INTRODUCTION

Suicide is a major public health concern globally, with significant social and psychological consequences for individuals, families, and societies ( World Health Organization, 2021 ) . Suicide happens because of a combination of mental, societal, biological, cultural, and environmental variables ( Zalsman et al., 2016 ) . Numerous factors have been identified as contributing to suicide attempts, including mental disorders, previous suicide attempts or self-harm, family history of suicide, access to lethal means, social isolation and lack of support networks, cultural and religious beliefs, and socio-economic factors ( Favril et al., 2022 ; Zalsman et al., 2016 ) .

In some countries, suicide attempt is considered criminal offences, punishable by fines and/or imprisonment ( Ochuku et al., 2022 ; United for Global Mental Health, 2021 ; ) . This includes several Muslim-majority countries, where suicide and suicide attempt are strictly condemned as per Islamic law and are considered as criminal offences ( Lew et al., 2022 ) .

Religious leaders, such as imams, play a significant role in shaping the beliefs and attitudes of their communities ( Suleiman et al., 2023 ) . Muslim leaders, such as imams, hold significant influence over their followers and communities ( ) . Their opinions and perspectives can have a profound impact on the social norms and cultural values surrounding suicide. Understanding their perceptions can provide valuable insights into policy development and intervention strategies.

Bangladesh is a densely populated country of about 170 million and more than 90% are Muslim ( World Population Review, 2023 ) . Suicide is an under-prioritized public health problem in the country where suicide attempt is considered a criminal offense ( Bose et al., 2023 ) . Academicians and researchers have raised their concerns in favour of the decriminalisation of suicide in the country. To effectively address this issue, it is crucial to consider the perceptions of religious leaders, particularly Muslim imams, on the legal status and decriminalisation of suicide attempts in Bangladesh. Therefore, we aimed to see the perception of religious leaders on the legal status and decriminalisation of suicide attempt in Bangladesh.

METHODS

Data collection

We conducted this cross-sectional study between April and July 2023 and collected data from religious leaders (imams) who were undergoing training provided by Islamic Foundation, Bangladesh (IFB; http://www.islamicfoundation.gov.bd/) between June and July 2023. IFB arranges regular training sessions for imams working in different parts of the country. We collected data from the Dhaka center where imams from eleven different districts were being trained. We approached all the available imams conveniently with the purpose of responding to the self-reporting questionnaire.

Measures

Our questionnaire consists of three parts namely socio-demographic variables, suicidal behavior, and perception of the legal status and decriminalisation of suicide attempt.

Socio-demographic variables

We considered several variables in this section, namely, age in years, marital status, educational attainment (Fafeez, Mawlana, and Mufti), family background, average monthly income, and family history of suicide.

Suicidality

Suicidal behavior of the respondents was assessed via several questions. We adopted this section from a previous study assessing suicidal behavior ( Arafat et al., 2022 ) . We prepared questions assessing suicidal thoughts during the last 48 hours, last month, last year, and the respondent´s life-time as well as any suicide attempts. The questions read as follows:

a. Did you have any idea of killing yourself in the past 48 hours?

b. Did you have any idea of killing yourself in the past month?

c. Did you have any idea of killing yourself in the past year?

d. Did you have any idea of killing yourself in your lifetime?

e. Have you ever suicide attempt?

Perception on Legal Status and Decriminalization of Suicide

We prepared six items to assess the status of suicide attempts in religion and existing law in Bangladesh. The items were as follows:

1) What is the status of suicide attempt in Islam?

2) What is the status of suicide attempt in existing law of Bangladesh?

3) Have you ever witnessed someone being punished for a suicide attempt?

4) In your opinion, where should someone be referred to after a suicide attempt?

5) Does the criminal legal status of suicide help prevention?

6) Do you think suicide attempt should be decriminalized to prevent suicide in Bangladesh?

Statistical analysis

Descriptive statistics were presented using tables. Data was expressed as frequency (percentage) and mean ± standard deviation for categorical and continuous variables, respectively. All statistical tests were conducted using Stata (Version 17).

Ethical considerations

Ethical approval for this study was taken from the ethical review committee of Enam Medical College on June 05, 2023 (EMC/ERC/2023/06-1). Informed written consent was taken from individuals before participating in the study.

RESULTS

The mean age of the imams was 38.6 ± 9.6 (range 22–63) years. All the participants were males; 87% were married; 65% were Maulana; and 60% lived in joint families (Table 1). Among the participants, about 18% had lifetime suicidal thoughts; 7.4% had suicidal thoughts in the last year; 3.7% had suicidal thoughts in the past month; and 6.2% had suicide attempt (Table 2). More than 95% (n=155) of participants mentioned that suicide is forbidden in Islam; 73.5% mentioned that suicide is a punishable crime in the current law of Bangladesh; 16% mentioned suicide attempt is a crime but not punishable; 94% had not seen any punishment of a suicide attempt; 62% thought that after attempting suicide, a person should be sent to hospital; 9% thought that they should be sent to a police station; 58% thought that the criminal legal status was harmful to suicide prevention. However, more than 50% of the participants thought decriminalization would not prevent suicide (Table 3).

