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Lifesaving turning points: First-person accounts of recovery after suicide attempt(s). DEATH STUDIES 2022; 47:550-558. [PMID: 35939504 DOI: 10.1080/07481187.2022.2108941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study explores the recovery processes of persons who had attempted suicide. Semi-structured interviews were conducted with eight persons who had attempted suicide and the data were analyzed by means of systematic text condensation. The participants described lifesaving turning points, which were connected to meaningful relationships, taking control over one's own life, and establishing a new everyday life. Suicide prevention efforts must be adapted to individual needs. First-person knowledge is important if we are to understand what is seen as helpful and should be emphasized when implementing suicide prevention work.
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A call for change from impersonal risk assessment to a relational approach: professionals' reflections on the national guidelines for suicide prevention in mental health care in Norway. Int J Qual Stud Health Well-being 2021; 16:1868737. [PMID: 33407039 PMCID: PMC7801051 DOI: 10.1080/17482631.2020.1868737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of the study is to explore how professionals working with suicide prevention experience the influence of the national guidelines on mental healthcare, and to gather recommendations for which steps to take next. METHODS This is a qualitative study with an explorative design. We interviewed 22 professionals responsible for implementing suicide prevention action plans and guidelines, and/or conducting relevant research. We analysed the data by means of thematic analysis. RESULTS We found that the participants had an ambivalent view on risk assessment-it may be a tool, but it may also compromise other important aspects in prevention. Moreover, the possibility of liability has resulted in the need for self-protection. Instead, the participants recommended a relational approach to suicide prevention. CONCLUSIONS We found that the emphasis on standardized suicide risk assessment has negatively influenced suicide prevention in mental healthcare, and an approach emphasizing relational aspects is recommended. However, the prevailing objectifying concept of knowledge, the epistemological debate and the emergence of the New Public Management ideology may obstruct a fundamental emphasis on relationships. A paradigm shift in mental healthcare is called for with respect to the concept of knowledge, which forms our understandings and practices.
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Religion as Meaning-Making Resource in Understanding Suicidal Behavior in Ghana and Uganda. Front Psychol 2021; 12:549404. [PMID: 34163388 PMCID: PMC8215103 DOI: 10.3389/fpsyg.2021.549404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/06/2021] [Indexed: 01/27/2023] Open
Abstract
Suicidal behavior is condemned by religions and tradition, and suicide attempts are criminalized by law in several African countries, including Ghana and Uganda. Suicide and suicide attempts may have severe consequences for both the entire family and the community. Religion is known to act as a protective coping force that helps people to make meaning and find comfort when dealing with stressful life events or situations like suicide. In this article, we focus on the cultural interpretations of the dominating religion in Ghana and Uganda, Christianity, and whether these affect attitudes toward suicidal behavior, meaning making, and coping possibilities for people who have attempted suicide or are bereaved by suicide. This article is based on data material from previous studies on the mentioned topics by the authors.
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Can we have a genuine debate about suicide prevention in Norway? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2021; 141:20-0945. [PMID: 33876621 DOI: 10.4045/tidsskr.20.0945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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"Time to Try Something New" - Professionals' Experiences and Reflections on Suicide Prevention in Norway. CRISIS 2020; 42:434-440. [PMID: 33241740 DOI: 10.1027/0227-5910/a000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: The suicide rate in Norway has remained relatively stable despite 25 years of government-funded suicide prevention efforts. Aim: We aimed to gather experiences of the professionals responsible for implementing suicide prevention action plans and guidelines and/or involved in relevant research. Method: We conducted semistructured interviews with 22 professionals about their reflections on the priorities and work done so far as well as where to go next. Data were analyzed by means of thematic analysis. Results: The participants described conflicting understandings and a monopolization of "the truth" within the suicide prevention community. They perceived the dominant biomedical understanding of suicidality and appurtenant approach to suicide prevention as too narrow. Thus, they found the suicide prevention work and collaboration challenging and recommend that it is time to try something new. Limitations: This study was conducted in a Norwegian context. A biomedical approach to suicide prevention is, however, common internationally. Conclusion: Participants described several challenges in the suicide prevention work. The contemporary "regime of truth" limits how suicide is understood and studied, as well as how suicide prevention is approached. A more open approach to suicide prevention, emphasizing the importance of relationships, context, and collaboration between sectors, is recommended.
