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      COVID-19-Related Suicides in Bangladesh Due to Lockdown and Economic Factors: Case Study Evidence from Media Reports

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          Abstract

          The incidence and mortality of the coronavirus-2019 disease (COVID-19) have increased dramatically around the world. The effects of COVID-19 pandemic are not limited to health, but also have a major impact on the social and economic aspects. Meanwhile, developing and less developed countries are arguably experiencing more severe crises than developed countries, with many small and medium-sized businesses being disrupted and even bankrupt (Fernandes 2020). Consequently, some individuals’ mental health is very fragile (Lin 2020). Sahoo et al. (2020) reported some of the psychological consequences in India (the neighboring country of Bangladesh) including self-harm due to COVID-19 misinformation. Moreover, impacts on mental health (e.g., depression, anxiety, panic, and traumatic stress) can also occur due to the lack of accurate information (Rajkumar 2020; Sahoo et al. 2020; Tandon 2020). In addition, pandemic-related restraints (e.g., spatial distancing, isolation, home quarantine, etc.) is impacting on economic sustainability and well-being, which may induce psychological mediators, such as sadness, worry, fear, anger, annoyance, frustration, guilt, helplessness, loneliness, and nervousness (Mukhtar 2020; Mamun and Griffiths 2020a). These mediators are also distinctive features of psychological suffering that individuals can experience during and after pandemics (Ahorsu et al. 2020; Pakpour and Griffiths 2020). Without early economic interventions, such mental health issues can facilitate suicidal behaviors among some individuals (Arafat and Mamun 2019; Mamun and Griffiths 2020b, c; Jahan et al. 2020), because economic recession, unemployment, and poverty are strongly associated with severe psychological comorbidities such as suicidal behaviors (Goldman-Mellor et al. 2010; Oyesanya et al. 2015; Rafi et al. 2019). There is one prior study that has examined COVID-19-related suicide in Bangladesh (Mamun and Griffiths 2020a). Cases The first published case study of COVID-19-related suicide in Bangladesh raised the possibility of further suicides (Mamun and Griffiths 2020a). Although this suicide occurred due to COVID-19 fear and xenophobia, the causes of consequent COVID-19 suicides have not been investigated in the country. Therefore, we briefly present eight additional suicide-related cases that occurred in Bangladesh during 3 weeks in April 2020, since the country lockdown (as a result of the COVID-19 pandemic) took effect. Case 1 On 6 April, an adult man (aged 30 years) from Mohespur Upazila in Jhenaidah committed suicide (by hanging himself) due to the pressure of unpaid debts. In addition, his family was half-fed and had starved for a week after losing work after the lockdown and was denied any financial support from local government authorities (United News of Bangladesh 2020). Case 2 On 10 April, a female adolescent (aged 10 years) from Belkuchi municipality of Sirajgonj committed suicide (by hanging herself) because she was rebuked by her father for asking for food. The lockdown meant that the girl’s father had to close his small loom factory and the family therefore had no money. The whole family had starved for a couple of days and they were also denied any financial relief from the local government authorities (Kaler Kantho 2020a). Case 3 On 12 April, a woman and mother of five children (aged 35 years) from Cox’s Bazar attempted suicide by hanging, although one of her sons rescued her by getting help from her neighbors. Her husband lost his job because of the lockdown and they were also ineligible to receive relief goods from the local government authorities. The mother could not bear to see her starving children’s faces and thought that by killing herself she could provide more food for her starving children (Campus Today 2020). Case 4 On 13 April, a young adult man (aged 27 years) from Noldangga village in Natore committed suicide (by hanging himself). He was a day laborer and he became unexpectedly unemployed as a result of the lockdown. He was struggling with starvation and to compound the situation, his wife also left him (prior to the pandemic) and the loneliness made his living situation worse (Kaler Kantho 2020b). Case 5 On 14 April, a woman (whose age was not reported) from Dhamrai in Dhaka attempted suicide and kill her two children by setting themselves on fire with kerosene oil. Her husband became unemployed due to the shutdown of a garment factory where he worked and the mother was unable to work in a tea shop where she and her father-in-law worked. Consequently, the family experienced economic hardship. Additionally, she was asked by her father-in-law to leave the house with husband and children (RisingBD 2020a). Case 6 On 16 April, an adult man (aged 30 years) from Bashkhali Upazila in Chattogram committed suicide (although no details of how were reported). The man was an auto-rickshaw driver and was unable to earn any money for his family