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Content
4 5 5 7 7
Introduction and Multi-level suicide risk Patterning and underlying Limitations of health Discussion
background and protective factors drivers of suicide services for suicide
prevention and
treatment
8 10
Policy and References
programming
recommendations
Introduction and et al. 2012; MOH et al., 2010).2Despite research expertise provided by the
background these low rates, there is growing Overseas Development Institute and
concern that suicide in Viet Nam is the Institute for Family and Gender
More than 800,000 people die globally on the rise and actions need to be Studies. The aim of this briefing is to
as a result of suicide every year and taken to address this issue. Similarly, highlight findings from the broader
many more attempt it. Low- and due to emerging evidence that rates study in relation to suicide. Drawing
middle- income countries (LMICS) are of suicide among children and young first on secondary data, it explores
at particular risk, accounting for 75% people may be rising (e.g. MOH et al. suicide risk and protective factors
of global suicides in 2012 and, among 2010), there is need to understand the at various levels. It then draws on
those, LMICS in Southeast Asia had drivers and causes of suicide. primary data collection3 to explore
the highest rate accounting for almost the characteristics of suicide victims
40% of all suicides (WHO, 2016). While This briefing draws on a broader study and survivors as well as the perceived
suicide occurs among all age groups, exploring the mental health and causes of suicide. The briefing
it was the second leading cause of psychosocial wellbeing of children concludes with programming and
death among 15-29 year olds globally and young people in Viet Nam carried policy recommendations.
in 2012 (after road traffic injuries). out as part of a collaboration between
When compared to both Southeast UNICEF Viet Nam and the Ministry of
Asia and the Western Pacific regions1, Labour, Invalids and Social Affairs, with
Viet Nam’s suicide rate is low at 5 (per
100,000 population) in 2012, down
from 5.7 in 2000. The rate of suicide 2. Blum et al. (2012) studied over 17,000
among adolescents in Viet Nam is adolescent and young people and found
that the prevalence of suicidal ideation in
also relatively low compared with the past 12 months was 2.3% in Hanoi, the
other countries in the region (Blum lowest in their sample compared to 8.1% in
Shanghai and 17% in Taipei. Similarly, less
than 1% of Vietnamese youth attempted
suicide compared to 1.3% in Shanghai, and
6.9% in Taipei. SAVY I also found low rates
1. Viet Nam along with a number of other of suicide in general - approximately 3.4%
countries including Cambodia and the Lao of the respondents reported that they had
People’s Democratic Republic, is classified contemplated suicide in 2003 (MOH, 2005). 3. Primary data collection was carried out in
as being part of the WHO Western Pacific SAVY II found an increase with 4.1% of those the two urban centres of Hanoi and Ho Chi
region which has a suicide rate of 7.5 per aged 14 - 25 reporting suicidal ideation Minh City and in peri-urban and rural areas
100,100 population (WHO, 2014). (MOH et al., 2010). of Dien Bien and An Giang provinces.
The nature of suicide amongst children and young people in selected provinces and cities in Viet Nam 5
Multi-level suicide risk and attempt were 2.41 times more likely by parents from entering romantic
protective factors to report suicidal ideation compared
with those without a family history
relationships, which led to further
distress (Nguyen et al., 2013). While
of suicide (Blum et al., 2012). Family bullying was found to be linked to
Individual-level suicide risk and socioeconomic status and family suicidal thoughts (Phuong, et al.,
connectedness were identified as 2013), school connectedness4 acted
protective factors. suicide risk factors for Vietnamese as a protective factor against suicidal
Being female, urban, a migrant youth. A number of studies show, ideation (Phuong et al., 2013). Finally,
and young were all risk factors for therefore, that living outside the findings from some studies show that
suicide, with women almost twice as parental home was protective, that inner-city urban schools were linked
likely in some studies to have suicidal is, a majority of suicide attempters to higher suicidal ideation for both
ideation compared with males (Blum were living together with their males and females and this was found
et al., 2012; Huong, 2009; Thanh et al., family members or others (Blum et in both Viet Nam (Phuong et al., 2013;
2005; MOH, 2005; MOH et al., 2010). al., 2012; Nguyen et al., 2010). This is MOH, 2005) and other Asian contexts,
In the SAVY II findings (MOH, 2010), an interesting and counterintuitive such as China and Malaysia (Hesketh et
for instance, more urban (5.4%) than finding given that parents are al., 2002; Choo, 2007, cited in Phuong
rural youth (3.6%) had thoughts of generally seen as a source of support. et al., 2013).
