% single
56.5% illiterate and prima-
ry school
52.5% housewives
30.4% unskilled workers
82.6% low SES
Depressive (74%) Self-
immola-
tion
(only)
Egypt
Okasha et al.
(1986)
91 Adolescents
to early 20s
(60%)
F>M
71% single
Majority belong to large
families (mean 7.8 mem-
bers +/- 2.2)
71% literate
37% students & 31% em-
ployed
59% low SES
83% were diagnosed:
adjustment: 27%
personality: 20%
dysthymia: 12%
60%
drug
overdose
Egypt 1,155 15-24 (60%) 53% single depressive: 63% 80%
Suicidality in the Arab World
22
Okasha & Lo-
taif
(1979)
(200
studied)
M > F 35% secondary school
40% students & 23% un-
employed
Mainly from middle to low
SES
“hysterical reactions”:
13%
drug
overdose
Iraq
Al-Samarrai &
Hussein
(2000)
58 Mean 28
Males: mean
31
Females:
mean 25
15-29 : 71%
F > M
48% single
48% University & post-
graduate
36% employed & 33%
housewives
Equal distribution of SES
classes
10.3% history of
psychiatric
consultation, admis-
sion or used psycho-
tropic drugs
Self-
poi-
soning
(only)
Jordan
Saadeh et al.
(1996)
70
(45
attempters)
Mean 23.25
+/- 8.2 1
15-19 : 43%1
F > M
67% single 1
57% lived in rural areas 1
43% unemployed 1
no data Self-
poison-
ing (on-
ly)
Jordan
Saadeh et al.
(1995)
709
(647
included)
15-24 : 76%
F > M
62% single
41% students, 22%
unemployed &
21%houswives
17% were diagnosed:
depression: 7%
drug addiction : 4%
schizophrenia : 4%
Self-
poi-
soning
(only)
Kuwait
Emara et al.
(1988)
227 2 Female: mean
22.5 +/- 6.
Male: mean
26.05 +/- 7.2 3
<25: 68
F > M
no data 35.0% were
diagnosed: 3
depression: 21%
drug dependence: 11%
Drug
overdose
(only)
Kuwait
Suleiman et al.
(1986)
92 4 Males: mean
27.2 +/- 7.3 3
Females:
mean 22.2 +/-
5.03 3
F > M
no data
"acute situational
distress" and depres-
sion (25%) 3
86%
drug
over-
dose3
Lebanon
Alyahfoufi
(1998)
147 16-25:
57.14%
F > M
77% single 24% psychological
problems
60%
drug
over-
dose27%
self-
poi-
soning
Oman
Zaidan et al.
(2002)
123 5 Mean: 23.5
+/- 6.86 3
20-30: 54%3
F > M
63% single
72% secondary school
36% students & 26%
unemployed
19% were diagnosed: 3
depression 11.4%
personality 4.1%
Self-
poi-
soning
(only)
Saudi Arabia
Al-Jahdali et al.
(2004)
79 6 Mean: 22 +/-
4.6 3
F > M
51% single 3
59% from large families 3
41% high school education 3
60% unemployed 3
psychiatric disorders
25%3
history of drug abuse
5%3
Drug
overdose
(only)
Elie G. Karam, et al
23
Saudi Arabia
AbuMadini &
Abdel Rahim
(2001)
398
(362
included)7
Mean 26.3 +/-
9.5 3
20-29: 53
F > M
49% single3
22% student3 & 38%
unemployed 3
69% had no income 3
87% of attempters
were diagnosed: 3
personality 32 %
adjustment 30%
79%
over-
dose3
26 %
self-
cutting 3
Saudi Arabia
Osman & Ibra-
him
(1997)
55 8 Female: mean
20.
Males: mean
29.7
F > M
78% single
89% secondary school or
less
29% with psychiatric
disorders 3
80%
self-
poison-
ing 3
Saudi Arabia
Malik et al.
(1996)
57
(46
attemp
ters) 9
Mean 23.6
+/- 9.11,3
< 40: 96% 1,3
F > M1,3
57.8% single 1,3
82% had 6-12 years of
school 1,3
74% of attempters
were diagnosed:1
depressive 40%
personality 35%
Drug
overdose
(only)
Saudi Arabia
Daradkeh &
Al-Zayer
(1988)
36 10,11
Female: mean
23.
Males: mean
24.9
F > M
55% married
36% housewives and 33%
students
55% "acute reaction
to stress"
70%
drug
overdose
1 Out of the total sample: not only among attempted suicide patients.
2 36% Kuwaiti nationals.
3 Out of the total sample: not only among Arab citizens.
4 41.7% Kuwaiti nationals.
5 77.2% Omani nationals.
6 96% Saudi nationals.
7 76.2% Saudi nationals.
8 65.5% Saudi nationals.
9 89% Saudi nationals.
10 92% Saudi nationals.
11 prospective.
Note: A study by Abu-Hijleh (1998) was not included in this table because it did not
Share common outcomes listed under the table
Table 3. Government record based studies on completed suicide in the Arab world. Country
/Author /
Year
N Annual
rate
/100,000
Age
(years)
Gender Marital
Status/
Family size
Education /
Employment
/ Socio-
economic
status
Mental
Disorders
Methods
Jordan
Daradkeh
(1989)
219 2.1 Males:
mean 31
Females:
mean 28
M > F
Males:
70% singl
Females:
51% mar-
ried
Males: 35%
manual work-
ers; 22% un-
employed
Females: 41%
housewives;
29% students
and 27%
unemployed
63%
"mentally ill"
Males: 26%
insecticides
and 26% self-
shooting
Females: 41%
self-immolation
and 37% insecti-
cides
Lebanon
(Beirut)
Abou-
Daoud
(1974)
12
01
2.42
10-29
(52%) 2
M > F 54% single 2
no data no data Males: 20%
fire-arms 2
Females: 28%
parathion
poisoning 2
Saudi
Arabia
Elfawal
(1999)
22
13
1.12
30-39
(44%) 2
M > F2 Males:
59% single2
Females:
65% married2
no data no data 39% hanging
and 37% gun-
shot injuries
Suicidality in the Arab World
24
United
Arab
Emirates
(Dubai)
Koronfel
(2002)
36
24
6.22
21-40
(81.5%) 2
M > F no data no data 9.7% were
previously di-
agnosed:2, 5
34% depress
sion and 9%
drug addic tion
71 % hanging
1 61% Lebanese nationals.,
2 Out of the total sample: not only among Arab citizens.m
3 23% Saudi nationals.
4 6% Dubai nationals. ,
5 Dependent on availability of such information in records.
Note: A study by Bang et. al (2000) was not included in this table because it did not share common
outcomes listed under the table.
__________________________________________________________________
Correspondence:
Elie G Karam, MD
Department of Psychiatry and Clinical Psychology,
Faculty of Medicine, Balamand University, Beirut Lebanon.
Institute for Development Research Advocacy and Applied Care (IDRAAC)
POBox: 166227, Ashrafieh,
Beirut, Lebanon 1100 2110
Tel/Fax: 961 1583583
Email: [email protected]
Ranya P. Hajjar, BA
Department of Psychiatry and Clinical Psychology,
St Georges Hospital University Medical Center,
Beirut, Lebanon.
Mariana M. Salamoun, BS, BA
Institute for Development Research Advocacy and Applied Care (IDRAAC),
Beirut, Lebanon.