Relationship between Suicidal Ideation, Depression and Self-Esteem among Physically Disabled Persons in Ghana
Research Paper (undergraduate) 2016 16 Pages
Background of the Study
2. EMPIRICAL REVIEW OF RELATED STUDIES
Statement of Hypotheses
Hypotheses One and five
Hypothesis two, three and four
5. DISCUSION OF RESULTS
Limitations of the Study
Conflict of Interest
The study aimed at examining the relationship between self-esteem, depression and suicidal ideation among the physically disabled in Ghana. Purposive sampling was used to select one Hundred and Eighty (180). Specifically, sixty (60) participants who are visually impaired, sixty (60) who have hearing impairment and sixty (60) who have mobility impairment were selected for the study respectively. In view of this, two hypotheses were stated and tested using the statistical package for social sciences (SPSS). Hundred and sixty (160) questionnaires were distributed. A modified versionBeck Depression Inventory (BDI) was used to test the depression level of the participant’s level of depression. Suicidal ideation was measured by using Positive and Negative Suicidal Ideation (PANSI) with 14 items self-report instrument. The outcome of the study revealed that:1. Self-esteem and depression related significantly with suicidal ideation. 2. Physical disability type had a significant influence on self-esteem and depression. 3.Mobility impaired had higher self-esteem than those who are visually impaired. 4. There was no significant difference between hearing impaired and visually impaired on depression. 5.There was no significant difference between mobility impaired and hearing impaired on suicidal ideation.
Keywords: Physical Disability, Self-esteem, Depression, Suicidal Ideation.
Background of the Study
Disability can be defined as a limitation or inability in performing a normal everyday activity such as seeing, walking, speech and among others (Rokach, Lechcier-Kimel, & Safarov, 2006). According to the World Health Organization (WHO) report on disability, there are more than 600 million disabled persons in the world of which approximately 80percent live in low income countries (Ghana Federation of the Disabled, 2008a). In America, evidence suggests that 3.3 million Americans are reported to have a disability affecting hearing, vision, or speaking; 30.6 million have difficulties with ambulatory activities; and 19.9 million have difficulties with upper body functioning (Brault, 2012). Evidence suggests that it is the third leading cause of death among young adults in some developed countries (Kaplan, McFarland, Huguet & Newsom, 2007). In Ghana, despite the somewhat inaccuracy of statistical data concerning persons with disability, the World Health Organization report on disability estimates between 7 and 10 percent of the population bulked down in the tormenting web of disability (Ghana Federation of the Disabled, 2008a). Most of these disability victims feel the burden of being a luggage on their respective dependents, the feeling of intense sadness, frustration, hopelessness and the quest of giving up in their lives.
Suicidal ideation is defined as thoughts that serve as a means to foster one’s own death (American Psychiatric Association, 2003). It can vary from thoughts about the worthlessness or hopelessness of life, a death wishes to concrete suicide plans and an obsession with self-destruction. It must be noted that there has been an alarming increase in suicide cases in recent times across the country and the globe at large. Studies conducted by researchers on the subject area suggests that suicide and suicidal issues have become a monumental challenge that calls for all the seriousness that it deserves (Osafo, Knizek, Akotia & Hjelmeland, 2011).
Several studies in the past have established a direct correlational relationship between disability and suicide or suicidal ideation (Fisher, Haythornthwaite, Heinberg, Clark, & Reed, 2001; Russel, Turner, & Joiner, 2009). This link between different types of disability and death by suicide is alarming, as millions of people are living with disabilities and more are born with disabilities each day whilst a lot more become disabled through accidents and other unfortunate incidents. Other studies on the other hand has also established ‘self-esteem’ (‘how favourably one evaluates himself or herself Baumeister, 2008’) and ‘depression’ is (the tendency to distort and misinterpret information from the world due to immense worry and apprehension) as predicators of suicidal ideation among people with disabilities (Van Orden, Witte, Gordon, Bender, & Joiner, 2008; Doyle, Moffat, & Corlett, 1994). A study showed that people with physical disabilities that have low self-esteem and depressive symptoms are more likely to have suicidal thoughts (Doyle, Moffat, & Corlett, 1994). Another study indicated that psychopathology is associated with increased disability even after adjustment for severity of physical illness (Ormel et al., 1994).