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" … I felt completely stranded": liminality and recognition of personhood in the experiences of suicidal women admitted to psychiatric hospital. Int J Qual Stud Health Well-being 2020; 15:1731995. [PMID: 32106793 PMCID: PMC7054963 DOI: 10.1080/17482631.2020.1731995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: The purpose of this study is to explore how patients experience their suicidality and how they experience being in a psychiatric hospital. Methods: This is part of a field study, and the article is based on data collected in interactions with 11 women who were admitted to a psychiatric hospital and were struggling with suicidality. Data were collected through interviews, conversations, and participatory observation. We analysed the data by means of Systematic Text Condensation, followed by a deductive process where the data and preliminary findings were interpreted in light of the theory of liminality. Results: We found that the patients’ experiences of suicidality and being a patient in a psychiatric acute ward involve “Liminality and weakened sense of personhood,” and from their perspective, “Recognition of personhood” is an important aspect of care. Conclusion: Our study indicates that suicidality and psychiatric hospitalization involve liminality and weakened sense of personhood, aspects that are important to consider in the care of the patients. Professionals need to acknowledge more the importance of recognition of personhood in care, since this can strengthen the patient’s self-worth and empower the person. Lack of recognition may increase the patient’s suffering and suicidality.
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Response to Bantjes and Swartz. QUALITATIVE HEALTH RESEARCH 2020; 30:942-943. [PMID: 31789132 DOI: 10.1177/1049732319890310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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"If you do not birget [manage] then you don't belong here": a qualitative focus group study on the cultural meanings of suicide among Indigenous Sámi in arctic Norway. Int J Circumpolar Health 2020; 78:1565861. [PMID: 30675809 PMCID: PMC6346707 DOI: 10.1080/22423982.2019.1565861] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Suicide is a major public health issue across the Arctic, especially among Indigenous Peoples. The aim of this study was to explore and describe cultural meanings of suicide among Sámi in Norway. Five open-ended focus group discussions (FGDs) were conducted with 22 Sámi (20) and non-Sámi (2) participants in South, Lule, Marka, coastal and North Sámi communities in Norway. FGDs were recorded, transcribed verbatim and analysed employing thematic analysis. Six themes were developed from the analysis: “Sámi are treated negatively by the majority society”, “Some Sámi face negative treatment from other Sámi”, “The historic losses of the Sámi have turned into a void”, “Sámi are not provided with equal mental health care”, “The strong Sámi networks have both positive and negative impacts” and “‘Birgetkultuvvra’ might be a problem”. The findings indicate that the participants understand suicide among Sámi in relation to increased problem load for Sámi (difficulties in life not encountered by non-Sámi) and inadequate problem-solving mechanisms on different levels, including lack of equal mental health care for Sámi and cultural values of managing by oneself (“ieš birget”). The findings are important when designing suicide prevention initiatives specifically targeting Sámi.
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The emperor's new clothes? A critical look at the interpersonal theory of suicide. DEATH STUDIES 2020; 44:168-178. [PMID: 30696383 DOI: 10.1080/07481187.2018.1527796] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/17/2018] [Indexed: 05/18/2023]
Abstract
The Interpersonal Theory of Suicide currently seems to be the most popular theory in suicidology. It posits that suicide can be explained by the simultaneous presence of three risk factors only, namely acquired capability for suicide, thwarted belongingness, and perceived burdensomeness. Suicide is, however, widely accepted as a complex, multifactorial, and contextual phenomenon. It is, therefore, surprising that a theory comprised by three internal factors only is so uncritically embraced by suicide researchers. In this article, we scrutinize the theory's background, core components, and purported empirical evidence and argue that its popularity is highly unwarranted.
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Abstract
Background: Condemnatory reactions toward suicide are prevalent in Africa, yet no study has examined how society reacts to suicides from the perspective of suicide-bereaved persons. Aims: This qualitative study explored societal reactions to suicides so as to further our understanding of the problem in Ghana. Method: Using a semi-structured interview guide, we interviewed 45 close relations of 14 men who took their lives. Results: The reactions followed ontological questions of what suicide means (construing the act), its impact (consequences), why it happened and who to blame (attributions and allocation of responsibility), and how to remedy perceived damages (damage control). Limitations: Focusing on suicides of only men might have limited the range of societal reactions to suicide in general. Conclusion: Reparative and retributive societal reactions to suicides were influenced predominantly by views that suicide is an extraordinary moral evil in the setting. Increased culturally focused suicide education can improve people's understanding and enhance responsive suicide prevention and postvention.
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Epistemological differences in the discussion of the interpersonal theory of suicide: A reply to the response. DEATH STUDIES 2019; 45:163-165. [PMID: 31074364 DOI: 10.1080/07481187.2019.1614112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This paper is a reply to Smith and colleagues' response to our critique of the interpersonal theory of suicide (IPTS). They believe that we mischaracterize and misinterpret aspects of the IPTS. Here, we argue that the problem rather seems to be that we are discussing the IPTS from two different epistemological "planets."
