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A known risk factor for suicide globally is substance use. Despite being public health problems across the globe, research on the association between suicide and substance use have often ignored the socio-cultural context in which these behaviors play out. This qualitative study examines bereaved persons' perception of the roles of substance use in the lifestyles and the suicides of their deceased relations. We conducted an in-depth qualitative interview with between two to seven close relations of nine men who killed themselves in Ghana in the period 2014 and 2015. A qualitative content analysis of bereaved persons' accounts shows three themes: Behavioral changes connected with substance use, Consequences of substance use and misuse, and Alcohol presence in the suicide act. Thus, novel and excessive alcohol or drug use followed economic, financial, or relational stressors faced by the men. Personal disruption and social disintegration occurring as consequences of continued substance use triggered suicidal behaviors, which in turn appeared to have shaped in particular, use of alcohol as ingredients or tools in the suicide acts itself in some of the suicides. Contextual nuances shaping a dynamic interrelationship between substance use and suicide calls attention to viewing substances as ingredients with shifting functions during the suicidal process. We propose that encouraging emotional disclosure, supporting men with problem-solving skills, and regulating the availability and use of substances through effective alcohol and drug policies may be vital for an integrative public health approach towards suicide prevention in Ghana., Author(s): Johnny Andoh-Arthur [sup.1] , Heidi Hjelmeland [sup.2] , Joseph Osafo [sup.1] , Birthe Loa Knizek [sup.2] Author Affiliations: (1) grid.8652.9, 0000 0004 1937 1485, Psychology Department, School of Social [...]

Engaging non-conventional gatekeepers such as the police presents both promises and perils. Although studies have relied on police data for researching suicide and other sensitive topics in Africa, there is a paucity of literature that explores or reflects on police gatekeeping and its research implications. This paper presents authors' reflections on police gatekeeping in a qualitative suicide study in Accra, Ghana. The main observation is that the process was double-edged. On the one hand, it led to field delays and costs, (mis)apprehensions and positionality problems, and trust building challenges. On the other hand, it vouched for research(er) credibility, provided therapeutic openings, and facilitated the viability of research with the suicide bereaved. Sensitivity to research context, sensitising the police, and reinforcing 'therapeutic-research discourse' with participants, are recommended means for aligning participants' goals to research goals and for achieving therapeutic disclosures.

Relatively little research has been conducted on religion and suicide in Africa, yet religion has a lot of influence on people's way of life in Africa. To study religious views on suicide among the Baganda, Uganda, we used grounded theory and discourse analysis on a total of 28 focus groups and 30 key informant interviews. Suicide is largely seen as a breach of God's doctrine life is sacred, God's commandment thou shall not kill, and God's rule of agape. The study also focuses on the consequences of breaching God's divine providence: punishment from God and the Church. Religion still has a lot of influence on people's views on suicide in Uganda despite the challenges highlighted in the study. A recommendation from these results is that suicide prevention should cater to divergent views on religion and suicide. More qualitative research should be conducted in this area to facilitate theoretical comparison with this study. (Contains 1 table.)

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. [ABSTRACT FROM AUTHOR]

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.

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.

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.

Our aim was to build a model delineating the relationship between attitudes toward suicide and suicidal behavior and to assess equivalence by applying the model on data from different countries. Representative samples from the general population were approached in Sweden, Norway, and Russia with the Attitudes Toward Suicide (ATTS) questionnaire. Data on experience of suicidal behavior among significant others and self-reported suicidal expressions were also collected. Structural equation modeling resulted in gender and country specific models where experience of suicidal behavior among significant others and self-reported suicidal expressions earlier in life predicted attitudes, and attitudes predicted current suicidal expressions. The models included the attitude factors acceptance of suicide, condemnation, and preventability; age and level of education were also incorporated. The different models reveal possible ways to better understand gender and culture-specific paths between attitudes and suicidal behaviors, and their relevance in a suicide prevention context is considered.

Psychological factors associated with deliberate self-harm (DSH) as seen in an African population in Uganda are described. A case-control study design was employed in which a Luganda version (predominant language in the study area) of the modified European Parasuicide Interview Schedule I (EPSIS I) was used to collect data. The controls were patients admitted to the participating hospitals for non-recurrent medical conditions. Hopelessness, global psychological distress, and state anger, but not depression, were significantly associated with DSH after controlling for other factors. Both depression and hopelessness were significantly associated with suicidal intent independent of each other. Differences were observed on the psychological factors associated with suicidal intent in the different age/sex groups and in the depressed/nondepressed group. Interventions for DSH in this population should include treatments for both depression and hopelessness. This study further raises questions about the universality of the structural relationship among depression, hopelessness, and suicidality.

