Suicide is a global health concern, with 79% of the annual incidence occurring in low- and middle-income countries.1 However, suicide remains illegal in many African countries, including Uganda, and no suicide attempter would dare not to complete it for fear of the repercussions attached.Reference Kaggwa, Nuwamanya, Ashaba, Rukundo and Harms2 Although suicide rates in Uganda decreased from 15.91 per 100 000 population in 2000 to 9.9 per 100 000 in 2017,3 the rates remained highest among the youth (approximately 700 000 are university students). University students are transitioning from adolescence to adulthood, a stage associated with many stressors (physical, psychological, social and spiritual) that overpower many, leading to suicide. Previous studies have demonstrated high numbers of suicides among university students.Reference Rasheduzzaman, Al Mamun, Faruk, Hosen and Mamun4–Reference Karbeyaz, Toygar and Çelikel6 The year 2020 came with multiple unexpected challenges due to the COVID-19 pandemic that may have put many at risk of dying by suicide.Reference Manzar, Albougami, Usman and Mamun7 Looking at past suicide cases may give us an insight into what to expect for better preparation and interventions. With no central database for suicide in Uganda, literature about suicide among university students is limited. This paper describes a study of press/media reports about suicide, its risk factors and the commonly used methods among university students in Uganda. We adopted an approach used by countries without suicide databases.Reference Griffiths, Mamun and Misti5
Method
Data collected were from various Ugandan media reports of university students who completed suicide from 1 January 2010 to 31 December 2020. Our search used the keywords of suicide, ‘Yese’, suicide, university students, youth, students and obutwa. Records with the same date of death, name, age, gender and university were considered duplicates and one entry retained (Fig. 1). Only 23 reports were identified.
Fig. 1 Flow diagram of case identification from the different media websites.
No ethical approval was required since the study had no direct contact with participants.
Results
All 23 individuals were undergraduate students, aged 19–25 years, and only 4 of them were female (Table 1). The majority (n = 10/21) were doing business-related programmes; the next most common programmes were in computer science (n = 3). The majority (n = 9/20) were in their second year of study; 7 were in their final year (the 3rd, 4th or and 5th year of study, depending on the programme offered).
Table 1 Characteristics of the participants
The majority of the students took their lives at night (n = 11/14). The most common methods were hanging (n = 7/18) and poisoning (n = 5). These incidents most commonly occurred in hostels (n = 13/20) and rentals near the universities (n = 5). The most commonly reported reasons for suicide were break-up of a romantic relationship (n = 6/21), family problems (n = 5) and betting/gambling (n = 5); academic failure was reported as a reason for only 1 student. Five students were reported to have had a mental illness at the time of the suicide, mainly depression (n = 3). None of the students was reported to have been using any substance of addiction.
Discussion
Risks associated with suicide
Gender
Completed suicide is consistently more common in males, but females attempt more;Reference Kaggwa, Nuwamanya, Ashaba, Rukundo and Harms2,Reference Mamun, Siddique, Sikder and Griffiths8 we attributed this to the culturally better coping skills of women, who grow up with their mothers as role models and learn from them how to handle most stressful situations. Additionally, most female students in Uganda are engaged with religious and spiritual groups/communities, which highly condemn suicidality and guide them.Reference Mamun, Siddique, Sikder and Griffiths8,Reference Mugisha, Hjelmeland, Kinyanda and Knizek9 On the other hand, men are left alone because their primary role models (fathers) are busy and occupied with work and looking for money rather than mentoring their sons. Culturally, men are more determined not to fail; a failure makes them ‘less of a man’. So, when it comes to suicide, men use more lethal methods and make sure they complete. Some reports also attribute the high rates of suicide among men to their high-risk lifestyle of being involved in gambling and addictive substance use and being emotionally fragile.
