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1 Dependency Factors in Suicidal C- 1 DEPENDENCY FACTORS IN SUICIDAL BEHAVIOR by Janet- M. Pollett B.A., Dalhousie University, 1973. A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in the School of Nursing We accept this thesis as conforming to the required standard The University of British Columbia May, 1977 Q Janet H. Pollett, 1977 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the Head of my Department or by his rep• resentatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of Nursing The University of British Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 ABSTRACT DEPENDENCY FACTORS IN SUICIDAL BEHAVIOR This study was undertaken to answer the following question: Is excessive dependence related to suicidal behavior? In addition, as depression may be an integral part of suicidal behavior, the following question was ex• plored: Is depth of depression related to suicidal behavior? These questions were explored by the administration of three questionnaires - the Navran Dy, the Frequency of Dependency Expression Questionnaire, and the Beck Depres• sion Inventory. The questionnaires were administered to two groups: Group 1 comprised those who had attempted suicide and Group 2, those who had not attempted suicide. In addition, the Navran Dy was administered to the mater of each client in both groups. There were ten clients and ten mates in each group. A t-test was done to determine whether the means of each group differed significantly on four measures: (1) the Navran Dy (administered to clients); (2) the Navran Dy (administered to mates); (3) the Frequency of Dependency Expression Ques• tionnaire; and (4) the Beck Depression Inventory. The findings partially supported the notion that those who attempted suicide are excessively more dependent than those who did not. That is, their i mean scores on the Navran Dy were significantly different; however, the mean scores on the Frequency of Dependency Expression Questionnaire did not differ. Dependency of mates in both groups was identical. Finally, there was a borderline significance between both groups in depth of depres• sion with the suicidal group being more depressed than the non-suicidal group. ii TABLE OF CONTENTS Page ABSTRACT i I INTRODUCTION 1 The Problem 3 Specific Objectives of the Study 3 Hypotheses Tested in the Study 3 Definition of Terms Used 4 Assumptions of the Study 5 Limitations 6 SIGNIFICANCE OF THE STUDY 6 Methodology 8 SUMMARY AND OVERVIEW OF THE REMAINDER OF THE STUDY 9 II REVIEW OF THE LITERATURE 10 INTRODUCTION 10 SUICIDE 11 The Sociological Theory of Suicidal Behavior 11 The Psychoanalytic Theory of Suicide 13 The Interpersonal Theory of Suicide 14 DEPENDENCY 17 Psychoanalytic Theory of Dependency 17 Social Learning Theory of Dependency 19 Parental Loss in Childhood and Suicidal Behavior in Adulthood 21 Adult Dependency 22 Farber's Theory of Suicide 25 Dependency and Suicide - Research Studies 27 Interpersonal Dependence and Suicide - Research Studies 29 Depression and Suicidal Behavior 33 Research Studies 33 SUMMARYary 36 III METHODOLOGY 38 Setting 38 Sample 38 Criteria for Selection of Sample 39 TABLE OF CONTENTS - continued Page DATA COLLECTION TOOLS 40 The Navran Dy:. 40 Measurement of Frequency of Dependency Questionnaire 41 Reliability of the FDEQ 45 Validity of the FDEQ 45 The Beck Depression Inventory 46 IMPLEMENTATION OF THE STUDY 47 Data Collection 47 Hypothesis..... , 48 Data Analysis 48 IV DATA ANALYSIS AND RESULTS 50 Data in Relation to Hypothesis 50 V SUMMARY, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS 63 summary 63 Discussion of Findings 64 Conclusions 66 Implications and Recommendations 66 BIBLIOGRAPHY 69 Books 69 Journals 70 APPENDICES 74 iv LIST OF TABLES Page TABLE I 51 TABLE II 54 TABLE III 57 TABLE IV 60 v LIST OF FIGURES Page Figure 1 Comparison of Groups 1 and 2 on a measure of trait dependence as measured by the Navran Dy 52 Figure 2 Comparison of groups 1 and 2 on a measure of interpersonal dependence as measured by the Frequency of Dependency Expression Questionnaire (FDEQ) • 55 Figure 3 Comparison of groups 1 and 2 on a measure of trait dependence as measured by the Navran Dy 58 Figure 4 Comparison of groups 1 and 2 on a measure of degree of depression as measured by the Beck Depression Inventory (BDI) 61 vi 1 Chapter I INTRODUCTION This study will examine the role of dependency as a determinant in suicidal behavior. In Canada, 2,413 people took their own lives in 1970; this was a rate of 11.3 per 100,000 of the population.