Suicide in the Middle East Part One: What Are the Real Problems?

(Warning: This article contains distressing information. If you are suffering from?emotional strain or suicidal thoughts, do not hesitate to seek professional help. You can find information on where to find such help, no matter where you live in the world, at this website:?https://www.befrienders.org/ )

"Suicides are preventable. Several measures can be taken at all levels of society to prevent suicide and suicide attempts. Let's work together to increase understanding about the issue and create hope through action."— Tedros Adhanom Ghebreyesus, President of World Health Organization (WHO)

“Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, ambition inspired, and?success ?achieved.” — Helen Keller

“Think of all the beauty that's still left in and around you and be happy!” — Anne Frank

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Introduction

Suicide is a serious ongoing problem throughout the world. Age, race, or gender does not matter; anyone can be impacted by it in one way or another. People commit suicide for various reasons, and one of two results can occur. The first is that they try to commit suicide but survive the attempt, being left to deal with the consequences of their actions. The second result is successfully committing suicide and leaving behind their loved ones with questions and great pain.?

Suicide is committed by vulnerable people everywhere and in all the regions of the world. The Middle East is no exception. In developed countries and caring societies and communities, many help and support facilities are offered to vulnerable people, especially children, and young men and women: Counseling Centers, Psychological Centers, Mental Health Centers, Specialized Clinics, and other facilities. There are 24/7 hotlines and helplines offered by organizations and professionals to discuss all sorts of problems with those who face difficult times to deter them from committing suicide. Scientific studies and research are constantly carried out to determine the high-risk persons and groups of all ages and all levels of education.

Unfortunately, the word "suicide" is taboo in the Middle East. You hardly find ordinary people, journalists, or writers who talk about suicide as a problem. However, it is a public health problem that cannot be denied even by corrupt officials and politicians. Research and scientific studies of suicide are almost non-existent and researchers are not normally allowed or encouraged to carry out any serious study or research. Suppose you ever write about the problem or do any sort of research about suicide. In that case, you will be unfairly accused of encouraging suicide among vulnerable people and trying to divide society, create problems for the authorities, and destabilize the communities. This is why we do not know how big the problem of suicide is in the Middle East and how we can deter our children and young men and women from committing suicide. Most of the suicide cases are reported as deaths by natural causes. There is an unbelievable level of ignorance, stupidity, indifference, and denial although everybody knows the problem does exist and needs to be dealt with in scientific and caring ways.

How Big Is the Problem?

According to the World Health Organization (WHO), an estimated 703,000 people a year take their life around the world. For every suicide, there are likely 20 other people making a suicide attempt and many more have serious thoughts of suicide.

Suicide and deliberate self-harm are considered major concerns for health professionals, particularly psychologists and psychiatrists. Despite efforts to predict the risk of self-harm, the rate of suicide is increasing worldwide (1). Various risk factors have been hypothesized to alert psychiatrists to the seriousness of suicidal ideation or plans including previous attempts, hopelessness, insomnia, stress, anxiety, and depression (3), (4). On the other hand, religious affiliation and social support are considered protective factors (4), (5).

Suicide is under-reported in Arab and Islamic countries. One of the main contributing factors is that it is culturally unacceptable, and the families of the victims do not report it to avoid shame and stigma (6). Moreover, the legal system in these countries depends on written suicidal notes, and this is not commonly done. These countries are also less likely to report the identified cases to the World Health Organization (WHO) (7). Research about suicide is scarce in Arab and Islamic countries (8). This limits our understanding of the whole problem in these countries.

Many rating scales are available for clinicians to assess the risk of suicide. However, these scales cannot predict suicide accurately, but they can provide an estimate of suicidal risk, which may help in patient management (9).

Clinically, the threshold for intervention in patients presenting with thoughts or acts of self-harm should be low, and treatment of any underlying mental or medical illness needs to be vigorous.

Unfortunately, the word "suicide" is taboo in the Middle East. You hardly find ordinary people, journalists, or writers who talk about suicide as a problem although it is a problem that cannot be denied. Research and scientific studies of suicide are almost non-existent and researchers are not normally allowed to carry out any serious study or research. Suppose you ever write about the problem or do any sort of research about suicide. In that case, you will be unfairly accused of encouraging suicide among vulnerable people trying to divide society creating problems for the authorities, and destabilizing the communities. This is why we do not know how big the problem of suicide is and how we can deter our children and young men and women from committing suicide. Most of the suicide cases are reported as deaths by natural causes. There is an unbelievable level of ignorance, stupidity, and denial although everybody knows the problem does exist and needs to be dealt with in scientific and caring ways.

As we have already said, suicide has been poorly studied in Islamic countries, and there are religious sanctions against suicide in Islam. Suicide is illegal in several Islamic countries (2). ?The stigma of suicide together with related cultural and religious factors lead to under-reporting of cases. Patients who commit suicide are often reported as accidental deaths or deaths by natural causes.

"Suicide has been poorly studied in Islamic countries, and there are religious sanctions against suicide in Islam. Suicide is illegal in several Islamic countries.?The stigma of suicide together with related cultural and religious factors lead to under-reporting of cases. Patients who commit suicide are often reported as accidental deaths. Suicide is referred to in the Quran (4:29) as?qatl-al-nafs?(self-murder) and?intihār?(cutting of the throat). The Quran is free of explicit thematic reference to suicide; however, it does contain verses where the term?qatl-nafs?appears. The Prophetic teachings and traditions not only prohibit suicide but also explicitly deter from wishing for death." (10).

Risk Factors for Suicide

Suicide is rarely caused by a single circumstance or event. Instead, a range of factors—at the?individual, relationship, community, and societal levels —can increase risk. These risk factors are situations or problems that can increase the possibility that a person will attempt suicide. The following are some of the risk factors for suicide (11).

Individual Risk Factors

These personal factors contribute to risk:

·???????? Previous suicide attempt

·???????? Depression and other mental illnesses

·???????? Chronic illnesses

·???????? Criminal/legal problems

·???????? Job/financial problems or loss

·???????? Impulsive or aggressive tendencies

·???????? Substance use

·???????? Current or prior history of adverse childhood experiences

·???????? Sense of hopelessness

·???????? Violence victimization

Relationship Risk Factors

These harmful or hurtful experiences within relationships contribute to risk:

·???????? Bullying

·???????? Family/loved one’s history of suicide

·???????? Loss of relationships

·???????? High conflict or violent relationships

·???????? Social isolation

Community Risk Factors

These challenging issues within a person’s community contribute to risk:

·???????? Lack of access to healthcare

·???????? Suicide cluster in the community

·???????? Stress

·???????? Community violence

·???????? Historical trauma

·???????? Discrimination

Societal Risk Factors

These cultural and environmental factors within the larger society contribute to risk:

·???????? Stigma associated with help-seeking and mental illness

·???????? Easy access to lethal means of suicide

·???????? Unsafe media portrayals of suicide

Warning Signs for Suicide

If someone is at risk for suicide, you can watch for warning signs, including:

·???????? Talking about being a burden

·???????? Being isolated

·???????? Increased anxiety

·???????? Talking about feeling trapped or in unbearable pain

·???????? Increased substance use

·???????? Looking for a way to access lethal means

·???????? Increased anger or rage

·???????? Extreme mood swings

·???????? Expressing hopelessness

·???????? Sleeping too little or too much

·???????? Talking or posting about wanting to die

·???????? Making plans for suicide

Mental Health Problems

Mental health problems—persistent problems with thinking, with feelings, with behavior, and with coping with life—are very common. In the UK about a quarter, and in the US, almost half, of people have a mental illness at some time during their life. Depression, for example, persistently lowers a person's mood and can make them feel hopeless and unmotivated. Anxiety—constant, unrealistic worries about daily life—can cause sleep problems and physical symptoms such as stomach pains. People with impulse-control disorders have problems with controlling their temper or their impulses which may sometimes lead to hurting themselves or other people. These and other mental illnesses seriously affect the work, relationships, and quality of life of the ill person and of their family. However, most people with mental illnesses can lead fulfilling and productive lives with the help of appropriate medical and nonmedical therapies.

