1
|
Zuromski KL, Wilks C, Al-Suwaidi M, Wittler E, Scherban L, Hite B, Raymond L, Dempsey CL, Stein MB, Ursano RJ, Benedek D, Nock MK. Perspectives of suicide loss survivors: Qualitative analysis of data from a psychological autopsy study of U.S. Army soldiers. Suicide Life Threat Behav 2024; 54:437-449. [PMID: 38353139 PMCID: PMC11164635 DOI: 10.1111/sltb.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Suicide loss survivors can provide information not otherwise available about the circumstances preceding a suicide. In this study, we analyzed interview data from suicide loss survivors collected as part of a psychological autopsy study of U.S. Army soldiers. METHODS Next-of-kin (NOK) (n = 61) and Army supervisors (SUP) (n = 107) of suicide decedents (n = 135) who had died in the last 2-3 months answered open-ended questions about suicide risk factors, ideas for improving suicide prevention, and the impact of the suicide. Responses were coded using conventional content analysis methods to identify common themes. RESULTS Many NOK (30%) and SUP (50%) did not observe any signs of risk preceding the soldier's suicide. The most common idea regarding suicide prevention from SUP was that the suicide was inevitable, whereas NOK were more likely to emphasize the importance of increasing mental health treatment and reducing stigma. Both NOK and SUP reported negative effects of the suicide, but SUP reported some positive effects (e.g., increased unit connectedness). CONCLUSIONS Results underscore the challenges of using informants to identify soldiers at high risk of suicide, given many respondents did not observe any warning signs. Findings also highlight attitudinal barriers present in the military that, if targeted, may increase soldiers' help-seeking and willingness to disclose their risk.
Collapse
Affiliation(s)
| | | | | | | | | | - Blake Hite
- Department of Psychology, Harvard University
| | | | - Catherine L. Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - Murray B. Stein
- Department of Psychiatry and Family Medicine & Public Health, University of California, San Diego
- Veterans Affairs San Diego Healthcare System
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - David Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | | |
Collapse
|
2
|
Gunn J, McGrain P, Ördög B, Guerin M. Their final words: An analysis of suicide notes from the United States. DEATH STUDIES 2024:1-11. [PMID: 38709641 DOI: 10.1080/07481187.2024.2348057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
The present study sought to explore motivations (affective, relationships, life events, injury/medical diagnosis) in suicide notes (N = 49) from the U.S. Authors ranged in age from 18 to 74 years and were majority male (73.5%). Four raters analyzed the notes and, through a series of meetings, came to a consensus on the motives behind each note writers' suicide in terms of the broader motivational themes and the narrower second-level themes. All notes were primarily affectional in nature, with some gender and age differences. For example, suicide notes from males frequently refer to financial hardships whereas suicide notes from females were more focused on lowered self-worth and notes written by younger persons focused more on affect and relationships, while notes written by older adults focused on life events and marriage difficulties and separation. Findings illuminate the varied nature of suicide motivations but also highlight important patterns across groups.
Collapse
Affiliation(s)
- John Gunn
- Gwynedd Mercy University, Gwynedd Valley, Pennsylvania, USA
| | | | - Brielle Ördög
- Gwynedd Mercy University, Gwynedd Valley, Pennsylvania, USA
| | | |
Collapse
|
3
|
Marionneau V, Nikkinen J. Gambling-related suicides and suicidality: A systematic review of qualitative evidence. Front Psychiatry 2022; 13:980303. [PMID: 36387006 PMCID: PMC9645554 DOI: 10.3389/fpsyt.2022.980303] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
The relationship between gambling and suicides or suicidality has received much research attention in recent years. Review studies have already mapped the quantitative occurrence of suicide attempts, suicides, and self-harm among gamblers, and found a positive association. Related comorbidities and conditions have also been charted in previous reviews. However, there is still a gap in knowledge regarding the actual processes that connect gambling and suicidal behavior. To understand these processes, the current paper conducts a systematic review of qualitative evidence on gambling-related suicides and suicidality. The aim was to identify the role of gambling as well as of confounding factors in suicidality, and what kind of support suicidal individuals have received or would need. We searched for relevant literature in seven scientific databases. We included all studies that presented empirical qualitative evidence on gambling-related suicide, suicidality and/or self-harm (N = 20). The results show two main processes that connect gambling and suicidal behavior: indebtedness and shame. At the same time, suicide is a multifactorial phenomenon, and related to other confounding factors. These include psychiatric conditions, personality traits, and life conditions. In many cases, these appear to emerge as a consequence of gambling. Treatment for suicidality has been effective in some cases, but indebtedness and shame may also function as barriers to help-seeking. We conclude that effective prevention is needed by adapting a more comprehensive public health approach and population-level interventions.