because he was unable to use his vehicle to earn money during the lockdown. He approached the local government authorities for financial relief but was denied because they claimed there were other more deserving cases for financial help than his own (Daily Star 2020a). Cases 7 and 8 On 24 April, a poverty-stricken husband (aged 30 years) and wife (aged 24 years) from Keshapur committed suicide both hanging themselves from the roof of their house due to lockdown-related economic distress. The couple had a 3-year-old child and the family were very poor. The local government authority reported that the suicides were due to existing debts made worse by the national lockdown (Manab Zamin 2020). Discussion The coronavirus-19 disease (COVID-19) pandemic is causing economic problems for those individuals whose livelihoods have been affected due to the lockdowns occurring in many countries around the world including Bangladesh (Banna 2020). Bangladesh is beset with widespread corruption and extreme politicization alongside other issues such as money laundering which seriously hamper smooth governance and economic growth (Daily Star 2020b; Khan and Islam 2015). Consequently, the country has substantial income inequality throughout (Mazid 2019). The country is developing day by day although the wealth distribution is imbalanced. Therefore, a significant minority of individuals live below the poverty line (i.e., 20% live below the poverty line and 10.5% live in extreme poverty as reported in the 2018–2019 economic year; Financial Express 2019). Additionally, (i) the country is also ranked as having the second most unemployed graduates among Asia-Pacific countries, based on the International Labour Organization (ILO) report (Daily Jugantor 2019); (ii) youth unemployment rates doubled between 2010 and 2017 (Daily Jugantor 2019); (iii) the country has an unemployment rate of 4.4% among the general population (Daily Jugantor 2019); and (iv) 70% of the people in Bangladesh live from hand-to-mouth (Kamruzzaman 2020). However, a recent report showed extreme economic fallout due to COVID-19 crisis among poor Bangladeshi people. More specifically, per capita income dropped by 82% to $0.32 (US) in early April from $1.30 in February among individuals who live in slums compared to a 79% reduction among rural poor people (i.e., $0.39 down from $1.05; Kamruzzaman 2020). Furthermore, sufficient food availability, production, and supply have been disrupted due to the lockdown. This has led to rising food costs making it difficult for unprivileged individuals to survive. Although the government is trying to support these people and combat the situation by the introduction of financial aid (Daily Bangladesh 2020), corruption and mismanagement have occurred during the distribution of relief goods (e.g., food, sanitary goods, household items, medicines that are required for the everyday life) and individuals have not been getting basic things they need. There have been serious allegations reported in the Bangladeshi press media (Daily Star 2020b) including the stealing and retention of relief goods by local government representatives instead of supplying it to individuals most in need. Consequently, the sudden economic recession has led needy individuals to contemplate suicide. Globally, it is well-established that unemployment, poverty, and economic distress are associated with suicide, and that when there are increases in these, there are increases in suicide (Goldman-Mellor et al. 2010; Oyesanya et al. 2015). Therefore, the suicide-related cases that are reported here are not unexpected in the COVID-19 lockdown situation because of the economic instability and disruption throughout the country. It is worth mentioning that Bangladesh is predicted by the Asian Development Bank to face an overwhelming economic impact as a result of the COVID-19 pandemic. For instance, the country is expected to lose approximately $3 billion in GDP (i.e., 1.10% total decline) and there will be job losses for around nine million people (Banna 2020). The situation is also getting worse day by day. For instance, at the time of writing, 78,000 garment workers have protested because their wages have not been paid. (RisingBD 2020b). Additionally, the country is also losing foreign money from garment and leather product exportation, and is losing investment in large-scale projects from host countries like China (Banna 2020). Consequently, it is evident that Bangladesh is going to face great economic fallout if the lockdown persists for a long time. There are at least eight COVID-19 suicide cases in Bangladesh (seven reported here and one previously reported by Mamun and Griffiths 2020a) and all but one was due to the economic-related issues. Additionally, the actual suicide incidence may arguably be higher than the reported cases because families do not want the death of loved ones reported as suicide news in Bangladesh to avoid the suicide-related social and criminal complexities (Mamun and Griffiths 2020d; Mamun et al. 2020a, 2020b). However, the findings for Bangladesh, a developing country, reflect the extreme psychological impacts for poor and unprivileged people.