Low wages and low salaries are among the main factors behind mental illnesses, mental disorders, diabetes, hypertension, and other health problems that may lead to suicide.

Many studies have found out that teachers and employees who accept low salaries are not only unqualified for the jobs but they have psychological problems or they will develop these problems as time passes to the extent that they will eventually have some sort of mental disorder. In a study titled: “The Impact of a Wage Increase on Mental Health: Evidence from the UK Minimum Wage” by Christoph Kronenberg, Rowena Jacobs & Eugenio Zucchelli (August 2015) (12), the researchers found that mental health problems cost the UK economy around ￡ 105 billion every year, arising from treatment costs, human costs and lost productivity (Centre for Mental Health, 2010). Examining the relationship between income and the mental health of low-wage earners is important as the lowest-income earners have twice the probability of facing mental health problems compared to average-income learners (Meltzer et al., 2002) (13).

There are several potential mechanisms through which income could affect mental health. Following Benzeval et al. (2014) (14), the literature connecting income and mental health is categorized into three pathways; these are broadly defined as material, psychosocial, and behavioral.

First, the material pathway can work directly through an income shock by enabling the purchase of physical goods and services which can improve an individual’s mental health. It has been shown, for instance, that mental illness is associated with poor diet, which is often caused by low income (Prince et al., 2007) (15). An income increase, therefore, might facilitate the attainment of a healthier lifestyle or better accommodation. The material pathway can also work through routes that enable an individual to cope with mental health problems, such as receiving mental health care. In countries with healthcare systems with no social insurance or not free at the point of use, higher income enables individuals to purchase better mental healthcare services.

Second, the psychosocial pathway (or stress pathway) concerns those psychosocial changes that may increase an individual’s level of stress and lead to depression or other mental illnesses. For example, individuals tend to compare their income with that of their peers and this might have an impact on their mental health or psychological well-being (Marmot, 2004 (16); Marmot and Wilkinson, 2001(17); O'Donnell et al., 2013) (18).

Third, looking at the behavioral pathway, there are several behaviors that positively or negatively affect mental health such as unhealthy eating (Scott et al., 2007) (19), physical exercise (Penedo and Dahn, 2005) (20), smoking (Mykletun et al., 2008) (21) or alcohol and substance misuse (Jane-Llopis and Matytsina, 2006).(22) A theory explaining why there might be changes in health behaviors as income increases is the Grossman model, an economic model explaining the demand for overall health and healthcare (Grossman, 1972(23); Grossman, 2000) (24). In this model, a wage increase affects both costs and benefits. The benefits increase since an individual has more “healthy days” which can be transformed into income via labor.

In his article, “Is Your Low-wage Job Bad for Your Heart?” published on HealthNews on January 7, 2013, (25) Brian Krans emphasizes that low wages are a risk factor for high blood pressure. According to research at the University of California at Davis. J. Paul Leigh, a professor of Health Economics, studies the role economics plays in human health. His previous work demonstrated that low wages increase a person’s likelihood of being obese, among other subjects. In this recent round of research, Leigh and his team took a look at how wages affect high blood pressure or hypertension. Published in the latest issue of the European Journal of Public Health, the study not only shows a link between low wages and hypertension but also notes that the highest risk is for women and people ages 25 to 44, two groups not typically at risk for hypertension. “I think wages are important over the psychological portions of the job,” Leigh said, adding that wages are a better indicator of job stress than other factors.

Another study titled, “Adverse Health Effects of High-effort/Low-reward Conditions” by Siegrist Johannes published in the Journal of Occupational Health Psychology, Vol 1(1), Jan 1996, 27-41(26) discusses many issues concerning the link between psychosocial occupational stress and health. The need to identify critical health-related components within the global psychosocial occupational environment is discussed, and 2 theoretical models, the person-environment fit and the demand–control models, are reviewed to help analytically define those components. The findings of the study point to adverse cardiovascular and other health effects of chronically stressful experiences in terms of high effort and low reward.

Teaching is a very stressful job but, regrettably, teachers all over the world are very low paid whereas the administrative staff, especially senior managers, receive far higher salaries but they spend most of their time in stupid meetings and useless things like reading newspapers! The general conclusion is that any scale of salaries for teachers needs to be determined not only based on monetary criteria, as some inefficient and stupid VCs may think, but also on several criteria including those related to mental health. It is a common sense approach to believe that the healthier the workforce in any organization, the more productive it is. Paying peanut packages to the teachers in education has disastrous outcomes not only in economic terms and lost productivity but also on efficient job performance and high rate of absences and turnover, which in turn leads to very low-quality teaching and worthless degrees and certificates. I have done many classroom observations of teachers in many colleges and universities and I can easily conclude that low-paid teachers teach very badly and behave like monkeys: they jump in the classrooms and even in the corridors; maybe they think they need to behave like that.

Suicide Risk Groups

There are many risk groups for suicide in any society. A mental health study conducted by Shannon et al (2020) titled, "Risk of Suicide and Self-harm in Kids: The Development of an Algorithm to Identify High-Risk Individuals Within the Children's Mental Health System" (27) has very important implications for identifying high-risk groups for suicide. The study has found that it is possible to identify high-risk groups for suicide and self-harm in kids within the Canadian mental health system. The following is a brief quotation from the Abstract of the study.

" Suicide is the second leading cause of death in adolescents within Canada. While several risk factors are associated with increased risk, appropriate decision-support tools are needed to identify children who are at highest risk for suicide and self-harm. The present study aimed to develop and validate a methodology for identifying children at heightened risk for self-harm and suicide. Ontario data based on the interRAI Child and Youth Mental Health Screener (ChYMH-S) were analyzed to develop a decision-support algorithm to identify young persons at risk for suicide or self-harm. The algorithm was validated with additional data from 59 agencies and found to be a strong predictor of suicidal ideation and self-harm. The RiSsK algorithm provides a psychometrically sound decision-support tool that may be used to identify children and youth who exhibit signs and symptoms noted to increase the likelihood of suicide and self-harm."

Students at all levels of education, especially at colleges and universities, are regarded as a very high-risk group for a variety of reasons: pressures of academic study, pressures of tests and exams, anxiety and social pressures of high performance and high grades, sexual harassment of female students, and ill-treatment by some teachers and managers.

This brings back to me bitter memories of A’Sharqiyah University in Oman. I still remember what Abood Al-Sawafi (former VC) and Hamed Al-Hajri (Assistant VC) used to force the students at A’Sharqiyah University to pay their tuition fees or any small amounts of money they owed to the University. They used to go around the classrooms of the Foundation Program and the lecture rooms of the colleges and “kick off” students out of their classes in a very insulting and degrading way. The students used to come to me to complain about this disgusting and impolite “procedure” and I used to allow them back to their classes. When Abood Al-Sawafi and Hamed Al-Hajri came to know about what I was doing, they sent direct instructions to my teachers at the Language Center and Foundation Program to allow students back in classes only through direct permission from them not from me as the Director of the Language Center. The procedure of sending students off classes because they owe small amounts of money to the college or the university is very disrespectful to the students and their families, especially in the very reserved society of A’Sharqiyah region where most of the students live in small villages and everyone knows one another. This is very humiliating, especially to the female students who used to cry in the hallways because they were feeling shameful. One of them went as far as to tell me that she was contemplating taking her own life because of Abood Al-Sawafi and Hamed Al-Hajri. If students are kicked off from their classes in Oman, which is supposed to be a rich country in the GCC bloc, what do we expect to see happening to our children and students elsewhere, especially in poor countries in Africa and Asia?

