48 SUICIDE AS A PHENOMENON IN THE MUNICIPALITY OF PRIZREN FROM CITIZENS’ PERSPECTIVE Alban KRYEZI South East European University, Faculty of Law, ak29665@seeu.edu.mk Article history: Submission 16 July 2022 Revision 29 September 2022 Accepted 05 November 2022 Available online 31 December 2022 Keywords: Suicide, Municipality of Prizren, Citizens’ Perspective. DOI: https://doi.org/10.32936/pssj.v6i3.348 A b s t r a c t Suicide as a phenomenon is present in almost all societies of the world, including the Kosovar society, through which the individual tries to take his own life. According to the law, this offense is not punished because the individual ceases to exist as a legal subject, but if we are dealing with pushing or assisting suicide, then investigations are initiated by the competent authorities. The main purpose of this paper is to provide an overview of the opinions of the citizens of the Municipality of Prizren on the cause, methods and treatments of suicide cases in this municipality. An online questionnaire was used to achieve the required results. The research method used is of quantitative type, through which it is attempted to present numerical data about the issue in question. The results of the research indicate that the main cause of suicides in the Municipality of Prizren are unstable economic conditions, narcotic substances use and psychological stress. The research determines that one of the main ways to commit suicide is hanging and jumping from high objects. According to the data provided, it is observed that the phenomenon of suicide is of medium frequency, and not all cases of suicide should be subject to autopsy examination. 1. Introduction Suicide is one of the phenomena that is present in almost all societies of the world, including the Kosovar society. Suicide is an act through which a person tries to take his own life. This paper aims to approach suicide as a social phenomenon in the Municipality of Prizren from the perspective of its citizens. It aims to study the citizens’ common thoughts on this issue, with regard to the causes, methods, ways of treating the affected ones, and further investigations on suicide cases. It aims to create a summarized picture of this phenomenon based on the answers of citizens who have little to no knowledge about the official statistics. The paper tries to shed new light and to strengthen even more the previous existing, universal theories regarding the phenomenon of suicide in society. Through it, it is attempted to create valuable, authentic and sustainable information. It aims to compare the thoughts of the citizens of Prizren to those of other societies in general. It intends to offer a comprehensive overview, as summarized as possible on the independent opinions of the citizens of the Municipality of Prizren on the cause, methods, treatments and examinations of suicide cases. The subject is tried to be analyzed in the social context, generally connecting it with the legal aspects. This research paper is important for enriching the corpus of findings in the field of legal sciences, by providing a general overview of the citizens' point of view on the phenomenon of suicide. The findings of this work can serve as a reference for the work of future researchers, creating an easily accessible and interpretable research base. The information presented here can be a necessary basis for the work of many researchers beyond the framework of legal sciences, extending its contribution to the field of psychology, sociology and many other academic structures. https://prizrenjournal.com/index.php/PSSJ/issue/view/11 mailto:ak29665@seeu.edu.mk https://doi.org/10.32936/pssj.v6i3.348 https://orcid.org/0000-0002-6171-3210 49 1.1. Hypotheses H1: Citizens think that suicide in Kosovo is a phenomenon of average frequency, which occurs mainly due to the negative impact of economic circumstances on the mental well-being of the individual and which in most cases is carried out through physical hanging. H2: Citizens think that the responsibility for the treatment of survivors of suicide attempts should belong to the state institutions of the Republic of Kosovo, while for suicide attempts that result in the death of the individual, an autopsy examination is not necessary, except in cases where there is a doubt as to whether the critical event was really a suicide or not. 1.2. Methodology In order to reach the necessary data, an online questionnaire was used. The questionnaire consists of six questions with multiple choice alternatives, where some of them were open-ended questions- the participants were given the opportunity to express their free opinion. The research method used here is of quantitative type, through which it is attempted to present quantitative data in relation to the subject in question. One hundred and seventy-three randomly selected participants from the Municipality of Prizren took part in the questionnaire. The respondents were not asked to meet any special criteria for participation, except for the criterion for them to be citizens of the Municipality of Prizren. The collected data have been interpreted in a theoretical and comparative way, with special emphasis on the creation of new and sustainable theoretical facts. 