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Parasuicide during Ramadan in Jordan Daradkeh TK. Parasuicide during Ramadan in Jordan. Acta Psychiatr Scand 1992: 86: 253-254.
T. K. Daradkeh Faculty of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
To investigate the impact of national and religious events on the rate of parasuicide, a comparison was made between the number of reported parasuicides during the month of Ramadan and the month before and after Ramadan in Jordan, for the years from 1986 to 1991. Significantly fewer parasuicides were reported during Ramadan than the month preceding it and the month that follows Ramadan. The findings confirm previous observations that national events reduce the rate of parasuicide, but the protective effect does not persist into the month that follows Ramadan.
A major difference between parasuicide and suicide is the absence of recognizable mental disorders in most parasuicide patients (1,2). National events and holidays have been reported to reduce suicidal behaviour. In Scotland, decreases in the parasuicide rate were observed during Christmas and following World Cup finals and general elections (3-5). A reduction in suicide rate during national holidays has also been demonstrated in the United States (6). For Muslims, the month of Ramadan is one of the most holy annual events. During Ramadan, all wrongdoing, including self-destructive behaviour, is strictly prohibited. Anger, envy and hostility towards others violate the principles of fasting and are deliberately avoided. Fasting people are requested to be forgiving. At sunset, when the fast is broken, it is recommended that people be in groups; this is the time when families, friends and relatives meet regularly. To increase the likelihood of the fast being accepted by God, people are also required to solve their interpersonal conflicts. The medical aspects of Ramadan have been investigated extensively, but to the best of my knowledge, the psychological impact of the month of Ramadan on Muslims has not so far being explored. Therefore, the subject of this report is the parasuicide during the month of Ramadan. Material and methods
Jordan is one of the smallest Arab countries in the Middle East; nearly 95 % of the population are Muslims. Jordan keeps records, not computerized, of all incidents of parasuicide and suicide. The process of registering parasuicide and suicide has been de-
Key words: attempted suicide; Ramadan; Jordan
T.K. Daradkeh, Faculty of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, P.O. Box 17666, United Arab Emirates Accepted for publication April 7, 1992
scribed elsewhere (7, 8). Contrary to the laws in some Arab countries, parasuicide is not regarded as a criminal offence in Jordan. However, all people who attempt suicide who seek medical help must be reported to the police. The police investigate the case with the aim of ruling out attempted murder or assault by others. The final verdict is reached by a court as to whether the incident is a parasuicide or a criminal offence. The proportion of parasuicides who do not seek medical help is unknown in Jordan. Almost all the officially registered parasuicides are those who seek medical aid for their attempts. Both suicide and parasuicide are believed to be underreported in Jordan, as elsewhere, but the procedure of registering parasuicide can be considered appropriate and reliable because it necessitates a court verdict supported by medical certification. There is no reason to believe that the reporting and registration procedures differ during Ramadan. For this study, the number of parasuicides during Ramadan and the month preceding it and following it were extracted from the Police Register records for the years 1986 through 1991. The hypothesis tested was that, if Ramadan has no effect on parasuicide, no significant difference would be found in the number of parasuicides during Ramadan and the month before and after it. Poisson rates were compared to assess the significance of differences. Results
The number of parasuicides during Ramadan and the preceding month and the month after it for the years 1986 through 1991 are shown in Fig. 1. At the
253
Daradkeh Parasuicide during Ramadan and the months before and after it in Jordan.