Low-wage workers, low-salary employees, and expatriate workers away from families and friends are also among the high-risk groups for suicide. This is why we find Indian workers; in particular, make up a very high-risk group in Oman and other Gulf states, especially when they are being exploited and abused by bad, corrupt, and inhumane business owners and managers like Abood Al-Sawafi, Hamed Al-Hajri, and Mohammed Al-Barashdi in Oman.?

Suicide in Middle Eastern Countries: A Random Sample

Suicide in Iraq

The Iraq National Study of Suicide (INSS) revealed that the crude suicide rate was 1.09/10,000 population in 2016 (28); moreover, the WHO stated that 590 people died from suicide and 1112 attempted suicide in Iraq in 2019, exceeding previous numbers of 422 and 519 reported in 2017 and 2018, respectively (29). According to Khalid al-Muhana, spokesperson for the Iraqi Interior Ministry, 772 people died by suicide in Iraq in 2021, higher than the 663 reported in 2020; among them, 36.6% were below the age of 20?years, 55.9% were males, and 44.1% were females (30) The WHO recommends that all organizations supporting mental health initiatives collaborate with communities to deliver quality mental health care. Traditional and social media campaigns to promote mental health are also required.

Suicide is a serious public health problem in Iraq. A study by Maha Sulaiman Younis and Ann John titled, " Insight of suicide in Iraq: a coroner’s report" (31) was conducted and published in 2023. The aim was to explore the demographic, clinical characteristics, and associated variables of people who died by suicide in Iraq through a limited retrospective sample symbolized as a biopsy.

The retrospective analysis included the electronic records of a hundred cases of suicide saved in the archives of the Medico-Legal Directory in Baghdad. Data were extracted from the legal investigation which included police investigations, family reports, and post-mortem reports. Simple descriptive statistical analyses of the selected data were conducted.

It estimated through this study that the crude rate of suicide was 1.75 per 100,000 population which is higher than 1.09/10,000, previously reported by the Iraq national study of suicide 2016. Most cases occurred in?≤?29?years old, Muslims, city dwellers, and middle-class people aged 29?years or less. The prevalence of suicide was significantly associated with unemployment, good education, and income. The most common methods used were self-burning, gunshot, hanging, and jumping from heights. The reason for taking their own life was unknown for half of the sample. Depression was relatively common, while other mental disorders were of low rate or unrecognized. Family conflicts and environmental stressors were considered as motives.

This study exemplifies suicide patterns where young age, female gender, and violent methods are represented more than before, reflecting the impact of environmental and personal stressors and may be related to violence and the post-conflict situation initiated by the 2003 war. Little is known about suicide architecture due to stigma and poor surveillance systems. A multidisciplinary suicide prevention strategy is crucial to implement in Iraq’s health service. Large-scale studies are called to cover the data gap.

There is a need to update the 1.09/10000 population crude suicide rate denoted by the (INSS); however, this study could not perform such a task for technical and logistic reasons. This study’s findings mirror those of a nationwide survey and highlight suicide in young people as a particular issue where two-thirds of the sample died by suicide before 50, around half were 10–29?years old, and more than half were males. The gender differences may be attributed to the differences in risk factors such as social factors “sole responsibility for the financial and social support of their families;” access and use of more lethal methods such as firearms and kerosene; and higher rates of males in alcohol and substance abuse than that of females (32). Most cases involved single people living in Baghdad; life in the city is more complicated than in the countryside, potentially with higher levels of loneliness predisposing them to mental disorders and suicidal behavior (33).

According to Jinha- Women News Agency, suspicious deaths of women in Iraq "have been recorded as “suicide” in the official documents in Iraq having the highest suicide rate in 2020.",?Wednesday, 28 April 2021). As the number of deaths by suicide has increased in Iraq, the number of suspicious deaths has also increased. The local sources reported that 12 women were killed under “honor killing” but their deaths were recorded as “suicide cases” in the official documents.

Suicide in Lebanon

"Lebanon sees a 21.7-percent surge in suicide cases in 2023.

On average, one person dies by suicide every two days in Lebanon.

In its annual report on mental health in Lebanon, published on Mar. 1, Embrace, a non-governmental organization, highlights a distressing trend: a 21.7-percent increase in deaths by suicide in 2023 compared to the previous year.

This rise comes amid the profound challenges facing a nation grappling with an unprecedented economic, political, and social crisis since 2019.

According to Embrace, which provides psychological counseling and operates Lebanon’s sole mental health helpline (1564), 168 individuals lost their lives to suicide in 2023. Among them were 119 Lebanese, 34 Syrians, five Ethiopians, three Palestinians, and seven individuals of undisclosed nationalities.

This stark figure represents a notable escalation from the 138 reported cases of suicide in 2022.

Mia Atoui, co-founder and president of Embrace, urges caution when interpreting these figures. She emphasized that various factors can influence the accuracy of reported cases each year.

“These statistics could indicate a genuine rise in suicides in Lebanon,” Atoui tells?L’Orient-Le Jour. “However, they could also reflect an increase in the reporting of suicides by families or law enforcement.”

On average, Embrace notes, one person dies by suicide every two days in Lebanon.

People aged 23-32 are most at risk

The report highlights specific age groups particularly vulnerable to suicide.

In 2023, the most at-risk category was individuals aged 23 to 32, with 48 reported cases of suicide.

Following closely were those aged 33 to 42, with 29 suicides reported. Additionally, the age groups of 13 to 22, 43 to 52, and 63 to 72 experienced 24, 23, and 16 suicides respectively. Eight suicides were reported among individuals aged 53 to 62, and four among those aged 73 to 82.

According to Embrace, the disproportionately high rates of suicide deaths among individuals under the age of 40 can be attributed to the profound crisis gripping the country, which particularly impacts young adults." (34)

Lebanon has not seen stability for many years amid economic meltdown and political turmoil that have greatly affected everything in the country, including the mental health of its citizens and residents Recently, Lebanon has seen a troubling rise in deaths by suicide.

The economic crisis has continued to this day, with the majority of Lebanese living in poverty and the state unable to provide basic services to its citizens.

As reported in The New Arab (6 March 2024), " Survey data shows that the war in Gaza has increased stress among people in the Arab world. New data revealed by a?mental service ?in?Lebanon ?on Wednesday showed that the incidence of suicides increased by 21 percent in 2023 as opposed to the year prior across the country.

The mental health service, Embrace, which provides mental health services and maintains a suicide help hotline in Lebanon, said that the increase in "suicide cannot be attributed to a single cause."

Embrace said the increase "underscores the urgent need to address mental health concerns and promote effective intervention to reduce the rise in these rates." (35)

" Data from Lebanon shows severe levels of distress among the people, in a country with minimal resources. Given current adversities in Lebanon, recent data in the country, and the literature on adversity and mental health outcomes of man-made disasters, Lebanon is most likely going to face an epidemic in poor mental health. A call is made for the wider scientific community and international organizations to support the mental health field in the country and help prevent further negative mental health outcomes. Understanding how to better navigate mental health in places with extreme adversity and emergencies can be beneficial to other communities which might face similar challenges."(36)

Suicide in Saudi Arabia

As of 2016, the Kingdom of?Saudi Arabia ?had a suicide rate of 3.4 per 100,000 people, ranked 163rd in the world.?However, due to the?laws against suicide , the data may be underreported (37).

Suicide is a crime in Saudi Arabia (38). Discrimination, severe social restrictions, and forced marriages are motivators for women's suicides (39), (40).