The purpose of the present study was to investigate attitudes toward suicide and suicide prevention among psychology students in Ghana by means of a qualitative analysis of open-ended questions about causes of suicide and how suicide best can be prevented. The students mainly saw the causes as intra-personal and almost all of them believed that suicide can be prevented. The results indicated a huge impact of religion on the attitudes toward suicide as well as some lack of distinction between their religious and professional roles and responsibilities. doi: 10.2190/OM.62.2.e

Few studies directly address vulnerable populations' motivation for participating in research. Often motives are expressed spontaneously and typically given post-interview. This article investigates motivation for research participation among informants who have been bereaved by suicide. Informants were specifically asked for their motivation either prior to, or directly after the interview. Four categories of motivations were identified: 1) Helping Others, 2) Venting, 3) Insight, and 4) Just Because. Sixty percent of informants gave more than one motivation. The majority was altruistically motivated; they hoped that by taking part they could play a role in helping to prevent suicide, improving services for the bereaved or moving research forward. Close family members were more likely to be motivated by a desire to help others than more distant family members. Findings are discussed in the context of suicide-related bereavements. Information about research participation as beneficial to others should be given parallel to that of possible strain. doi: 10.2190/OM.62.2.d

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.

Our aim was to build a model delineating the relationship between attitudes toward suicide and suicidal behavior and to assess equivalence by applying the model on data from different countries. Representative samples from the general population were approached in Sweden, Norway, and Russia with the Attitudes Toward Suicide (ATTS) questionnaire. Data on experience of suicidal behavior among significant others and self-reported suicidal expressions were also collected. Structural equation modeling resulted in gender and country specific models where experience of suicidal behavior among significant others and self-reported suicidal expressions earlier in life predicted attitudes, and attitudes predicted current suicidal expressions. The models included the attitude factors acceptance of suicide, condemnation, and preventability; age and level of education were also incorporated. The different models reveal possible ways to better understand gender and culture-specific paths between attitudes and suicidal behaviors, and their relevance in a suicide prevention context is considered.

The associations between life events in the 12 months preceding an episode of self-poisoning resulting in hospital attendance (the index episode), and the suicide intent of this episode were compared in individuals for whom the index episode was their first, episode and in individuals in whom it was a recurrence of DSH. Results indicated a significant interaction between independent life events, repetition status, and gender in the prediction of suicide intent, the association between life events and intent being moderated by repetition status in women only. The results provide preliminary evidence to suggest the presence of a suicidal process in women, in which the impact of negative life events on suicide intent diminishes across episodes.

Psychological factors associated with deliberate self-harm (DSH) as seen in an African population in Uganda are described. A case-control study design was employed in which a Luganda version (predominant language in the study area) of the modified European Parasuicide Interview Schedule I (EPSIS I) was used to collect data. The controls were patients admitted to the participating hospitals for non-recurrent medical conditions. Hopelessness, global psychological distress, and state anger, but not depression, were significantly associated with DSH after controlling for other factors. Both depression and hopelessness were significantly associated with suicidal intent independent of each other. Differences were observed on the psychological factors associated with suicidal intent in the different age/sex groups and in the depressed/nondepressed group. Interventions for DSH in this population should include treatments for both depression and hopelessness. This study further raises questions about the universality of the structural relationship among depression, hopelessness, and suicidality.

Information obtained at interview from 1,646 parasuicide patients in 14 regions in 13 European countries participating in the WHO/EURO Multicentre Study on Suicidal Behaviour was used to study self-reported intentions involved in parasuicide. Comparisons were made across cultures, genders, and age groups. Although some statistically significant differences were found, the effect sizes were very small. The main finding from this study is thus that parasuicide patients in different countries tend to indicate that similar types of intentions are involved in their acts of parasuicide, and that the intentions do not vary greatly with gender or age. The hypothesis that rates of suicide and parasuicide vary between regions with the frequency with which suicidal intention is indicated by the patients was also tested, but was supported only for women and in relation to national suicide rates. The findings from this study are likely to be generalizable to other settings and have implications for clinical practice.