CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Suicide is a global public health issue. More than 800,000 people commit suicide and many more attempt it every year (WHO, 2014). In 2012 suicide accounted for 1.4% of all deaths and was the 15th leading cause of death worldwide (WHO, 2014). Moreover, suicide was the fourth leading cause of death among young males and the third among young females aged 15–19 years [Wasserman et al, 2015]. Suicidal behaviour has different stages, such as suicidal ideation, suicide planning, and attempting suicide [Baggio et al, 2010]. Wishes, ideas, and the tendency towards committing suicide are defined as suicidal ideation [Ahmad et al, 2014]. In adolescents, suicidal ideation has been reported as an important risk factor for suicide [Groleger et al, 2003]. It is also associated with a subsequent risk of attempting suicide [Cluver et al, 2015]. In the general population, a suicide attempt is the most important risk factor for suicide, and the risk of suicide increases with the number of attempts [Vidal et al, 2013]. According to a systematic review, around one third of adolescents aged 12-20 years have reported suicidal ideation [Evans et al, 2015]. Suicide is a serious public health problem, but it is preventable with timely and low-cost intervention (WHO, 2014). To date, several environmental, psychosocial and behavioural factors have been found to be associated with suicidal ideation, suicidal attempts and suicide in studies conducted in various countries. Physical, sexual and emotional abuse has been associated with adolescent suicidal ideation and attempts [Miller et al, 2013; Enns et al, 2015; Martin et al, 2017]. In addition, childhood physical and sexual abuse appears to be risk factors for future suicide attempts (Joiner et al, 2017). It is noted that suicidal behaviours often coexist with other health risk behaviours (Garrison et al, 2012; Afifi et al, 2017). Studies have shown that aggressive behaviour, smoking (Garrison et al, 2012), illicit drug use [Randall et al, 2014], and alcohol use [Han et al, 2010] and experience of sexual intercourse [16] are associated with suicidal behaviours in adolescents. Studies in other countries also revealed that parental support, family factors as well as psychological factors also influence suicidal behaviour [Randall et al, 2014; Peltzer et al, 2012]. Such findings suggest that recognizing health risk behaviours [Afifi et al, 2017] and other factors that influence suicidal behaviour can improve understanding about those at high risk of suicide. By reviewing the previous studies conducted in different countries, it is observed that prevalence of suicidal ideation in a year varies widely, ranging approximately from 8% to 30% [Randall et al, 2014; Han et al, 2010; Peltzer et al, 2012; Muula et al, 2017]. Suicidal ideation is both a strong risk factor and a stage in the suicidal process from planning to attempting to dying [Thanh et al 2015; Nock et al, 2008]. A 60% rate of transition has been observed from suicidal ideation to first suicide attempt within the first year of ideation onset [Nock et al, 2008]. Hence, one of the key challenges for preventing suicide among adolescents is improving the prediction of suicide risk [Hawton et al, 2012]. In Brazil, the prevalence of suicidal ideation and suicide attempt observed to be 14.0% and 5.9%, respectively, and associated with violent behaviour, smoking and alcohol consumption [Silva et al, 2014]. Although studies have shown that substance abuse is a risk factor for completed suicide (Brent, 2010; Shaffer, 2013; Shaffer & Fisher, 1981; Shaffer, Gould et al., 2010), as well as for suicide attempt and ideation (Goldman & Beardslee, 2012; Gould et al., 2013; Levy & Deykin, 2015), rarely have the independent contributions of specific substances been the focus of inquiry (Garrison, McKeown, Valois, & Vincent, 2013; Kandel, 2013; Kandel, Raveis, & Davies, 1991). Studies on completed suicide have not had sufficient statistical power to detect differences between types of drugs used, due to small sample sizes (Shaffer, Gould et al., 2010). In some epidemiological studies of suicidal behaviours and substance use (Garrison et al., 2013; Kandel, 2013; Kandel et al., 1991), psychiatric disorders, highly associated with both suicidal behaviours and substance use/abuse, were not assessed or taken into account.

1.2 STATEMENT OF THE PROBLEM

Students which are adolescents and young people in general are particularly vulnerable to experimentation and initiation into substance use habits, resulting in significant impairment, including poor school performance, teenage pregnancies, school dropout, and involvement in crime. The prevalence rates for drug use among students are generally high. There is global evidence supporting the strong relationship between student’s depression and substance use. Depressed students are twice as likely to use substances when compared with their peers without depression.  Students with co-morbid depression and substance use also show more substance‒related problems and a poorer quality of life than those with only substance use problems. The presence of co-morbidity with depression among students receiving care for substance use problems also results in a poorer treatment outcome, increased rates of drop‒out, and earlier relapse rate. It is commonly assumed that externalizing problems, such as attention deficit hyperactivity disorder and conduct disorders, are strong predictors of future substance use, with scant attention being paid to the role of internalizing disorders, such as depression and anxiety. The question therefore arises as to whether there are cases of depression, suicidal behaviours and drug use among secondary school students in Ado Ekiti, Ekiti state. If there are, which preventive measures against such behaviours are appropriate? These, in the main, constitute the problem of the study.