A study of 221 suicides in Dammam between 1986 and 1995 revealed that 63% were?by hanging , 12% were?by jumping from height , 9% were?by gunshot , and 6% were?by poisoning (41).

A retrospective study was carried out on 126 suicide cases autopsied at the Forensic Medicine Center in Dammam, Kingdom of Saudi Arabia, from 2000 to 2003. Of these 126 cases, 109 (86.5%) were males and 17 (13.49%) were females, and the ratio of the males to females was 6.4:1 with the highest ratio in 2000 (10:1). Around 88% of the studied subjects were in their third or fourth decades. The largest percentage of suicides was among non-Saudis, and the highest is the Indian population with 54 cases (42.85%), followed by Saudi nationals (15.07%) and then 10 other nationalities. Suicide by hanging was the most common method (89.68%), followed by firearms in only eight individuals (5.55%) and the other four methods of suicide. Family troubles were documented in 5.5% of cases. While a history of psychological illnesses was more than double this figure, 13.49%. Suicide notes were discovered at the scene of death in five cases. Postmortem blood alcohol was found in only 5.55% of cases, and toxicological analysis resulted in the detection of amphetamine and cannabinoids in 3.69% and 1.587% of them, respectively.

There was an unstable curve in the suicide rate in Dammam; in 2000 there were 33 cases, with fewer in 2001, more in 2002, and the fewest in 2003.

There was an irregular rate in the number of suicide fatalities across the studied four-year period. However, it is still considered a public health problem and should be given a high priority to prevention and more research on the social and life circumstances of these groups, focusing on both nationals and foreigners. We encourage further studies regarding psychological and other causes of suicide in the region (42).

Suicidal thoughts and behaviors (STB) constitute an escalating public health concern globally. Despite the growing burden of suicidal ideation, plans, and attempts, national information on the trends of STB is lacking in the Kingdom of Saudi Arabia (KSA). A study was conducted by Yasmin Altwaijri et al (43) to report on the prevalence, correlates, and treatment-seeking behaviors associated with STB in the country using nationally representative information from The Saudi National Mental Health Survey (SNMHS).

The SNMHS is a national household survey of Saudi citizens aged 15–65 (n?=?4004). The adapted Composite International Diagnostic Interview (CIDI) 3.0 was administered to produce lifetime and 12-month prevalence and treatment estimates of STB in the KSA. Associated correlates were calculated using cross-tabulations and logistic regressions.

Results

Suicidal ideation, plan, and attempt had respective lifetime prevalence rates of 4.90?%, 1.78?%, and 1.46?%; 12-month prevalence rates of 1.82?%, 0.89?%, and 0.63?%. Significant correlates of STB include younger age, female gender, low education, urban rearing, and single-marital status. STBs were also significantly associated with the presence of prior mental disorders, childhood adversities, and low treatment-seeking.

High unmet needs and significant sociocultural and psychological risk factors have been identified in association with STB in the KSA. Given the community-based nature of the SNMHS and the limited national data on STB in the Middle East and North Africa region, our findings can extend to inform the necessary healthcare policies, treatment plans, and prevention strategies needed to alleviate the burdens of STB in the region.

Suicidal thoughts and behaviors (STB) are precursors to death by suicide and as such are recognized as major global public health concerns and are projected to become even greater contributors to the global burden of disease in the future (44).

A review article by Ghadeer Abdullah Altaqaq et al (2021) offers useful data about the studies that were carried out about suicide in Saudi Arabia up to 2021 although such studies are very limited in the Kingdom (45).

Suicide in the United Arab Emirates (UAE)

Suicide was considered illegal ?in the UAE. The Federal Penal Law in the country previously stated that it was considered an offense to attempt suicide, completely disregarding the reason leading up to the attempt. Anyone who attempted suicide or assisted someone else in the act was to be prosecuted by the law. Such prosecution led to the underreporting of suicide cases and to the issuance of fines or even imprisonment.?This law was not in favor of suicide victims and was identical to the existing laws in most Islamic and Arab countries.

The UAE has recently taken a giant step forward by changing the above law and has set up a very good example for other Muslim and Arab countries. According to the new law, suicide attempts and self-harm have been decriminalized and are no longer punishable by law. Instead, those who are victims of such attempts are referred to professional psychological centers and mental health treatment.

It is of utmost importance that leaders and lawmakers of a nation recognize the importance of mental health and mental health treatment. This is a huge step in the direction of eliminating the stigma associated with suicides and mental health illnesses in the Middle East. Mental health advocates and the mental health community are more than proud of the UAE for making such a big decision to help the community suffering from mental illnesses and related conditions.?

There have been many studies about suicide in UAE, especially Dubai which is well-known for its very large population of expatriate workers.

One of these studies was conducted by Abbas A. Koronfel in 2002. The study was titled, " Suicide in Dubai, United Arab Emirates" published in Journal of Clinical Forensic Medicine Volume 9, Issue 1 ,?March 2002, pages 5-11 (46). The study found that the annual rate of suicide in Dubai between 1992 and 2000 was 6.2/100,000. There was a non-significant peak incidence in November while July recorded the lowest incidence. Fridays showed the lowest incidence with no significant difference between Muslims and non-Muslims. Victims were predominantly male expatriates with no difference between Muslims and non-Muslims. However, a significant increase in the number of non-Indian female expatriates was recorded. The majority of victims were of the age group 21-40 with a significant increase in teenaged females and teenaged citizens. Hanging was the most common method for committing suicide. Females and non-Indian expatriates resorted significantly to jumping from a high and self-poisoning. The age of the victim did not affect the choice of the method used to commit suicide. The majority of incidents took place in the victim's own house. A suicide note was left behind in 5% of cases. A history of psychological illness or trauma was available in 9.7% of cases. In these cases, depressive illness and recent unemployment were the major triggers for suicidal impulses. A total of 27.7% of screened victims tested positive for alcohol and were predominantly males with no significant difference between Muslims and non-Muslims.

Another study was conducted by Kanita Dervic et all in 2012 titled, " Suicide Rates in the National and Expatriate Population in Dubai, United Arab Emirates" and was published in the International Journal of Social Psychiatry (47). The study aimed to investigate total and gender-specific suicide rates in the national and expatriate population in Dubai and to elicit socio-demographic characteristics of suicide victims.

Registered suicides in Dubai from 2003 to 2009, and aggregated socio-demographic data of suicide victims were analyzed. Suicide rates per 100,000 populations were calculated.

The suicide rate among expatriates (6.3/100,000) was seven times higher than the rate among the nationals (0.9/100,000). In both groups, the male suicide rate was more than three times higher than the female rate. Approximately three out of four expatriate suicides were committed by Indians. The majority of suicide victims were male, older than 30 years, expatriate, single and employed, with an education of secondary school level and below.

The study concluded that further research on risk factors for and protective factors against suicide, particularly among the expatriate population, is needed. Epidemiological monitoring of suicide trends at the national level and improvement of UAE suicide statistics would provide useful information for developing suicide prevention strategies.

A much-publicized case of suicide that happened in Dubai some years ago was that of award-winning Indian businessman, Joy Arakkal, who was the managing director of Dubai-headquartered Innova Group of Companies. He committed suicide on April 23, 2020, by jumping from the 14th floor of a building.

Joy Arakkal has received many awards including a lifetime achievement award. He committed suicide over financial problems, police confirmed after an investigation, according to a media report.

Joy Arakkal, who hailed from Kerala and was the managing director of Dubai-headquartered Innova Group of Companies which had diverse businesses, with a major focus on the oil sector, committed suicide on April 23 by jumping from the 14th floor of a friend's building on Business Bay, Dubai police told Gulf News. His companies include oil refineries, petrochemical trading, ISO tank cleaning services, shipping services, and a telecom company working for infrastructure projects in the UAE. (New Delhi Television Ltd, updated: April 30, 2020).

