Attitudes toward suicide: A comparison between urban and rural dwellers in Ghana

Emma Sethina Adjaottor; Daniel Kwasi Ahorsu

doi:10.4103/SHB.SHB_27_20

ORIGINAL ARTICLE

Year : 2020 | Volume : 3 | Issue : 3 | Page : 89-92

Attitudes toward suicide: A comparison between urban and rural dwellers in Ghana

Emma Sethina Adjaottor¹, Daniel Kwasi Ahorsu²
¹ Department of Behavioural Sciences, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
² Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong

Date of Submission	13-Apr-2020
Date of Decision	14-Jun-2020
Date of Acceptance	20-Jun-2020
Date of Web Publication	27-Jul-2020

Correspondence Address:
Daniel Kwasi Ahorsu
RM QT414, 4/F, Core T, The Hong Kong Polytechnic University, Hung Hom, Kowloon
Hong Kong
Emma Sethina Adjaottor
Department of Behavioural Sciences, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi
Ghana

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/SHB.SHB_27_20

Abstract

Introduction: Appropriate attitudes toward suicide (ATTS) is key to preventing suicide, a major mental health challenge worldwide. Hence, this study examined the differences between urban and rural dwellers on ATTS (in total and across the subscales – principal attitude (suicide as a right), representations of intentionality, tabooing, preventability of suicide, and knowledge (myths about suicide). Methods: A cross-sectional survey design was used in this study. A convenient sampling technique was used to select 400 respondents from urban (n = 200) and rural (n = 200) areas. A questionnaire packet comprising a self-designed demographic section and valid ATTS scale was used for the data collection from respondents (urban and rural dwellers). Descriptive (frequency and percentages) and inferential (independent t-test) statistics were used to analyze the data using SPSS software. P < 0.05 was considered statistically significant. Results: Both urban and rural dwellers were found to have negative ATTS with urban dwellers (131.40 ± 10.75) having significantly more negative ATTS (P = 0.000) than rural dwellers (118.59 ± 13.62). Furthermore, urban dwellers were found to have significantly more negative attitudes toward principal attitude (suicide as a right), representations of intentionality, tabooing, preventability of suicide, and knowledge (myths about suicide) than rural dwellers (P = 0.000). Conclusion: Settings influence ATTS such that urban dwellers have become more informed and more prepared to help prevent suicide compared with their rural counterparts.

Keywords: Attitudes toward suicide, “negative attitudes toward suicide,” “positive attitudes toward suicide,” “rural dwellers,” “urban dwellers”

How to cite this article:
Adjaottor ES, Ahorsu DK. Attitudes toward suicide: A comparison between urban and rural dwellers in Ghana. Soc Health Behav 2020;3:89-92

How to cite this URL:
Adjaottor ES, Ahorsu DK. Attitudes toward suicide: A comparison between urban and rural dwellers in Ghana. Soc Health Behav [serial online] 2020 [cited 2023 Jun 9];3:89-92. Available from: https://www.shbonweb.com/text.asp?2020/3/3/89/290976

Introduction

Suicide is one of the major mental health challenges worldwide and especially in Ghana.^[1] The success in dealing with suicide and its prevention largely depends on people's attitudes toward it^[2],[3] as there is a strong association between suicide ideation and attitudes toward suicide (ATTS).^[4],[5] That is, participants with suicide ideation approved that they believed that suicide should not be prevented, it can be justified, and it does not reflect mental disturbance which mainly reflects a more permissive ATTS.^[5] ATTS can be categorized into two: positive and negative attitudes.^[6] In this study, we operationally define positive ATTS as the expression of a permissive, agreeable, or liberal attitude or clear-cut support in thought or behavior about suicide while negative ATTS refers to the expression of a restrictive or rejecting attitude in thought or behavior about suicide. Hence, people with positive ATTS are more likely to commit suicide during challenging situations compared with people who have negative ATTS.

Africans in general and Ghanaians particularly have been reported to have more negative ATTS.^[6] However, some Ghanaians still hold on to cultural values and belief systems^[3],[7],[8] that are inimical to suicide prevention.^[9],[10] Religion is core to Ghanaian cultural values and belief systems with traditional beliefs underlining most of their religious beliefs.^[11],[12] Traditionally, there is a negative and condemnatory view of suicide which is reflected in rituals for the corpse, the living relatives, and the community members. Nonetheless, religion facilitates their willingness to help people during suicidal crisis.^[12] That said, urbanization and its economic effects have been found to weaken cultural values and belief systems which include mortuary rituals and suicide.^{[8],[13],[14]} Hence, it should be expected that urbanization will affect urban dwellers' ATTS compared with rural dwellers.