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Abstract
Based on a 10-year systematic review of suicide prevention strategies, “29 suicide prevention experts from 17 European countries” recommend 4 allegedly evidence-based strategies to be included in national suicide prevention programs. One of the recommended strategies is pharmacological treatment of depression. This recommendation is problematic for several reasons. First, it is based on a biased selection and interpretation of available evidence. Second, the authors have failed to take into consideration the widespread corruption in the research on antidepressants. Third, the many and serious side effects of antidepressants are not considered. Thus, the recommendation may have deleterious consequences for countless numbers of people, and, in fact, contribute to an increase in the suicide rate rather than a decrease.
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Abstract
This study examined the reasons for suicide attempts among patients in Ghana. Semi-structured interviews were conducted among 30 informants who had been hospitalized for attempted suicide. Interpretative Phenomenological Analysis (IPA) was used to analyse the transcribed narratives, and five main themes emerged: 1) lack of support; 2) abandonment; 3) shame; 4) existential struggles; and 5) supernatural reasons. There were gender differences with abandonment reported by only women and shame associated with economic difficulties reported only by men. Findings are discussed within the context of a socio-cultural theory of suicide behaviour, and implications for the prevention of suicide and care of suicidal persons are suggested.
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Abstract
In Ghana, some studies have reported a high rate for both fatal and non-fatal suicidal behaviors among men. The current study aimed at understanding the psychosocial circumstances involved in male suicides. We interviewed between two to seven close relations of each of 12 men who died by suicide. Interpretative phenomenological analysis of data indicates that experiences of shame related to loss of economic control, breach of patriarchal norms, and threats to sexual competence contributed to the suicides. Addressing socioeconomic issues, creating opportunities for men to disclose their emotions, and identifying sources of these emotions may help prevent suicide among men.
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Abstract
Purpose: The purpose of this study is to explore how former suicidal inpatients experienced treatment and care in psychiatric wards in Norway following the implementation of the National guidelines for prevention of suicide in mental health care. The focus of the analysis was on aspects of treatment and care with potential for improvement. Method: We interviewed five former inpatients and analysed the data by means of Interpretative Phenomenological Analysis. Results: Experiencing a sense of companionship with the staff and receiving individualized treatment and care was important for the participants. This involved establishing trusting connections with mental health workers who treated them with respect, made them feel valued, and who recognized their suffering and needs. The formerly suicidal patients experienced being in a recovery process, which was promoted by the support of mental health workers. Although the participants reported mostly positive experiences, there were examples of insufficient care. Sometimes, they felt that their suffering and suicidality were not sufficiently recognized. Conclusion: Our study indicates that although there has been increased focus on suicidality in the mental health services, among other through clinical guidelines, some mental health workers still lack competence and should focus more fully on how to provide individualized care for suicidal inpatients.
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Abstract
BACKGROUND Suicide is a public health problem in Uganda among indigenous societies, and different societies manage its aftermath differently. AIM To explore how the Acholi in Northern Uganda manage the aftermath of suicide. METHODS We conducted a qualitative study in Gulu district, a post-conflict area in Northern Uganda. We conducted a total of four focus group discussions (FGDs) and 12 key informant (KI) interviews. KI interviews were conducted with community leaders, while the FGDs were conducted with members of the general population. We analysed the data by means of Grounded Theory. RESULTS Our findings indicate that rituals form a large part in managing suicide among the Acholi. Study communities practised distancing (symbolically and physically) as a way of dealing with the threat of suicide. CONCLUSION Distancing was organized into two broad themes: affect regulation and securing future generations. It is recommended that public health interventions should utilize cultural institutions in the prevention of suicide.
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To die or not to die: a qualitative study of men's suicidality in Norway. BMC Psychiatry 2018; 18:263. [PMID: 30134954 PMCID: PMC6103984 DOI: 10.1186/s12888-018-1843-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/10/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Previous research has shown that men who adhere to traditional beliefs about masculinity have increased health risks compared to those who do not. Single marital status, unemployment, retirement, and physical illness are commonly known risk factors for male suicidal behavior. Most men struggling with these risk factors are, however, not suicidal. To find out more about what makes some men vulnerable to suicidal behavior, risk factors must be analyzed in light of men's life history as well as the social context where they live their masculinity. METHOD We conducted semi-structured qualitative in-depth interviews with 15 men (20-76 years old) who were admitted to hospital after a suicidal act. We analyzed the data by means of qualitative content analysis with a directed approach. The analysis was directed by the participants' reports on whether they had wanted to die or not at the time of the suicidal act. On this basis, they were divided into two groups: a "to die" and a "not to die" group. We then analyzed each group separately before comparing them. RESULTS In both groups, the main reason or trigger for the suicidal act were problems in intimate relationships. These problems were complex and connected to the men's lived masculinity, ranging from shame, or tainted masculine honor, to taking responsibility as a man for the wife. Some men pointed to pain and ennui as reasons or triggers for their suicidal act. Only one in the "not to die" group took full responsibility for the suicidal act, whereas all but one did the same in the "to die" group. The men not taking responsibility described the suicidal act as involuntary because of either alcohol or a kind of "black-out". Not taking responsibility for the act may be a way of preserving masculine identity. CONCLUSION Relationship problems are the main reason or trigger of the suicidal act for most participants, but in very different ways, mirroring lived masculinity. The most striking finding is the uniqueness of each story, questioning the utility of standardized suicide prevention efforts.
