published_or_final_version / abstract / toc / Psychiatry / Master / Master of Philosophy

published_or_final_version / abstract / Psychology / Master / Master of Philosophy

published_or_final_version / Journalism and Media Studies Centre / Doctoral / Doctor of Philosophy

Research on risk factor for suicidal behaviors has been broadly conducted to enhance knowledge of suicide prevention. However, there are still challenges for risk factor research. Four major research gaps have been identified: (1) uncertain effectiveness of the population approach versus the high-risk approach for suicide prevention; (2) lack of a valid and convenient Chinese-version screening tool for the severity of suicidal ideation among adolescents; (3) demand for testing the prospective associations of risk factors with suicidal ideation using a longitudinal designed population-based sample; and (4) necessity of pathway analysis to explore and confirm how risk factors interact with each other and lead to suicidality. This thesis aims to address these gaps through a combination of five studies. Study 1 introduces an illness and death model to suicide prevention research. Elasticity and sensitivity analyses were performed. The findings revealed that the control of suicide incidence among the healthy population is the most effective prevention strategy whereas treatment of mental illness appears to be the least effective approach to suicide prevention. Study 2 validates the psychometric properties of the Chinese versions of Reynolds’s Suicidal Ideation Questionnaire (SIQ) and Suicidal Ideation Questionnaire Junior (SIQ-JR, a short version of the SIQ) in a sample of Hong Kong adolescents. A short, four-item version of the SIQ-JR has been suggested as an alternative to the SIQ and the SIQ-JR. Study 3 identifies the history of psychiatric treatment, depression, anxiety, hopelessness, unstable marital status, poor economic circumstance, and a recent death of a first-degree relative as significant risk factors for the incidence of suicidal ideation. The associations of change in risk factors with the development of suicidal ideation have been tested. There are gender and age differences in the patterns of such associations. Study 4 focuses on psychological factors associated with the first-ever incidence of suicidal ideation. Psychological factors have been detected generally to differ in their associations with the incidence and persistence of suicidality. The idea that depression partially mediates the effect of average life distress on the persistence of suicidal ideation has clinical value. Study 5 introduces and tests a stressor and illness model as a theoretical framework reference for future risk factor research. Risk factors are classified into stressor, illness, and pattern factors. Both the simple and complex models are tested. Evidence supported the proposed mediating role of mental disorders between negative life events and severity of suicidal ideation. A gender-specific pattern of associations between stressors, illness, and severity of suicidal ideation has also been detected. This thesis has made substantial theoretical, psychometric, and empirical contributions to the existing knowledge of suicide research. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

Tolstoy, in ‘Death and the meaning of life’, says: “The truth was that life was meaningless. It was as though I had just been living and walking along, and had come to an abyss, where I saw clearly that there was nothing ahead but perdition. And it was impossible to stop and go back, impossible to shut my eyes, in order that I might not see that there was nothing ahead but suffering and imminent death, complete annihilation (Dickenson, 2001). Suicide act does not only leave family members, relatives and acquaintances shocked, but leaves feelings of anger and resentment, combined with exaggerated guilt. Suicide continues to be a pressing public health problem in South Africa. Suicide is a complete and permanent withdrawal from interaction and therefore a valid field of sociological study. The aim of the study is to explore the primary causal factors of suicide in Tembisa. A qualitative methodology is used to understand the life events, experiences and beliefs of people who attempted suicide. The focus of the research is on people who received counselling at Tembisa clinics for attempted suicide. A non-probability, purposive sample is utilized to seek information. Five respondents are interviewed. An interview schedule was formulated by the researcher. An interview schedule formulated from literature is utilized to create consistency in face-to-face interviews. The in-depth interviews facilitate exploration. Data is gathered by means of a literature review, field notes and audiotape transcribed by the researcher. Analysis of the data is done manually according to a schedule. The schedule is developed according to coding categories that are identified when working with raw data. Raw data is given to an independent coder for verification. The information gathered from the raw data is analysed and used to identify themes, which are offered as results. An extensive literature control is conducted, to compare and contrast the findings; and for the purpose of validity. From the study, methodological and theoretical conclusions are made. Methodological conclusions indicate the effectiveness of using a qualitative methodology and face-to-face interviews in exploring the question under study. The theoretical conclusions indicate the respondents’ understanding of suicide. Recommendations in terms of future research are drawn from research process and the context of the study ensures the link between results and conclusions, and aims and objectives. The research indicates multifaceted and multi-factorial aspects related to suicide. The understanding of suicide shows a continued struggle for hope. / Dr. Emmarentie Oliphant