^ In recent years in Canada suicide rates have been on the increase, however, the increase in the preva• lence of suicide attempts has been even more dramatic. Relative to the magnitude of the problem there has been a scarcity of studies, particularly Canadian studies, which can assist in the evaluation of, and intervention in, the problem of attempted suicide. In recent years increasing attention has been given to defining the role of a nurse. More nurses are accepting responsibility for broadening their knowledge to include skills in understanding the psychological and sociological aspects of human behavior. How can we enhance our understanding of suicidal behavior to ensure effective prevention and treatment? The wish to die has been historically associated with a depressed state. Consequently, a major therapeutic approach has been the treatment of the 1 J. H. Brown, "Suicide - The Deserted Field," Canadian Psychiatric Association Journal, Vol. 18, 1973, p. 93. 2 Ibid. 3 Ibid. 4 Eugene Levitt, et al, Depression (New York : Springer Publishing Company, 1975) p. 47. 2 symptoms of depression. Some theoreticians claim that the only difference between those who attempt suicide and those who do not is their depth of .'5 depression. In other words, depression is a significant determinant of sui• cidal behavior.^ It is the researcher's contention that problems arising from dependency difficulties cannot be overlooked as a major contributing factor to suicidal behavior and, furthermore, that suicidal behavior can be a product of conflicts resulting from excessive trait and interpersonal dependence with• out a significant degree of depression. Lester (1972) did a comprehensive review and summary of all research findings on suicidal behavior. In relation to dependency and suicidal behavior he stated: "Dependency has frequently been noted in the suicidal individual. However, there have been few intensive investigations of the degree of dependency of the suicidal person. "7 Are suicidal persons generally more dependent? Are suicidal persons excessively dependent in their interpersonal relationships? Ane1 isuicidal persons more apt to select a dependent spouse? This present study is an attempt to answer these questions by investigating the degree of dependency of the suicidal person and his/her mate. Norman Farberow et al, "Suicide Among Patients With a Diagnosis of Anxiety Reaction or Depressive Reaction in General Medical and Surgical Hospitals," Journal of Abnormal Psychology, 71 : 4, 1966, p. 287. ^ Eugene Paykel et al, "Suicide Attempts Following Acute Depression,11 The Journal of Nervous and Mental Disease, 153 : 4, 1971, p. 234. ^ David Lester, Why People Kill Themselves (Springfield, Illinois : Charles C. Thomas, 1972) p. 185. 3 The Problem The problem with which the present study is concerned is this: Is dependency a significant contributing factor in suicidal behavior? The problem will be explored by administration of two dependency scales, the Navran Dy and the Frequency of Dependency Expression Question• naire (FDEQ) to two groups of adults: one group seen following a suicide attempt, and one group seen following a psychiatric admission not precipit• ated by a suicide attempt. In addition, the Navran Dy was administered to the mate;;of each individual in both groups. Specific Objectives of the Study The specific objectives of this study were: 1. To determine whether individuals who attempted suicide were more dependent, both in trait and interpersonal dependence, than those who did not attempt suicide. 2. To determine whether those who attempt suicide select a more highly dependent mate than those who do not, attempts suicide. 3. To monitor the extraneous variable of depression which will demon• strate whether those who attempted suicide were more depressed than those who did not attempt suicide. Hypotheses Tested in the Study The null hypotheses tested in this study are: 1. There is no significant difference between those who attempt suicide and those who do not attempt suicide in their degree of trait dependence. 4 2. There is no significant difference between those who attempt suicide and those who do not attempt suicide in their degree of interpersonal dependence. 3. There is no significant difference between those who attempt suicide and those who do not attempt suicide in the trait dependency of their selected mates. The depth of depression of all subjects is to be monitored. Consequently, it was also possible to test the following null hypothesis: 4. There is no significant difference between those who attempt suicide and those who do not attempt suicide in their degree of depression. Definition of Terms Used Adult - for the purpose of this study refers to persons between the ages of eighteen and fifty-five. Suicide Attempter - for the purpose of this study refers to any individual seen following non-fatal self inflicted injury. Dependent Adult - for the purpose of this study is defined as the person possessing the following characteristics: 1. Likes to be in close physical proximity to other people.
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