Alcohol and Suicide in Postconflict Northern Uganda
A Qualitative Psychological Autopsy Study
Abstract
Background: Alcohol has been noted to be an important factor in nearly 68% of the suicides in Northern Uganda, yet exactly how alcohol contributes to suicide in this region has not been studied. Aims: To determine how alcohol contributes to suicide in this region. Methods: Qualitative psychological autopsy interviews were conducted with bereaved relatives and friends of 20 suicides mainly from Internally Displaced Peoples’ camps in Northern Uganda. Data were analyzed using a modified Interpretative Phenomenological analysis (IPA). Results: Alcohol had a direct or an indirect influence on the suicide of 16 out of the 20 decedents. Directly, alcohol facilitated the suicidal process, was a means to suicide, or had an influence on the decedents’ lifestyles. Indirectly, alcohol had an influence on the suicidal process of the deceased through the drinking behavior of significant others. Conclusions: This study established that alcohol not only contributes to the suicidal process of the individuals through acute and chronic alcohol consumption, but also through victimization of those lowest in the power hierarchy by alcohol abusers higher up in the power hierarchy. Therefore, future development of suicide prevention programs should address the interrelated public health problem of alcohol abuse.
References
2006). Mental states of adolescents exposed to war in Uganda: Finding appropriate methods of rehabilitation. Torture, 16, 93–107.
(2004). Suicide: Psychological autopsy, a research tool for prevention. Retrieved from www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi?book=inserm2&part=sui cide& blobtype=pdf
(2005). Traumatic life events and suicide risk among jail inmates: The influence of types of events, time period and significant others. Journal of Traumatic Stress, 15(1), 9–16.
(2006). The association between alcohol misuse and suicidal behavior. Alcohol and Alcoholism, 41, 473–478.
(1998). Who takes alcohol prior to suicide? Journal of Clinical Forensic Medicine, 5, 65–68.
(2009). Social torture: The case of Northern Uganda 1986–2006. New York: Berghahn Books.
(2005). Cycles of violence gender relations and armed conflict. Nairobi: ACORD.
(2007). Going back home: IDP return monitoring in Gulu District. Retrieved from www.avsi-usa.org
(2006). Traditional ways of coping in Acholi. Kampala: Intersoft Business Services.
(1998). The psychological autopsy approach to studying suicide: A review of methodological issues. Journal of Affective Disorders, 50, 269–276.
(2009). Therapeutic effects of psychological autopsies: The impact of investigating suicides on interviewees. Crisis, 30, 20–24.
(2005). Neighborhood disorder, psychological distress, and heavy drinking. Social Science and Medicine, 61, 965–975.
(2001). Drinking to cope, emotional distress and alcohol use and abuse: A ten-year model. Journal of Studies on Alcohol, 62, 190–204.
(2001). Alcohol and suicidal behavior. Clinical Psychology Review, 21, 797–811.
(2008). Elucidation of the challenges of return in Acholiland: Learning across lived realities. A research report of human rights focus Gulu. Retrieved from www.hurifo.org/Publications/elucidation%20of%20the%20challenges%20of%20return%20in%20acholiland.pdf
. (1998). Focus on qualitative methods “not as bad as it could have been”: Assessing and mitigating harm during research interviews on sensitive topics. Research in Nursing and Health, 21, 91–97.
(2006 ). Deliberate self-harm in urban Uganda – A case-control study (Unpublished doctoral dissertation). Norwegian University of Science and Technology, Trondheim.2009,October). Suicide in rural war affected Northern Uganda: A study from 4 subcounties. Paper presented at the XXV World Congress on Suicide Prevention of the International Association for Suicide Prevention, Montevideo, Uruguay.
(2011). Qualitative psychological autopsy interviews on suicide in postconflict Northern Uganda: The participants’ perceptions. Omega: Journal of Death and Dying, 63, 235–254.
(in press ). Men in despair: A qualitative psychological autopsy study of suicide in Northern Uganda. Transcultural Psychiatry.2003). Domestic violence in rural Uganda: Evidence from a community-based study. Bulletin of the World Health Organization, 81(1), 53–60.
(2008). Violence against women in Northern Uganda: The neglected health consequences of war. Journal of International Women’s Studies, 9, 174–192.
(2005). Roco wat I Acoli-Restoring relationships in Acholiland: Traditional approaches to justice and reintegration. Retrieved from www.ligi.ubc.ca/sites/liu/files/Publications/JRP/15Sept2005_Roco_Wat_I_Acoli.pdf
. (2003). Determinants of suicide in the Transkei subregion of South Africa. Journal of Clinical Forensic Medicine, 10, 71–76.