2. Suicide as a Social Phenomenon 2.1. The notion and origin of the phenomenon of suicide Regarding the phenomenon of suicide, Ander (2017) defines the seriousness of the problem of suicide as a social phenomenon, which determines that suicide is a problem that is connected in a certain way to different social categories. Suicide, in fact, is a manifestation of a certain mental state, whether it is a pathological or social state, which ends with the loss of the individual's life by himself. From the legal point of view, the act of suicide is not punishable for the fact that the individual is not considered a legal subject now that his life is over. But in the cases where we are dealing with a drive towards suicide, the investigation by the competent bodies and the further proceedings of the case come into expression here (Salihu, 2014). The way how we approach suicide as a social phenomenon is an indicator of social awareness and information about its consequences. Among different peoples, there is different consciousness in relation to knowledge and views on the phenomenon of suicide. According to the World Health Organization (2021), more than seven hundred thousand die due to suicide every year and that suicide is the main cause of death among 15–19-year-olds. According to this organization, about seventy-seven percent of suicides occur in middle- and low-income countries But can there be an origin of such a phenomenon as suicide? The first mention of suicide dates back to ancient Egypt around 1900 BC. It is poined out that such evidence is kept in the Berlin Museum and has been translated into German by Adolph Erman. This translation is literally about a philosophical dialogue between man and his soul, in which the spiritual fatigue of the character and the desire not to live anymore is manifested (Oshan, 2018). Regarding the later stages of antiquity, according to Cooper (1989), in Greek and Latin antiquity there was no word that refers to today's term "suicide", although in many countries self- destruction was considered a criminal act. 2.2. Types of Suicides by Manner and Cause According to the method: A larger categorization of suicides is that of dividing them into acute or immediate suicides and chronic or slow suicides; directly and indirectly (Latifi, 2014). According to the understanding of the concept, acute suicide is called that type of suicide whose effect tends to be immediate. An example of this is jumping from tall buildings. What is meant by the term chronic suicide is that type of suicide, the effect of which tends to be slow, so not immediate. An illustration of this type of suicide can be the consumption of slow-acting poisons. From the general understanding, we can say that direct suicide occurs when the author acts violently directly on himself with the intention of killing himself. An example of the first type of suicide can be the use of a firearm with the intention of the author causing mortal wounds on his body. While its opposite is indirect suicide, during which the author prepares a violent environment with the aim of ending his life, but the effect of which does not directly depend on the author. An example of such suicide could be the case of a man who enlists in the army with the intention of ending his life sooner or later. 50 According to the cause: The division of suicides according to the cause is often related to the causes that influence the appearance of this phenomenon, such as: mental or physiological diseases, financial situations, mental traumas, strained family relationships, etc. (Miftari et al, 2010). What can be added here is that from simple observations of such a phenomenon, other causes of suicides can be: prejudice, neglect of parents, influence of narcotics, external pressures, etc. 3. The Views of the Citizens of the Municipality of Prizren on the Causes of Suicide In order for the subject to be treated in the most general sense, avoiding the details viewed from a medical, legal or emotional point of view, a questionnaire has been established which has tried to reveal the views of citizens about the main points related to the phenomenon. of suicides. Among the points discussed was that of finding out what the citizens of the Municipality of Prizren think are the main motivations for carrying out such an act among the individuals of the Kosovar society. From the obtained results, we can say that the main cause of suicides in Kosovo, always according to the views of the citizens, are the difficult and low economic conditions. Such a thing can be completely reasonable considering that according to the statistical data of the World Bank, the poverty rate in the Republic of Kosovo for 2015 was 17.6 percent (The World Bank, 2015). The participants listed the use of narcotic substances as the second cause, that leads people to commit suicide. The psychological and emotional stress that the drug user goes through when he cannot have access to the substance of addiction is better known from the medical side. On the other hand, the United States Department of Health and Human Services in the data published on the official website states that the abuse of narcotic substances is among the main causes of suicide in America, especially among teenagers (U.S Department of Health and Human Services, 2008). The third cause based on the research results turns out to be the psychological pressure and prejudice that members of Kosovar society often face. According to them, the prejudices that an individual face, which can come from different sources such as society, the educational environment or even from the family itself, send individuals to stressful situations which then worsen and, if not taken care of, reach the point of losing the will to live. Citizens have chosen external influences as the fourth cause, which inspires members of Kosovar society to commit suicide. So, suicide can occur as a result of external social stimuli, either through direct verbal stimulation or through indirect stimulation which is mainly related to the frequency of occurrence of the phenomenon in question within a certain social circle. As the fifth because that stimulates a person to commit suicide is neglect of care and with special emphasis the uncontrolled use of social networks, especially for children and teenagers. For adults, such a cause can appear when personal data is distributed on different websites or other digital platforms without the knowledge and approval of the individual, in the form of verbal data, audio sequences or sensitive images. They can also be the prey of organized cyber-attacks which lead to consequences such as threatening or blackmailing the individual. In the case of children, we are dealing with an even more sensitive