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Perceptions of Adolescents, Teachers and Parents Towards Causes And Surachai Chaniang et al. Perceptions of Adolescents, Teachers and Parents towards Causes and Prevention of Suicide in Secondary School Students in Chiang Mai Surachai Chaniang*, Warunee Fongkaew, Hunsa Sethabouppha, Sumalee Lirtmunlikaporn, Karen G. Schepp Abstract: Adolescent suicide has become a major public health concern worldwide, including in Thailand. This qualitative descriptive study explored the perceptions of adolescents, teachers and parents towards causes and prevention of suicide in secondary school students in Chiang Mai. Purposive sampling was used to select 40 adolescents for focus group discussions, and in-depth interviews were conducted with 4 parents and 3 school teachers, from October 2014 to February 2015. The data were analyzed using content analysis. The categories of this study were two-fold: 1) the causes of adolescent suicide which could be summarized into four sub-categories, namely parents' expectations, lack of skills to confront problems, feeling lonely from inadequate support, and lack of parental skills, and 2) Prevention of adolescent suicide, which had four sub-categories, namely cultivating self-esteem, parental support and caring, peer support, and supportive school environments. The findings of this study could help as evidence for developing a suicide prevention program for Thai secondary school students and should help parents, teachers and school nurses to understand the emotional needs of adolescents better. Pacific Rim Int J Nurs Res 2019; 23(1) 47-60 Keywords: Qualitative study, Causes of suicide, Suicide prevention, Secondary School students, Thailand Received 29 November 2017; Accepted 24 March 2018 Correspondence to: Surachai Chaniang*, RN, PhD Candidate, Faculty of Nursing, Chiang Mai University, Thailand and Lecturer, Boromarajonani College of Nursing Nakhon Phanom, Nakhon Phanom University, Thailand. Introduction E-mail: [email protected] Warunee Fongkaew, RN, PhD, Professor, Faculty of Nursing, Chiang Mai University, Thailand. E-mail: [email protected] Adolescent suicide is a significant public health 1 Hunsa Sethabouppha, RN, PhD,Lecturer, Faculty of Nursing, Chiang Mai problem worldwide and suicide is the third leading University, Thailand. E-mail: [email protected] cause of death among adolescents aged 15 - 19 years Sumalee Lirtmunlikaporn, RN, PhD, Assistant Professor, Faculty of Nursing, 2 Chiang Mai University, Thailand. E-mail: [email protected] old. In the United States, the Youth Risk Behaviors Karen G. Schepp, RN, PhD, PMHCNS-BC, FAAN, Professor, School Surveillance Survey [YRBSS] showed that nearly of Nursing, University of Washington, Seattle, Washington, USA. 18% of high school students had seriously considered E-mail: [email protected] suicide within 12 months prior to the 2015 survey.3 central Thailand aged 12-19 years had suicidal In Thailand, adolescent suicide is the fourth highest ideation.5 A situational analysis of adolescent suicide cause of death among Thai adolescents.4 In recent years, in a district in Chiang Mai, Thailand found that the evidence indicates that 20.6% of the adolescents in adolescent suicide attempted and completed rate was Vol. 23 No. 1 47 Perceptions of Adolescents, Teachers and Parents towards Causes equal to 13.3 per 100,000 population and the adolescent Previous studies in Western countries and suicide rate was higher than Thai national rate and the Thailand reported that factors related to suicide risk average rate of 5.96 and 6.3 per 100,000 population behaviors among adolescents could be categorized respectively.6 The significant burden related to suicide into risk and protective factors. Risk factors related to such as emotional and psychosocial morbidity, medical adolescent suicide have been identified by several care, lost productivity and secondary distress caused studies, including perceived negative life events11,12,15, to family members and friends is evident from the rumination11, and emotional distress11,16 (depression, fiscal and societal cost associated with adolescent hopelessness, and anxiety) that have been emphasized suicidal behavior.7,8 Thai secondary school students as predictors of suicide risk behaviors. Even though today are facing increasing amounts of school work negative life events, rumination and emotional distress and are worried about their future field of study as are associated with increased risk for suicide, other well as their pending future career.9 In particular, students variables such as resilience11,15,17, family support18,19,20,21, who aim to study in a university must pass rigorous and social support11,22,23,24 serve as protective factors entrance examinations which include two decisive by mediating the risk factors of emotional