Collapse
Affiliation(s)
- Virve Marionneau
- Faculty of Social Sciences, Centre for Research on Addiction, Control, and Governance, University of Helsinki, Helsinki, Finland
| | | |
Collapse
|
4
|
Conner KR, Chapman BP, Beautrais AL, Brent DA, Bridge JA, Conwell Y, Falter T, Holbrook A, Schneider B. Introducing the Psychological Autopsy Methodology Checklist. Suicide Life Threat Behav 2021; 51:673-683. [PMID: 33559215 PMCID: PMC8378509 DOI: 10.1111/sltb.12738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Case-control psychological autopsy studies are the research standard for the postmortem, quantitative study of ongoing or recent risk factors for suicide. We aimed to develop a reliable checklist of methodological quality of these studies. METHOD We adapted items from a validated checklist to address general methodological elements and created novel items to address the unique aspects of psychological autopsy research to generate a 16-item checklist assessing reporting, external validity, internal validity, and power. We used percent agreement and kappa to evaluate inter-rater reliability of the items and overall checklist based on independent ratings of 26 case-control psychological autopsy studies conducted internationally. We also summed the items to generate overall quality ratings, assessing internal consistency with coefficient alpha (α). RESULTS Inter-rater reliability for the overall checklist was high (percent agreement, 86.5%) and that based conservatively on kappa was substantial (κ .71) whereas internal consistency was low (α = 0.56). The inter-rater reliability of the individual items showed acceptable to high agreement. CONCLUSION A novel checklist provides a reliable means to assess the methodological quality of specific elements of quantitative case-control psychological autopsy studies, providing detailed guidance in planning such studies. Lower internal consistency may limit its utility as a summary measure of study quality.
Collapse
Affiliation(s)
- Kenneth R. Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Benjamin P. Chapman
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - David A. Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey A. Bridge
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Tyler Falter
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Amanda Holbrook
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Barbara Schneider
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Centre of Psychiatry, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany
| |
Collapse
|
5
|
Hjelmeland H, Loa Knizek B. 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.
Collapse
Affiliation(s)
- Heidi Hjelmeland
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Birthe Loa Knizek
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
6
|
Hagaman AK, Khadka S, Wutich A, Lohani S, Kohrt BA. Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths. Cult Med Psychiatry 2018; 42:704-734. [PMID: 29881930 PMCID: PMC6286252 DOI: 10.1007/s11013-018-9585-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
South Asia accounts for the majority of the world's suicide deaths, but typical psychiatric or surveillance-based research approaches are limited due to incomplete vital surveillance. Despite rich anthropological scholarship in the region, such work has not been used to address public health gaps in surveillance and nor inform prevention programs designed based on surveillance data. Our goal was to leverage useful strategies from both public health and anthropological approaches to provide rich narrative reconstructions of suicide events, told by family members or loved ones of the deceased, to further contextualize the circumstances of suicide. Specifically, we sought to untangle socio-cultural and structural patterns in suicide cases to better inform systems-level surveillance strategies and salient community-level suicide prevention opportunities. Using a mixed-methods psychological autopsy approach for cross-cultural research (MPAC) in both urban and rural Nepal, 39 suicide deaths were examined. MPAC was used to document antecedent events, characteristics of persons completing suicide, and perceived drivers of each suicide. Patterns across suicide cases include (1) lack of education (72% of cases); (2) life stressors such as poverty (54%), violence (61.1%), migrant labor (33% of men), and family disputes often resulting in isolation or shame (56.4%); (3) family histories of suicidal behavior (62%), with the majority involving an immediate family member; (4) gender differences: female suicides were attributed to hopeless situations, such as spousal abuse, with high degrees of social stigma. In contrast, male suicides were most commonly associated with drinking and resulted from internalized stigma, such as financial failure or an inability to provide for their family; (5) justifications for suicide were attributions to 'fate' and personality characteristics such as 'stubbornness' and 'egoism'; (5) power dynamics and available agency precluded some families from disputing the death as a suicide and also had implications for the condemnation or justification of particular suicides. Importantly, only 1 out of 3 men and 1 out of 6 women had any communication to family members about suicidal ideation prior to completion. Findings illustrate the importance of MPAC methods for capturing cultural narratives evoked after completed suicides, recognizing culturally salient warning signs, and identifying potential barriers to disclosure and justice seeking by families. These findings elucidate how suicide narratives are structured by family members and reveal public health opportunities for creating or supplementing mortality surveillance, intervening in higher risk populations such as survivors of suicide, and encouraging disclosure.
