|Mallo MD* and Binan ED|
|Corresponding Author: Mashat David Mallo, Block 134 state Low-cost Housing Estate, Jos, Plateau State, Nigeria|
|Received: February 06, 2020; Accepted: February 28, 2020; Published: July 08, 2020|
|Citation: Mallo MD & Binan ED (2020) Self-Esteem, PTSD and Suicidal Ideation among Survivors of Sexual Violence - A Mini-Review. J Psychiatry Psychol Res, 4(1): 219-223.|
|Copyrights: ©2020 Mallo MD & Binan ED. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
The study examined the impact of self-esteem and post-traumatic stress disorder on suicidal ideation among female victims of sexual violence in Jos Nigeria. An Ex Post facto design was used with a double-blind technique in the process of data collection. Participants were within the ages of 11-31 years. Findings revealed that self-esteem has no significant main effect on suicidal ideation F (1, 24) = 0.439, p = 0.514 while PTSD has a significant main effect on suicidal ideation F (1, 24) = 0.032. The results further revealed that self-esteem and PTSD do not have any significant interaction effect on suicidal ideation F (1, 24) = 1.56, P = 0.224. Survivors of sexual and gender-based violence with therefore need to be exposed to some degree of psychological intervention, immediately after exposure to traumatic events.
Keywords: Post-traumatic stress disorder, Suicidal ideation, Psychosocial, Self-esteem
Today we live in a world that is continuously plagued by numerous psychological distresses such as post-traumatic stress disorder (PTSD), suicide, sexual violence, suicidal ideation. Also, because of so much life happenings and the experiences people pass through, people are likely to create social environments and class for themselves, influencing how they behave in the presence of others, either consciously or unconsciously, leading to an interpretation of their self-esteem by others as low or high.
In Nigeria, cases of suicide have become increasingly rampant over the last few years with the most recent one being that of a man who hung himself on a pole in the street in Lagos state. With suicide becoming so prevalent, attempts to curtail it have not produced any significant progress as the potential drivers to suicide are seen environmentally, creating a need for a holistic combative approach. Several factors play roles in attempted or completed suicides. However, one key factor that seems to prepare the way for suicide is suicidal ideation.
Suicidal ideation viewed as a preoccupation with intensive thoughts of ending one’s own life, while suicide is the
Self-esteem reflects a person’s overall subjective emotional evaluation of his or her own worth. It is a judgment of oneself as well as an attitude towards the self. Self-esteem encompasses beliefs about oneself, as well as emotional states, such as triumph, despair, pride and shame. For the purpose of this research, self-esteem will refer to a person’s positive or negative feeling about herself.
Post-traumatic stress disorder (PTSD) is a mental health condition that a person can develop after experiencing a horrifying event such as violent crisis, armed robbery, bombing, rape, or a severe automobile accident. Formally, PTSD consists of a protracted response to an extremely stressful or threatening event . Post-traumatic stress disorder (PTSD) is an abnormal response to an event outside the scope of a person’s normal process of comprehension. The PTSD diagnosis was originally developed to characterize the psychological reactions of combat veterans after many of them returned home from war .
Several factors have been found to play significant roles in suicidal ideation and this phenomenon cuts across individuals irrespective of age, gender, ethnicity, race, academic performance or even social status. Suicide and suicidal behaviors are both national global phenomena. Suicidal behavior, ranging from suicidal ideation to suicidal acts such as para suicide, attempted suicide and completed suicide, is widely pervasive and has reached critically wide-ranging proportions [5,6].
Similarly, research has shown that sexual violence has been on the increase over the last decade. For example, Christian Women for Excellence and Empowerment in Nigeria Society (CWEENS) documented 446 cases of sexual and gender-based violence (SGBV) from January 2015 to December 2016 in Plateau state alone. Out of the 446 cases documented, 29% (129.34) were sexual violence cases out of which 24% (107.04) were rape cases .
These startling rates of suicide and sexual violence in Nigeria as well as literature gaps motivated the current study on self-esteem, post-traumatic stress disorder and suicidal ideation among victims of sexual violence.
Self-esteem and suicidal ideation
Self-esteem has also been linked with PTSD. For instance, scientists reported  that uncertainty about self-worth predisposes to negative mood states leading to the probability of suicidal acts . Examined whether explicit and implicit self-esteem, the interaction between these two constructs and their discrepancy are associated with depressive symptoms, suicidal ideation and loneliness. They found that the interaction of implicit and explicit self-esteem was associated with suicidal ideation, indicating that participants with high implicit self-esteem combined with a low explicit self-esteem showed more suicidal ideation.