Studies concerning the abovementioned variables with their correlation with people with disabilities have not been widely been undertaking in Ghana. Existing studies like Adinkrah, (2010) looked at ‘depression’ as a medium of suicidal ideation among victims of disability. In other words, most of these studies did not in comprehensive terms investigate the relationship between suicidal ideation, self-esteem, and depression among people with disability. It is against this background that the above study seeks to examine the relationship between these aforementioned variables especially among people in the research setting.
Joiner Interpersonal-Psychological Theory of Suicide
According to the Joiner Interpersonal-Psychological theory, perceived burdensomeness and thwarted belongingness are the two state of mind that presents dangerous suicidal desires (Van Orden et al., 2010). The former refers to an individual’s belief that he or she is a burden to others, and that others would benefit from his or her death. A person with a disability believes perhaps that they cause trouble for others because they draw on their resources (e.g., time, finances, and energy). Dempsey, Karver, Labouliere, Zesiewicz, and De Nadai (2012) found that functional impairment related to movement disorders, a type of physical disability, was a predictor of depression. Furthermore, perceived burdensomeness has also been indicated as a predictor of suicidal ideation in individuals living with chronic pain (Kanzler, Bryan, McGeary, & Morrow, 2012). The latter on the other hand refers to an individual’s feelings of isolation and a lack of reciprocal, caring relationships (Joiner, 2005; Van Orden et al., 2010). People experiencing thwarted belongingness may have thoughts such as “I am alone” or “I have nobody to turn to when I’m in need”. Now when these two state of mind (perceived burdensomeness and thwarted belongingness) are both present, the most dangerous form of suicidal desire may occur.
2. EMPIRICAL REVIEW OF RELATED STUDIES
A considerable number of studies have been contacted on suicidal ideation, depression and self-esteem among persons with and without physical disabilities. Most of these studies concludes a positive significant relationship between suicidal ideation, self-esteem and depression with or without physical disability. Below includes a synopsis of some related studies.
Khazem, Jahn, Cukrowicz and Anestis (2015) studied the influence of physical disability on suicidal desire. The variables of Interpersonal-Psychological Theory of Suicide were used to examine suicidal ideation between university students with and without physical disabilities were examined. Participants were 184 students from two Universities in Southern United States provided answers to online-based self-report questionnaires. It was revealed that no differences existed in the Interpersonal-Psychological Theory of Suicide variables and suicidal desire between students with and without physical disabilities, and the tests of indirect effects were non-significant. That is, students with disabilities and those without disabilities showed no significant difference in their suicide ideation.
In a study by Lakshmi and Anuradha in 2014 on self-esteem among the mobility impaired and visually impaired late adolescent. The study aimed to find out the level of self-esteem among the mobility impaired and the visually impaired late adolescents, and to know the gender difference in self-esteem among them using a quantitative comparative research design. The sample size taken for the purpose of the study was 120, consisting of 60 physical disabled (30 male and 30 female) and 60 visually disabled (30 male and 30 female). The Rosenberg self-esteem scale was used and the respondents were asked to reflect on their current feelings. T-test was planned for the analysis of the data. The result of the study revealed that there was a significant difference on self-esteems between mobility impaired and visually impaired late adolescents, with visually impaired late adolescents having more self-esteem. Also, there was no gender difference in self-esteem of mobility impaired and visually impaired late adolescents.
