Thesis (MSc) -- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Suicidal behaviour is a serious public health problem. Globally and in South Africa a gendered pattern of suicide rates has been observed, with males being more likely to kill themselves than females. To date little quantitative and qualitative research is available on young male suicidal behaviour in South Africa. This study investigated the attitudes, beliefs and myths young male students hold about suicidal behaviour. Thirteen male university students (ages 20 to 25 years; with and without a history of suicidal behaviour), who volunteered to take part in the present study in response to an email invitation, were interviewed. The attitudes, beliefs and myths identified from the qualitative data are grouped into four themes: 'Moral acceptability of suicidal behaviour', 'Perceived causes and risk factors of suicidal behaviour', 'Perceived motives of suicidal behaviour', and 'Perceived prevention and protective factors of suicidal behaviour'. Besides these four themes, two underlying narratives are identified and discussed: (1) 'Apart or a part: Belonging and suicidal behaviour' is centred on the idea that perceiving oneself to be an integral part of a social system is protective against suicidal behaviour, while a thwarted sense of belonging increases vulnerability to suicidal behaviour. (2) 'Dying to be a man: (Re) negotiating masculinity and suicidal behaviour' is concerned with participants' views that men's relational position to hegemonic (socially most dominant) forms of masculinity is a factor in male suicidal behaviour. Participants regard hegemonic forms of masculinity to be both a part of the problem of suicidal behaviour and a potential solution to suicidal behaviour. These findings are interpreted through a social constructionist lens of gender as performance. Finally, implications of findings for future research, prevention and treatment are discussed. / AFRIKAANSE OPSOMMING: Selfmoordgedrag is 'n ernstige openbare gesondheidsprobleem. Wêreldwyd en in Suid-Afrika is mans meer geneig as vrouens om selfmoord te pleeg. Tot op hede is daar min kwantitatiewe en kwalitatiewe navorsing beskikbaar van jong manlike selfmoordgedrag in Suid-Afrika. Hierdie studie ondersoek die houdings, oortuiging en mites oor selfmoordgedrag van jong manlike studente. Dertien manlike universiteitstudente (ouderdomme 20 tot 25 jaar, met en sonder 'n geskiedenis van selfmoordgedrag) het vrywillig aan die huidige studie deel geneem in reaksie op 'n e-pos uitnodiging. Die houdings, oortuiging en mites wat vanaf die kwalitatiewe data geïdentifiseer is, is in vier temas gegroepeer: 'Morele aanvaarbaarheid van selfmoordgedrag', 'Siening van die oorsake en risiko faktore van selfmoordgedrag', 'Waargenome motiewe van selfmoordgedrag', en 'Waargenome voorkoming en beskermende faktore van selfmoordgedrag'. Naas hierdie vier temas, is twee onderliggende temas geïdentifiseer en bespreeek: (1) 'Samehorigheid en selfmoordgedrag' is gemoeid met die idee dat om 'n integrale deel van 'n sosiale sisteem te wees is beskermend teen selfmoordgedrag, terwyl 'n persepsie van isolasie tot selfmoordgedrag kan lei. (2) 'Onderhandeling van manlikheid en selfmoordgedrag' is gemoeid met die deelnemers se sienings dat mans se verhouding tot hegemoniese vorme (sosiaal mees dominante vorme) van manlikheid 'n faktor in manlike selfmoordgedrag is. Deelneemers beskou hegemoniese vorme van manlikheid as beide 'n deel van die probleem en 'n moontlike oplossing vir selfmoordgedrag. Hierdie bevindinge is geïnterpreteer deur middel van 'n sosiale konstruksionistiese lens van geslag as prestasie. Die implikasies van die bevindings vir toekomstige navorsing, voorkoming en behandeling word ten slotte bespreek.

Anger is often associated with poor physical and mental health, including suicidal behaviour. Anger expression is typically conceptualised as inward or outward-directed, with each mode of expression having potentially different aetiologies and health manifestations. Individual characteristics such as religion or spirituality may buffer against the effects of anger. One such characteristic, forgiveness, is the voluntary process of changing ones’ beliefs, behaviours, and emotions towards a transgressor from negative to positive. We examined forgiveness of self, forgiveness of others and feeling forgiven by God as moderators of the relationship between anger expression and suicidal behaviours in a sample of 372 ethnically diverse college students. In independent and full models, we found that forgiveness of self was a significant moderator of the association between inward and outward anger and suicidal behaviour. Interventions targeting anger via the promotion of forgiveness may be useful in the prevention of suicide ideation and attempts.