Challenges/disappointments
Studies have found university students commonly to take their lives towards the end of their programmes;Reference Griffiths, Mamun and Misti5,Reference Karbeyaz, Toygar and Çelikel6 our investigation also found that only four students took their lives during their first year. This is possibly attributable to the compounding pressure as one progresses in school due to the various challenges that interplay. When it comes to students, academic disappointment may top the list of risk factors for suicide, but in our investigation, only one student was reported to have ended her life for this reason. Romantic problems are a frequent cause of suicide among Ugandan university students, with 6 out of 21 in our sample reported as having had such a challenge. These findings are consistent with previous studies among students.Reference Griffiths, Mamun and Misti5,Reference Karbeyaz, Toygar and Çelikel6,Reference Mamun, Siddique, Sikder and Griffiths8 Throughout a student's education, mental preparation for academic challenges occurs, with exams at every step of academia. This is not the case for romantic relationship challenges. The transition to adulthood comes with many social expectations, and no student would want to fail in maintaining an emotional attachment that they have personally chosen. The bond formed with most individuals’ first love is so strong and we believe that some individuals cannot view their life without that person, and at times, some may opt for suicide. A break-up is one of the major and sometimes the first disappointment in these students’ lives. The exploratory nature of this stage of life makes many students try out numerous risks, such as betting/gambling. These easy schemes of money harvesting have made many students prey to systems owned by master tricksters. Many students in other parts of the world have taken their lives because of gambling.Reference Reith, Wardle and Gilmore10,Reference Mamun and Griffiths11
Substance use
Studies report use of addictive substances among university students as an etiological factor for suicide completion,Reference Schneider12 attributing it to the psychotic symptoms experienced during intoxication or withdrawal.Reference Kaggwa, Nuwamanya, Ashaba, Rukundo and Harms2,Reference Schneider12 However, substance use was not identified in this study, and we attribute this mainly to the study design of using press/media houses, which rarely report such information in Uganda. For this same reason, mental illness, especially depression, a common cause of suicide, was not reported in most cases. Most media houses lack the expertise to deductively report the cause of suicide but do a great job in notifying the community about what is happening to the students.
The aftermath of student suicide
The majority of the suicides occurred in hostels, rentals or the home – places where students feel comfortable. Suicide is a signal or message to individuals important to the person,Reference Synnott, Ioannou, Coyne and Hemingway13 thus causing most people to carry out the act at home to inform an individual or the community about their stress. For this reason, some individuals leave a suicide note with specific messages, addressed to an individual. With the advancement in technology, communication is via social media; and the trend or tradition of written suicide notes is changing to social media posts or messaging to the target group.Reference Luxton, June and Fairall14
Despite advanced technology, some aspects of suicide may take long to change, such as the method used. As in other studies, hanging was the most commonly used method by the students.Reference Griffiths, Mamun and Misti5,Reference Karbeyaz, Toygar and Çelikel6 Despite many alternatives, many individuals still find this the best method of ending their lives. We suggest that this might be attributed to the unintentional advertisement of this method by showing a rope as a sign of suicide or social media emoji that communicate suicide with a rope sign.
The way forward
Despite all universities in Uganda employing qualified psychologists and counsellors to improve students’ well-being, students are still dying by suicide, leaving us questioning their effectiveness. Do we need a new approach? For a generation so absorbed in their gadgets, would the use of technology rather than human beings sitting in offices be a more acceptable – and more successful – way of improving mental well-being? We believe that, if possible, all the counselling services should be made anonymous, not face to face with a therapist, to increase their uptake by this generation of students. Many countries have opted for machine learning in an attempt to identify individuals at risk of suicide.Reference Naghavi, Teismann, Asgari, Mohebbian, Mansourian and Mañanas15 Maybe this is the approach universities should employ to cut the suicide rate.
Strength and limitations
Owing to the lack of an official database, the use of press reports was the best available approach to tracking suicide among university students. The study had limitations: the press may not have reported all student suicides and the number of cases identified was too few to make any generalisations.
Data availability
The data that support the findings of this study are available from the corresponding author, M.M.K., upon reasonable request.
Author contributions
M.M.K. and S.M.N. conceived the study; M.M.K., G.Z.R. and E.N. designed the concept and protocol; I.A., M.K., S.M.N., M.M.K., J.K. and M.M. did the literature search; and M.M.K. and E.N. drafted the initial manuscript. All authors contributed to critical revision for the intellectual content of the manuscript.
Funding
The research received no specific funding from any organisation, public or private.
Declaration of interest
None.
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