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          First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: Possible suicide prevention strategies

          The novel coronavirus 2019 (COVID-19) pandemic has become a global concern. Healthcare systems in many countries have been pushed to breaking point in an attempt to deal with the pandemic. At present, there is no accurate estimation about how long the COVID-19 situation will persist, the number of individuals worldwide who will be infected, or how long people’s lives will be disrupted (Suicide Awareness Voices of Education, 2020; Zandifar and Badrfam, 2020). Like previous epidemics and pandemics, the unpredictable consequences and uncertainty surrounding public safety, as well as misinformation about COVID-19 (particularly on social media) can often impact individuals’ mental health including depression, anxiety, and traumatic stress (Cheung et al., 2008; Zandifar and Badrfam, 2020). Additionally, pandemic-related issues such as social distancing, isolation and quarantine, as well as the social and economic fallout can also trigger psychological mediators such as sadness, worry, fear, anger, annoyance, frustration, guilt, helplessness, loneliness, and nervousness. These are the common features of typical mental health suffering that many individuals will experience during and after the crisis (Ahorsu et al., 2020; Banerjee, 2020; Cheung et al., 2008; Xiang et al., 2020). In extreme cases, such mental health issues can lead to suicidal behaviors (e.g., suicidal ideation, suicide attempts, and actual suicide). It is well stablished that around 90 % of global suicides are due to individuals with mental health conditions such as depression (Mamun and Griffiths, 2020). Similar situations have been reported in previous pandemics. For example, the suicide rate among elderly people increased in Hong Kong both during and after the SARS (Severe Acute Respiratory Syndrome) pandemic in 2003 (Cheung et al., 2008). On March 25 (2020), after returning from Dhaka, a 36-year-old Bangladeshi man (Zahidul Islam, from the village of Ramchandrapur) committed suicide because he and the people in his village thought he was infected with COVID-19 based on his fever and cold symptoms and his weight loss (Somoy News, 2020). Due to the social avoidance and attitudes by others around him, he committed suicide by hanging himself from a tree in the village near his house. Unfortunately, the autopsy showed that the victim did not have COVID-19 (Somoy News, 2020). The main factor that drove the man to suicide was prejudice by the others in the village who thought he had COVID-19 even though there was no diagnosis. Arguably, the villagers were xenophobic towards Mr. Islam. Although xenophobia is usually defined as a more specific fear or hatred of foreigners or strangers, xenophobia is actually the general fear of something foreign or strange (in this case COVID-19 rather than the victim’s ethnicity). Given that the victim believed he had COVID-19, it is also thought that he committed suicide out of a moral duty to ensure he did not pass on the virus to anyone in his village. A very similar case was reported in India on February 12 (2020), where the victim, returning from a city to his native village, committed suicide by hanging to avoid spreading COVID-19 throughout the village (Goyal et al., 2020). Based on these two cases, it appears that village people and the victim’s moral conscience had major roles in contributing the suicides. In the south Asian country like Bangladesh and India, village people arguably less educated than those that live in cities. Therefore, elevated fears and misconceptions surrounding COVID-19 among villagers may have led to higher levels of xenophobia, and that xenophobia may have been a major contributing factor in committing suicide. Suicide is the ultimate human sacrifice for anyone who cannot bear the mental suffering. However, the fact that the fear of having COVID-19 led to suicide is preventable and suggests both research and prevention is needed to avoid such tragedies. At present, it is not known what the level of fear of COVID-19 is among the Bangladeshi population although levels of fear are high among countries where there have been many deaths such as Iran according to a recent study examining fear of COVID-19 (Ahorsu et al., 2020). We would suggest there is an urgent need to carry out a nationwide epidemiological study to determine the level fear, worry, and helplessness, as well as other associated issues concerning mental health in relation to COVID-19. This would help in developing targeted mental wellbeing strategies (e.g., such as those who live in villages). Additional mental health care is also needed for patients confirmed as having COVID-19, patients with suspected COVID-19 infection, quarantined family members, and healthcare personnel (Xiang et al., 2020). We would also suggest the following to the general public: (i) avoid unreliable and non-credible news and information sources (such as that on social media and what neighbors say) to reduce fear and panic surrounding COVID-19, (ii) help individuals with known mental health issues (e.g., depression, anxiety) in appropriate ways such as consultation with healthcare professionals using telemedicine (i.e., online interventions) where possible, (iii) offer support and signposting for individuals displaying pre-suicidal behavior (i.e., talking about death and dying, expressing feelings of being hopeless and/or helpless, feeling like they are a burden or that they are trapped), (iv) offer basic help (e.g., foods, medicines) to those most in need during lock-down situations (Suicide Awareness Voices of Education, 2020; Yao et al., 2020). We would also recommend online-based mental health intervention programs as a way of promoting more reliable and authentic information about COVID-19, and making available possible telemedicine care, as suggested in recent previous papers (Liu et al., 2020; Xiang et al., 2020; Yao et al., 2020). Finally, as suggested by Banerjee (2020), the role of a psychiatrist during a pandemic such as COVID-19 should include as (i) educating individuals about the common adverse psychological consequences, (ii) encouraging health-promoting behaviors among individuals, (iii) integrating available healthcare services, (iv) facilitate problem-solving, (v) empowering patients, their families, and health-care providers, and (vi) promoting self-care among health-care providers. Role of the funding source Self-funded. Financial disclosure The authors involved in this research project do not have any relationships with other people or organizations that could inappropriately influence (bias) their work. Declaration of Competing Interest The authors of the correspondence do not have any conflict of interest.
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            Social reaction toward the 2019 novel coronavirus (COVID-19)

