INTRODUCTION
Bullying is defined as intentional and
repeated acts that occur through physical, verbal, and relational forms in
situations where a power difference is present.(1). Suicide attempt, on the other hand can be defined as a self-destructive act deliberately carried out where
there is a clear expectation of death.(2).Bullying victimization has been identified as a risk factor for suicide
ideation and attempts in adolescence.(3). A case of verbal
bullying leading to attempted suicide in a female schooling adolescent is hereby
reported.
CLINICAL OBSERVATION
F.O. is a 14-year-old female adolescent who was first seen at the
Emergency Department of the University College Hospital, Ibadan after a one-day
history of deliberate ingestion of Saponated cresol (a
potent germicide) in a bid to commit suicide due to ongoing verbal bullying at
school and frequent altercations with her mother at home. Prior to this, the
patient had been experiencing melancholy, despondency, insomnia, and loss of
appetite. She was ridiculed because of her naturally curly and thick hair and
was constantly referred to as 'Medusa' (a creature in Greek mythology with snakes
on her head instead of hair). Repeated attempts at obtaining parental consent
to straighten her hair with chemical agents were denied. She said, 'I was
tired of the name-calling and wanted to end it all'. There was no history
of chronic illness. There was a two-year prior history of suicide
ideation, which was dismissed following a conversation with a close friend.
This ideation was not disclosed to any family member or the school authorities.
After ingestion of the substance, she was given palm oil by her parents which
caused three episodes of vomiting and abdominal pain. She was thereafter rushed
to the emergency room. Examination at presentation revealed a calm female
adolescent who was conscious and alert. The only abnormality noted was the
presence of suprapubic tenderness, all other systems were normal. Mental state
examination by the adolescent psychiatrist was normal. Her abdominal ultrasound
scan, full blood count, urinalysis, pregnancy test, electrolytes and urea did
not reveal any abnormality. A diagnosis of deliberate self-harm was made. She
was admitted for one night in the emergency room and discharged thereafter to
be followed up at the adolescent paediatric clinic.
All clinic
appointments were attended in the company of her mother with the adolescent
paediatrician and public health nurse in attendance. Both mother and FO were
counselled extensively. F.O. exhibited reluctance at reporting the bullying
episodes to the school authorities as she believed it would further worsen the
situation. There was no anti bullying policy in her school. Her mother
eventually granted permission for the use of hair straightening agents. The relationship between patient and mother
improved significantly, FO became more self-confident, and she was able to
stand up to her bullies. The bullying eventually stopped. Her appetite and mood
improved significantly with the sleep pattern becoming better. Her clinic
attendance also continued.
DISCUSSION
In recent years,
there has been a rise in global attention to bullying and its attendant
consequences as a major public health concern.It has been shown to have negative short and long term consequences
affecting the perpetrator, the victim and the observers(4). A meta-analysis conducted on
schooling adolescents in low- and middle-income countries reported the
prevalence of suicide attempts and bullying victimization as 10.7% and 30.4%
respectively. This same study also reported a 32.7% prevalence of suicide
attempts amongst bullied adolescents compared to 5.9% in those who were not
bullied. (3). Suicidal ideation and attempts have been reported to be significantly
associated with bullying in schooling Nigerian adolescents.(5)In Eastern Nigeria, it was reported that bullied adolescents had a 51.8%
prevalence of suicidal ideation(6).
In literature, the various
means of attempted suicide are hanging, ingestion of poisons, drowning and the
use of firearms.(7) Males tend to use more
violent methods when attempting suicide such as hanging/gunshots unlike their
female counterparts who are more likely to use self-poisoning as was seen in
the case reported(8).In Nigeria, the most
reported poison deliberately ingested by adolescents during suicidal attempts
is organophosphate(9)However, Saponated Cresol was the poison of choice in this case. Acute
cresol poisoning has been shown to affect various systems of the body such as
respiratory, haematological, gastrointestinal, renal, neurological and
cardiovascular(10). The patient however did not present with any
clinical or laboratory signs of poisoning. This could be explained by the fact
that the cresol was diluted with approximately 200mls of water prior to
ingestion thus minimising the toxic effects of the compound.
CONCLUSION
This case brings to
the fore that bullying is a common occurrence amongst secondary school students
and can lead to suicidal ideation and attempts. Forestalling this trend
requires the institution ofanti-bullying laws and policies in all learning
centres in the country. It also highlights the fact that in regular practise,
paediatricians must have a heightened index of suspicion for the dangers of
bullying and address them appropriately.
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