Suicide in Kuwait

The latest suicide cases of citizens and residents raise a red flag, as many of them used various means and methods in ending their lives. Suicides reached 120 cases from January until November 2021; around 12 cases per month, according to official statistics. Al-Qabas Arabic Daily reported yesterday quoting security sources that a majority of these suicides are committed by Asians, with cases increasing since the beginning of the coronavirus pandemic.

They added security authorities will deport any resident who attempts to commit suicide, after the increase in such attempts, particularly from Jaber Causeway. Police stations have received repeated calls about suicide attempts, mostly by Asians, and firefighters have responded and saved 10 lives.

The National Diwan of Human Rights revealed in a study conducted with seven government entities to find the reasons behind the rising number of suicides by citizens and residents. Chairman of the complaints committee at the Diwan Ali Al-Baghli said "Having three suicide cases in one day should catch the attention of the society to act quickly to save more lives". He said Kuwait registered the largest number of suicide cases in its history during 2020 (48).

Most people who committed suicide in Kuwait were young people and Bidoons (stateless) as well as expatriates, according to official statistics. The statistics indicate that the total number of people who took their lives in Kuwait during the period between 2015 to the end of 2021 was about 620 suicides. While Indian residents ranked the highest with 342 cases, Kuwaitis came in second place with 54 suicide cases. Kuwait Times discussed with Psychologist Ahmad Al-Mulla the problems that may lead a person to commit suicide.

Regarding the causes of suicide, Mulla said that depression, schizophrenia, addiction, and personality disorders such as borderline personality disorder may lead to suicide. According to Mulla, a person first suffers from psychological problems that ultimately lead them to commit suicide.

Mulla also mentioned cases of suicide among stock market speculators who declared bankruptcy. "Suffering from financial loss is not what led them to commit suicide, but their mental illness such as depression did," he said. Mulla explained that the victims were using speculation and making a profit in the stock market as a way to 'treat' their depression. "But when they were exposed to financial loss, their depression escalated and led them to commit suicide," he argued. He added that people who suffer from depression cannot be distinguished from any normal person, except that they are in constant danger due to their willingness to commit suicide.

Regarding the solutions, Mulla said that preventive solutions are the only effective solution to protect people from mental illness that may lead to suicide. "People must be aware that mental illnesses are like normal diseases, which could be treated to avoid the aggravation of these psychological problems because if a person suffers from a mental illness, it cannot be predicted whether these diseases may lead to suicide or not," he said.

Meanwhile, Mulla stressed the importance of raising awareness among patients, saying, "As for prevention of suicide itself, there must be awareness for patients that there are solutions to any psychological crisis that they may go through, because suicide will not solve the crisis." He added, "The problem of mental illnesses such as depression is that they deceive the sufferer that there are no solutions to their problem, and this is not true." (49).

Some put the?rising suicides ?among Kuwaiti youth down to the crises in mental health afflicting this age group, most of whom don't receive any kind of psychological treatment.?One Kuwaiti teenager killed herself ?after she was bullied for her "Asiatic"?features, inherited from her mother.

In addition to this, several of Kuwait's Bidoon community committed suicide last year. The suicides have shaken Kuwaiti society and sparked increasing demands that the cases be looked into to curb the situation.

The Jaber Bridge – the Sheikh?Jaber?Al-Ahmad Al-Sabah Causeway which links the two banks of the Gulf of Kuwait?–?has become a symbol of suicide due to the number of those who have attempted to throw themselves off it and the police have now started running regular security patrols to try to prevent this from happening.

A Bidoon activist (who preferred to remain anonymous), says to Al-Araby Al-Jadeed: "There have been 13 suicides in our community, one of them a 12-year-old child. His suicide led to a wave of condemnation from human rights organizations, due to the poor economic and social conditions the Bidoon suffer because of?the?suffocating restrictions ?placed on them by the Central Agency For Remedying Illegal Residents' Status.

Khalil Khaled, a sociology researcher at Kuwait University, says: "Suicide cases are not a new phenomenon in Kuwait – they are a symptom of modern societies in which many feel alienated. Additionally, the culture here rejects the idea of psychiatric?treatment or therapy, as mental health issues are heavily stigmatized. Because of this,?those who do want to seek treatment often can't afford the high costs of going to private doctors'?surgeries?– especially as most of these people are either immigrants or from the Bidoon community who are on very low incomes."(50).

Salah Al-Waheeb and Nadia Al-Kandary published an informative research article in 2015 based on their study of patterns of suicide in Kuwait (51).

A review of suicide cases was performed to investigate the demographics of this phenomenon and the suicide modalities used and to uncover issues that can be addressed by the region's government.

The sole source of data was the General Department of Criminal Evidence (GDCE), where cases are referred by police authorities and hospital investigators from the entire country. All cases signed out by forensic investigators as “suicide” during the period 2003–2009 were retrieved. A full review of the data from the case files was made. This included demographic data, scene examination, radiographic investigations, autopsies with histo-pathological examination findings, and toxicological screening results in each case.

A total of 347 cases were retrieved and studied. Hanging was found to be the most common suicide modality used by subjects (60?%). Non-citizens constituted 87?% of cases, and no significant difference was found between married and single subjects or between Muslims and non-Muslims. Regions that were more populated with an expatriate labor force had the highest suicide prevalence.

?The researchers concluded that the government of Kuwait needs to investigate the dire conditions in which some expatriates live and to improve their situation. More control over the dispensing of certain medications needs to be enforced. Finally, strict firearm control could help reduce the suicide rates in Kuwait.

Suicide in Bahrain

The mean suicide rate was?0.6 per 100,000 for the Bahraini nationals and 12.6 per 100,000 for the non-Bahrainis with 17.7 per 100,000 for the Indian migrants. Men were six times more likely than women to commit suicide.

According to a study by Ahmed Al Ansari et al (2007) (52), there is a combination of social, legal, and religious factors that make reporting suicide difficult in Bahrain, an Islamic country. Limited available data indicates a very low incidence rate of 3 per 100,000. The objective of the present study was to describe the pattern of suicide in Bahrain for 10 years. The registered suicide cases (N = 304) at the Ministry of Interior for the 10 years from 1995 to 2004 were reviewed and analyzed. The mean suicide rate was 0.6 per 100,000 for Bahraini nationals 12.6 per 100,000 for non-Bahrainis and 17.7 per 100,000 for the Indian migrants. Men were six times more likely than women to commit suicide. The majority of the subjects were under 35 years of age with financial domestic problems being the most common reason reported in the record and hanging the most commonly used mode of suicide (92.8%). The suicide rate for the Bahraini population remains low compared to other countries. The higher rate of suicide among Indians merits further investigation. Moreover, more research is needed on the epidemiology of suicide risk factors in ethnic groups for further prevention and intervention.

Another study by A. Al Ansari and M.K. Ali (2009) has found that the characteristics of suicide victims have not been studied systematically in Arab countries, including Bahrain (53). A questionnaire-guided interview of families of 29 Bahraini suicide cases from 1996 to 2005 was conducted in their homes by a social worker. Medical and psychiatric files were examined to complete the data. More suicide victims were male, young, single or divorced, unemployed, and with a low education level compared with the general population. The majority of victims had chronic mental disorders, mainly schizophrenia, depression, and substance abuse. The most notable environmental risks were reported to be family problems, a family history of suicidal behavior, and financial and relationship problems. The sociodemographic and clinical risk profile in Bahrain differs from other developed and developing countries. Suicide among Bahraini subjects was more prevalent among young males and decreased with advancing age. This is in contrast with the typical suicide completer in developed countries being an elderly male. The age distribution was somewhat similar to several reports from developing countries which showed increasing involvement of younger people.