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              A rare case of Bangladeshi student suicide by gunshot due to unusual multiple causalities

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                Author and article information

                Contributors
                akmisrafilbhuiyan@gmail.com
                n.sakib@just.edu.bd
                pakpour_amir@yahoo.com
                mark.griffiths@ntu.ac.uk
                mamunphi46@gmail.com
                Journal
                Int J Ment Health Addict
                Int J Ment Health Addict
                International Journal of Mental Health and Addiction
                Springer US (New York )
                1557-1874
                1557-1882
                15 May 2020
                15 May 2020
                : 1-6
                Affiliations
                [1 ]Undergraduate Research Organization, Savar, Dhaka, Bangladesh
                [2 ]Department of Microbiology, Jashore University of Science and Technology, Jashore, Bangladesh
                [3 ]GRID grid.118888.0, ISNI 0000 0004 0414 7587, Department of Nursing, School of Health and Welfare, , Jönköping University, ; Jönköping, Sweden
                [4 ]GRID grid.12361.37, ISNI 0000 0001 0727 0669, Psychology Department, , Nottingham Trent University, ; 50 Shakespeare Street, Nottingham, NG1 4FQ UK
                [5 ]GRID grid.411808.4, ISNI 0000 0001 0664 5967, Department of Public Health & Informatics, , Jahangirnagar University, ; Savar, Dhaka, Bangladesh
                Author information
                http://orcid.org/0000-0001-8880-6524
                Article
                307
                10.1007/s11469-020-00307-y
                7228428
                32427168
                ec86d8b5-49b0-4d30-bedb-03ad89bdec9f
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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                Funded by: Nottingham Trent University
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