suicide, and younger cohorts were This could be the result of parents
more likely to report suicidal ideation. having high expectations of their
Additionally, those aged 18-21 years children regarding their academic Patterning and underlying
reported the highest levels of suicidal
thoughts (4.4% of 18-21 year olds),
achievements, which may lead to
more conflict between children and
drivers of suicide
followed by the youngest age groups parents. Parents’ education level and
(4.1% of 14–17 year olds), and followed occupation are also associated with Characteristics of suicide victims
by the oldest group (3.8% of 22-25 children’s suicide behaviour. Studies and survivors In this section we
year olds) (MOH 2010). In terms of show that a majority of children who explore the characteristics of suicide
migration status, one study shows that have thought of suicide live in families victims and survivors as described
migrants were particularly at risk of with parents who have low education by our respondents in Dien Bien
suicidal ideation in Hanoi, with rural- levels and are manual workers (Le, and An Giang. There was a general
to-urban migrants being almost twice 2009). Family connectedness was also perception among both girls and boys
as likely as urban native peers to have a protective factor against suicide. Thus as well as key informants that it was
suicidal thoughts and urban-to-urban father bonding acted as a protective mostly young people and particularly
migrants being 6.45 times more likely factor against thoughts of suicide girls who committed or who tried to
to report suicidal ideation compared (Phuong et al., 2013). Similarly, higher commit suicide, as this quote from
with their urban native peers (Blum et mother and father relationship scores a boys’ focus group discussion in An
al., 2012). were associated with a 5% decrease in Giang shows:
likelihood of suicidal ideation (Blum
Suicidal ideation is also associated with et al., 2012). The converse is also true: ‘There are more girls among those
mood disorders and substance abuse. a majority of children who attempted who commit suicide and do harm
Studies show how depression, anxiety, suicide cited family conflict and poor to their bodies like chopping their
feelings of sadness and hopelessness quality of relationships with parents as hands or confining themselves,
also among children and young the cause (Thanh et al., 2005 and Le, as girls are more sensitive to their
people are all associated with suicidal 2009 respectively). emotional issues. Their hearts are
ideation and suicide attempts (Huong, easy to be hurt, meanwhile boys are
2009; Nguyen et al., 2013a; Thanh et School-level suicide risk and more steadfast and calmer when
al., 2006). Similarly, studies show how protective factors Academic encountering a problem. So there
alcohol and cigarette use are also risk pressure, romantic relationships, are more girls in this group’
factors for suicide, that is, those who bullying, school connectedness
report using these substances are also and school location were all risk (Focus group discussion, boys
more likely to report suicidal ideation factors for suicidal ideation. As a aged 17, An Giang).
(Blum et al., 2012). result of a highly competitive school
environment, children felt pressure Similarly, a key informant in Dien Bien
Household-level suicide risk and from teachers, parents and peers to states ‘...children and young people
protective factors Residence patterns, excel academically. Moreover, the need account for a larger proportion (of
family history of suicide (individuals to focus on academic achievements suicides) because they are easy to have
with a family history of suicidal resulted in children being prohibited conflicts with their friends. It happens
6 The nature of suicide amongst children and young people in selected provinces and cities in Viet Nam
among girls more than boys’ (Key failure of romantic relationships, for
informant interview, Department of instance being abandoned usually
Labour, Invalids and Social Affairs, Dien by a boyfriend; problems at school,
Bien Phu City). Other boys added that including bullying, teasing and getting
girls are more likely to commit suicide low scores, and which affect both boys
because of ‘superficial thinking because and girls; problems at home including
they live in remote areas, they don’t being scolded by parents, lack of
have much contact with society’ (focus communication between children
group discussion, boys aged15, Dien and parents, parents disagreeing with
In my area, there was a Bien Phu City). Similar to the review (most often) a girl’s choice of marriage
family who forced their of secondary literature, respondents partner, conflict between parents, a
also suggest that socioeconomic violent father, financial pressure and
daughter to marry a man difficulties are related to suicide, as one parental addiction; early marriage of
she didn’t love. Therefore, adolescent male in An Giang stated: girls, also leading to their school drop-
‘The majority of those who commit out and marital discord; and inability
she sought death; she suicide and use substances are from and reluctance to share feelings. For
took la ngon (poisonous poor families’ (focus group discussion, boys other reasons also included not
boys, 17, An Giang). Diverging, being able to live up to expected
leaves)... however, from some of the findings in masculine attributes and behaviour,
the literature review are perceptions including an ability to maintain the
(focus group discussion, girls, from some people that because people family/household (Box 1). All this leads
15, upper secondary school, Dien in towns are believed to be ‘more to young people feeling sad, upset and
Bien Phu City) knowledgeable’ than those in villages, frustrated, which in turn leads them to
they are less likely to commit suicide. attempt and sometimes even succeed
in taking their own lives.
