A Content Analysis of Online Suicide Notes: Attempted Suicide Versus Attempt Resulting in Suicide

Mindsets of suicide trajectories: An Linguistic Inquiry and Word Count analysis of suicide hotline conversations

OBJECTIVE

The aim of the study was to explore the psychological characteristics of the individuals with various suicide risks using computerized text analysis, in the hopes of a better understanding of suicide trajectories.

METHODS

627 first-time callers' records were randomly selected from Taiwan An-Shin Hotline database between 2013 and 2018. The voice records were evaluated by two psychologists to determine the levels of suicide risk (156 with uncertainty of risk, 177 with low suicidal ideation, 157 with high suicidal ideation, and 137 with suicide preparation/attempt) and transcribed into text. The Linguistic Inquiry and Word Count 2015 (LIWC2015) program combined with Chinese dictionary were then used to calculate the frequency of word categories.

RESULTS

Exploratory factor analysis identified four mindsets of language characteristics, named "opposition and questioning", "active engagement", "negative rumination", and "focus on death". Psychological descriptions of the mindsets were also obtained through correlation analysis with the LIWC2015 categories and indicators. The four mindsets effectively distinguished the callers with different levels of suicide risk.

CONCLUSION

The psychological characteristics of people with various suicide risks can be described and differentiated via the closed-word categories and composite indicators. These results provide useful information for practitioners and researchers.

Their final words: An analysis of suicide notes from the United States

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.

Understanding for Prevention: Qualitative and Quantitative Analyses of Suicide Notes and Forensic Reports

Suicide risk is associated with vulnerabilities and specific life events. The study's objective was to explore the relevance of data from forensic documentation on suicide deaths to the design of person-centered preventive strategies. Descriptive and thematic analyses were conducted of forensic observations of 286 deaths by suicide, including some with suicide notes. Key findings included the influence of health-and family-related adverse events, emotional states of loss and sadness, and failures of the health system to detect and act on signs of vulnerability, as confirmed by the suicide notes. Forensic documentation provides useful information to improve the targeting of preventive campaigns.

Content Analysis of Warning Signs Identified as Part of Crisis Response Planning in a Community Sample of Gun Owners and Non-owners

Background

Assessing for and identifying those at imminent risk for suicide continues to present challenges, especially as many who die do not interact with specialty mental health treatment preceding suicide. Suicide-specific interventions in healthcare settings have been found to improve suicide-related outcomes, yet little is known about the confluence of behavioral, cognitive, emotional, and physiological indicators of emotional distress as they correspond to other key risk characteristics and high-risk groups like gun owners.

Aim

The purpose of this content analysis was to examine self-identified warning signs of distress between gun owners and non-owners through crisis response planning (CRP).

Methods

Participants completed a collaborative CRP. Warning signs were categorized as being either behavioral, cognitive, emotional, or physiological in nature. Bivariate logistic regression models were used to examine associations between firearm ownership and variables of interest. Participants were evenly split between men (n = 44) and women (n = 44) and were predominantly white (67.1%) with a mean age of 35.9 (SD = 13.6).

Results

Emotional warning signs of distress (68.2%) were reported slightly more often than behavioral (65.9%) followed by physiological (52.3%), and cognitive (46.6%). Firearm owners were significantly more likely to be male (OR = 2.5, 95%CI [1.07-6.0]). All participants were about a fourth as likely to report both a behavioral and physiological warning sign concurrently (OR = 0.26, 95% CI [0.09-0.67]).

Conclusion

Similarities and departures in warning signs of emotional distress may inform future research exploring both self-reported warning signs and related self-management strategies identified through suicide-specific interventions, particularly among high-risk groups such as gun owners.

Funeral arrangements requested by suicide decedents in Shanghai and Wuhan, China

This qualitative study analyzed suicide notes left by 591 decedents in Shanghai and Wuhan, in China. General guidelines and detailed requests with regard to funeral service were coded. In general, suicide decedents preferred untraditional funerals, which were simple and speedy rather than grand and costly funeral arrangements. These choices suggested that suicide decedents could fear stigmatization and discrimination. Some suicide decedents regarded suicides as vicious deaths, and thus wished their families to dispose of the cursed bodily remains and tombs as swiftly as possible.

