Abstract
Objectives. Literacy and stigma of suicide among doctors affect health-service delivery for persons with suicidal behavior. However, no attempt has been identified to assess those among physicians in Bangladesh. We aimed to determine the level and associated factors of suicide literacy and stigma toward suicide among physicians in Bangladesh. Methods. We collected data from 203 physicians in February 2022 by Google Forms. We used the Bangla literacy of suicide scale (LOSS-B) and the Bangla stigma of suicide scale (SOSS-B) to assess the literacy and stigma of suicide. The instrument also included questions for collecting sociodemographic variables and assessing suicidal behavior. Results. The mean age of the physicians was (range 23–66) years, 109 (53.7%) were females, 150 (73.9%) were married, and 181 (89.2%) were Muslim. The mean LOSS-B score was (range 1-10). Suicide literacy was higher in singles (), doctors with a family history of suicide (), a history of suicidal thought in lifetime (), and in the last year (). Muslims () and city dwellers () had higher scores in the stigma subscale of SOSS-B whilst respondents with history of mental illness had a significantly lower level of stigma (). The stigma and isolation subscales were positively correlated indicating a higher value stigma creates higher isolation (). No relationship between suicide literacy and suicide stigma was identified among the physicians. Conclusions. Suicide literacy among the physicians of Bangladesh is low albeit higher than the level among the students. Appropriate programs should be designed to improve the status quo because physicians play fundamental roles as health-service providers as well as gatekeepers in suicide prevention.
1. Introduction
Suicide is a multifactorial global public health problem that killed 703,000 people all over the world in 2019 [1]. It is an outcome of a complex interaction between multiple factors expressed as genetic, environmental, psychological, social, and cultural [2–4]. Due to its multidimensional causal association, prevention activities cover a wide spectrum of intervention areas [2]. Among the several risk factors, psychiatric disorders have been identified as a prominent risk factor, and identification and treatment of mental illnesses are potential prevention strategies [2, 3]. Evidence showed that about three-fourths of the people who died by suicide got in touch with primary care providers within the year of suicide, and near about half of the victims did so in the preceding month [5]. Nevertheless, risk factors like depression and anxiety with suicidal ideations are often remained unnoticed in primary health care [6]. Healthcare providers may feel incompetent to deal with suicidality and reluctant to seek or provide adequate care to suicidal individuals [7, 8]. Primary care physicians (PCPs) are potential persons to identify risky individuals for suicidal behavior; therefore, empowering PCPs is a potential intervention point for suicide prevention [2]. Stigmatization is considered one of the major barriers against care-seeking as well as identification and subsequent management of suicidality [9]. At the same time, high levels of stigma and low levels of literacy among the services providers also affect health-service care provision. Research suggests that deficits in suicide literacy—the knowledge about the risk factors, sign/symptoms, and management of suicidality—is associated with a higher level of stigma [10].
Bangladesh is a Muslim majority low- and middle-income (LMIC) category country where suicide is a criminal offence [11]. Due to the religious and sociocultural factors and fear of harassment by police, there have been strong negative cultural attitudes and stigma toward suicide [11]. Health care services for persons with self-harm and suicidal behavior are scanty, untapped, and neglected. Patients with suicidal and self-harm behavior presented at hospital emergency are stamped as “police case” and referred to public hospitals where they are grossly neglected due to patient load, inadequate services, low literacy, and high stigma [12]. One recent study revealed that there is a lower level of literacy and higher level of stigma among university students in Bangladesh that warrants adequate intervention strategies [13]. Although an increased number of studies is coming out assessing various aspects of suicide in the country assessment of suicide literacy and stigma among the health-service providers specially physicians has not been identified [14]. Therefore, we aimed to determine the level of suicide literacy and stigma toward suicide among physicians in Bangladesh. Assessing the level of stigma and literacy along with determinants in other groups would help to get the complex picture and bolster the national suicide prevention strategies in Bangladesh which could be tested in other LMIC settings also. As physicians are the vital component of health care service provision and play important roles as gatekeepers, the level of suicide literacy and stigma can sort the potential areas for improved services and suicide prevention in low-resource settings.