(1986-1991) Number 60
+
Ramadan
20 1
1
lo 0' 1986
1
I
I
1987
1988
1989
,
I
1990
1991
Year A
Ramadan
+before
++ after
Fig. I . Distribution of parasuicides by months in Jordan (19861991)
5 % level, the mean Poisson rate of parasuicides during Ramadan was significantly lower than the mean rates of parasuicides for the month that preceded Ramadan and the month after it ( z = 2.5 and 2.4 respectively, P c 0.05). There was no significant difference in the mean Poisson rates of parasuicides for the month that preceded Ramadan and the month after it. Discussion
The findings of this study further support the preventive effect of national holidays and events in suicidal behaviour (3-6). Most parasuicides in Jordan followed periods of increasing tension and conflicts with relatives and friends (5). It is therefore to be
1 I
254
expected that circumstances that negate such conflicts should reduce the rate of parasuicide. The strengthening of ties within families and the sense of belonging during Ramadan as well as the ban on drinking alcohol are additional factors that divert distressed people from reverting to self-destructive behaviour as a way out of their problems. The rise in the rate of parasuicide in the month that follows Ramadan can be explained by people returning to their previous style of living and, subsequently, the fading away of the inhibiting factors of suicidal behaviour created by the nature of Ramadan. Of course, the small sample size should make us cautious in interpreting the results, but the consistent pattern of fewer parasuicides during Ramadan is encouraging. This study confirms previous observations that national events reduce the rate of parasuicide; at the same time, the findings suggest that the preventive effects of Ramadan against suicidal behaviour do not seem to persist into the month that follows Ramadan. A replication study of this kind is strongly recommended to confirm or refute the findings of this study. Acknowledgement I thank Lieutenant N . Momani for his help in extracting the data from the Police Register.
References 1. NEWSON-SMITHJGB, HIRSCH SR. Psychiatric symptoms in self poisoning patients. Psychol Med 1979: 9: 493-500. JL. Psychiatric diagnosis in self poisoning 2. URIN P , GIBBONS patients. Psychol Med 1979: 9: 501-508. 3. MASTERTONG. Monthly and seasonal variation in parasuicide. A sex difference. Br J Psychiatry 1991: 158: 155-157. 4. MASTERTONG, STRACHAN J. Parasuicide, Scotland and the world cup. Br Med J 1987: 295: 386. 5. MASTERTONG, PLATTS. Parasuicide and general elections. Br Med J 1989: 298: 803-804. 6. PHILIPS D P , WILLISJS. A drop in suicides around major national holidays. Suicide Life Threat Behav 1987: 17: 1-12. 7. DARADKEH T. Reported parasuicide in Jordan (1980- 1985). Calls for urgent reorganisation of psychiatric services. J Med Sci (Dirasat) 1988: 4: 59-69. 8. DARADKEH T. Suicide in Jordan (1980-1985). Acta Psychiatr Scand 1989: 19: 241-244.
Parasuicide during Ramadan in Jordan Daradkeh TK. Parasuicide during Ramadan in Jordan. Acta Psychiatr Scand 1992: 86: 253-254.
T. K. Daradkeh Faculty of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
To investigate the impact of national and religious events on the rate of parasuicide, a comparison was made between the number of reported parasuicides during the month of Ramadan and the month before and after Ramadan in Jordan, for the years from 1986 to 1991. Significantly fewer parasuicides were reported during Ramadan than the month preceding it and the month that follows Ramadan. The findings confirm previous observations that national events reduce the rate of parasuicide, but the protective effect does not persist into the month that follows Ramadan.
A major difference between parasuicide and suicide is the absence of recognizable mental disorders in most parasuicide patients (1,2). National events and holidays have been reported to reduce suicidal behaviour. In Scotland, decreases in the parasuicide rate were observed during Christmas and following World Cup finals and general elections (3-5). A reduction in suicide rate during national holidays has also been demonstrated in the United States (6). For Muslims, the month of Ramadan is one of the most holy annual events. During Ramadan, all wrongdoing, including self-destructive behaviour, is strictly prohibited. Anger, envy and hostility towards others violate the principles of fasting and are deliberately avoided. Fasting people are requested to be forgiving. At sunset, when the fast is broken, it is recommended that people be in groups; this is the time when families, friends and relatives meet regularly. To increase the likelihood of the fast being accepted by God, people are also required to solve their interpersonal conflicts. The medical aspects of Ramadan have been investigated extensively, but to the best of my knowledge, the psychological impact of the month of Ramadan on Muslims has not so far being explored. Therefore, the subject of this report is the parasuicide during the month of Ramadan. Material and methods