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Abstract
This study explores barriers to help-seeking among young men prior to suicide. We analyzed 61 in-depth interviews with parents, siblings, friends, and ex-partners of 10 young men (aged 18-30) with no record of mental illness, as well as 6 suicide notes, using interpretative phenomenological analysis. Three barriers emerged: (a) a total defeat; (b) no room for weakness; and (c) fear of mental disorder. The shame from falling short of standards (own/significant male others') could be a considerable barrier to help-seeking in a suicidal crisis.
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Better care, fewer suicides? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2018; 138:17-1039. [DOI: 10.4045/tidsskr.17.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Abstract
One of the most well-established truths in suicidology is that mental disorders play a significant role in at least 90% of suicides, and a causal relationship between the two is often implied. In this article, the authors argue that the evidence base for this truth is weak and that there is much research questioning the 90% statistic. Based on numerous examples, they also argue that ideology, politics, power, and vested interests among influential professionals in the field obstruct argument-based discussion of this issue. The authors also discuss unfortunate consequences of the constant reiteration of the 90% statistic.
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From condemnation to understanding: Views on suicidal behavior in Ghana in transition. DEATH STUDIES 2017; 41:532-541. [PMID: 28532253 DOI: 10.1080/07481187.2017.1333357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The cultural context in which suicide occurs has been emphasized as critical in understanding the act and informing prevention. Yet the penchant of psychiatrizing suicidality in mainstream suicidology relegates cultural issues to the background. Through the lenses of critical cultural suicidology, the authors have re-emphasized the importance of culture by reviewing the two major meanings of suicide as observed in our 8-year study in Ghana: moral transgression and life crisis. They have also showed the usefulness of the life crisis perspective of suicidality in reducing stigma and sustaining advocacy in decriminalizing attempted suicide in the country.
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Abstract
In this qualitative interview study, the authors investigated how therapists experience and view treatment and care for suicidal patients in psychiatric wards. The focus is on aspects that may contribute toward shaping and possibly constraining therapists' connections with suicidal individuals. They conducted semistructured interviews of 4 psychiatrists and 4 psychologists and analyzed the data by means of thematic analysis. The findings suggest that high emphasis on diagnostics and standardized suicide risk assessments, limited direct care of suicidal patients, and fragmented mental health services may challenge therapists' connections with suicidal patients.
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Mental Health Nurses' Experiences of Caring for Suicidal Patients in Psychiatric Wards: An Emotional Endeavor. Arch Psychiatr Nurs 2017; 31:31-37. [PMID: 28104055 DOI: 10.1016/j.apnu.2016.07.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 01/10/2023]
Abstract
The purpose of the study is to investigate mental health nurses' experiences of recognizing and responding to suicidal behavior/self-harm and dealing with the emotional challenges in the care of potentially suicidal inpatients. Interview data of eight mental health nurses were analyzed by systematic text condensation. The participants reported alertness to patients' suicidal cues, relieving psychological pain and inspiring hope. Various emotions are evoked by suicidal behavior. Mental health nurses seem to regulate their emotions and emotional expressions, and balance involvement and distance to provide good care of patients and themselves. Mental health nurses have an important role and should receive sufficient formal support.
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Relational Principles in the Care of Suicidal Inpatients: Experiences of Therapists and Mental Health Nurses. Issues Ment Health Nurs 2017; 38:99-106. [PMID: 27901635 DOI: 10.1080/01612840.2016.1246631] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study explored and compared therapists' and mental health nurses' experiences of caring for suicidal inpatients in light of ethics of care and ethics of justice. Analysis of interview data from eight therapists and eight mental health nurses indicates two approaches: "connection and care" and "duty and control," reflecting aspects of both ethical perspectives. There are some differences between the two professional groups, and sometimes there might be conflicts between the two approaches and ethical perspectives. Clinical practice is increasingly shaped by standardization and guidelines, and it is important to promote professionals' efforts to provide relational-emotional care for suicidal patients.
