Suicide in Muslim world and way forward

1. INTRODUCTION

Islam is the world's second‐biggest religion, with a population of almost 1.9 billion people and a major presence in nearly 50 nations and territories. According to a survey published in 2020, 1.9 billion people follow Islam, accounting for around 24.9% of the global population. ¹ The majority of Muslim nations are in Asia (one‐third from South Asia) and Africa's LAMIC region. Most of them are classified as low and middle‐income countries (LMICs). ² Suicide is the world's fourth‐biggest cause of mortality among those aged 15–29. In 2019, LMICs accounted for 77 percent of all suicide deaths, with adolescent suicide accounting for 88 percent of all suicide deaths globally. ³ Suicide rates are lower in Muslim nations, according to reports, since Islam forbids Muslims from taking their own life. However, these data should be interpreted with caution since there are still some unresolved concerns with suicide reporting, the criminal status of suicide, and the stigma associated with suicide. Furthermore, stigma, attitudes, perceived behavioral control, and intention about the use of formal mental health services impact mental health of Muslims. ⁴ While the lower rates of suicide can greatly be directly attributed to religion, indirect impacts of religion and other factors, less related to religion (such as social pressure, denser networks of family, peer, ethnic, and other social ties, smaller windows of opportunity for committing suicide in the multigenerational households), are also effective. The level of religiosity is also responsible for low suicide rates among Muslims. Nevertheless, a few Muslim countries (Nigeria, Burkina Faso, Chad, Kazakhstan, and Sierra Leone) have higher suicide rates than the global average. ³ The disproportionately high levels of civil conflict, wars, or internal disputes within Muslim‐majority which at times see adaptation of suicide as a tactic of warfare can be a reason that can justify this finding.

2. ISLAMIC PERSPECTIVE ON SUICIDE

Muslims are given a code of conduct, ethics, and social values by Islam, which aids them in tolerating and developing adaptive coping techniques in the face of stressful circumstances. Islam teaches how to live in peace with one another. Quran advises: “Pursue the life to come with what God has given you, but don't forget your true place in this world. As God has been kind to you, do well to others. Do not try to spread corruption throughout the land, since God does not love people who do so” (Sural al‐Qisas, 28:77). According to Islam, humans are entrusted with the gift of life, so they are not permitted to make decisions about their own life and death without the approval of God as they do not have absolute possession of this gift.

Suicide is considered a cardinal sin in Islam. Muslims believe those who have committed suicide to be forbidden from entering Paradise. “And do not kill yourselves,” declares Quran (nor kill one another). “Allah is, without a doubt, most merciful to you” (Surah al‐Nisa, 4:29). Despite the fact that suicide is prohibited and seen as a sin, suicide is viewed with more nuance by Islam as it is widely agreed that a person suffering from a mental condition who is unable to make decisions is not held responsible for his or her acts. Furthermore, most Muslims, including religious scholars, believe that faith and prayer alone will not prevent a Muslim from experiencing sadness, thoughts of self‐harm, or contemplating suicide.

Although many factors influence suicide such as biological, social, or even environmental factors, depression is considered the main contributing psychiatric cause. ⁵ According to Carletona, ⁶ suicide rates rise when mental health is neglected, especially in situations of turmoil, war zones, and refugee camps. Mental illnesses like depression, anxiety, and posttraumatic stress disorder are more likely to rise among people who have been affected by conflict and displacement, limited access to water, shelter, and challenges such as unemployment and immigration. For instance, Sara Hegazy, an Egyptian LGBT activist who was seeking asylum in Canada, committed suicide. Instead of the torture and incarceration she was subjected to in her own nation of Egypt, her refuge situation may have led her to commit herself. ⁷ These factors have affected a huge population in Muslim countries, especially in the Middle East and Africa, which has led to higher rates of mental illnesses among these populations. ⁸ , ⁹

Suicide advice and other similar topics can be found in Hadiths and the Quran. Primary, secondary, and tertiary preventative recommendations are the three kinds of instruction. ¹⁰ Primary preventive lessons include verses, hadiths, and narratives aimed at reducing and eliminating suicide risk factors. Secondary guidelines emphasize the importance of religious figures in identifying at‐risk individuals. ¹¹ , ¹² Teachings at the tertiary level encourage providing assistance to the friends and family of persons who commit suicide and exercising empathy and compassion towards them.

3. CHALLENGES OF SUICIDE PREVENTION IN ISLAM

Mental health issues are stigmatizing in many Muslim communities, and culturally and religiously appropriate resources are scarce or inaccessible. In some parts of the globe, Muslims face specific pressures in their everyday lives that harm their mental health, such as discrimination (especially a mix of Islamophobic and gender‐based discrimination), which can lead to mental illness and suicide attempts. Low financial resources to systematize suicide prevention programs like that have been established in Iran. ¹³ Many countries are engaged in war or terrorisms threat like Sudan, Afghanistan, Pakistan, and Ethiopia. In these conditions, providing basic needs to mental health programs takes precedence. The digital opportunities that have emerged by the advent of online environment should be seized to provide mental healthcare to these populations.

In Table 1, there are a few suggestions for preventing and dealing with the special challenges of Muslim suicide.

Table 1.

Few suggestions for preventing and dealing with the special challenges of Muslim suicide

1. It is vital to have trained care providers who are religiously affiliated and who can give the appropriate psychological assistance to aid seekers, especially for those who are having suicidal thoughts or considering suicide as a result of feelings of loneliness and hopelessness. 2. To focus on training, healthcare workers who are not religiously affiliated on cultural and religious awareness to Islam. This is to enhance communication and care for their patients, especially for those who are having suicidal thoughts or considering suicide as a result of feelings of loneliness and hopelessness. 3. More research and resources are needed to establish the scale of the problem and to offer Islamic‐based care. The need for mental health treatment should be better communicated, and the special pressures that Muslim communities face should be acknowledged. Community leaders should also take responsibility to guide their communities to a healthier future. 4. To meet the mental health needs of Muslim patients, not just cultural humility is required, but also an awareness of the particular difficulties that this varied community faces. 5. Suicide risk assessments should include, among other things, previous and current ideation, planning, intent, methods, pertinent hazards, and resilience variables. Muslims, particularly when accompanied by family members, may have a cultural tendency to deny such thoughts. Patients' moods and actions that are inconsistent should serve as a red flag to healthcare practitioners. 6. Psychiatric therapies that are tailored to a person's culture and religion. For instance, while the framework of psychotherapy is constant, the content should be culturally and religiously appropriate. 7. Suicide prevention initiatives should be included into basic healthcare services. The Red Crescent is a shared political, educational, and research institution across Islamic countries. They should prioritize the issue of suicide and make use of these resources.

AUTHOR CONTRIBUTIONS

Sheikh Shoib conceptualized the idea and wrote the first draft. Other authors worked equally and revised and edited the final manuscript.

CONFLICT OF INTEREST

The authors declare no conflict of interest.