In general, most studies that have examined ATTS between Ghanaian urban and rural dwellers used a qualitative approach that does not shed light on the extent to which these groups statistically differ.^[1],[12] This study sets out to fill this gap and builds on previous findings by comprehensively examining the differences between the groups across known cultural values and belief systems.^[3],[6] Hence, this study aims to examine the differences between urban and rural dwellers on attitudes toward suicide (in total and across the subscales). The findings hold implications for further studies and can serve as a guide for mental health education, especially on suicide.

Methods

Study design and participants

A cross-sectional survey design^[15] was used in recruiting a total of 400 respondents (200 each from urban and rural areas). The urban dwellers were recruited from a university in Kumasi, the second-largest city in Ghana. The university was chosen to represent an urban area due to its cosmopolitan nature and in order to get access to a comparable rural area that shares similar cultural values with Kumasi. Hence, a rural community with a population of approximately 5000 people and about 40 km away from Kumasi was chosen for recruiting the rural dwellers. This community is in a transition zone between the forest and grassland, and the main occupation of its members is farming (cocoa and other food crops).

The study was approved by the Research and Ethics Committee of the Department of Psychology, University of Ghana. Informed consent was obtained from all respondents who were conveniently selected.^[16] Other ethical procedures involving human participants and in accordance with the 1975 Helsinki Declaration and its later amendments were adhered to. Due to the sensitivity of the topic under investigation, anonymity and confidentiality of the data were ensured by informing respondents that the data collected would be used for only academic purposes and that no identification or follow-up is needed. Psychology graduates were trained to assist in the data collection. A pilot study was used to assess the feasibility of the main ATTS questionnaire (English) and the Akan (Asante-Twi) version. A total of 90 respondents were recruited in settings similar to the main study for the pilot study. The main data were collected after favorable findings were obtained from the pilot study.

Measurement

The questionnaire used had two parts: the demographic and ATTS section. The demographic section had items such as sex, age, religion, and educational levels. The ATTS, on the other hand, is a 37-item scale with a five-point Likert scale response format (1 – strongly agree to 5 – strongly disagree) that assesses people's ATTS.^[17] Eleven items (1, 2, 3, 9, 10, 12, 19, 27, 30, 33, and 37) of the ATTS questionnaire were reverse scored. The ATTS has five subscales: principal attitude (suicide as a right), representations of intentionality, tabooing, preventability of suicide, and knowledge (myths about suicide) as initially explored by Hjelmeland et al.^[3] Total ATTS score (sum of all item responses) ranges from 37 to 185, with scores ranging from 37 to 111 reflecting a positive attitude while scores ranging from 112 to 185 reflect a negative attitude. Both the English and Akan versions had an acceptable Cronbach's alpha coefficient of 0.76 and 0.73, respectively.^[18]

Statistical analysis

The collected data were coded and entered into the SPSS Version 16 (SPSS, Inc., Chicago, IL, USA) database. The data were also checked for errors, including wild codes, i.e., the procedure carried out included thorough inspection of the frequency distribution values. The main dependent variable was the ATTS scale, while the independent variable was urban and rural dwellers. Descriptive statistics (frequency and percentages) were used to analyze the demographic variables such as sex, age, religion, and educational levels across urban and rural dwellers, and an inferential statistic (independent t-test) was used to analyze the data based on the objective of this study.^[19] A Benjamini–Hochberg procedure was performed to decrease the false discovery rate of our findings.^[20]

Results

A total of 400 respondents participated in this study with an equal number of males and females (50% each, respectively) among both urban and rural dwellers. In general, majority of the respondents were 30 years or below (256, 64%), especially among the urban dwellers (190, 47.5%), while the rural dwellers had more participants above 30 years (134, 33.5%). Most of the participants were Christians (355, 88.8%) which reflected among both urban (186, 46.5%) and rural (169, 42.3%) dwellers compared with the total number of Muslims (19, 4.8%) and Traditionalists (26, 6.5%). Furthermore, most of the respondents were university students (200, 50%; all being urban dwellers 200, 50%), followed by those with basic (126, 31.5%), no formal (38, 9.5%), and senior high (36, 9%) as the educational level for rural dwellers [Table 1].