In a recent research on the influence of self-esteem on suicidal ideation among university students in Nairobi County, it was found that  there is a close relationship between self-esteem and suicidal ideation. Scientists reported  in a study of suicidal ideation among adolescents that low self-esteem group scored higher on suicidal ideation scale (M = 49.51) as compared to moderate self-esteem group (M = 47.09) and high self-esteem group (M = 39.49). This suggests that persons with low self-esteem are much more vulnerable to suicidal indulgence than the persons with higher self-esteem.
Post-traumatic Stress Disorder and Suicidal Ideation
In the last 10 years, Nigerians have been living in apprehension and perpetual trauma as a result of the menace of the insurgency that has bedeviled the country since the year 2009. It will not be out of place to say that Nigerians have suffered different degrees of trauma as a result of this. A lot of Nigerians have been directly affected by violence thereby experiencing trauma at first degree, others have watched other people suffer violence resulting in second degree trauma; yet others have listened to other people narrate their experiences or other people’s experience of violence, resulting in third degree trauma.
In spite of all these horrible experiences by Nigerians irrespective of their gender, a certain group (women and girls) have had to bear even more pain by experiencing sexual violence. These events have exposed them to higher levels of psychological distresses such as post-traumatic stress disorder and suicidal ideation. This is not surprising as several research findings have found that people who suffer PTSD are more likely to contemplate of committing suicide. PTSD has been linked to suicidal ideation (SI) and past suicide attempts , a relationship that appears to be ampliﬁed among individuals with comorbid major depressive disorder [13,14]. PTSD is predictive of a future suicide attempt among individuals reporting suicidal ideation . Sexually abused adolescent girls are at high risk of suicidal ideation and attempts [16,17].
Self-esteem, post-traumatic stress disorder and suicidal ideation
There is very limited literature on the interaction of self-esteem, post-traumatic stress disorder and suicidal ideation. The limited available literature did not show any direct interaction of self-esteem and PTSD to cause suicidal ideation but an interaction of several factors including self-esteem, PTSD and suicidal ideation. For instance, some studies show that the evidence base on the psychological dimensions of sexual violence suggests that they too are often long-lasting. Survivors are more likely to exhibit symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), low self-esteem and suicidal thoughts [18,19]. Perceived physical or sexual abuse, shame and psychological pain are highly related to suicidal ideation and intent. Scientists reported that sexual abuse consists of 20% of the overall risk factors of suicide.
Unbearable physical pain, devotion to cause of heroism, loyalty to a leader or spouse, loss of loved one, loss of a job, or social isolation can also be significant risk factors for suicide [20,21]. In a study on suicidal ideation among young adults, found that adolescents who suffer traumatic experiences are known to have an increased risk of depression and suicide attempts. However, positive psychological characteristics, such as self-esteem, can protect against psychological problems, such as depression, anxiety and suicide. Similarly, in a study  on effects of traumatic experiences on suicidal ideation among 173 Korean adolescents found that self-esteem decreased the prevalence of suicidal ideation by moderating the effect of depression in adolescents who suffered traumatic experiences.
1. There is the main effect of self-esteem on suicidal ideation among victims of sexual violence.
2. There is the main effect of post-traumatic stress disorder on suicidal ideation among victims of sexual violence.
3. There are the interaction effects of self-esteem and post-traumatic stress disorder on suicidal ideation among victims of sexual violence.
The population of the study consisted of 35 female victims of sexual violence in Jos, Plateau state drawn from three (3) Civil Society Organization (CSOs) Christian Women for Excellence and Empowerment in Nigeria Society (CWEENS), Women and Girl Child Rescue and Development Initiative and Simji Girl Child Development Initiative that work with victims/survivors of sexual violence. A total of 35 questionnaires were issued out to the participants using a purposive sampling technique specifically targeting victims of sexual violence. However, only 28 questionnaires were completed correctly while 7 were discarded for incomplete responses. The final sample consisted of 28 respondents out of which 24 (85.71%) were Christians, 5 (14.29%) were Muslims. 13 (46.43%) of the respondents reported to have been victims of rape, 3 (10.71%) were victims of attempted rape, 7 (25%) were victims of intimate partner violence while 5 (17.86%) reported to have suffered other unspecified forms of sexual violence. Majority of the participants 12 out of the 28 (42.9%) fall within the age range of above 31 years and above.
The three variables in this research were measured using three different scales. Self-esteem was measured using the Rosenberg self-esteem scale; post-traumatic stress disorder was measured using the PTSD Diagnostic Scale for DSM-5 and suicidal ideation was measured using the Suicidal Affect-Behavior Cognition Scale (SABCS).