The research examined mental health practitioners' attitudes towards, satisfaction with and use of suicide prevention contracting (SPC) techniques. Survey respondents comprised consultant psychiatrists, clinical psychologists, occupational therapists, mental health nurses, psychologists, registered medical officers and social workers. A self-report questionnaire was mailed to 1347 potential respondents, together with three follow-up letters sent out at two-week intervals. There was a 31% response rate, producing 420 valid questionnaires. The results of the research re-confirm the historical trajectory of SPC, from its early beginnings as a relationship-based suicide-risk assessment technique to one that is used in contemporary practice by practitioners to meet a range of objectives. The research focused on three SPC techniques in operation in clinical practice: verbal no-suicide assurances, no-suicide agreements, and written no-suicide contracts. Analysis of the data suggests a number of important findings. The first of these is that practitioners perceive different utility among these three techniques. Secondly, the least experienced practitioners were significantly less likely to use no-suicide contracts, despite seeing more suicidality and having more formal training in the use of the technique. Thirdly, a practitioner's gender, and formal training were significant in the perception and application of SPC techniques. Finally, suicidal behaviours and completed suicide was a clinical outcome in some situations irrespective of the use and non-use of SPC. The findings of this research are used to provide an emerging conceptual framework and associated nomenclature that inform clinical decision-making in relation to SPC. In addition, a conceptual model is presented which demonstrates that the potential for injudicious use of SPC techniques is as much precipitated by individual factors as it is by broader environmental factors. Key words: no-suicide contracts, suicide prevention contracts, no-suicide agreements, no-suicide decisions, contingency contracting.

Adolescence is generally regarded as a time of developmental change in all aspects: physical, emotional and psychological. This change is difficult and stressful for the adolescent to comprehend and assimilate into their way of being. During these times of developmental change and stress the manner in which the adolescent chooses to or learns to cope with the various stressors they face can be a signifier of things to come. In other words, coping strategies that an individual chooses to use, be they functional or maladaptive, may inform their future. This study’s focus is the relationship between an individual’s ability to cope and his level of suicidal ideation, and explores whether these two variables are related. In South Africa, and throughout the world, there is a trend of a greater number of younger people engaging in suicidal behaviour than previously and research into any and all aspects of this phenomenon is thus valuable. Many hypotheses have been proposed and there are many related factors that need to be considered. A quantitative approach was used to examine the relationship between coping strategies and suicidal ideation. The Coping Across Situations Questionnaire and the Suicidal Ideation Questionnaire were administered to a sample of adolescent males at a co-educational high school in KwaZulu-Natal, South Africa. The results determined that there is a significant, positive relationship between maladaptive coping strategies and high levels of suicidal ideation, that demographic variables such as grade and race seem to have some impact on this relationship and that further investigation is necessary into the relationship between adaptive coping skills and low levels of suicidal ideation. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