approach to the factor in question, because in most cases children are unconscious subjects regarding the consequences of exposure on social networks. The neglect of parental control creates an even more favorable environment for cyber attackers who, through continuous psychological pressure, lead the child subject to the infamous act of suicide. The participants of the questionnaire assessed the lack of institutional-state awareness towards the phenomenon of suicides as one of the causes of this occurrence. Here the term institutional-state awareness refers to the lack of awareness campaigns in schools, different work environments, other public or private institutions, the lack of psychological counseling engaged by state institutions, the organization of various seminars and trainings with the aim of awareness of the people on the phenomenon of suicides, etc. On the option where the participants were asked to personally mention other causes which they think are stimulating to the act of suicide, the mention of the religious factor stands out. Some of them think that the lack of a spiritual connection with a religious figure against whom we are helpless and accountable, is a factor that leads to the increase of suicide cases. They mention fear in the religious context as a tool which, if it were to exist in the emotional and spiritual composition of the one who tries to commit suicide, would prevent the latter from realizing such a life-saving goal, because the spiritual reckoning would be a preventive factor of this act. 4. The Views of the Citizens of the Municipality of Prizren on the Frequency of Suicides Based on the statistics of the Statistics Agency of Kosovo for the year 2019, 119 violent deaths were registered in Kosovo, among which suicides make up about 39 cases or 24.8%. There is also 51 the fact that in the category of suicides, the 20-40-year-old age group dominates the most (Statistics Agency of Kosovo, 2020). From the questionnaire developed with the citizens of the Republic of Kosovo, new points of view have been revealed regarding the phenomenon in question. When asked whether or not they experienced such an experience in their family or in their social circle, they gave different answers. More than half of them or about 71 percent have said that they have not experienced such a phenomenon in their families or social circles, while the rest - about 28 percent have said that they have experienced such a notorious phenomenon in their families or in their society. This data, presented graphically, looks like the following: Table 1. Presentation of suicide cases in percentage units of the family or social circle of the respondents Suicide in the family or social circle of the respondents: Value by percentage: Yes 71% No 28% Abstention 1% Also, they were then asked to give their opinion about how frequent the phenomenon of suicide is in the Municipality of Prizren. Among the alternatives: very frequent, average and not frequent, their answers presented graphically were these: Table 2. Citizens' views about the frequency of suicides in Kosovo presented with numerical values. The prevalence of suicide: Numerical value: Very frequent 36 Moderately frequent 101 Not frequent 35 From the above data, we can see that more than half of the respondents think that suicide is not very widespread as a phenomenon and that as a phenomenon it is considered to be of average level. Among the voters for the "very frequent" and "not frequent" options, the results were almost equal, with a difference vote in favor of the "very frequent" option. Suicide is considered to be a rather widespread phenomenon which may not necessarily be visible only when it happens in the family. Such a phenomenon which occurs in the society is considered by the citizens as a collective pain as well. It is interesting that the data from the first graph and the data from the second graph present a small contradiction if seen under the lens of comparative mathematical calculations. Since the vast majority of the respondents did not have a case of suicide in their families or societies, the data in the second graph should be much more in favor of the phenomenon's infrequent frequency option. Such a thing…such a contradiction can be explained by the fact that the rate of suicides of the municipal setting seems numerically lower for many times compared to the number of suicides of the state setting. 5. The Views of Citizens of the Municipality of Prizren on the Most Frequent Forms of Suicide From the collection of data using the questionnaire with the alternatives with the possibility of unlimited choice, as well as the question being an open question where at the end the participants can give their opinion, diverse and easily comparable data have been obtained. From the graph of the answers collected through the questionnaire, it is established that the most widespread form or way in which the act of suicide is committed, according to the citizens of Prizren, is hanging. In fact, hanging is one of the ten main causes of death worldwide, and only in India is this form of suicide more common. Different data report that the use of this method to commit suicide has increased a lot in recent years, especially among adults (Ambade et al, 2015). The second form through which citizens think suicide is committed is jumping from tall buildings. Nothing has been specified regarding the parameters of the objects from which the suicides are committed, but from a basic understanding we can understand that we are talking about those objects, the height of which is sufficient to cause severe body blows which can end easily with fatality. A group of scientific researchers have analyzed 20 years of observations of the suicide phenomenon in Brazil, from 1997 to 2017. Of the total number of suicides committed in this country, the method of jumping from a height had a value of only 8.4 percent, which is an indicator that this is one of the less widespread methods in a country