Table 1: Demographic characteristics of participants (n=400)

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The independent t-test analysis revealed that urban dwellers (mean ± standard deviation; 131.40 ± 10.75) had significantly more negative ATTS than the rural dwellers (118.59 ± 13.62) taking into consideration the total ATTS (t (398) = 10.435, P = 0.000). Further subscale analyses revealed that urban dwellers (47.66 ± 5.61) had significantly more negative attitudes than their rural counterparts (44.24 ± 7.20) with respect to principal attitude–suicide as a right (t (398) = 52.96, P = 0.000). Furthermore, urban dwellers (15.27 ± 3.37) had significantly more negative attitudes than rural dwellers (12.44 ± 3.21) taking into consideration representation of suicidal intent (t (398) = 86.07, P = 0.000). Again, urban dwellers (5.92 ± 1.73) had significantly more negative attitudes than their rural counterparts (3.99 ± 1.70) on tabooing (t (398) = 11.263, P = 0.000). In addition, urban dwellers (23.41 ± 2.63) had significantly more negative ATTS than rural dwellers (22.00 ± 3.32) taking preventability of suicide into consideration (t (398) = 65.88, P = 0.000). Finally, urban dwellers (39.13 ± 4.68) had significantly more negative ATTS than their rural counterparts (35.91 ± 5.09) with respect to knowledge–myths about suicide (t (398) = 6.588, P = 0.000) [Table 2].

Table 2: Summary of attitudes toward suicide between urban and rural dwellers

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Discussion

This study used a cross-sectional survey design to examine ATTS between urban and rural dwellers. The results showed that, in general, both urban and rural dwellers had negative ATTS. This indicates that both groups of dwellers have attitudes that express a restrictive or rejecting attitude in thought or behavior about suicide compared to a positive attitude which involves expressing a permissive, agreeable, or liberal attitude or clear-cut support in thought or behavior about suicide. The presence of these negative attitudes largely corroborates the findings of previous studies^[3],[6] and builds on previous findings by investigating the extent to which one's location influences his or her ATTS.

A comparison between the groups revealed that, in total, urban dwellers had more negative ATTS than their rural counterparts. This indicates that urban dwellers generally have appropriate ATTS which will be helpful in preventing suicide compared with rural dwellers. This finding is contrary to a previous study which found no difference between urban and rural dwellers.^[21] At the subscale levels, it was observed that urban dwellers had better principal attitude (suicide as a right) toward suicide than rural dwellers. This is particularly important as it reflects morality or justification for suicide. Furthermore, urban dwellers had more scores on representations of intentionality subscale than rural dwellers. This subscale reflects the reasons ascribed to committing suicide; hence, the findings indicate that urban dwellers, compared with rural dwellers, have a better understanding of suicide and may not support the use of suicide as a means to an end. Furthermore, urban dwellers had more scores on tabooing as a subscale than rural dwellers. This indicates that urban dwellers, compared with rural dwellers, mostly agree that suicide should be talked about in society rather than being viewed as a taboo topic. Consequently, urban dwellers had more scores on preventability of suicide than rural dwellers which indicates that urban dwellers have enough knowledge on suicide, especially on the ways of helping someone harboring the thought of committing suicide. It was, therefore, not surprising to have found that urban dwellers had more scores on knowledge (myths about suicide) than rural dwellers. That is, urban dwellers, compared with rural dwellers, have factual information (and not myths) on suicide. These findings (the total and subscales) indicate that urban dwellers are well informed about suicide, thereby influencing their ATTS compared to rural dwellers. The possible sources of information for the urban dwellers include research conferences, seminars, or workshops which are common features of a university. In addition to the above-mentioned sources, the urban dwellers are capable of accessing information on the Internet or on social media unlike the rural dwellers who may be unable to do so or to a lesser degree even if they could.

Limitation

Although this study offers unique insights into ATTS between urban and rural dwellers in Ghana, it is not without limitations. One of the limitations is the use of convenient sampling which limits the generalizability of the findings. Furthermore, the use of a cross-sectional design limits the causal effects of the findings. Notwithstanding these limitations, this study makes a significant contribution to the psychology literature in that it is one of the first studies to reveal significant differences between urban and rural dwellers on ATTS across culturally specific norms and values such as principal attitude (suicide as a right), representations of intentionality, tabooing, preventability of suicide, and knowledge (myths about suicide). Future studies can adopt a much larger sample size by recruiting more respondents in multiple urban and rural areas so as to strengthen the generalizability power of the findings.

Conclusion

This cross-sectional study revealed that both urban and rural dwellers had negative ATTS, thereby suggesting that both groups of dwellers had a restrictive or rejecting attitude in thought or behavior about suicide. Furthermore, urban dwellers had more negative ATTS than rural dwellers and this reflected in all the subscales: principal attitude (suicide as a right), representations of intentionality, tabooing, preventability of suicide, and knowledge (myths about suicide). The study assumes that the educational programs at the university such as seminars, workshops, and conferences on mental health may have enlightened the respondents on suicide. It is, therefore, recommended that purposeful mental health education among Ghanaians, especially in rural areas, is led by the National Commission for Civic Education, mental health experts, and using diverse means of information dissemination.

Financial support

Nil.

Conflicts of interest

There are no conflicts of interest.

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