Negative coping style mediates the relationship between negative mental and suicide risk among migrant workers in China

Suicide is increasingly recognized as a major public health concern among migrant workers in China. Despite negative mental and negative coping styles being core themes found in suicide notes, there is scarce research addressing the theoretical framework of underlying mechanisms between these variables. The study was designed to examine the relationships of negative mental, negative coping styles, and suicide risk among migrant workers. It hypothesized that negative mental would exert a positive effect on suicide risk via increased negative coping. Using a cross-sectional design, the study was conducted using a sample of 3095 migrant workers from Shenzhen, China. Self-made Suicide Risk Scale (SRS), Short-form of the ULCA Loneliness Scale (USL-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Scale (GAD-7), Simplified Coping Style Questionnaire (SCSQ) were used to collect data. Structural equation modeling (SEM) was performed to quantitatively explore the path effects between negative mental, negative coping styles and suicide risk. Results showed that negative coping style had a positive association with suicide risk (β = 0.029, P < 0.001). Negative mental had both direct and indirect positive effects on suicide risk through negative coping styles (β = 0.109, β = 0.013, P < 0.001). Therefore, to prevent suicidal behaviors among migrant workers, targeted interventions focusing on improving their mental health and coping strategies are needed.

Self-Stigma and Its Relationship With Rates of Depression Diagnosis

Background: Self-stigma about suicide might impede people seeking help from mental health professionals. There is little research about self-stigma expressed by suicide decedents. Aims: We aimed to explore (a) self-stigma about suicide through examination of suicide notes; and (b) whether the expression of self-stigma was associated with the formal diagnoses of depression. Method: Data were extracted from notes left by people who died by suicide in two major Chinese cities (Shanghai, 2004-2017; Wuhan, 2005-2019). Note content was examined and self-stigma items were coded. Demographics associated with self-stigma were reported. Rates of depression were compared between note-leavers who expressed self-stigma, and those who did not. Results: Notes were left by 567 suicide decedents (representing about 19% all suicides). Approximately 25% notes contained at least one self-stigma item. Older people made fewer self-stigma references, as did people from Wuhan. Depression was not associated with self-stigma. Limitations: Not all people dying from suicide leave notes, and suicide notes variably report self-stigma, thus self-stigma about suicide may be underestimated. Conclusion: Self-stigma items varied across regions and age groups, but not with depression. Therefore, self-stigma expressed by suicide decedents may not reflect help-seeking behaviours from professional mental health services.

Suicide among Ugandan university students: evidence from media reports for 2010-2020

University students are in transition to adulthood and face multiple challenges that may lead to suicide. They are reported to have a higher risk of suicide by the World Health Organization. As there is no national suicide database in Uganda, we analysed student suicide using the press/media reports of suicides published between 2010 and 2020. A total of deaths by 23 suicide were identified: 19 were males, relationship problems were the main suicide reason (n = 6) and hanging was the most frequently used suicide method (n = 7). A strategic intervention to tackle suicide risk among university students is warranted.

Association between sensory impairment and suicidal ideation and attempt: a cross-sectional analysis of nationally representative English household data

OBJECTIVES

Sensory impairments are associated with worse mental health and poorer quality of life, but few studies have investigated whether sensory impairment is associated with suicidal behaviour in a population sample. We investigated whether visual and hearing impairments were associated with suicidal ideation and attempt.

DESIGN

National cross-sectional study.

SETTING

Households in England.

PARTICIPANTS

We analysed data for 7546 household residents in England, aged 16 and over from the 2014 Adult Psychiatric Morbidity Survey.

EXPOSURES

Sensory impairment (either visual or hearing), Dual sensory impairment (visual and hearing), visual impairment, hearing impairment.

PRIMARY OUTCOME

Suicidal ideation and suicide attempt in the past year.

RESULTS

People with visual or hearing sensory impairments had twice the odds of past-year suicidal ideation (OR 2.06; 95% CI 1.17 to 2.73; p<0.001), and over three times the odds of reporting past-year suicide attempt (OR 3.12; 95% CI 1.57 to 6.20; p=0.001) compared with people without these impairments. Similar results were found for hearing and visual impairments separately and co-occurring.