DISCUSSION

Major findings of the study

The present study evaluates the perceptions of imams (Islamic religious leaders) of the legal status and decriminalization of suicide in Bangladesh. Among the participants, 95% of participants were of the view that suicide is forbidden in Islam; about two-thirds (73%) of them considered it a punishable offense; about six in ten imams (58%) thought that a criminal legal status is harmful to suicide prevention; and about one quarter of imams thought that decriminalization was necessary. The findings indicate several gaps in perceptions, namely, that suicide is prohibited in Islam; it is considered a punishable offense in Bangladesh; there has been no incidence of punishment for suicide attempt in the country ( Bose et al., 2023 ) .

Suicide is considered a grave sin in Islam based on Islamic teachings. Islam refers to life as a sacred gift from God, and intentionally taking one’s own life is seen as a violation of this gift. The International Association of Suicide Prevention (IASP) policy strongly recommends the decriminalization of suicide (IASP, 2020) arguing in favor of eliminating social barriers and encouraging help-seeking behaviors ( Ochuku et al., 2022 ; United for Global Mental Health, 2021 ; ; Lew et al., 2022 ; Wu et al., 2022 ) .

Even though suicide is considered a punishable crime, 62% of the participants believe that persons who have suicide attempt need help and, thus, should be referred to hospitals. Studies predicting suicide attempts have found emotional and psychological distress a major risk factor ( Arafat et. al., 2021 ; Hockey et. al., 2022 ) .

About half of the participants thought decriminalization would not prevent suicide. This finding demands serious attention for the decriminalizing of suicide in Bangladesh as study findings reveal that a criminal legal status of suicide hinders its prevention and many countries that have decriminalized suicide attempt may end up lowering suicide rates ( Wu et. al., 2022 ) . Moreover, modifications in the legal status of suicide in Bangladesh may be helpful in destigmatizing problems and facilitating help-seeking behavior ( Arafat, 2019 ; Bose et al., 2023 ) .

Criminalization of suicide attempts has detrimental effects on an individual’s help-seeking behavior in times of crisis. Wherefore, individuals may develop a fear of legal repercussions as well as stigma about mental health issues. Thus, making it more challenging for people who have suicidal thoughts to talk openly about their circumstances. Such individuals require a more compassionate and supportive approach from society rather than a punitive one ( ) .

Responses to two questions in this study revealed a somewhat contradictory perception: 58% of imams mentioned that a criminal status was harmful to suicide prevention whilst half of them thought that decriminalization would not prevent suicide. This may be explained by psychological resistance caused by religious guidance. However, we could not validate their response as responses were collected by self-reporting instruments. Further qualitative studies would be helpful in answering such questions.

Implications of Study Findings

The present study may be helpful in considering the measures to decriminalize suicide attempt in Bangladesh. It reveals the understanding of Islamic leaders regarding the religious and social context of suicidal behavior and decriminalization of suicide attempts in Bangladesh, and will be beneficial in making effective evidence-based policies. These measures include raising awareness about mental health and suicide, advocacy, and accessible mental health services that help in reducing the stigma associated with these issues. Resultantly, by promoting empathy and understanding, people may be more inclined to support decriminalization and view suicide attempts as cries for help rather than criminal acts. This study indicates urgency of actions to break the resistance that may arise from religious beliefs.

STRENGTHS AND LIMITATIONS

This is the first initiative to explore the perceptions of imams on the legal status and decriminalization of suicide in Bangladesh. However, several limitations should be considered. First, the psychometric properties of the instruments were not assessed. Second, data was collected purposively with self-reporting instruments that may be influenced by social desirability and recall bias. Additionally, responses were not cross validated by confirming questions. Third, all participants of this study were male.

CONCLUSION

The findings of the study indicate that awareness programs for imams should be targeted to decriminalise suicide attempts in Bangladesh as more than half of the participants’ perceptions were against decriminalisation. Additionally, further research, including qualitative studies, would better explain the religious perceptions about suicide, suicide prevention, and decriminalization of suicide attempt in Bangladesh.

DECLARATIONS

Acknowledgement

We thank Dr. Md Noor E Alam for his support during data processing.

Authors’ Contribution

Conception and design: SMY Arafat

Methods and instrument development

SMY Arafat, MK Islam

Data collection

MK Islam

Data analysis

MAS Khan

Drafting the manuscript

SMY Arafat, R Amin

Revision and approval

All authors

Conflict of Interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability

The data that support the findings of this study are available on request from the corresponding author.

Ethical Approval

Ethical approval for this study was received from the ethical review committee of Enam Medical College on June 05, 2023 (EMC/ERC/2023/06-1).

Funding

No funding was received for this paper.

Informed Consent

Written Informed consent was taken from individuals before participating in the study.

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