As the researchers have admitted, " Our study suffers from several limitations. As the information was mostly gathered from a family member, the accuracy of the information may be questioned. Also, the number of Bahraini suicide cases is underestimated, especially for females and the elderly, for several reasons. Suicides that occur at home or those that could be mistaken for accidents are not vigorously investigated. Moreover, a postmortem examination is performed only if there is a suspicion raised by a family member about the cause of death or to avoid legal implications. Other limitations include those related to the retrospective nature of the study, lack of population norms for certain psychosocial factors, and the small sample size." (53).

Suicide in Qatar

Suicide is not discussed often in Qatar. Though the country’s comprehensive?National Development Strategy ?acknowledges social problems like domestic violence and depression, there is no mention of suicide.

Ahead of the annual suicide prevention day held in Qatar some years ago, Dr. Suhaila Ghaloum, a consultant psychiatrist in Doha,?urged ?the country to keep better records of people who kill themselves.

Desperation can push a person of any background to end their life, and residents of Qatar are no exception, an official at the?Social Rehabilitation Center ?(Al Aween) has said.?

Speaking at a lecture ahead of?World Suicide Prevention Day , Mamoun Mobayyad, consultant psychiatrist and Al Aween program manager, said more could be done here to reduce suicides (54).

In a recent conversation with Dr. Ahsan Nazeer, Division Chief, of Child and Adolescent Mental Health Services at Sidra Medicine, he said:

“We have recognized that if we want to make a difference in the lives of children in Qatar, we need to work closely with schools and families. At this time, we have numerous programs to promote awareness and to help parents, teachers and school counselors to recognize early warning signs of depression and to seek much-needed help”.

Dr. Manal Othman, HMC’s Consultant Child and Adolescent Psychiatrist , said depression is common in children in Qatar.

“Children represent 1-3% of the total incidence of depression diagnoses. Girls are twice as likely as boys to suffer from depression, especially in their adolescence. Depression in children can often have social triggers such as the breakup of their parent’s marriage, family problems, or problems at school or with friends, and it can even be caused by genetic factors. Depression can affect the child’s performance at school and can even lead to self-harm or attempted suicide.” (54).

Dr. Suhaila Ghaloum, Senior Consultant at HMC’s Psychiatry Department stated :

“Contrary to a common belief that suicide or the act of killing oneself is a sign of weakness or lack of faith, in the majority of cases, suicide is not a deliberate act but is due to a mental illness such as severe depression or anxiety that impairs the judgment of the person committing or attempting suicide." (55).

Rising suicide rate sparks concern among Indians living in Qatar

The rising number of suicide attempts among Indians in Qatar is pushing people to do something about it. Community members are appealing to Qatari authorities and to the Indian Embassy to reverse the growing trend.

The rising number of suicide attempts among Indians in Qatar is pushing people to do something about it. Community members are appealing to Qatari authorities and to the Indian Embassy to reverse the growing trend.

Following several suicides over the past few days, especially among Keralites, Indians at an open forum on Saturday said most cases involved problems with sponsors or abuse.

An Indian was reported to have died in Al Wakra last week.

His death is suspected to be a suicide because, according to community sources, he was extremely depressed.

In another incident, 27-year-old Keralite Sunood B. Tulsidas was found hanging on Monday from the ceiling of the corridor outside his apartment in an isolated area near Shara Kaharba.

According to a source at the Indian Embassy in Doha, the death toll in the Indian community in Qatar reached 109 this year, surpassing the 100 deaths in the corresponding period last year (January to Nov-ember 2003).

The total death figure for the last year was 119, the highest in five years. The source said many were suicides and the majority of those were people who came from Kerala, although he did not provide exact figures.

According to the latest data provided by the Indian Embassy, there are 171,000 Indians in Qatar, and about 70 percent of them are from Kerala.

Speaking at the monthly open house organized by the Indian Embassy, Dr. Ebraham Kollamana, vice-president of the Indian Community Benevolent Fund (ICBF), said immediate action had to be taken.

“We must do something to help check this trend. We must provide counseling to our people,” Kollamana said.

He presented other cases of suicide-related deaths, including that of a young Keralite who ended his life after he was refused an exit permit by his employer.

In another case, a Keralite driver tried to hang himself because he could not repay a loan of 18,000 Qatari riyals (Dh18,165). He did not succeed because the rope broke.

The General Secretary of Sanskriti, a Kerala social organization, announced a psychiatrist would soon be available for public lectures and counseling (56).

A study conducted by Abdullah, M., Iqba (2023) titled, " Management of suicide and self-harm risk by the National Mental Health Helpline in the State of Qatar" was published in the British Journal of Psychiatry (BJPsych) Open 9(3). The study aimed to investigate the sociodemographic and clinical features of callers (patients) classed by the Qatar National Mental Health Helpline (NMHH) as moderate to high priority based on the risk of self-harm or suicide during the COVID-19 pandemic. The study design was a retrospective chart review of patients who contacted the helpline in the first 12 months, starting 1 April 2020. Data of those classed as moderate to high priority based on risk to self were collected using a specifically designed form. Absolute and relative frequencies for each of the studied categorical variables were determined. Four hundred and ninety-eight patients were included. More than half were female. The mean age was 32 years (range 8–85 years). Two-thirds of patients were from Arab countries and more than half of all patients had contacted mental health services for the first time. The most common symptoms elicited included suicidal thoughts, depressed mood, and disturbed sleep. The most common psychiatric disorders were depression and generalized anxiety disorder. Most patients were seen within 4 h and received psychiatric interventions. Virtually all patients received non-pharmacological interventions; only 38.5% received pharmacological interventions. The majority had follow-up appointments arranged with mental health services. People from the Indian subcontinent and males proportionally approached services less, which may reflect stigma. The NMHH improved access to care for patients considered at risk to self and prevented hospital admissions. The NMHH offers a valuable additional choice to patients and assists in the prevention and management of suicidal behavior and other mental health difficulties (57).

Suicide in Oman

The right side of the picture to this article above represents a statement made by Dr. Marwa Al-Baluchi in Arabic to Al-Shabeeba Newspaper (Al-Shabeeba in Arabic means young men and women). The following is a translation of the statement in English:

"There has been an increase in the rate of suicide attempts in the Sultanate of Oman among the teenage population and the students of schools, colleges, and universities. This is causing concern and is ringing the bell of danger. Almost every week, there is a case of attempted suicide, and the person is admitted to hospital."

The left side of the picture to this article represents another statement in Arabic by the Omani teacher and educator Ayesha Al-Salhi about suicide in Oman. She said, "Watching Japanese and Korean TV series and music bands have negatively impacted the Omani girls. There have been six suicide attempts in one school in Oman."

Although this statement represents a personal observation and not a scientific study, it does refer to a frightening trend of suicide attempts among students in Omani schools.

There is no academic or scientific study of suicide in Oman because of the absence of academic freedom for scientists and researchers to carry out research in many areas of scientific or social concerns like suicide, corruption, and human rights. The most you find about suicide is one report about a suicide attempt by one man. The report is titled, "Surviving a Suicide Attempt" by Ahmed Al-Harrasi et al (2016) (10). It describes a middle-aged man with depression and multiple social stressors who survived a serious suicide attempt. The discussion will focus on the factors that lead him to want to end his life and the impact of the assumed protective factors such as religious belief and family support on this act of self-harm. Such patients can be on the edge when there is an imbalance between risk factors (such as depression, insomnia, and psychosocial stressors) and protective factors (like religious affiliation and family support.