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Abstract
Theoretical publications have been relatively few and far between in suicidology. This paper is a contribution to the theoretical development of this field. A model of suicidal behaviour as communication (MoSBaC) is elaborated through a combination of Scandinavian theories within the framework of communication theory and semiotics. The model is functional as it can be used as a tool to analyse both verbal and non-verbal data. It is also flexible in the sense that a variety of qualitative data can be analysed systematically by this model. The typology of the model also is suitable for quantitative approaches. The scientific and multidisciplinary grounds on which a model should be built, what requirements it has to meet, as well as the methodological consequences of this, are also discussed.
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The law criminalizing attempted suicide in Ghana: the views of clinical psychologists, emergency ward nurses, and police officers. CRISIS 2015; 35:132-6. [PMID: 24197485 DOI: 10.1027/0227-5910/a000235] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Attempted suicide is still considered a crime in Ghana. AIMS The purpose of this study was to investigate the attitudes toward this law held by health workers and police officers in Ghana so as to provide culture-sensitive arguments to aid in abolishing the law. METHOD Qualitative interviews were conducted with eight clinical psychologists, eight emergency ward nurses, and eight police officers. RESULTS The majority of informants did not agree with the law criminalizing attempted suicide in Ghana, although five of the emergency ward nurses and two police officers did. Arguments for agreeing with the law were that people have no right to take life and that the law has a deterrent effect and thus it will help reduce the suicide rate. The main argument for not agreeing with the law was that suicidal behavior is a mental health issue. Those who argued in favor of the law did not seem to reflect much on the reasons for suicidal behavior. CONCLUSION Education on how to understand suicidal behavior and suicidal people may aid the work toward decriminalizing attempted suicide in Ghana.
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Suicidal behaviour across the African continent: a review of the literature. BMC Public Health 2014; 14:606. [PMID: 24927746 PMCID: PMC4067111 DOI: 10.1186/1471-2458-14-606] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 05/28/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Suicide is a major cause of premature mortality worldwide, but data on its epidemiology in Africa, the world's second most populous continent, are limited. METHODS We systematically reviewed published literature on suicidal behaviour in African countries. We searched PubMed, Web of Knowledge, PsycINFO, African Index Medicus, Eastern Mediterranean Index Medicus and African Journals OnLine and carried out citation searches of key articles. We crudely estimated the incidence of suicide and suicide attempts in Africa based on country-specific data and compared these with published estimates. We also describe common features of suicide and suicide attempts across the studies, including information related to age, sex, methods used and risk factors. RESULTS Regional or national suicide incidence data were available for less than one third (16/53) of African countries containing approximately 60% of Africa's population; suicide attempt data were available for <20% of countries (7/53). Crude estimates suggest there are over 34,000 (inter-quartile range 13,141 to 63,757) suicides per year in Africa, with an overall incidence rate of 3.2 per 100,000 population. The recent Global Burden of Disease (GBD) estimate of 49,558 deaths is somewhat higher, but falls within the inter-quartile range of our estimate. Suicide rates in men are typically at least three times higher than in women. The most frequently used methods of suicide are hanging and pesticide poisoning. Reported risk factors are similar for suicide and suicide attempts and include interpersonal difficulties, mental and physical health problems, socioeconomic problems and drug and alcohol use/abuse. Qualitative studies are needed to identify additional culturally relevant risk factors and to understand how risk factors may be connected to suicidal behaviour in different socio-cultural contexts. CONCLUSIONS Our estimate is somewhat lower than GBD, but still clearly indicates suicidal behaviour is an important public health problem in Africa. More regional studies, in both urban and rural areas, are needed to more accurately estimate the burden of suicidal behaviour across the continent. Qualitative studies are required in addition to quantitative studies.
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J. Hagen og medarbeidere svarer:. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:593-4. [DOI: 10.4045/tidsskr.14.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Selvmord og psykiske lidelser. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014. [DOI: 10.4045/tidsskr.14.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Selvmordsforebygging i psykisk helsevern – på tide å tenke nytt? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:1222. [DOI: 10.4045/tidsskr.14.0479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Hagen og medarbeidere svarer:. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:1022. [DOI: 10.4045/tidsskr.14.0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Influence of religious factors on attitudes towards suicidal behaviour in Ghana. JOURNAL OF RELIGION AND HEALTH 2013; 52:488-504. [PMID: 21547612 DOI: 10.1007/s10943-011-9487-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The objective of this qualitative study was to understand how religion influences lay persons' attitudes towards suicide in Ghana. Twenty-seven adults from both rural and urban settings were interviewed. Interpretative phenomenological analysis was used to analyse the data. Results showed that the participants are committed to core and normative religious beliefs and practices they perceived as life preserving. Such an understanding influenced their view of suicidal behaviour as unacceptable. Nevertheless, religion facilitated their willingness to help people during suicidal crisis. Religious commitment theory is used to explain some of the findings of this study. Implications for suicide prevention are discussed.