The study analyses harmful behaviour towards self and others among students studying in the 5th to 12th grades. Harmful behaviour towards self and others is defined as substance use, suicidal and aggressive behaviour. This study explores an assumption that tobacco, alcohol and other drug abuse, suicidal and aggressive behaviour constitute one problem behaviour syndrome, as they perform the same functions in the life of an adolescent. The study is aimed to determine whether harmful behaviour towards self and others can be identified with the same psychosocial factors. Due attention is focused in the study on the changes of this behaviour from grades 5 to 12, in the duration of three years in different student groups. The empirical part of the dissertation presents a study of a large group of secondary school students during a period of 3 years. The results illustrate that substance use, suicidal behaviour and aggressive behaviour can be understood as a problem behaviour syndrome, but only in the girls’ group. Depressive mood, poor relations with teachers and negative learning attitudes predict all three forms of harmful behaviour towards self and others. Prevalence of this behaviour becomes increasingly evident during adolescence, but its different forms undergo different transformation processes. Changes in harmful behaviour towards self and others occur due to the age effect, but not the cohort effect. / Disertacijoje nagrinėjamas 5 – 12 klasių mokinių save ir kitus žalojantis elgesys, kuris apibrėžiamas kaip tabako, alkoholio, kitų narkotinių medžiagų vartojimas, agresyvus ir savižudiškas elgesys. Darbe tikrinama prielaida, kad šios save ir kitus žalojančio elgesio formos paauglystėje sudaro vieną elgesio konstruktą, nes atlieka tas pačias funkcijas paauglio gyvenime. Siekiama įvertinti, ar save ir kitus žalojantis elgesys gali būti aprašytas tais pačiais psichosocialiniais veiksniais. Darbe didelis dėmesys skiriamas šio elgesio kitimams nuo 5 iki 12 klasės ir per tris tyrimo metus skirtingose mokinių amžiaus grupėse. Empirinėje darbo dalyje pristatomas 3 metus trukęs didelės mokinių grupės tyrimas. Išanalizavus rezultatus, nustatyta, kad tabako, alkoholio, kitų narkotinių medžiagų vartojimas, agresyvus ir savižudiškas elgesys gali būti suprantami kaip vieno elgesio konstrukto dalys, tačiau tik mergaitėms. Pablogėjusi nuotaika, prasti santykiai su mokytojais ir neigiamas požiūris į mokymąsi geriausiai nusako paauglių save ir kitus žalojantį elgesį. Šio elgesio kitimų analizė atskleidė, kad save ir kitus žalojančio elgesio paauglystės laikotarpiu daugėja, tačiau kinta jo pasireiškimo forma. Save ir kitus žalojančio elgesio kitimai atsiranda dėl amžiaus įtakos, bet ne dėl kohortos efekto.

Disertacijoje nagrinėjamas 5 – 12 klasių mokinių save ir kitus žalojantis elgesys, kuris apibrėžiamas kaip tabako, alkoholio, kitų narkotinių medžiagų vartojimas, agresyvus ir savižudiškas elgesys. Darbe tikrinama prielaida, kad šios save ir kitus žalojančio elgesio formos paauglystėje sudaro vieną elgesio konstruktą, nes atlieka tas pačias funkcijas paauglio gyvenime. Siekiama įvertinti, ar save ir kitus žalojantis elgesys gali būti aprašytas tais pačiais psichosocialiniais veiksniais. Darbe didelis dėmesys skiriamas šio elgesio kitimams nuo 5 iki 12 klasės ir per tris tyrimo metus skirtingose mokinių amžiaus grupėse. Empirinėje darbo dalyje pristatomas 3 metus trukęs didelės mokinių grupės tyrimas. Išanalizavus rezultatus, nustatyta, kad tabako, alkoholio, kitų narkotinių medžiagų vartojimas, agresyvus ir savižudiškas elgesys gali būti suprantami kaip vieno elgesio konstrukto dalys, tačiau tik mergaitėms. Pablogėjusi nuotaika, prasti santykiai su mokytojais ir neigiamas požiūris į mokymąsi geriausiai nusako paauglių save ir kitus žalojantį elgesį. Šio elgesio kitimų analizė atskleidė, kad save ir kitus žalojančio elgesio paauglystės laikotarpiu daugėja, tačiau kinta jo pasireiškimo forma. Save ir kitus žalojančio elgesio kitimai atsiranda dėl amžiaus įtakos, bet ne dėl kohortos efekto. / The study analyses harmful behaviour towards self and others among students studying in the 5th to 12th grades. Harmful behaviour towards self and others is defined as substance use, suicidal and aggressive behaviour. This study explores an assumption that tobacco, alcohol and other drug abuse, suicidal and aggressive behaviour constitute one problem behaviour syndrome, as they perform the same functions in the life of an adolescent. The study is aimed to determine whether harmful behaviour towards self and others can be identified with the same psychosocial factors. Due attention is focused in the study on the changes of this behaviour from grades 5 to 12, in the duration of three years in different student groups. The empirical part of the dissertation presents a study of a large group of secondary school students during a period of 3 years. The results illustrate that substance use, suicidal behaviour and aggressive behaviour can be understood as a problem behaviour syndrome, but only in the girls’ group. Depressive mood, poor relations with teachers and negative learning attitudes predict all three forms of harmful behaviour towards self and others. Prevalence of this behaviour becomes increasingly evident during adolescence, but its different forms undergo different transformation processes. Changes in harmful behaviour towards self and others occur due to the age effect, but not the cohort effect.