CONCLUSIONS

We found evidence that individuals with sensory impairments are more likely to have thought about or attempted suicide in the past year than individuals without.

Loneliness, hopelessness and suicide in later life: a case-control psychological autopsy study in rural China

AIMS

Loneliness is increasingly recognised as a serious public health issue worldwide. However, there is scarce research addressing the association between loneliness and suicide in older adults in rural China. We set out to examine loneliness and other psychosocial factors in elderly suicide cases and explore their interaction effects.

METHODS

Using a 1 : 1 matched case-control design, data were collected from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including demographic characteristics, loneliness, depression, hopelessness and social support. The chi-square automatic interaction detection (CHAID) tree model and multivariable logistic regression analysis were used to explore the relationships of these factors and suicide.

RESULTS

The CHAID tree model showed that loneliness, hopelessness and depressive symptoms were closely associated with completed suicide and that loneliness and hopelessness interacted with each other. The result of multivariable logistic regression showed that individuals who were unemployed [odds ratio (OR) = 2.344; 95% confidence interval (CI): 1.233-4.457], living alone (OR = 2.176; 95% CI: 1.113-4.254), had lower levels of subjective social support (OR = 2.185; 95% CI: 1.243-3.843), experienced depressive symptoms (OR = 6.700; 95% CI: 3.405-13.182), showed higher levels of hopelessness (OR = 7.253; 95% CI: 3.764-13.974) and felt higher levels of hopelessness × higher levels of loneliness (OR = 2.446; 95% CI: 1.089-5.492) were significantly associated with an elevated suicide risk in older people in rural China.

CONCLUSIONS

Regular evaluation of loneliness, hopelessness and depression can help detect older adults who are at risk of committing suicide. Interventions should target social support systems, particularly among people living alone, to alleviate feelings of loneliness and hopelessness. Treating depression is also key to preventing suicide among elderly people in rural China.

A Study of the Characteristics of Suicide Notes in China

Abstract. Background: Suicide notes in China are rarely studied and seldom available. Aims: This study examines the characteristics of suicide note leavers and analyzes the contents of their suicide notes for the period of 2004–2016 in Pudong, Shanghai, which has more than 5.5 million inhabitants. Method: The characteristics of the note leavers ( n = 458) and those who left no notes ( n = 1949) were compared. Four major groupings of the suicide note content were identified, namely, addressees, mandates/requests, expressions, and difficulties. Results: Only 19.0% of the deceased left suicide notes and they were characterized by having no diagnosed psychiatric illnesses, being in debt, having a high education level, having made no previous suicide attempts, and having used suicide methods that required preparation. Wanting to hide their suicide information was not uncommon for these individuals (9.7%). Adolescents were likely to mention a negative interpersonal relationship with someone (27.4%). Illnesses/pain was frequently mentioned by adults (33.4%) and older people (61.5%). Limitations: Many features of suicide notes, e.g., interpersonal features of suicides, were not examined. Conclusion: Education level might be a key factor influencing the likelihood of leaving suicide notes. Most people who left suicide notes showed a negative attitude toward suicidal behavior. The myth of an afterlife should also be addressed.

Suicidal ideation and attempt among school going adolescents in Bhutan - a secondary analysis of a global school-based student health survey in Bhutan 2016

BACKGROUND

Suicide is one of the leading causes of death and Disability Adjusted Life Years (DALYs) worldwide. The economic, emotional and human cost of suicidal behaviour to individuals, families, communities and society makes it a serious public health issue. We aim to determine the prevalence and factors associated with self-reported suicidal behaviour (suicidal ideation and attempt) among school going adolescents (13-17 years).

METHODS

This is a secondary analysis of a nationally representative data for Bhutan namely Global School Based Student Health Survey in 2016 which reports on various dimensions of adolescent health including suicidal behaviour. The survey employed a multistage sampling method to recruit participants aged 13-17 years (n = 5809) from 50 schools (25 each in rural and urban area). The survey used an anonymous self-administered pre-tested 84-item questionnaire. Weighted analysis was done. Adjusted prevalence ratios (aPRs) and adjusted Odds Ratios (aORs) have been presented with 95% confidence intervals (95% CI).