Moreover, Picardi, Mazzotti, and Pasquini in (2013) conducted a study to find out deliberate self-harm and suicide among patients with dermatologic conditions. They sought to estimate the prevalence of suicidal ideation among patients with dermatologic conditions, and to identify demographic, clinical, and psychosocial correlates. Two samples of outpatients with dermatologic conditions numbering 294 and inpatients numbering 172 were made to complete the 12-item General Health Questionnaire, the Skindex-29, and the Patient Health Questionnaire. Results from the study showed that 40 patients (8.6%) reported suicidal ideation during the previous 2 weeks. In univariate analysis, the presence of suicidal ideation was associated with female sex, inpatient status, presence of a depressive or anxiety disorder, and higher 12-item General Health Questionnaire and Skindex-29 scores. The size of the diagnostic groups allowed reasonable prevalence estimates only for psoriasis (10%) and acne (7.1%). In multivariate analysis, only emotional distress (12-item General Health Questionnaire) and impaired social functioning (Skindex-29) were independently associated with suicidal ideation. The conclusion from the study indicated that suicidal ideation is not rare among patients with dermatologic conditions
A study conducted by Osafo, Knizek, Akotia & Hjelmeland in (2011) tried to find out the attitude of the ordinary Ghanaian person toward suicide. It must be noted that apart from the criminal nature of suicide in Ghana, Ghanaians largely have a negative perception towards individuals who attempts suicidal intentions and the family in question (Adinkrah, 2010). A total of 27 lay persons ( 15 females and 12 males) were selected from both the rural and urban centres in Ghana. Whereas a semi-structured interview guide was used to solicit the relevant information Interpretative Phenomenological Analysis was used to analyse the data. Findings showed that the perceived breach of interrelatedness between people due to suicidal behaviour influenced the informants’ view of suicide as representing a social injury. Such view of suicide influenced the negative attitudes the informants expressed towards the act. The negative attitudes towards suicide in Ghana are cast in consequential terms.
Moreover, several studies research regarding feelings of isolation in individuals with physical disabilities has yielded diverse results. Whereas Rokach et al. (2006) did not find that those with physical disabilities experienced interpersonal isolation, another study found that those with physical disabilities felt ostracized and isolated from peers (Doyle, Moffat, & Corlett, 1994).
Furthermore, Nugent and Mona in 2001 investigated the relationship between comorbidity of depression with other problems in personal or interpersonal functioning and severity of suicidal ideation. The results of their study suggested that the interactive comorbidity of depression and problems with self‐esteem is a significant predictor of severity of suicidal ideation. To them this relationship differs across men and women, and that the interactive comorbidity of depression with aggression and with alcohol abuse were significant predictors of severity of suicidal ideation.
Brenda et al (1999) in a study on depression and physical disability used a cohort study of 6247 subjects, 65 years and above who were initially free of disability was followed up for 6 years. They found out that 5751 non-depressed subjects, the 496 depressed subjects had a relative risk and for incident disability in daily activities and mobility, respectively. The study did not consider individuals who were born with disabilities.
Statement of Hypotheses
H1: There will be a negative relationship between self-esteem and depression among physically disabled persons.
H2: Those who are mobility impaired would have higher self-esteem than those who are visually impaired.
H3: Those who are visually impaired would have high depression than those who are hearing impaired.
H4: Those who are mobility impaired would have high suicidal ideation than those who are hearing impaired.
H5: There will be a positive relationship between depression and suicidal ideation among physically disabled persons.
The specific data collection method used was the cross-sectional. The most appropriate sampling technique used was non-probability sampling. Purposive sampling was used to select one Hundred and Eighty (180) participants of the target population in order to provide an accurate information or data within the specific time limit. Specifically, sixty (60) participants who are visually impaired, sixty (60) who have hearing impairment and sixty (60) who have mobility impairment were selected for the study respectively. The Population for this study was drawn from Akropong School for the Blind, Mampong School for the deaf and Ghana Federation of the Disabled.
A modified versionBeck Depression Inventory (BDI) was used to test the depression level of the participant’s level of depression. The internal consistency for the Beck Depression Inventory (BDI) ranges from .73 to .92 with a mean of .86. Self-esteem was also measured by using Rosenberg self-esteem scale with test reliability ranging from 82 to .88, Cronbach’s alpha.
Suicidal ideation was also measured by using Positive and Negative Suicidal Ideation (PANSI) with 14 items self-report instrument. The scale has a Cronbach alpha (internal validity) for both positive and negative scales of 0.80 and 0.91 respectively and the internal reliability for both subscales are 0.80 to 0.93.