1.3 AIMS AND OBJECTIVES OF THE STUDY

The major aim of the study is to examine the prevalence of depression, suicidal ideation and drug use among secondary school students.  Other specific objectives of the study include;

1.  To examine the risk factors of depression, suicide and drug use among students of secondary schools in Ado Ekiti, Ekiti State

2.  To examine the extent to which senior secondary school students are depressed in Ado Ekiti, Ekiti state

3.  To examine the prevalence of depression and suicidal ideation among secondary school students in Ado Ekiti, Ekiti state

4.  To examine the prevalence of depression and drug use among secondary school students in Ado Ekiti, Ekiti state

5.  To examine the impact of depression, suicidal ideation and drug use on students academic performance in secondary schools in Ado Ekiti, Ekiti state

6.  To examine the preventive measures against the prevalence of depression, suicidal behaviours and drug use based on student’s characteristics (sex and year of study).

1.4 RESEARCH QUESTIONS

1.  What are the risk factors of depression, suicide and drug use among students of secondary schools in Ado Ekiti, Ekiti State?

2.  To what extent are senior secondary schools students are depressed in Ado Ekiti, Ekiti state?

3.  What are the prevalence of depression and suicidal ideation among secondary school students in Ado Ekiti, Ekiti state?

4.  How is the prevalence of depression and drug use among secondary school students in Ado Ekiti, Ekiti state?

5.  What is the impact of depression, suicidal ideation and drug use on student’s academic performance in secondary schools in Ado Ekiti, Ekiti state?

6.  What are the preventive measures against the prevalence of depression, suicidal behaviours and drug use based on student’s characteristics (sex and year of study)?

1.5 RESEARCH HYPOTHESIS

H0: Depression, Suicidal ideation and drug use has no significant influence on secondary school students in Ado Ekiti state

H1: Depression, Suicidal ideation and drug use has a significant influence on secondary school students in Ado Ekiti state

1.6 SIGNIFICANCE OF THE STUDY

The results of the findings from the data analysed on the prevalence of depression, suicidal ideation and drug use is hoped to enable health educators to suggest intervention and prevention strategies appropriate for students at risk for suicidal behaviours. It would help sociologists and other educators to provide intervention programmes to prevent premature deaths due to risk factors across the lifespan in Nigeria. It is expected also that the results of the findings from the study will help to reduce the harmful after-effects associated with risk factors and significant others, as well as reduce the social stigma attached to depression, suicidal ideation and drug use. The finding will also help to ginger up the various secondary schools in Nigeria to establish suicide prevention strategy centres with telephone ‘hotline’ services. It will also help the psychiatrists and suicidologists to identify early enough students with signs of depression, schizophrenia and other mood problems and to treat them before they start attempting suicide. It will also help guidance counsellors to plan out programmes of activities to enable the students reduce incidences and prevalence of suicidal ideation through a co-ordinated and planned programme of guidance counselling in the secondary schools. A well-coordinated and planned programme of guidance counselling for students in secondary schools in Ado Ekiti, it is expected, would decrease risk and/or increase protective factors against such behaviour. The result of the present finding, is hoped, would help to improve social integration and social regulation and might reduce social isolation and social withdrawal among the students of secondary schools in Ado Ekiti. In other words, it might help improve the relationship between the individual student and the social setting in which he or she finds him/herself, and also improve further research and expansion of body of knowledge.

1.7 SCOPE AND LIMITATION OF THE STUDY

The study is restricted to the prevalence of depression, suicidal ideation and drug use among secondary school students in Ado Ekiti, Ekiti state.

1.8      LIMITATION OF THE STUDY

Financial constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview)

Time constraint: The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

1.9      DEFINITION OF TERMS

Suicide: Is the act of intentionally causing one's own death. The most commonly used method of suicide varies between countries, and is partly related to the availability of effective means.

Drug Use: Drug use is a broad term to cover the taking of all psychoactive substances within which there are stages: drug-free (i.e. non-use), experimental use, recreational use and harmful use, which is further sub-divided into misuse and dependence.

Youth: Refers to young people between 13 and 25 years of age or their activities and their characteristics. The majority of youths in Nigerian secondary schools are between 13 and 19 years, a stage referred to as adolescence. The term youth therefore includes this age bracket of youths.

Depression: Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

Suicidal Ideation: Suicidal ideation lies in establishing the presence of suicidal intent. This is particularly important, as intention is a crucial link between thought and action, indicating the extent to which a person wants to die (Hjelmeland, 2017).