Birthe Loa Knizek

Why We Need Qualitative Research in Suicidology.

Using the differentiation between explanations and understanding from philosophy of science as the point of departure, a critical look at the current mainstream suicidological research was launched. An almost exclusive use of quantitative methodology focusing on explanations is demonstrated. This bias in scope and methodology has to a large extent taken the suicidological field into a dead-end of repetitious research. It is argued that an increased focus on understanding and thus extended use of qualitative methodology is essential in bringing the suicidological field forward.

Psychological Autopsy Studies as Diagnostic Tools: Are They Methodologically Flawed?

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.

Self-Reported Suicidal Behavior and Attitudes Toward Suicide and Suicide Prevention Among Psychology Students in Ghana, Uganda, and Norway

Self-reported suicidal behavior and attitudes toward suicide in psychology students are reported and compared in Ghana, Uganda, and Norway. Small differences only were found in own suicidal behavior. However, experience of suicidal behavior in the surroundings was more common in Uganda than in Ghana and Norway. Although differences were found between the three countries in attitudes toward suicide, which emphasizes the need for culture-sensitive research and prevention, many of the differences were not as big as expected. The most pronounced difference was that the Norwegian students were more reluctant to take a stand on these questions compared to their African counterparts. Some differences were also found between the two African countries. The implications of the results for suicide prevention in Africa are discussed.

The General Public's Views on Suicide and Suicide Prevention, and their Perception of Participating in a Study on Attitudes towards Suicide

The aim of the presented study was to investigate whether common myths about suicide still prevail, what people in general think are the most common causes for suicide, whether suicide can be prevented, and if so, how. How subjects perceived their participation in a study on attitudes towards suicidal behavior, was also investigated. The Attitudes Towards Suicide questionnaire was sent to a random sample of 1,000 Norwegians. The data were analyzed both quantitatively and qualitatively. The results showed that the common myths still prevail, that people in general mainly assign intrapersonal causes to suicide, with the belief that suicide can be prevented, and that they perceived their participation in the study positively. The value of the general public in suicide prevention and the need for increased openness and competence building were emphasized.

Influence of Religious Factors on Attitudes Towards Suicidal Behaviour in Ghana

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.

Meaning-making through psychological autopsy interviews: the value of participating in qualitative research for those bereaved by suicide.

Too often ethical boards delay or stop research projects with vulnerable populations, influenced by presumed rather than empirically documented vulnerability. The article investigates how participation is experienced by those bereaved by suicide. Experiences are divided into 3 groups: (a) overall positive (62%), (b) unproblematic (10%), and (c) positive and painful (28%). The positive experiences are linked to processes of meaning-making, gaining new insight, and a hope to help others. Objective factors concerning the gender of participants, their relationship to the deceased, the method of suicide, and time since loss were largely unrelated to their experience of the interview.

Attitudes of psychologists and nurses toward suicide and suicide prevention in Ghana: A qualitative study

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.

Social injury: An interpretative phenomenological analysis of the attitudes towards suicide of lay persons in Ghana.

One way of furthering our understanding of suicidal behaviour is to examine peoples 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.

Distancing: a traditional mechanism of dealing with suicide among the Baganda, Uganda.

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.

A Discussion of the Value of Cross-Cultural Studies in Search of the Meaning(s) of Suicidal Behavior and the Methodological Challenges of Such Studies

ABSTRACT The main purposes of this study was to test the psychometric properties of a questionnaire on attitudes towards suicide in a cross-cultural setting, and to discuss the value of cross-cultural studies in the search of meaning(s) of suicidal behavior as well as the methodological challenges encountered in such studies. Data on attitudes towards suicide among health and social science students from Norway and Uganda were employed to illustrate the points made. Both exploratory and confirmatory factor analyses showed different factor structures in the two countries. Whether this result is due to different latent variables indicating differences in meaning(s) of suicidal behavior between the two countries or lack of reliability and/or validity of the instrument is discussed.