with a large population such as Brazil (Nunes et al., 2019). According to the respondents, the third way or form of committing suicide is ending one's own life with firearms. Even in this case, the type of weapon is not specified, but the matter is dealt within the context of any tool that functions as a firearm, the action of which on the victim's body causes severe wounds, in the lower part accompanied by external bleeding. Referring to a study done by the Harvard School of Public Health conducted in about fifty American states, it has been discovered that there is a great relationship between gun owners and suicides with guns. As the study points out, in countries where the possession of guns was greater, the number of suicides among them was significantly higher, and vice versa, in countries that possessed fewer registered guns per capita, the number of reported suicides committed through weapons was the lowest (Karin, 2008). According to the respondents, the fourth most frequent way is to commit suicide by using doses of medication with the aim of ending life. Unlike the cases where the individual consumes 52 medication with the aim of healing or improvement, in the case of suicides the tendency of their consumption is negative, by which the deterioration of the general state of health until the death of the individual is aimed. The effect of their use can be toxic effect, shock effect, coma effect, etc. Another way, classified by the respondents as less common, is the use of toxic substances such as detergents, various poisons, toxic food, etc. Through the use of these substances, whose primary purpose is domestic, curative, etc., it is intended to cause health complications, which in certain cases end in fatality. And finally, the respondents in the free answer section considered the use of high voltage sources as one of the ways to commit suicide, but which is less widespread in our country. An attempt to better elaborate this lower evaluation of the method in question can be explained by the fact that the use of high voltage sources of electricity is more difficult to be accessed and tends to cause other injuries to other members of the family or society, who are not the target of the suicide. To justify what was said, it should be emphasized that in most cases the suicide or suicide attempter continues to have good judgment in relation to other people whom he does not consider as a driver or source of thoughts to commit suicide. 6. The Views of Citizens on the Treatment of Persons with Suicidal Tendencies In most cases, suicide does not happen suddenly and the perpetrator has time to think about the way of suicide, the means, the scene of the crime, etc. Many people who in most cases are family relatives of the victims report strange behavior of the suicidal individual which was not usual for his previous character. To better elaborate what is said, a study mentions the signs displayed by a person who plans to commit suicide are: deep sorrow, sudden calmness, isolation, changes in personality or appearance, dangerous behavior against oneself, experience of fresh traumas and life crises (Cleveland Clinic, 2021). From the social aspect, two existing types of individuals involved in the suicide phenomenon can be identified: those who will attempt, in the near or distant future, to commit suicide in a planned manner and those who have previously attempted to commit suicide. suicide. People who plan to commit suicide are more predisposed to recover from such a phenomenon compared to those who have already attempted suicide which resulted in failure to achieve the objective. According to the Centre for Suicide Prevention (2016), the individual who has attempted suicide should undergo appropriate treatment because the chances of attempting suicide again are many times greater. 6.1. The Primary Epilogue - The Individual is Still Alive The question of who should deal with the treatment of people who have previously attempted or are predisposed to commit suicide was also answered by the participants of the survey on the views of citizens about the phenomenon of suicide. Among several alternatives with the possibility of multiple choices, citizens think that the family structure is the number one responsible for dealing with cases of individuals involved in suicide. They think that such people should be under the care of the family in order to receive treatment as close as possible and all the time. The same ranks the private psychologist as the second most important method through which the treatment of individuals should be done, immediately followed by the public mental services provided by the state institutions of the Republic of Kosovo. For unexplained reasons, they think that the quality of private mental health services in Kosovo is by a very small percentage more advanced compared to the same services offered in the public health system in Kosovo. Such a change really only has a difference of three votes in favor of the first factor. As the next factor, the citizens have chosen the social factor. According to them, society also has a moral and spiritual responsibility when it comes to caring for individuals affected by the phenomenon of suicide. Often, individuals easily discuss their problems with members of society, making it easier to deal with this phenomenon. Finally, with a total of four votes difference, the citizens estimate that the individual who has attempted suicide before or will attempt suicide must try to seek treatment for his or her problems before it’s too late. Such a thing in the realm of reason would seem abstract, but from the perspective of a Kosovar society characterized by traditionalism and a very hermetic general culture, this would be quite logical. What it is tried to be said is that the cultural influence on the civic mentality can create the belief among some participants that people are responsible for their illnesses or mental disorders due to a weak emotional character. Among other