(2003). The gender gap in suicide and premature death or: Why are men so vulnerable? European Archives Psychiatry Clinical Neuroscience, 23, 1–8.
(2011). Distancing: A traditional mechanism of dealing with suicide among the Baganda, Uganda. Crisis, 32, 15–23. doi 10.1027/0227–5910/a000047
(2006). Perspectives on suicide in Africa. International Psychiatry, 3(1), 7–8.
(2009). Female suicides in Dares Salaam: The ultimate uncertainty and despair. In , Dealing with uncertainty in contemporary African Lives. Retrieved from nai.diva-portal.org/smash/record.jsf?pid=diva2:232981
(2004). Profile of suicide in Dar es Salaam. East African Medical Journal, 81, 207–211.
(2006). A narrative approach to child and family therapy in Africa. Contemporary Family Therapy, 28(1), 1–23.
(2006). Gulu-IDP camps population as of February 2006. Retrieved from www.internaldisplacement.org/8025708F004BE3B1/(httpInfoFiles)/94A9D7E83DDB0279C12571470038488F/$file/IDP%20camps%20and%20populationGulu-%20Feb2006.pdf
. (2001). Uganda: The resilience of tradition. Displaced Acholi in Kitgum. In , Caught between borders: Response strategies of the internally displaced (pp. 99–114). London: Pluto.
(2005). Depression and suicidal behaviors in Uganda: Validating the response inventory for stressful life events. (Doctoral dissertation). Stockholm: Karolinska University Press.
(2008). Posttraumatic stress disorder among former child soldiers attending a rehabilitative service and primary school education in Northern Uganda. African Health Sciences, 8, 136–141.
(2008). Tales of biographical disintegration: How parents make sense of their sons’ suicides. Sociology of Health and Illness, 30, 237–254.
(2005). International public health research involving interpreters: A case study from Bangladesh. BMC Public Health, 5, 71. Retrieved from www.biomedicalcentral.com/content/pdf/1471-2458-5-71.pdf
(2010). Suicidal behavior and alcohol abuse. International Journal of Environmental Research and Public Health, 7, 1392–1431.
(2008). Factors associated with post traumatic disorder and depression among internally displaced persons in Northern Uganda. BMC Psychiatry, 8, 38. doi 10.1186/1471-244X-8-38
(2005). Substance use and suicidal behavior. In , Prevention and treatment of suicidal behavior: From science to practice (pp. 261–277). Oxford: Oxford University Press.
(2005). Alcohol use and suicide rates. Medical Hypotheses, 65, 1010–1012.
(2006). Commentary: Alcohol consumption and suicide. QJM: An International Journal of Medicine, 99, 57–61. Retrieved from qjmed.oxfordjournals.org/cgi/reprint/99/1/57
(1993). Suicide as psychache. A clinical approach to self-destructive behavior. Northvale, NJ: Aronson.
(2001). Disempowerment of men in rural and urban East Africa: Implications for male identity and sexual behavior. World Development, 29, 657–671.
(2007). Interpretative phenomenological analysis. In , Analyzing qualitative data in psychology (pp. 35–50). London: Sage.
(2009). Interpretative phenomenological analysis: Theory, method and research. Los Angeles: Sage.
(2003). Interpretative phenomenological analysis. In , Qualitative psychology: A practical guide to research methods (pp. 51–80). London: Sage.
(1993). Marital status, alcohol consumption, and suicide: An analysis of national data. Journal of Marriage and Family, 55, 1018–1024.
(1994). The Socio-economic Impact of HIV/AIDS on rural families with an emphasis on youth in Uganda (Rep. No. TCP/UGA/2256). Rome: Food and Agriculture Organization of the United Nations. Retrieved from www.fao.org/docrep/t2942e/t2942e03.htm#TopOfPage
(2005). Gender and the major consequences of alcohol consumption in Uganda. In , Alcohol, gender and drinking problems: Perspectives from low and middle income countries (pp. 189–208). Geneva: World Health Organization, Department of Mental health and Substance Abuse.
(2006). Uganda national cultural policy. Retrieved from ocpa.irmo.hr/resources/policy/Uganda_Culture_Policy-en.pdf
. (2008). Uganda mental health policy. Kampala, Uganda: Author.
. (2001). The suicidal process and related concepts. In , Understanding suicidal behavior: The suicidal process approach to research, treatment and prevention (pp. 3–14). New York: Wiley.
(2010,September). Public health approach to suicide prevention. Poster session presented at the 13th European Symposium on Suicide and Suicidal Behavior, Rome.
(2004). WHO global status report on alcohol 2004. Geneva: Author.
. (2008). Demonstrating validity in qualitative psychology. In , Qualitative psychology: A practical guide to research methods (2nd ed., pp. 235–251). London: Sage.
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