published_or_final_version / Nursing Studies / Master / Master of Nursing

A review of the literature strongly suggests that poor family dynamics play a critical role in an adolescent's choice of suicide. This thesis examines the literature and research findings on adolescent suicide and family functioning. It will bring together recent findings to help professionals access the information on adolescent suicide as it relates to the family. The psychosocial and cognitive theories of development are explored to provide a framework for understanding adolescents and the reasons for the choices and problem solving they make in their quest for identity. Since social workers are increasingly implicated in the prevention of youth suicide, the thesis applies the argument to prevention from a social work perspective.

No description available.

published_or_final_version / Gerontology / Master / Master of Social Sciences

Opioid morbidity and mortality and suicide are two current and central public health problems in the U.S. Both have continuously increased in the last two decades, and disproportionately affected some groups more than others, leading to the suggestion that these epidemics are connected. However, there is little evidence on the potential role that the opioid epidemic had on the rise of suicides. The overarching goal of this dissertation was to advance our understanding of the effects of the opioid epidemic on the rise in suicide rates in the U.S. First, a systematic review of the literature was conducted to critically evaluate the evidence on the effects of different opioid exposures on suicidal outcomes (e.g., suicidal ideation, attempts and suicides). There was ample evidence of individual-level associations between opioid use and related abuse/ dependence on suicidal outcomes. In contrast, the gap in the literature on group-level effects was clear, with only two studies examining these effects and showing that opioid availability was associated with suicide behavior in different populations. Several limitations were also identified in the reviewed studies that could partially explain the observed associations, indicating the need for further research. Second, the individual-level effects of prescription opioids nonmedical use and related abuse/ dependence on persistence and onset of suicidal ideation and attempts were examined. Longitudinal data from a national representative sample of the adult U.S. population was used to examine these associations. Results showed that heavy/ frequent use of prescription opioids and related abuse/ dependence had an effect on persistence and onset of suicidal ideation and persistence of attempts. However, none of these exposures were associated with onset of suicide attempt. Overall, these findings suggest that by increasing the number of those using prescription opioids and with opioid abuse/ dependence, and in turn the number of those with suicidal ideation/ behavior, the prescription opioid epidemic could have led to increases in suicide rates in the population. Finally, the group-level (i.e., state level) effects of three state level exposures, i.e., increasing trends in the per capita volume of prescription opioids, in the nonmedical use of these drugs, and in unintentional fatal opioid overdoses, on the increase in suicide rates were examined. For this, pooled cross sectional time series data from the 50 states (1999-2016) were used in linear regression models with state and year fixed effects. Although the volume of prescription opioids and the rate of fatal opioid overdoses increased over the study period, the prevalence of nonmedical use of prescription opioids decreased in most states. Results showed that the rate of unintentional fatal prescription opioid overdoses was associated with an increase in the rate of suicides. The range of effects sizes compatible with the data also suggested that the increase in the per capita volume of prescription opioids was linked to increases in suicide rates. Overall, this dissertation increased our understanding of the possible role that the opioid epidemic played on the increase in suicide rates in the U.S. As public efforts continue to fight the opioid epidemic, these findings can help inform future research that will guide the development of suicide prevention strategies and approaches to reduce the burden that the opioid epidemic poses on communities.