This report is not a scientific study; it is just a report and the writers are very cautious in their report for fear of being prosecuted if they cross too many red lines of the Oman public Prosecutors who are narrow-minded, uneducated, and among the most corrupt and brutal public prosecutors in the world. I still remember the article I published on LinkedIn some years ago about some suggestions I offered to improve the Oman healthcare system for expatriate workers who suffer from many health problems, including mental health problems.

There has recently been an increase in suicide cases and suicide attempts in Oman but they are often ignored and underreported in the press. The very limited number of suicide cases that sometimes find their way to the local press are very cautiously reported in some English-language newspapers published in Oman and many are deleted later on. The following are all we have found on the public platforms.

Fourteen-year-old student commits suicide in Oman

Muscat:?A 14-year-old student took his own life by hanging himself from a bike tire tube in his room. The incident occurred on Tuesday evening around 7 PM, a police official confirmed. According to the Royal Oman Police, the child was a resident of Wilayat Ibri in Al Dhahirah governorate. An argument with his father, who is said to have taken away his phone during lunchtime, led to the child taking this extreme step. The official said, "Al Dhahirah Police Command received a report that a 14-year-old child committed suicide in his home and as a result, the police and the Criminal Investigative Team went to uncover the circumstances of the incident.” (58). An official from the Public Prosecution told the Times of Oman, “In 2016, there were 28 suicide cases among expatriates, while in 2017 there were nine recorded cases.

Indian Suicide in Oman

Indians make up nearly half of Oman’s expatriate workforce.

"An Indian living in Oman has been found to commit suicide every sixth day, owing to financial stress or personal issues, official data shows.

23 Indians had committed suicide in different parts of the Sultanate till mid-April this year. In January and February, eight Indians committed suicide in each month, while four ended their life in March." (59).?

Woman lands Oman job, hangs herself in one month

HYDERABAD: In less than a month of going to Oman as a housemaid, a 31-year-old woman from East Godavari district of Andhra Pradesh reportedly committed suicide by hanging. The family has alleged foul play and sought an investigation into the death.

Sadhe Ananthalakshmi of Machara, Kapileswaram, went to Muscat in Oman on March 9 this year. She was in contact with her family till April. (60).

Indians make up the majority of suicides in Oman

Low wages and bank loans are common triggers for suicide and campaigns to help the labor class cope with burdens needed

Muscat: Indians make up the majority of the suicide victims in Oman, new data has revealed.

According to data released by the Public Prosecution, Indians made up 15 out of the 25 suicides registered in 2016.

Ahmad Al Kharousi, a sociologist, said that suicide cases are most common among those belonging to blue-collar workers who have low wages.

“Low wages and unpaid bank loans are the common triggers for suicide, thinking that they would be relieved of the burden,” Al Kharousi told Gulf News.

He stressed that more campaigns were needed to help people cope with psychological illnesses.

Article 274 of Omani Penal Law prohibits people from committing suicide or attempting suicide or even aiding or abetting someone to commit suicide. Violators will face a jail term of up to five years.

Nasser, whose 27-year-old brother killed himself two years ago, said that his brother took his life after he was suspended from university because of low grades.

“He committed suicide in his room slitting the veins in his hands with a razor. He was found in a pool of blood,” Nasser said.

“It was the saddest moment in my life when the phone rang to inform us that my brother committed suicide. He was a kind-hearted person. I sorely miss him,” he said.

Twenty-five suicides were registered in Oman in 2016, down from 30 in 2015.

Males made up 90 percent of the registered suicides in 2016 — five were Omani. (61).

Indian expat in Oman becomes latest to commit suicide due to debts

The worker was the latest Indian expatriate to kill themselves due to the pressures of debt as the cost of living rose in both Oman and India.

The 33-year-old man had complained of a headache and was last seen on Saturday evening, sitting alone in a courtyard of the construction site in the Omani capital, his fellow workers said.

Police confirmed the man’s death was a suicide but gave no further details.

A police source said it was the second suicide this year by an Indian expatriate in Oman.

Last year, 23 Indian expatriates committed suicide in Oman, according to the source.

“We had teachers, students, office managers, salesmen, and manual workers taking their lives in the Indian community. The common link is financial pressures they go through that gets out of control,” the police officer said.

Ravindranath Nair, an Indian psychologist in Muscat, said an increase in the cost of living both in Oman and India had put extraordinary pressure on expatriates.

"It is the mental stress the Indian community working in Oman faces, mainly about their financial status. Salaries have not gone up in the last five years in the country. They have expenditure commitments such as accommodation rents, and education of their children and they have to send money back as well for their savings. It leads to depression and eventually to the taking of their lives," Mr Nair told?The National.

The drop in global oil prices since 2014 has forced most local employers to freeze increments and bonuses and to recruit new staff at reduced salaries, which has particularly affected Indian expats in lower-paying jobs (62).

Most of the cases of suicides and suicide attempts in Oman are due to poverty, poor working conditions, social problems, economic problems, financial pressures, and an inadequate healthcare system, especially for expatriate workers and employees in the private sector. After working and living in Oman for almost 15 years, I realized that the Oman healthcare system is defective as expatriate workers are not offered effective healthcare insurance in the private sector. So I wrote an article and offered some suggestions to improve the present situation. There is no attack on the system but there are suggestions as any reader can see from the article itself. The article was titled, “Oman Health at Risk: Oman Labour Law and Medical Insurance Companies, and was published on October 12, 2015,?on LinkedIn and other international websites. For convenience and because of its importance, I would like to quote something from the article below:

“Productivity and health are closely connected. This is one of the axioms in economics and life. People cannot work if they are sick; productivity is greatly reduced if they do not feel healthy. The Healthcare System in Oman differentiates between Omanis and expatriates and between those who work for the government institutions and those who work in the private sector. Omani nationals, as is the case in many countries in the world, receive their health care in government hospitals and other medical facilities that are, in general, very well-equipped and well-staffed. Expatriate workers who work for the government also receive their health care in government medical facilities but need to pay in some cases. However, they are a lot better off than those who work in the private sector. Expatriates and their families working in this sector are supposed to receive the same, or almost the same, level of health care and we find the?Oman Labor Law?instrumental in ensuring that expatriates should get good health care. Article (33) deals with this point.

There are certainly many loopholes and shortcomings in the healthcare system in Oman related to the expatriate workers and need to be quickly addressed. We do miss the touch of the humanity of the Law. Oman needs expatriate workers and the expatriate workers need good healthcare to be healthy and productive. So we cannot leave the health of the nation to greedy VCs and greedy medical insurance companies?that think of accumulating huge profits at the expense of our health. We hope for the best but we should be prepared for the worst. We urgently?need those in charge of the health system in Oman?to listen and take action at this critical time when all sorts of infectious diseases are around in the region and the world. We are talking here about the health of Oman; not about coffee shops!!”

Abood Al-Sawafi and Hamed Al-Hajri did not like this article. They regarded it as an attack on the Oman Health system! Again, they have revealed themselves as stupid and ignorant people. They do not understand anything in English nor do they care about the health of their employees and their people. As the reader can see, this article praises the Government Healthcare system; it says?“Omani nationals, as is the case in many countries in the world, receive their health care in government hospitals and other medical facilities that are, in general, very well equipped and well-staffed.”?Any expatriate working in Oman would tell you about the different health care the Omani nationals get from that offered to the expatriate workers in the private sector. This is one of the bitter realities facing expatriates in Oman and it is a very serious problem that needs to be addressed by the health authorities in Oman to keep the country healthy. I have said this very clearly:?“illnesses and diseases do not differentiate between Omanis and non-Omanis, between those who work for the government and those who work for the private sector. We are on the same ship and if it sinks, God forbid, we will all sink with it.”