Causes of suicidal ideation and
attempted suicide According to Suicidal thoughts or suicide
study respondents, causes of suicidal attempts appeared to be most
ideation and attempted suicide, which commonly mentioned in Dien Bien
again mostly affect girls, include: and in relation to pressures around
school drop-out and early marriage with their parents, he or she is easy et al., 2016; Samuels et al., 2016a). The
particularly for girls. The abundance to commit suicide. And, it is also data collected by the DOH and DOLISA
of la ngon or poisonous leaves in Dien convenient to do so because there is also, to a large extent, supported by
Bien, which grow in the forests in are plenty of poisonous leaves in narratives from the primary qualitative
the surrounding areas, also facilitate the area. Only one or two leaves data collection where again girls are
the relative ease by which people can kill a person. Only if someone viewed to be more susceptible than
can commit or attempt suicide. knows about it, the child [who eats boys to committing suicide, and this
Focus group discussions in Dien poisonous leaves] is cured in time. is the case for both Dien Bien and An
Bien highlighted that girls who are In Dien Bien Dong, there have been Giang province. Additionally, in Dien
pressured to drop-out of school and campaigns to root up poisonous Bien, the availability of poisonous
marry against their will may resort plants, but it has yet to be done’ leaves, appears to facilitate suicide
to suicide: ‘In my area, there was a attempts particularly among Hmong
family who forced their daughter to (Key informant interview, girls, who live near to where the
marry a man she didn’t love. Therefore, Department of Labour, Invalids poisonous leaves grow. Despite
she sought death; she took la ngon and Social Affairs, Dien Bien Phu some progress (see Samuels et al.
(poisonous leaves) but didn’t die, City). 2016 and Samuels et al., 2016a) the
because she was discovered and then service environment and response for
taken to the emergency room’ (Focus Viet Nam as a whole remains largely
group discussion, girls, 15, upper Limitations of health inadequate to both prevent suicide
secondary school, Dien Bien Phu City).
One respondent also noted that there
services for suicide and treat suicidal ideation, particularly
in relation to less severe mental health
is a fear of ‘being kidnapped’ into prevention and treatment disorders, which are often at the heart
marriage in the area and recounted of suicidal ideation and attempts.
the story of a 16-year-old girl who Generally, as both the secondary
was kidnapped and then committed literature as well as the primary data Secondary data collection on suicide
suicide because she was so unhappy in collection for the study show (see shows that, while there is need for
her new marital home. Samuels et al., 2016), service for mental more updated and disaggregated
health and psychosocial wellbeing- data (including by sex, age, province
According to perceptions largely related issues, including suicide and district), rates of suicide in Viet
from key informants, ethnicity was prevention and treatment, are limited. Nam remain low compared to other
also a possible driver of suicide, Services that do exist focus largely on countries in the region. However,
with the Hmong in particular being severe mental health problems and, there is no room for complacency:
seen as ‘haughty and proud’ and given that suicide results from factors our broader study findings show that,
thus easily tempted into suicidal that are often not related to severe according to respondents, mental
actions. The availability nearby of la mental health problems, such services health and psychosocial ill-being
ngon, particularly for the Hmong in are inadequate. Even where there among children and young people
Dien Bien, facilitated the process of are services, people may be reluctant appears to be on the rise, which could
committing suicide. The following to access them for a range of issues contribute to increasing suicide rates.
narrative from a key informant in Dien including stigma, lack of awareness Moreover, as other studies are also
Bien captures both the perception and limited financial resources. If they showing (see e.g. Katz et al., 2015),
of the Hmong people as being more do access them, the quality of these rates of suicide globally are typically
prone to suicide than other ethnic services is extremely variable and may underestimated and this is also likely
groups as well as the issue of the not be age- and gender-sensitive, all to be the case in Viet Nam. Reasons for
availability of poisonous leaves: of which can limit uptake, including of this range from the stigma of reporting
follow-ups and referrals. suicide as the cause of death to
‘Not all the ethnic minority groups misdiagnosis, to how suicide numbers
are the same. It occurs only with are collected and reported, which
the Hmong people. I haven’t got Discussion leads to variations and interpretations
the report of other ethnic minority of these rates (see, e.g., Hagaman,
groups. Hmong people have a bad There is no doubt that suicidal ideation 2016).
custom of eating la ngon to kill and suicide attempts are an issue in
themselves. It happens a lot in Dien Viet Nam and particularly, according to There is also a relatively large body of
Bien Dong. The reason relates to data gathered by the DOH and DOLISA literature on the social contagion effect
the superiority complex of Hmong of suicide behaviour (Ali et
people. When a child has an urgent in Dien Bien, among children and
matter with classmates or disagrees young people and women (Samuels
8 The nature of suicide amongst children and young people in selected provinces and cities in Viet Nam
- Investing in developing
psychological counselling
and social work services in all
schools
References
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INVITATION
On the occasion of the visit to Viet Nam of the
UNICEF Deputy Executive Director, Mr Omar Abdi,
the UNICEF Representative, Mr Youssouf Abdel-Jelil,
requests the pleasure of the company of
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at a dinner reception
on Monday, 5 December, 2016 at 19:00
at Grill 63 Restaurant (Lotte Tower, 63rd Floor)
Address: 54 Lieu Giai Street, Ba Dinh, Hanoi
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