distress, tests: O-NET (Ordinary National Educational Test) rumination, and negative life events on suicidal risk and A-NET.10 Adolescents who fail to cope well behaviors. with their growth development may have intense Within the past decade, a great deal of suicide emotional and behavioral problems.11 To understand prevention literature review has been conducted in this phenomenon and develop an effective suicide order to investigate the types of prevention activities prevention program, it is necessary for the researchers. being implemented, the effectiveness of prevention However, little research has explored the perception activities and program, and the methodological rigor of suicide among adolescents, teachers and parents of prevention research and program evaluation.25 towards causes and prevention of suicide in secondary Suicide prevention strategies can be categorized into school students in Chiang Mai, Thailand by employing three levels, including universal strategies, selective a qualitative study. strategies, and indicative strategies.25 Universal strategies that target the entire population and are designed to Review of Literature enhance protective factors or reduce risk factors across the whole population include suicide education26 Since 2005 until 2017, there has been an and suicide awareness26, and skill building.27 Selective investigation of the prevalence rates of suicidal strategies that target the sub-population of adolescents behaviors among Thai adolescents. Existing research who may be at higher risk for engaging in suicidal in 2005 indicated that 11.9% of students in grade behavior include screening techniques28, gatekeeper 10-12 reported having suicidal ideation.12 In 2007, training 28 and peer support programs.29 Indicative research showed that 11.4% of students in grade 7–12 strategies, on the other hand, target adolescents who seriously considered attempting suicide, 11.5% had have already exhibited suicidal thoughts and behaviors made a plan to attempt suicide and 9.3% had attempted and aim to minimize the consequences of an adverse suicide.13 Furthermore, in 2012 it was found that the event or situation. For adolescent suicide, these strategies overall prevalence of suicidal ideation in the past 12 aim to provide resources to adolescents that have months among school-going adolescents was 8.8% moved beyond being at risk and are struggling with (9.9% males and 7.7% females, N= 2,758).14 suicidal ideations and suicide attempts. Two current 48 Pacific Rim Int J Nurs Res • January - March 2019 Surachai Chaniang et al. programs that have been rigorously tested and show Purposive sampling was used to select the promising results are Counselors Care (C-Care)/ participants who were divided into 3 groups. The first Coping and Support Training (CAST)30 and the group of 40 adolescents included 20 male students IPT-A-IN program.31 Although many research and 20 female students who were studying in Grades prevention studies claimed to have obtained positive 10-12 and they volunteered to participate and results, unfortunately, the methodological rigor of undertook in focus group discussions (FGDs). The the studies has generally been weak. Another problem second group, four female parents of students who with current prevention and intervention programs were willing to participate and undertook in-depth is the lack of a theoretical framework to guide interview. The third group, three female school teachers implementation and measurement of effectiveness of who had experience with issues related to adolescent’s such programs.32 suicide risk behavior or work related to adolescents’ In contrast, in Thailand, previous studies focused health and were willing to participate and undertook on reducing depressive symptoms among Thai in-depth interview in the study. adolescents33,34 However, there are still some limitations of these existing programs. First, the intervention Ethical Considerations programs for reducing depressive symptoms did not explain strategies for preventing suicidal risk behavior This study was approved by the Ethics Review among Thai adolescents. Second, the intervention Board of the Faculty of Nursing, Chiang Mai University programs were primarily developed and delivered by (Approval number Full-007-2014) and the director researchers. Finally, Thai adolescent suicide prevention of a public school used as study site. All potential may require comprehensive collaboration among participants were informed verbally and in writing of professionals, parents, school teachers, and peers in the purpose of the study, methods, potential risks and prevention effort. Although there are a number of benefits of participation, and duration of the study. existing suicides prevention programs in Western All potential participants were
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