Collapse
Affiliation(s)
- Ashley K Hagaman
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W Franklin St, Chapel Hill, NC, 27516, USA.
| | - Seema Khadka
- Transcultural Psychosocial Organization Nepal, Research Department, Kathmandu, Nepal
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
| | - Shyam Lohani
- Nobel College, Pokhara University, Kathmandu, Nepal
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
| |
Collapse
|
7
|
Mugisha J, Muyinda H, Hjelmeland H, Kinyanda E, Vancampfort D, Knizek BL. Cultural responses towards the aftermath of suicide among the Acholi in Northern Uganda. Int J Soc Psychiatry 2018; 64:545-553. [PMID: 29963938 DOI: 10.1177/0020764018784625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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.
Collapse
Affiliation(s)
- James Mugisha
- 1 Department of Sociology and Social Administration, Faculty of Arts and Social Sciences, Kyambogo University, Kampala, Uganda.,2 Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Herbert Muyinda
- 2 Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Heidi Hjelmeland
- 3 Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eugene Kinyanda
- 4 Medical Research Council (MRC)/Uganda Virus Research Institute, Entebbe, Uganda
| | - Davy Vancampfort
- 5 Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Catholic University Leuven, Leuven, Belgium
| | - Birthe Loa Knizek
- 3 Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
8
|
Hagaman AK, Khadka S, Lohani S, Kohrt B. Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1483-1494. [PMID: 28856382 PMCID: PMC5705471 DOI: 10.1007/s00127-017-1433-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Yearly, 600,000 people complete suicide in low- and middle-income countries, accounting for 75% of the world's burden of suicide mortality. The highest regional rates are in South and East Asia. Nepal has one of the highest suicide rates in the world; however, few investigations exploring patterns surrounding both male and female suicides exist. This study used psychological autopsies to identify common factors, precipitating events, and warning signs in a diverse sample. METHODS Randomly sampled from 302 police case reports over 24 months, psychological autopsies were conducted for 39 completed suicide cases in one urban and one rural region of Nepal. RESULTS In the total police sample (n = 302), 57.0% of deaths were male. Over 40% of deaths were 25 years or younger, including 65% of rural and 50.8% of female suicide deaths. We estimate the crude urban and rural suicide rates to be 16.1 and 22.8 per 100,000, respectively. Within our psychological autopsy sample, 38.5% met criteria for depression and only 23.1% informants believed that the deceased had thoughts of self-harm or suicide before death. Important warning signs include recent geographic migration, alcohol abuse, and family history of suicide. CONCLUSIONS Suicide prevention strategies in Nepal should account for the lack of awareness about suicide risk among family members and early age of suicide completion, especially in rural and female populations. Given the low rates of ideation disclosure to friends and family, educating the general public about other signs of suicide may help prevention efforts in Nepal.
Collapse
Affiliation(s)
- Ashley K Hagaman
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - S Khadka
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - S Lohani
- Nobel College, Pokhara University, Kathmandu, Nepal
| | - B Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
| |
Collapse
|
9
|
Hjelmeland H, Knizek BL. Suicide and mental disorders: A discourse of politics, power, and vested interests. DEATH STUDIES 2017; 41:481-492. [PMID: 28535129 DOI: 10.1080/07481187.2017.1332905] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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.
Collapse
Affiliation(s)
- Heidi Hjelmeland
- a Department of Mental Health , Norwegian University of Science and Technology , Trondheim , Norway
| | - Birthe L Knizek
- a Department of Mental Health , Norwegian University of Science and Technology , Trondheim , Norway
| |
Collapse
|