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Why Suicide?

Reasons for Suicide Attempts as Self-Reported by Youth: A Systematic Evaluation of Qualitative Studies

  • Qualitative Review
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Abstract

Suicide is a complex phenomenon, and no two suicides are ever the same. While current theoretical models of suicide are heavily informed by first-rate epidemiological and clinical knowledge, little research has qualitatively investigated the motivation for a suicide attempt, from the personal perspective of the person who makes the attempt. These perspectives are particularly absent for youth, whose cognitive interpretation and reasoning skills are less likely to be adequately established than those of adults, and who may need to be approached differently to adults to ensure their reported reasons are genuinely reflected in the published literature. This study sought to identify and examine past qualitative research which has investigated motivating factors for suicide attempts among youth aged 12–25. MEDLINE, EMBASE, and PsycINFO databases were searched and a systematic narrative review of qualitative studies was undertaken. Independent raters assessed comprehensiveness of reporting of included studies. Thematic networks analysis was used to analyze the data. From 17 studies involving 613 participants, basic and organizing themes were identified and grouped into four major themes: intrapersonal, sociocultural, interpersonal and historical factors, as those directly attributed to suicide attempts. Comprehensiveness of reporting among studies was assessed, and particular subdomains identified as inadequately reported, i.e., relationships with participants, theoretical frameworks, and design and implementation of studies. We conclude that more robust and comprehensive theoretical frameworks could enhance the knowledge base of the complex and multiple factors that motivate youth to take their own lives. These findings revealed that comprehensive qualitative inquiry is essential in effectively identifying central themes which may otherwise be minimized or missed in clinical and epidemiological studies.

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Notes

  1. While grey literature can provide important information pertaining to unique content in certain disciplines, this study employed a traditional, scientific approach, using only peer-reviewed journals, as per the evidence-based Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Moher et al., 2009).

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Acknowledgements

The NHMRC Centre of Research Excellence in Suicide Prevention (CRESP) and The Anika Foundation both sponsor Ms Nicolopoulos as a PhD candidate. We therefore acknowledge their full support of the research reported in this article.

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Authors and Affiliations

  1. Black Dog Institute. University of New South Wales: School of Psychiatry, Randwick, Sydney, NSW, 2031, Australia

    Alexandra Nicolopoulos, Katherine Boydell, Fiona Shand & Helen Christensen

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  1. Alexandra Nicolopoulos
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  2. Katherine Boydell
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  3. Fiona Shand
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  4. Helen Christensen
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Contributions

AN conceived of the study and its design and coordination, directed the design and interpretation of data, and drafted the manuscript. KB participated in the interpretation of data and measurement outcomes, and helped to draft the manuscript. FS participated in the design and coordination of the study, as well as assisting in the design and interpretation of data. HC oversaw the design of the manuscript in its entirety. All authors read and approved the final manuscript.

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Correspondence to Alexandra Nicolopoulos.

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The authors report no conflicts of interest.

Appendix A: Thematic Network Analyses (Attride-Sterling 2001) Process

Appendix A: Thematic Network Analyses (Attride-Sterling 2001) Process

Analysis stage A: Reduction or breakdown of text

 Step 1: Code material

  Themes as originally reported in each study are extracted and tabulated in ‘code’ form respectively by AN.

 Step 2: Identify themes

  Table of ‘codes’ provided to FS and KB for individual perusal. ‘Codes’ allocated into subjectively reclassified Basic Themes by each author with all original codes placed categorically into one of the newly derived basic themes. There is no restriction enforced regarding number of basic themes.

 Step 3: Construct thematic networks

  Basic Themes as reclassified by each author are then to be further broken down independently into subthemes. The order of thematic breakdown is as such;

  Basic Themes → Organizing Themes → Global Themes

Analysis stage B: Exploration of text

 Step 4: Describe/explore thematic networks

  Consensus meeting is held between researchers and themes to be discussed. A mutual set of themes and subthemes resulting from this meeting will form the basis of the newly defined thematic networks.

  Studies subsequently revisited by AN with a focus on extracting text/quotes relative to the agreed upon new themes/subthemes. Consensus between AN, FS and KB to ensure extracted text is representative of each researchers’ individual theme interpretation.

 Step 5: Summarise thematic networks

  Results of thematic network analysis written into results section of this review.

Analysis stage C: integration of exploration

 Step 6: Interpret patterns

  Joint discussion between all reviewers regarding individual results. Discrepancies resolved and final thematic results discussed.

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Nicolopoulos, A., Boydell, K., Shand, F. et al. Why Suicide?. Adolescent Res Rev 3, 155–172 (2018). https://doi.org/10.1007/s40894-017-0070-3

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