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Pushing the boundaries: understanding self-harm in a non-clinical population. Arch Psychiatr Nurs 2013; 27:78-83. [PMID: 23540517 DOI: 10.1016/j.apnu.2012.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/31/2012] [Indexed: 10/27/2022]
Abstract
This study investigates 122 people's descriptions of their self-harm experiences using thematic analysis. Analysis revealed four themes: What counts as self-harm, What leads to self-harm, Intentions and Managing stigma. Our participants challenged commonly accepted understandings in terms of method, outcome and intentions. Several difficulties associated with discriminating between suicidal and non-suicidal self-harm were highlighted, which may be important in clinical practice. Few participants mentioned diagnosed psychiatric disorders; they best understood self-harm through their social experiences. Focusing on social understandings of self-harm may help reduce associated stigma and barriers to help-seeking.
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Self-harm and conventional gender roles in women. Suicide Life Threat Behav 2013; 43:161-73. [PMID: 23293983 DOI: 10.1111/sltb.12005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 10/22/2012] [Indexed: 11/30/2022]
Abstract
A total of thirty-two women admitted to a general hospital for medical treatment after self-harming completed measures of conventional positive and negative masculinity and femininity. Comparisons were made with two control groups with no self-harm history; 33 women receiving psychiatric outpatient treatment and a nonclinical sample of 206 women. Multinomial logistic regression analyses showed that those with lower scores on Instrumentality and Unmitigated Agency (positive and negative masculinity) and higher scores on Insecurity (negative femininity) had greater odds of self-harming. Relationships were weaker after accounting for generalized self-efficacy. Results are discussed in relation to previous findings and suggestions for prevention are made.
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Abstract
Relatively little research has been conducted on religion and suicide in Africa, yet religion has a lot of influence on people's way of life in Africa. To study religious views on suicide among the Baganda, Uganda, we used grounded theory and discourse analysis on a total of 28 focus groups and 30 key informant interviews. Suicide is largely seen as a breach of God's doctrine life is sacred, God's commandment thou shall not kill, and God's rule of agape. The study also focuses on the consequences of breaching God's divine providence: punishment from God and the Church. Religion still has a lot of influence on people's views on suicide in Uganda despite the challenges highlighted in the study. A recommendation from these results is that suicide prevention should cater to divergent views on religion and suicide. More qualitative research should be conducted in this area to facilitate theoretical comparison with this study.
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Social-Environmental Factors and Suicide Mortality: A Narrative Review of over 200 Articles. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/sm.2013.32021] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The psychosocial circumstances surrounding men's suicide in postconflict Central Northern Uganda were investigated using qualitative psychological autopsy interviews. Records of 17 men who died by suicide were identified through police and local leaders in Internally Displaced Peoples' camps of Amuru and Gulu Districts. Two to five significant others were interviewed around each case. Data were analyzed by interpretative phenomenological analysis (IPA). Lost dignity and social value, lack of hope for the family's future, overwhelming family responsibility, and mental illness were circumstances found to have preceded the suicides. The protracted war in the Northern region of Uganda left men in rural communities feeling disempowered and disenfranchised. This may have contributed to suicidal behavior in some of them. Suicide prevention in this area needs to be multidisciplinary with an emphasis on helping both men and women understand and deal with the many social changes that have evolved over time and affected their traditional roles and responsibilities.
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An escape from agony: a qualitative psychological autopsy study of women's suicide in a post-conflict northern Uganda. Int J Qual Stud Health Well-being 2012; 7:1-13. [PMID: 22989691 PMCID: PMC3435508 DOI: 10.3402/qhw.v7i0.18463] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2012] [Indexed: 11/14/2022] Open
Abstract
We set out to investigate suicide among women in a post-conflict context in Northern Uganda using qualitative psychological autopsy interviews. Three to five relatives and friends for each of the three suicides recruited were interviewed (N=11). Through interpretative phenomenological analysis (IPA) we found that the women all had been through traumatic experiences attributable to the protracted war/conflict between the rebel groups and Ugandan Government armed forces. Nevertheless, the decision of self-inflicted death seemed to have been due to a combination of unpleasant experiences/events that prevailed within the last 3 months prior to the suicide. These experiences are summarized in two broad themes: No control in life and No care. Changes in the traditional gender roles, men's quest for their lost masculinity, and women's attempt to fight for their rights that was perceived as a cultural transgression contributed to the women's suicides.