RESULTS

A total of 667 (11.6%) adolescents reported considering a suicide attempt whereas 656 (11.3%) reported attempting suicide in the past 12 months. Among those reporting suicidal ideation, 388 (58.6%) reported attempting a suicide and 274 (41.4%) had ideation alone, whereas, 247 (38.9%) reported attempting a suicide without previous ideation. Female sex, food insecurity, physical attack, sexual violence, bullying, feeling of loneliness, low parental engagement, reported worry about lack of sleep, urge to use drugs/alcohol, smokeless tobacco use, drug abuse and parental smoking were the factors associated with suicidal attempt. All these factors except smokeless tobacco use and parental smoking were associated with suicidal ideation. Having helpful/close friends was found to be protective against suicide ideation.

CONCLUSION

Suicidal behaviour among school going adolescents in Bhutan is high and alarming, especially among girls. Bullying, sexual violence, feeling of loneliness and drug abuse were some of the key risk factors identified. It is important to identify these risk factors early and effectively tackle them in order to prevent suicides. It requires a multi-faceted intervention with the support of the children, community, teachers and parents.

The Criminal Narrative Experience of Psychopathic and Personality Disordered Offenders

Given the challenges associated with psychopathic and personality disordered offenders, further insight is needed. One way of doing this is by looking at offending from the first-person perspective. The study investigated the criminal narrative experience (CNE) of this population during the commissioning of crimes. Twenty-two high-risk male offenders were recruited and a questionnaire design was used. The data were analysed using Smallest Space Analysis which revealed four themes consistent with Ioannou, Canter, and Youngs's CNE framework: depressed victim, distressed revenger, calm professional, and elated hero. Independent samples t tests explored whether personality disorders related to CNE themes, and Pearson's product-moment correlation was used to explore the relationship between psychopathy and the CNE themes. Borderline personality disorder identified with the depressed victim. Paranoid and schizoid personality disorders did not identify with the calm professional. There was no significant relationship between psychopathy and the CNE themes. The theoretical and practical implications are discussed.

A thematic content analysis of suicide notes from South Africa

Suicide remains a serious public health problem nationally and globally. Rates of completed suicide in South Africa are reported to be 13.25 per 100,000. Data are needed to assist in the understanding of suicide and to inform evidence-based prevention efforts. This article presents the first known thematic analysis of suicide notes from South Africa. A sample of 24 suicide notes was collected from three independent sites located in Johannesburg and Durban. Thematic analysis yielded 12 themes that showed marked similarity to themes reported in comparable international studies. Two themes – ‘Expressions of love and gratitude’ and ‘Concern for those left behind’ – were found to be unique in relation to the international literature. It is recommended that further research on suicide notes be conducted in South Africa, using a standard coding scheme.

The validity of proxy-based data on loneliness in suicide research: a case-control psychological autopsy study in rural China

BACKGROUND

There is a lack of evidence for the role of loneliness on suicide using psychological autopsy method, and the validity of proxy informants' reports on loneliness is not well established. This study aimed to investigate the validity of proxy respondent reports on loneliness, and the reliability and validity of the University of California Los Angeles Loneliness Scale-6 (ULS-6) as used in psychological autopsy method with rural elderly people in China.

METHODS

Two hundred forty-two suicide cases and 242 normal community controls were selected, and the psychological autopsy method was utilized to collect information. Data from proxy respondents of the living controls were compared with data reported by the targets (gold standards).

RESULTS

Subject-proxy concordance for ULS-6 was fair (ICC = 0.447) in the living controls. The suicide cases were more likely to have a higher score of ULS-6 than the living controls. Additionally, our data supported that ULS-6 had adequate psychometric properties in both suicide and control groups: factor analyses yielded one-factor component solution; Cronbach's alpha (both > 0.90) demonstrated excellent internal consistency; the Spearman correlation analysis indicated that the ULS-6 score was positively correlated with depression; and negatively correlated with QOL and social support.

CONCLUSIONS

Results support proxy-based data on loneliness in research of suicide in older adults in rural China, and the ULS-6 is a psychometrically sound instrument for measuring loneliness in psychological autopsy studies.