This study examined the influence of social support on the relationship between posttraumatic stress disorder and comorbid psychopathology, suicidal behaviour, and mental and physical health functioning in the general population. Data came from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (N=34,653). Results showed a differential impact of posttraumatic stress disorder and social support depending on gender. For men, social support had a moderating effect, where social support had a greater influence on the prevalence of comorbid psychopathology for men with posttraumatic stress disorder compared to those without the disorder. In contrast, social support had an additive effect for women, where social support was associated with decreased psychopathology and posttraumatic stress disorder was associated with increased psychopathology. This study suggests that social support should be included in the treatment of men with posttraumatic stress disorder and encouraged among women regardless of mental disorder diagnosis.

Bipolar disorder is a psychiatric illness characterized by recurrent fluctuations in mood and increased risk of suicide. Twin and family studies have identified the highly heritable nature of the disorder, but the limitations of the current DNA-centric paradigm underscore the need for a new perspective to gain a clearer understanding of its basis. This project investigates various facets of bipolar disorder from an epigenetic standpoint. We used mass spectrometry-based mapping of individual DNA modification differences of the brain-derived neurotrophic factor gene. Moreover, the epigenetic basis of suicidal behaviour in bipolar disorder was investigated using DNA methylation microarrays. We also used a newly-developed enrichment technique, mTAG, to interrogate chromosome-wide DNA modification profiles using tiling microarrays in post-mortem brains of bipolar disease patients and controls. Findings from these experiments highlight observable features of epigenomes of patients affected with mood disorders, and may further the understanding of the molecular origin of psychiatric diseases.

Bipolar disorder is a psychiatric illness characterized by recurrent fluctuations in mood and increased risk of suicide. Twin and family studies have identified the highly heritable nature of the disorder, but the limitations of the current DNA-centric paradigm underscore the need for a new perspective to gain a clearer understanding of its basis. This project investigates various facets of bipolar disorder from an epigenetic standpoint. We used mass spectrometry-based mapping of individual DNA modification differences of the brain-derived neurotrophic factor gene. Moreover, the epigenetic basis of suicidal behaviour in bipolar disorder was investigated using DNA methylation microarrays. We also used a newly-developed enrichment technique, mTAG, to interrogate chromosome-wide DNA modification profiles using tiling microarrays in post-mortem brains of bipolar disease patients and controls. Findings from these experiments highlight observable features of epigenomes of patients affected with mood disorders, and may further the understanding of the molecular origin of psychiatric diseases.

According to the World Health Organisation (WHO), suicide is one of the three main causes of deaths in the age group 15 to 34 years. Persons who previously attempted to commit suicide are more inclined to succeed with a second attempt. With the eventual focus on suicide prevention by means of life guidance as an assistance strategy in social work, the researcher undertook qualitative exploration amongst a specific group of adolescent girls between ages 15 and 21 years. These girls were each admitted to hospital after having attempted to commit suicide. The researcher used semi–structured in–depth interviews as a qualitative data collection method until data saturation was reached. The investigation was discussed against the backdrop of the strength perspective, crisis intervention, the system theory and existentialism. A discussion was led in Article 1 about findings regarding the psychosocial needs of adolescent girls who displayed suicidal behaviour. From the interviews, three overarching needs were foregrounded, namely the need for love and acceptance, the need for communication and the need for a secure future. The psychosocial needs were subdivided into sub–themes, which were discussed respectively. In Article 2 a discussion followed regarding the findings in terms of the support systems adolescents possess. Life guidance was eventually based on the needs of adolescent girls, as identified in Article 1, and the involvement and responsibility of the support systems, as discussed in Article 2. The guidelines for life guidance, as set out in Article 3, serve as a guiding recommendation and framework for intervention programmes for adolescent girls who display suicidal behaviour, as well as for the support systems involved. / Thesis (M.A. (MW))--North-West University, Potchefstroom Campus, 2012.