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Alcohol and suicide in postconflict northern Uganda: a qualitative psychological autopsy study. CRISIS 2012; 33:95-105. [PMID: 22343055 DOI: 10.1027/0227-5910/a000119] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Alcohol has been noted to be an important factor in nearly 68% of the suicides in Northern Uganda, yet exactly how alcohol contributes to suicide in this region has not been studied. AIMS To determine how alcohol contributes to suicide in this region. METHODS Qualitative psychological autopsy interviews were conducted with bereaved relatives and friends of 20 suicides mainly from Internally Displaced Peoples' camps in Northern Uganda. Data were analyzed using a modified Interpretative Phenomenological analysis (IPA). RESULTS Alcohol had a direct or an indirect influence on the suicide of 16 out of the 20 decedents. Directly, alcohol facilitated the suicidal process, was a means to suicide, or had an influence on the decedents' lifestyles. Indirectly, alcohol had an influence on the suicidal process of the deceased through the drinking behavior of significant others. CONCLUSIONS This study established that alcohol not only contributes to the suicidal process of the individuals through acute and chronic alcohol consumption, but also through victimization of those lowest in the power hierarchy by alcohol abusers higher up in the power hierarchy. Therefore, future development of suicide prevention programs should address the interrelated public health problem of alcohol abuse.
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Psychological autopsy studies as diagnostic tools: are they methodologically flawed? DEATH STUDIES 2012; 36:605-26. [PMID: 24563941 PMCID: PMC3662079 DOI: 10.1080/07481187.2011.584015] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 01/18/2011] [Indexed: 05/04/2023]
Abstract
One of the most established "truths" in suicidology is that almost all (90% or more) of those who kill themselves suffer from one or more mental disorders, and a causal link between the two is implied. Psychological autopsy (PA) studies constitute one main evidence base for this conclusion. However, there has been little reflection on the reliability and validity of this method. For example, psychiatric diagnoses are assigned to people who have died by suicide by interviewing a few of the relatives and/or friends, often many years after the suicide. In this article, we scrutinize PA studies with particular focus on the diagnostic process and demonstrate that they cannot constitute a valid evidence base for a strong relationship between mental disorders and suicide. We show that most questions asked to assign a diagnosis are impossible to answer reliably by proxies, and thus, one cannot validly make conclusions. Thus, as a diagnostic tool psychological autopsies should now be abandoned. Instead, we recommend qualitative approaches focusing on the understanding of suicide beyond mental disorders, where narratives from a relatively high number of informants around each suicide are systematically analyzed in terms of the informants' relationships with the deceased.
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Mental health workers' views on the criminalization of suicidal behaviour in Uganda. MEDICINE, SCIENCE, AND THE LAW 2012; 52:148-151. [PMID: 22528562 DOI: 10.1258/msl.2012.011107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Attempted suicide is still criminalized in Uganda. However, the Ministry of Health has asked the psychiatric community to help in the work to abolish this law. The purpose of this study was to investigate how Ugandan mental health workers view this law. We conducted a qualitative interview study of 30 mental health workers (psychiatrists, psychologists, psychiatric clinical officers and psychiatric nurses). We found that two-thirds of this sample wanted the law abolished, mainly because they view suicidal behaviour as a mental health issue. Some, however, wanted to keep the law because they viewed it as a suicide prevention in that it would deter people from killing themselves. A few were ambivalent. The findings indicate a need for increased awareness of the negative consequences of the law as well as educating mental health workers in understanding of suicidal behaviour and suicidal people.
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Abstract
This study investigates whether positive and negative conventional gender roles relate to suicidal ideation and self-harming in different ways among young adults. Participants completed an online survey about previous self-harm, recent suicidal ideation, and positive and negative aspects of conventional masculinity and femininity. Logistic regression analyses showed that negative femininity positively predicted self-harm and recent suicidal ideation status. Positive femininity was unrelated. Positive masculinity was negatively related to suicidal ideation and self-harming while negative masculinity was negatively related to self-harming only. The findings suggest that it is not the conventional feminine gender role per se that is associated with suicidality but specific negatively evaluated aspects. Conceptualizing gender as a multivariate construct may be useful in the gender socialization theory of suicidal behavior.