The article is a very serious attempt to tackle a serious issue anywhere in the world, that is, the health care system and how it can be made more effective for everybody for the safety and well-being of the whole country. The writer should have been rewarded, as many lawyers in the court told me, not put on trial. The other important point is the fact that the article does not mention Abood Al-Sawafi, Hamed Al-Hajri or A’Sharqiyah University by name so what has the article got to do with them? Are they the representatives of the Ministry of Health in Oman? The Ministry of Health knows about the article and has read it and I have sent them a copy. They are educated people and they understand English, later on, they sent me more than one survey about the healthcare provided by the private sector in Oman. So where is the problem for Abood Al-Sawafi and Hamed Al-Hajri to take the article to court and claim “it is cybercrime”?! Is this a sign of intelligence and education or a sign of utter stupidity, ignorance, wickedness, and lack of leadership?

It is utter nonsense to regard such an article as a “cybercrime” and take the University Professor to court. The article has nothing to do with any cybercrime. There is not a single definition of cybercrime that applies to it.

Corrupt and inhumane officials and managers like Abood Al-Sawafi, Hamed al-Hajri, and Mohammed Al-Barashdi are among the main factors behind defective healthcare systems and behind the rising trend of suicides in Oman, especially among expatriate and Indian workers who are exploited and abused in Oman and elsewhere.

For more details, read the following articles:

1.???? CNN Freedom Project: Are These LinkedIn Articles a Cyber Crime?! (LinkedIn, March 14, 2018)

2.???? Fighting Modern-Day Slavery: Save the Cleaners at A’Sharqiyah University in Oman (LinkedIn, March 14, 2019)

3.???? Oman Health at Risk: Oman Labour Law and Medical Insurance Companies’, (LinkedIn, October 12, 2015)

4.???? Are Indians Cheap Labor? Who is to blame? Expatriate Indian Teachers in Higher Education (LinkedIn, October 1, 2015)

5.???? COVID-19 and “Herd Immunity”: Implications for Governance and Management (January 18, 2021)?

Support and Facilities

Everyone experiences a problem or a crisis at some point in their life. They might feel that their mental health has been steadily deteriorating for some time, or perhaps something has happened in their life that has affected their stability or their desire to live. The person may have already been diagnosed with a mental health condition or might be going through symptoms for the first time which they do not fully understand. Whatever the situation, if the person feels unable to cope, or to keep themselves safe, it is important to seek urgent help and support. It is more important that support and facilities exist, are available, and are affordable for them.

Trained professionals and equipped services for support and treatment should be publicized in clinics, hospitals, rehabilitation centers, and all concerned bodies and organizations with effective campaigns to eliminate the stigma associated with mental and psychological illnesses and problems.

Specialized units should be available all the time in the Accident and Emergency Departments in every country for all citizens and expatriates free of charge for those who cannot afford such services. Hotlines and helplines operated by trained professionals are to operate 24/7 non-stop.

Families and friends should not be reluctant to talk to their family members and friends if they see that the person is going through difficult times or crises and should be offered emotional and moral help and support. They should not be told in any way and in any circumstance that it is their problem and should find a solution for it by themselves. This is a very destructive approach that leads vulnerable people to take extreme measures and take their lives.

Teachers, head teachers, principals, deans, supervisors, and all concerned administrators and officials in schools, colleges, universities, and all other organizations are to be trained and made aware of the importance of observing and reporting any irregular or abnormal signs, symptoms, and behaviors that their sons, daughters, students, and colleagues may show, especially during exams and tensional times.

Suicide is one of the public health problems that have not been given due attention because of the stigma and the taboo culture associated with it. Even though suicide prevalence may seem low in any country compared with others, educational and preventive suicidal programs are necessary for all residents and expatriates. It is also important to maintain easy access to medical and psychological healthcare and routine follow-ups for foreign workers to assess their environmental, medical, and psychological well-being.

Conclusions

Suicide is a serious problem around the world, and it seems to be on the increase, so now, it's becoming increasingly important to pay more attention and try to find out the underlying issues that may lead to the suicide of vulnerable people, especially young men, and women. Students, kids, and expatriate workers. To help prevent suicide, we need to highlight mental health, depression, inhumane management in businesses, and companies, bullying, and social media and how these factors can and may lead to contemplation of suicide, and even suicide itself.

It is very important to speak out about suicide and conduct a public, informative, and cultural campaign against the stigma of mental and psychological problems. When people feel comfortable expressing their feelings and know that they are not going to be judged or looked down upon because they have thoughts of ending their lives, then they are more likely to seek help. By talking about suicide, we can also look at the factors that cause it and how we can prevent it.

An effective healthcare system for all citizens and residents has become an essential element for a decent, human life if governments are serious about the well-being of their people and if they want to behave as conscientious nations in the modern world.

In Islam, committing suicide is regarded as a major sin and the person who has committed suicide may face damnation and the wrath of Allah. According to the Quran, the holy book of Muslims, there is nothing more precious than life. But telling people about these religious things is not a sufficient policy by itself. There must be problem-solving policies, strategies, and mechanisms that offer tangible help and assistance to vulnerable groups and individuals who might contemplate suicide and self-harm because they are left alone struggling with problems they cannot deal with by themselves.

Despite having a strong religious affiliation, patients with mental illness can become helpless and hopeless and try to end their lives. Depressive illness, insomnia, and social stressors can trigger a person to attempt suicide despite knowing the consequences of their actions from a religious point of view. Mental health professionals should perform detailed risk assessments in patients with depression regardless of their religious beliefs.

To curb mental and psychological health problems that may take a person down the path of contemplating suicide, it is essential to promote better awareness and provide support for those at risk, such as teaching coping skills to help students deal effectively with stress, and training teachers to recognize students who may have mental health problems such as depression, anxiety, what may be the factors along with measures to reduce work-related stress, psychological therapy, family support, and medication-based treatments to students suffering from depression and stress at all levels of education.

There are thousands and thousands of problems almost everywhere in the world and in all sorts of organizations and institutions: schools, colleges, universities, companies, and corporations down to the smallest units of human activity in society. The measure of success lies not in denying or avoiding problems but in the problem-solving techniques and procedures adopted to solve these problems. Problems will always come to us whether we like them or not. To ignore them, deny them, or try to get around them is a very bad and ineffective policy that will certainly lead to failure.

Higher education is one of the most important public priorities for any modern-day nation. It is regarded as the guardian of national culture the main factor in economic growth and an indispensable engine for the realization of public and individual aspirations. It cannot be left for greedy, incompetent, and vulgar managers like Abood Al-Sawafi, Hamed Al-Hajri, Mohammed Al-Barashdi, Saeed Al-Rubaii, and Abdallah Al-Harthi to make arbitrary decisions and messy plans for the sole purpose of making profits and torturing those who stand in their way of corruption, fraud, forgery, and thievery.

It is unreasonable, uneconomical, and immoral that a higher education provider like A’Sharqiyah University in Oman is allowed to operate and receive millions and millions of dollars as grants from the Ministry and the government every year but it practices disinformation and deception on a large scale, and does not qualify to be a university in any sense of the word and may lead many students to commit suicide because they are unable to find jobs with their worthless degrees and certificates granted them by such a university.

Everybody knows the situation very well but does nothing to help solve the problem of suicide in many Middle Eastern countries. The governments, the officials, and all the bottom and top decision-makers understand the problem, but keep silent or resort to hypocrisy and irresponsible excuses to justify a very damaging public health situation.

To live comfortably, accumulate wealth, and be rich while many people around you are suffering and need help and support should not be our main goal in life. Only bad, selfish, corrupt, and inhumane managers and officials like Abood Al-Sawafi, Hamed Al-Hajri, Mohammed Al-Barashdi, Saeed Al-Rubaii, and Abdallah Al-Harthi do not understand this fact.

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