The Rosenberg Self-Esteem Scale
This scale consists of self-worth statements ranging from low self-esteem to high self-esteem. The scale is a ten item Likert type. Items are four-point scale ranging from strongly agrees to strongly disagree. Strongly agree has three points, agree two points, disagree one point and strongly disagree no points. Scoring: The scale consists of five positive items and five negatives items. Negative items (2, 5, 6, 8 and 9) are reversed scored. Scores on the scale range from 10-40 with a mean of 1-4. High scores on the scale mean a higher level of self-esteem and vice versa. For this research, an average score of 1-2.9 is low self-esteem while an average score of 3.0-4.0 is high self-esteem. This scale is well known measure of self- esteem all over the world. Scientists reported internal consistency reliability (Cronbach alpha) ranging from 0.85 to 0.88 for the participating students.
DSM 5 PSTD Symptom Levels Scale (PSLS)
Post-traumatic stress disorder symptoms were evaluated by a questionnaire compiled by Gil, corresponding fully with the DSM 5 criteria for PTSD. The questionnaire adheres to the construct and expert validity of the DSM-5 diagnosis of PTSD. It is a 20-item self-report questionnaire aimed at assessing levels of PTSD symptoms over the period after the traumatic event. Each item corresponds to one of the 20 DSM-5 diagnostic criteria for PTSD. The severity of each item is rated on a four-point Likert type scale ranging from 0 = not at all to 3 = severely. A score of 0.0 is no trauma, 1.0-10.0 is mild trauma, 11.0-20.0 is moderate trauma, 21.0-30.0 is severe trauma. For the purpose of this study however, trauma will be divided into two levels with a score of 1.0-20.0 representing mild PTSD and 21.0-30.0 representing severe PTSD. The scale is divided into four clusters: Intrusion (items 1-5), avoidance (items 6-7), negative alterations (items 8-14) and alterations in arousal (items 15-20). The scale showed high Cronbach alpha internal consistency for both the general scale and for its subscales. Validity and reliability of the DSM-5 PSTD Symptom Levels Scale (PSLS) Construct validity: The PSLS was developed in adherence to the diagnostic criteria presented in the DSM-5. Each question corresponds to the 20 items developed by experts; thus, construct validity is maintained.
Suicidal Affect-Behavior-Cognition Scale (SABCS)
The Suicidal Affect-Behavior-Cognition Scale (SABCS) is a six-item scale built on premise of the ABC theory for the assessment of suicidal ideation. The scale is suitable for research and for clinical purposes. It includes items on death-related affect, wish to live (WTL) and wish to die (WTD); suicidal behaviors; suicidal cognition, debate and ideation; and prediction of future suicide attempts, a self-assessment item which may have underlying cognitive and affective attributes. Items are totaled, with higher scores indicating greater suicidality and vice-versa. The scale has demonstrated good split-half reliability of up to 0.90-0.94 in two different studies.
The researchers employed a double-blind approach where questionnaires were administered to the participants through female research assistants who are staff of the organizations. The choice of the use of this approach was necessitated by the need to avoid discomfort of the participants considering the sensitive nature of issues of sexual violence. The research assistants were asked to seek the individual consent of each of the participants and also assure them that the information they will give would be kept confidential and used only for the purpose of research.
Confidentiality of the respondents was ensured throughout the execution of this study. All the information obtained was used strictly for the purpose of this study. The study respondents were contacted through Civil Society Organizations that work with victims of sexual violence and they gave their voluntary consent to before participating in this study.
The study had three hypotheses and the findings are as follows:
Hypothesis one which states that there is a main effect of self-esteem on suicidal ideation among survivors of sexual violence was not statistically significant. The finding shows that one’s level of self-esteem (high or low) does not have any effect on suicidal ideation. Secondly, hypothesis two which states that there is a main effect of post-traumatic stress disorder on suicidal ideation was statistically significant. The findings show that people with severe PTSD have higher levels of suicidal ideation than those with mild PTSD. Finally, the third hypothesis which states that there is an interaction effect of self-esteem and PTSD on suicidal ideation among survivors of sexual violence was not statistically significant. This shows that self-esteem and PTSD do not interact to influence suicidal ideation.
In conclusion, these research findings show that suicidal ideation is common among survivors of sexual violence and sexual violence is on the increase in the society. Suicidal ideation is one of the leading causes of suicide and several factors have been found to influence it. These factors include PTSD as found in this study; this means that individuals and organizations offering mental health and psychosocial support to victims of traumatic experiences such as sexual violence must take note of this in order to help them cope with their trauma rather consider suicide.