things, in one of the free-answer questions of the questionnaire, one percent of the citizens has declared that religious preachers are also responsible for the treatment of the individuals in question, by affecting the spiritual and religious aspect of creating the belief that such an act is against the laws of life. 6.2. Secondary Epilogue - The Individual Ends in Death In cases where the person who has committed suicide has achieved the objective - his life has ended, circumstances may rise 53 doubts among the legally responsible persons if the case was suicide or murder, based on the evaluation of the elements of the crime scene: the position of the victim, the means of suicide, the place where the suicide was committed, other persons included etc. In these cases, a medical-legal examination may be requested through an autopsy to discover the true cause of death. But would it be useful to carry out such a procedure in all cases of suicide, without evaluating other factors on which doubts may be raised? The respondents gave their evaluation presented graphically as below: Table 3. Percentage of citizens' opinions about the necessity of the autopsy procedure in cases of suicides Autopsy procedure in cases of suicide: Value by percentage: Against autopsy 5% Pro autopsy 94% Abstention 1% From the data presented, we can understand that out of one hundred and seventy-three respondents, one hundred and seventy-one of them have given their vote regarding the issue in question, while only two of them or one percent abstained. Ninety-nine percent of them have voted, of which one hundred and sixty-three respondents or ninety-four percent were in favor of the medical-legal examination to be done for all cases of suicide without exception. Of them, only eight respondents or five percent have declared against the autopsy examination for each case of suicide. 7. Conclusions My work through this research has given concrete and clear answers regarding the views of the citizens of the Municipality of Prizren on the phenomenon of suicides in this municipality. Through this research, I managed to create a comprehensive overview of the thoughts and attitudes of Kosovar citizens on this phenomenon. My work fully supports the first hypothesis and shows minimal changes in relation to the second hypothesis. From the data found, it results that according to the citizens of the Municipality of Prizren, the main cause of suicides in our country is the lack of sustainable economic conditions, the use of narcotic substances and psychological stress. Other less important causes are family neglect, social influence, use of social networks and religious and political factors. This is in accordance with other researches such as the one from Cohut (2020), which emphasizes the cause-and-effect relation between poor economic conditions and suicide attempts. My work has provided information on the opinion of citizens about the main ways in which the citizens of the Municipality of Prizren commit suicide, where hanging and jumping from high buildings are considered to be the most frequent at the top of the list. Not very expressed ways are suicide committed through firearms and overdoses with medications. Ways very little expressed based on the given report are poisoning with toxic substances, as well as suicide by electric voltage. The same has been said by Biddle et al., (2018) where they emphasize that around seventy percent of suicides in the UK are done through hanging. The data found regarding the opinion of the citizens on the frequency of the occurrence of suicide show that the majority of the respondents have not had cases of suicide in the family or society and that they consider that such an occurrence belongs to the average frequency, which is in complete agreement with the first hypothesis, raised at the beginning of this research. Furthermore, the same think that the main responsibilities for the treatment of suicide survivors are the family, private mental health institutions and state medical institutions. Also, they consider that every case of suicide should go through an autopsy examination. So, according to what was written above, the last result is in contradiction with the second hypothesis of this paper, which assumes that citizens think that it is not necessary to request such an examination for all cases of suicide, excluding situations with homicidal tendencies. A similar aspect has been said on Suicide Call Back Service, where it is stated that every suicide goes under post-mortem examination. Society, daily contacts in relation to education or schooling, self- treatment and religious figures are among the least important factors based on the findings of my work. In conclusion, we can say that my work has borne fruit in support of previous theories about early statistics regarding the phenomenon of suicide and that its final result has satisfactorily and effectively fulfilled the goals of this research. 7.1. Recommendations As the author of the paper in question, who has tried to cover the most important and exclude the least important points of elaborating on such a broad topic, I would recommend students, professors, different researchers to create a research on a same or similar topic in the future that would bring new information about the real statistics of the suicide phenomenon in the Municipality of Prizren, found by field research and expanded beyond the citizen's point of view presented in this paper. I also propose for all those researchers who will study the same subject to present the obtained data in a qualitative way, in addition to the quantitative method. 54 References 1. Kosove-2019. Retrieved on 2022, July 6. Available at: https://ask.rks-gov.net/sq/agjencia-e-statistikave- te-kosoves/add-news/statistikat-e-vdekjeve-2019 2. Ambade, V. N., Tumram, N., Meshram, S., & Borkar, J. (2015). Ligature material in hanging deaths: The neglected area in forensic examination. 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