Suicide and Domestic Violence: Could There Be a Correlation?

Sobia Haqqi, MBBS, MCPS


December 22, 2008

To the Editor:

WHO [World Health Organization] reports that 1.5% of all deaths worldwide are due to suicide. Suicide is estimated to be the eighth leading cause of death in all age groups. The mean age for successfully completed suicide is reported to be 40 years.[1] Although globally, more women attempt suicide, more men die from suicide by a factor of 4.5:1.[2] Evidence is mounting that an increase in the number of suicides in some communities may represent only the tip of the iceberg of an epidemic of self-injurious behaviors and suicidal ideation.[3]

The risk factors for suicide include female gender, low socioeconomic status, lack of education, unemployment, increasing age, being married, not working outside of the home, and domestic violence.[4] As the literature reports, women known to be exposed to a violent intimate relationship were significantly more likely to be hospitalized with a psychiatric diagnosis, injury and poisoning diagnoses, and diagnoses of assault or attempted suicide.[5] As WHO's recently released World Report on Violence and Health notes: "One of the most common forms of violence against women is that performed by a husband or male partner." The result is that half of humanity is vulnerable to a risk factor with profound implications for health, but one which is nevertheless often ignored.[6,7,8]

The incidence of depression and anxiety was found to be higher among Pakistani women who were victims of domestic violence, as measured by depression and anxiety scales. Sixty percent of the victims had depression and 65% of the victims had anxiety.[9] Another study focused on the prevalence and severity of physical and psychological abuse, its consequences, and predisposing factors. Findings indicated that verbal, physical, and emotional abuses were common, leading to intimidation, emotional trauma, continued depression, suicidal plans, and suicidal attempts among women.[10,11]

Keeping in view the above mentioned facts, a study was conducted by the author. This was a questionnaire-based cross-sectional study carried out at a 500-bed tertiary care hospital, in Karachi, Pakistan. The sample consisted of married women presenting to the psychiatric facility, which is composed of a 16-bed inpatient ward, 26 outpatient clinics per week, and an occupational therapy unit as well as emergency and liaison psychiatric services available 24 hours a day, 7 days a week. A questionnaire adapted from Multi-country Studies on Women's Health and Domestic Violence Against Women[12] was used for the initial screening and evaluation in regard to domestic violence. It had separate questions for different forms of domestic violence, such as emotional, physical, and sexual. The Mini International Neuropsychiatric Interview (MINI) version 5.0.0 (English and Urdu version) was used for evaluating depression. The MINI[13] is a standardized instrument for the diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 2000) and International Classification of Diseases (ICD)-10 psychiatric disorders (World Health Organization, 1992). A total of 171 women were interviewed by the author. The majority of the women who were included in the study fell into the age category of 26-35 years (39.8%, n = 68).

Although the data are currently being analyzed, the author would like to share the preliminary findings: More than 1 form of domestic violence was reported by 69.05% (n = 118) of the sample. Sixty-two percent (n = 106) of the women were found to be suffering from depression at the time of interview, out of which 9.4% (n = 10) of the depressed women reported having current suicidal ideations, for which they were offered inpatient treatment and further assessment. Further analysis will clarify whether there is a correlation between women exhibiting suicidal ideations and the severity of domestic violence. Also, the author will be following the identified women prospectively to see the trends in regard to the continuation of domestic violence and suicidality.

Although still in the initial phase, this study could prove to be the first of its kind in a tertiary care setting. Similar further research could help in formulating laws in regard to domestic violence, early diagnosis of associated depression, and early treatment of the suffering women.

Sobia Haqqi, MBBS, MCPS, FCPS



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