The role of family support should be emphasized. Families where these survivors emanate from need to show love and concerns for their wards. These families should also make conscious attempts to dismantle unequal power dynamics within the family system and this will foster a respectful family environment.
In schools, students/teenagers need to have sex education to be able to manage the outcomes of exposures to negative life challenges. Parenting should be more involving and not passive, this will create a room for 360-degree interaction between children and parents and in the even children are passing through these experiences, they would find the chance to report to parents and be provided with immediate attention.
1. Conner K, Duberstein P, Conwell Y, Seidlitz L, Caine E (2001) Psychological vulnerability to completed suicide: A review of empirical studies. Suicide Life Threat Behav 31: 353-385.
2. Bertolote J, Wasserman D (2009) Suicidology and Suicide Prevention: A Global Perspective. Oxford University Press, Oxford UK, pp: 87-90.
3. World Health Organization (2010) International Classifications of Diseases. Available online at: http://apps.who.int/classifications/icd10/browse/2010/en#/F40-F48
4. Foy DW, Sipprelle RC, Rueger DB, Carroll EM (1984) Etiology of post-traumatic stress disorder in Vietnam veterans: Analysis of premilitary, military and combat exposure influences. J Consult Clin Psychol 52: 79-87.
5. Fergusson DM, Woodward LJ, Horwood LJ (2000) Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychol Med 30: 23-39.
6. Fanous AH, Prescott CA, Kendler KS (2004) The prediction of thoughts of death or self-harm in a population-based sample of female twins. Psychol Med 34: 301-312.
7. Cweens (2016) Violence against women and girls: An urgent call for action in Plateau state.
8. Swann WB, Chang-Schneider C, McClarty KL (2007) Do ourself-views matter? Self-concept and self-esteem in everyday life. Am Psychol 62: 84-94.
9. Creemers DH, Scholte RH, Engels RC, Prinstein MJ, Wiers RW (2012) Implicit and explicit self-esteem as concurrent predictors of suicidal ideation, depressive symptoms and loneliness. J Behav Ther Exp Psychiatry 43: 638-646.
10. Wanyoike BW, Nguti D, Omulema BEE, Njoroge M, Mwenda M (2016) Influence of self-esteem on suicidal ideation among youth in universities in Nairobi county. IJSSHR 4: 408-416.
11. Singh RN, Pathak N (2017) Effects of self-esteem on suicidal ideation among adolescents. Int J Indian Psychol 4.
12. Cougle JR, Keough ME, Riccardi CJ, Sachs-Ericsson N (2009) Anxiety disorders and suicidality in the national comorbidity survey-replication. J Psychiatr Res 43: 825-829.
13. Cougle JR, Resnick H, Kilpatrick DG (2009) PTSD, depression and their comorbidity in relation to suicidality: Cross-sectional and prospective analyses of a national probability sample of women. Depress Anxiety 26: 1151-1157.
14. Panagioti M, Gooding P, Tarrier N (2009) Post-traumatic stress disorder and suicidal behaviour: A narrative review. Clin Psychol Rev 29: 471-482.
15. Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, et al. (2009) Cross-national analysis of the associations among mental disorders and suicidal behaviour: Findings from the WHO World Mental Health Surveys. PLoS Med 6: e1000123.
16. Devries KM, Mak JY, Child JC, Falder G, Bacchus LJ, et al. (2014) Childhood sexual abuse and suicidal behavior: A meta-analysis. Pediatrics 133: e1331-e1344.
17. Miller AB, Esposito-Smythers C, Weismoore JT, Renshaw KD (2013) The relation between child maltreatment and adolescent suicidal behavior: A systematic review and critical examination of the literature. Clin Child Fam Psychol Rev 16: 146-172.
18. Josse E (2010) “They came with two guns”: The consequences of sexual violence for the mental health of women in armed conflicts. Int Rev Red Cross 92: 177-195.
19. Spirić Z, Opacić G, Jović V, Samardzić R, Knezević G, et al. (2010) “Gender differences in victims of war torture: Types of torture and psychological consequences”. Vojnosanit Pregl 67: 411-418.
20. Chehil S, Kutcher SP (2012) Suicide risk management: A manual for health professionals. Chicester: John Wiley Sons 174.
21. Lieberman Z, Solomon Z, Ginzburg K (2005) Suicidal ideation among young adults: Effects of perceived social support, self-esteem and adjustment. J Loss Trauma 10: 163-181.
22. Kwon SY, Nam JA, Park HJ, Yu JC, Choi KS (2017) Effects of traumatic experiences on suicidal ideation among Korean adolescents: The roles of depression and self-esteem.
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