الفهرس 
Historical Background of SuicideOnly 14 pages are availabe for public view
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Abstract
Historically Suicide among the various societies and nations had been an issue of disparity. Certain ages and societies condemned it whilst others considered it as an act of honor and respect. An example of such debate is during the early renaissance, it was considered as a “malaise connected with birth of modernity”. Later on in the 17th century it was greatly condemned (Minois, 2001).
Thereafter in 18th century the “age of reason” where religious position recedes in the face of an increasing importance and influence of science, suicide was no longer considered a threat, but instead is well thought out as a scientific discourse of madness and psychology (Minois, 2001). By the end of 18th century and beginning of 19th century it was further glorified as the heroic last act of a free man (Goethe, 1774). And lastly the tendency today is to view suicide in psychosocial rather than moral terms (Funk & Wagnalls, 2006).
Socially, in Egypt suicide is considered as a taboo, an un-forgiven sin as well as unjustified offense because of being prohibited by all religion (Essam, 2005). And hence from the religious point of view, Feelings of hopelessness and the intention to kill oneself are not common among Muslims, for whom losing hope in relief by God and self-inflicted death are blasphemous and punishable in the afterlife. However, rates of suicide attempts (parasuicide), which are more likely to be intended to elicit care, have no significant associations with religiousness among Arabs. Although the wish to die is not uncommon among people with depression in Arab cultures, it usually remains at the level of wishing that God would terminate their life, and does not progress to the wish to kill themselves (Fakhr el Islam, 2000).
According to Judaism, it is considered disobedience to the Giver of life to end it before the time is set by the Creator. By disdaining suicide, Judaism affirms the high valuation it places on life and its belief in the sovereignty of the Creator (Mahalawy, 1985). In christianity, Catholic theologians in principle agree that direct suicide is intrinsically evil and that there can be no mitigating circumstances (Mahalawy, 1985). Some pastorally minded Protestant authorities accepted mental illness as exceptions to the rule that suicide was the most hated sin (Maris et al., 2000).
Leaving religion, social and historical backgrounds, and going through the age group chosen, where literature acknowledged how meaningful it would be to study adolescents’ suicide. As it was mentioned that suicide is the 3rd leading cause of death (in 15-19 year-olds) after accidents and homicide, accounting for approximately 1500 deaths in the United States per year (7.4/ 100000) (Anderson and Smith, 2005). In Egypt, suicide among youth is rising year after year. In 2002 only 282 cases are recorded in documents; however the actual sum is estimated to range between 750 and 1200 per year (Social Sciences and Medicine Journal, 2007).
With reference to WHO, 2000 the rate of suicide /100,000 in Egypt is found to be as follows ; in the age group 5-14 years 0.02 in males while 0.03 in females, whereas in the age group 15-24 years the rate in males is 0.23 and in females 0.04. Moreover, it was not unwise to not to include children in the study. It is also important to note that the childhood suicide rate (i.e. the rate among those 5-14 years of age) has also increased over the past 30 years. In fact this rate has doubled between 1979 and 1992 (Greydanus, 2006).
Another point we have been through in the study is that official reports about suicide rates are misleading that was proved from various sources. Okasha and Lotief, 1979 showed that the official annual reports of suicides for allover Egypt was fewer than those who were admitted to Ain Shams University Hospitals in one month. Moreover, as we demonstrated before that the PCCA data from archive goes with the underestimated suicide rates.
Other than age, and other socio-demographic data, Impulsivity is considered a crucial risk factor in attempting suicide. (Moeller et al., 2001) states that impulsivity comprise the following elements: 1) decreased sensitivity to negative consequences of behavior; 2) rapid, unplanned reactions to stimuli before complete processing of information; and 3) lack of regard for long-term consequences not only to the individual but, also to others.
Impulsivity must not always be thought as a trait but rather could be a state. That was agreed upon and highlighted by Professor David Shaffer’s Lecture during his attendance to the 2nd Annual International Kasr El-Einy Congress.
Site of recruitment of the study was the Poison Control Center, Ain Shams University Hospitals, serving as a catchment area of Greater Cairo with a population of 20.250 million. It includes Cairo (8.37 million), Giza (5.38 million), and Kalyobia (3.931 million) governorates respectively, thus it represents all social sections. Also, it is important to know that PCCA receives most cases of self-inflicted poisoning in those governorates (Egyptian Governmental Statistics, 2011).
Regarding the study duration, it was of 6 months, The study was conducted during all days of the week; however the number of guardians who refused to sit for the interview outnumbered those who accepted. This was not surprising and instead was vastly expected due to our knowledge of the cultural background from which youths were driven. Essam, 2005 stated that patients and their families tend to hide avoiding stigmatization that could accompany such behavior and remain secretive about it.
Another point of view on the contrary to the just mentioned issue, is that although the Egyptian Society considers suicide a taboo, it is encouraged through media and parents find themselves entangled in a vicious circle. This vicious circle is formed of either to do what their care takers request or else they would be threatened by their suicide, and this will in turn reinforce such behavior and any future refusal of the youth demand would provoke such dilemma. The summit would be when parents would take such threats lightly and the individual executes their unplanned thoughts.
What remains an unsolved debate is that were those youths who attempted suicide really meant to put an end to their misery or is it just a cry for help. The accompanying emotions ranged from sadness, chest tightness and helplessness. Such high emotionality was found to be a result of their great demands for a reward. Yet we depended on the lethality of the attempt in order to have some certainty. Still a great possibility posed in that these emotions were stronger than what they could bare and put them in a state of inability to reason or is it what they felt lately all through the preceding period?? Thus if we are able to design a mean to that assesses the intent, maybe we can have a better prediction of whether those attempts were just for help or otherwise.
Along with the same theme, life events affected youths greatly. The greater the stressor value
Discontinuation of education was among the risk factors tested. It remains to be an important issue in our study. As previously mentioned in results
Family harmony and well being is considered of a great value even if parents were divorced. It is not the divorce itself that matters most, but the efficient communications. Abuse of any kind physical, verbal, sexual can worsen the situation. Also the severity of abuse is directly proportional with suicidal attempt. More than that, abuse is a sort of humiliation where the individual according to kendler, 2003 is liable to pure depression. Yet these results are of moderate predictive value
Other crucial factors affecting suicidality were impulsivity and presence of psychiatric diagnoses. Last but not least, and to conclude, it is not a simple equation, but rather a complicated one tailored for every individual solely just like the supposed treatment plan. A multi-factorial model as Beautrais, 2000 suggested with different proportion for every youth on each item. A management plan must be constructed according to each and every youngster in order to end up in youth who are safe and sound.