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Attitudes of psychologists and nurses toward suicide and suicide prevention in Ghana: a qualitative study. Int J Nurs Stud 2011; 49:691-700. [PMID: 22177569 DOI: 10.1016/j.ijnurstu.2011.11.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 11/21/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND One way of preventing suicide has been increasing awareness among health care professionals of their own attitudes and taboos toward suicide and its prevention. OBJECTIVE The purpose of this study was to understand the attitudes of health professionals toward suicidal behavior and its prevention in Ghana. METHODS A total of 17 informants (9 clinical psychologists and 8 emergency ward nurses) in an urban center were interviewed using a semi-structured interview guide. Interpretative Phenomenological Analysis (IPA) was used to analyze the data. RESULTS We found that the attitudes of these health workers toward suicide and suicide prevention seemed to be transiting between morality and mental health. The psychologists generally saw suicide as a mental health issue, emphasized a caring and empathic view of suicidal persons and approached suicide prevention from a health-service point of view. Mental health education and improvements in primary health care were reported as practical approaches toward suicide prevention. The nurses on the other hand, held a moralistic attitude toward suicide as a crime, viewed suicide persons as blameworthy and approached suicide prevention from a proscriptive perspective. Informal approaches such as talking to people, strengthening the legal code against suicide and threatening suicidal persons with the religious consequences of the act were also indicated as practical approaches to suicide prevention. Educational level, clinical experience with suicidal persons, and religious values, are discussed as influencing the differences in attitudes toward suicide and suicide prevention between psychologists and nurses. CONCLUSION Health workers in Ghana need training in suicidology to improve both knowledge and skills relevant for suicide prevention.
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Social injury: An interpretative phenomenological analysis of the attitudes towards suicide of lay persons in Ghana. Int J Qual Stud Health Well-being 2011; 6:QHW-6-8708. [PMID: 22065981 PMCID: PMC3209819 DOI: 10.3402/qhw.v6i4.8708] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2011] [Indexed: 11/14/2022] Open
Abstract
One way of furthering our understanding of suicidal behaviour is to examine people's attitudes towards it and how they conceive the act. The aim of this study was to understand how lay persons conceive the impact of suicide on others and how that influences their attitudes towards suicide; and discuss the implications for suicide prevention in Ghana. This is a qualitative study, using a semi-structured interview guide to investigate the attitudes and views of 27 lay persons from urban and rural settings in Ghana. Interpretative Phenomenological Analysis was used to analyse the data. Findings showed that the perceived breach of interrelatedness between people due to suicidal behaviour influenced the informants' view of suicide as representing a social injury. Such view of suicide influenced the negative attitudes the informants expressed towards the act. The negative attitudes towards suicide in Ghana are cast in consequential terms. Thus, suicide is an immoral act because it socially affects others negatively. The sense of community within the African ethos and The Moral Causal Ontology for Suffering are theoretical postulations that are used to offer some explanations of the findings in this study.
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Abstract
This qualitative study investigated attitudes and cultural responses to suicide among the Baganda in Uganda using both focus group discussions and key-informant interviews. Interviews indicate that suicide is perceived as dangerous to the whole family and the entire community. Communities and family members adopt various ritual practices to distance themselves both symbolically and socially from the suicide. These rituals are characterized by broad themes: the regulation of affect and the attempt to secure future generations.
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Abstract
The objective of this study was to examine psychology students' attitudes toward suicidal behaviour and the meanings they assign to the act. In-depth interviews were conducted with 15 final year psychology students at a university in Ghana. Interpretative Phenomenological Analysis (IPA) was used to analyze the data. The results indicated that the students had a generalized negative attitude toward suicide. Religious beliefs and family harmony are cultural contexts influencing the interpretation of suicidal behaviour as breach of divine and communal moralities. The implications of these meanings of suicidal behaviour for suicide prevention in Ghana are discussed.
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Qualitative psychological autopsy interviews on suicide in post-conflict Northern Uganda: the participants' perceptions. OMEGA-JOURNAL OF DEATH AND DYING 2011; 63:235-54. [PMID: 21928598 DOI: 10.2190/om.63.3.c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Participants' perceptions of psychological autopsy interviews were investigated in post-conflict Northern Uganda. Data were derived out of their responses in the debriefing session after the formal interviews. These responses were subjected to Interpretative Phenomenological Analysis (IPA). The majority of the participants were positive about the interview as reflected in the two broad themes: positivation of the situation through the possibility of helping others and opportunity for personal development through sharing. To some few participants the interview aroused guilt, self-reproach, and anger and reactivated painful memories. As regards suicide postvention, the findings implied that not much has been done to help the bereaved by suicide in this region, and few resources for such efforts are currently available. However, the bereaved are ready to contribute toward the fight against suicide in their communities. Hence, it is argued that a community-based mental health and Primary Health Care approaches should be encouraged in this context.
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