Jordan is one of the smallest Arab countries in the Middle East; nearly 95 % of the population are Muslims. Jordan keeps records, not computerized, of all incidents of parasuicide and suicide. The process of registering parasuicide and suicide has been de-
Key words: attempted suicide; Ramadan; Jordan
T.K. Daradkeh, Faculty of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, P.O. Box 17666, United Arab Emirates Accepted for publication April 7, 1992
scribed elsewhere (7, 8). Contrary to the laws in some Arab countries, parasuicide is not regarded as a criminal offence in Jordan. However, all people who attempt suicide who seek medical help must be reported to the police. The police investigate the case with the aim of ruling out attempted murder or assault by others. The final verdict is reached by a court as to whether the incident is a parasuicide or a criminal offence. The proportion of parasuicides who do not seek medical help is unknown in Jordan. Almost all the officially registered parasuicides are those who seek medical aid for their attempts. Both suicide and parasuicide are believed to be underreported in Jordan, as elsewhere, but the procedure of registering parasuicide can be considered appropriate and reliable because it necessitates a court verdict supported by medical certification. There is no reason to believe that the reporting and registration procedures differ during Ramadan. For this study, the number of parasuicides during Ramadan and the month preceding it and following it were extracted from the Police Register records for the years 1986 through 1991. The hypothesis tested was that, if Ramadan has no effect on parasuicide, no significant difference would be found in the number of parasuicides during Ramadan and the month before and after it. Poisson rates were compared to assess the significance of differences. Results
The number of parasuicides during Ramadan and the preceding month and the month after it for the years 1986 through 1991 are shown in Fig. 1. At the
253
Daradkeh Parasuicide during Ramadan and the months before and after it in Jordan.
(1986-1991) Number 60
+
Ramadan
20 1
1
lo 0' 1986
1
I
I
1987
1988
1989
,
I
1990
1991
Year A
Ramadan
+before
++ after
Fig. I . Distribution of parasuicides by months in Jordan (19861991)
5 % level, the mean Poisson rate of parasuicides during Ramadan was significantly lower than the mean rates of parasuicides for the month that preceded Ramadan and the month after it ( z = 2.5 and 2.4 respectively, P c 0.05). There was no significant difference in the mean Poisson rates of parasuicides for the month that preceded Ramadan and the month after it. Discussion
The findings of this study further support the preventive effect of national holidays and events in suicidal behaviour (3-6). Most parasuicides in Jordan followed periods of increasing tension and conflicts with relatives and friends (5). It is therefore to be
1 I
254
expected that circumstances that negate such conflicts should reduce the rate of parasuicide. The strengthening of ties within families and the sense of belonging during Ramadan as well as the ban on drinking alcohol are additional factors that divert distressed people from reverting to self-destructive behaviour as a way out of their problems. The rise in the rate of parasuicide in the month that follows Ramadan can be explained by people returning to their previous style of living and, subsequently, the fading away of the inhibiting factors of suicidal behaviour created by the nature of Ramadan. Of course, the small sample size should make us cautious in interpreting the results, but the consistent pattern of fewer parasuicides during Ramadan is encouraging. This study confirms previous observations that national events reduce the rate of parasuicide; at the same time, the findings suggest that the preventive effects of Ramadan against suicidal behaviour do not seem to persist into the month that follows Ramadan. A replication study of this kind is strongly recommended to confirm or refute the findings of this study. Acknowledgement I thank Lieutenant N . Momani for his help in extracting the data from the Police Register.
References 1. NEWSON-SMITHJGB, HIRSCH SR. Psychiatric symptoms in self poisoning patients. Psychol Med 1979: 9: 493-500. JL. Psychiatric diagnosis in self poisoning 2. URIN P , GIBBONS patients. Psychol Med 1979: 9: 501-508. 3. MASTERTONG. Monthly and seasonal variation in parasuicide. A sex difference. Br J Psychiatry 1991: 158: 155-157. 4. MASTERTONG, STRACHAN J. Parasuicide, Scotland and the world cup. Br Med J 1987: 295: 386. 5. MASTERTONG, PLATTS. Parasuicide and general elections. Br Med J 1989: 298: 803-804. 6. PHILIPS D P , WILLISJS. A drop in suicides around major national holidays. Suicide Life Threat Behav 1987: 17: 1-12. 7. DARADKEH T. Reported parasuicide in Jordan (1980- 1985). Calls for urgent reorganisation of psychiatric services. J Med Sci (Dirasat) 1988: 4: 59-69. 8. DARADKEH T. Suicide in Jordan (1980-1985). Acta Psychiatr Scand 1989: 19: 241-244.
