Lifesaving turning points: First-person accounts of recovery after suicide attempt(s).

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.

Religion as Meaning-Making Resource in Understanding Suicidal Behavior in Ghana and Uganda.

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.

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.

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.

Epistemological differences in the discussion of the interpersonal theory of suicide: A reply to the response.

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."

"Time to Try Something New" - Professionals' Experiences and Reflections on Suicide Prevention in Norway.

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.

" I felt completely stranded": liminality and recognition of personhood in the experiences of suicidal women admitted to psychiatric hospital.

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.

The emperor's new clothes? A critical look at the interpersonal theory of suicide.

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.

Societal Reactions to Suicide in Ghana.

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.

"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.

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 ("ies birget"). The findings are important when designing suicide prevention initiatives specifically targeting Sámi.

Reasons for attempting suicide: An exploratory study in Ghana.

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.

To die or not to die: a qualitative study of men's suicidality in Norway.

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.

Cultural responses towards the aftermath of suicide among the Acholi in Northern Uganda.

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.

Former suicidal inpatients' experiences of treatment and care in psychiatric wards in Norway.

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.

Suicide among men in Ghana: The burden of masculinity.

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.

Barriers toward help-seeking among young men prior to suicide.

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.

From condemnation to understanding: Views on suicidal behavior in Ghana in transition.

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.