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Suicide Notes from Mexico and the United States: a Thematic Analysis

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Suicide Notes from Mexico and the United States: a Thematic Analysis ARTÍCULO ORIGIN A L Chávez-Hernández AM y col. Suicide notes from Mexico and the United States: a thematic analysis Ana-María Chávez-Hernández, PhD, (1) Antoon A Leenaars, PhD,(2) María-Isabel Chávez-de Sánchez, PhD,(2) Lindsey Leenaars, MEd(3) Chávez-Hernández AM, Leenaars AA, Chávez-Hernández AM, Leenaars AA, Chávez-de Sánchez MI, Leenaars L. Chávez-de Sánchez MI, Leenaars L. Suicide notes from Mexico and the United States: Notas suicidas de México y Estados Unidos: a thematic analysis. un análisis temático. Salud Publica Mex 2009;51:314-320. Salud Publica Mex 2009;51:314-320. Abstract Resumen Objective. This study sought to investigate suicide notes Objetivo. Este estudio tuvo por objetivo la comparación de drawn from Mexico and the United States (US) as these notas suicidas (póstumas) de México y de Estados Unidos, countries share geographical proximity, but markedly different países que aunque vecinos geográficos, presentan marcadas cultures and suicide rates. Material and Methods. A theo- diferencias culturales y porcentajes de suicidio. Material y retical conceptual analysis of 102 suicide notes drawn from métodos. Se realizó un análisis conceptual de 102 notas (51 these countries, matched for age and sex, was undertaken mexicanas, 51 estadunidenses), pareadas por edad y sexo. based on a thematic model of suicide developed by Leen- Se utilizó el Modelo temático de suicidio desarrollado por aars,1,2 across countries. Results. The inter-judge reliability Leenaars1,2 y que ha sido la base de varios estudios en diversos was adequate (.86 coefficient of concordance).Conclusions. países. Resultados. La técnica de Análisis de contenido obtu- The results suggested that there are more psychological vo un adecuado nivel de concordancia (86%) con el Método commonalities than differences. Yet, as this study marks the de interjueces. Conclusiones. Los resultados informan que first one using suicide notes, between Mexico and the USA, existen más semejanzas que diferencias psicológicas entre much greater study is warranted. ambas muestras. El presente es el primer estudio que utiliza notas suicidas entre ambos países. Key words: suicide/psychology; thematic analysis; comparative Palabras clave: suicidio/psicología; análisis temático; estudio study, Mexico, United States comparativo; México, Estados Unidos uicide is a worldwide problem and cross-cultural can countries.5,6 The study of the role of culture on studies are essential in developing our understand- suicide rates has developed from Durkheim’s seminal ingS of suicidal behavior.3,4 The studies to date confirm work7 relating suicide to social integration. that suicide rates are different among nations; suicide Much of the research on suicidal behavior in Latin levels have been found to be lower in less developed American countries has been simple descriptive samples countries, particularly African, Asian and Latin Ameri- of completed and attempted suicides. Yet, there is a (1) Universidad de Guanajuato. León Guanajuato, México. (2) Investigadores independientes. (3) University of Alberta. Edmonton, Canada. Received on: September 10, 2008 • Accepted on: May 12, 2009 Address reprint requests to: Dra. Ana María Chávez Hernández. Departamento de Psicología, Universidad de Guanajuato. Av. De las Rosas 501, col. Jardines de Jerez. León. 37530 Guanajuato, México. E-mail: [email protected] 314 salud pública de méxico / vol. 51, no. 4, julio-agosto de 2009 Suicide notes from Mexico and the USA ARTÍCULO ORIGIN A L strong possibility that these findings may be mislead- cross-cultural perspective, one has to be careful selecting ing because suicide rates in these countries, as in many the methods of study, because of the risk of validity and others, are underreported. However, even when Mexico reliability problems between different cultures.18 Our has a relatively low rate of suicide, according to a study method will be the study of suicide notes. conducted by the WHO8 amongst countries with popu- Early research19,20 on suicide notes largely used an lations over 100 million inhabitants, it turned out to be approach that incorporated descriptive information. the country with the highest increase within certain age Subsequent methods, using Frederick’s21 scheme for groups, under the Changes in Age-standardised Suicide methods of analysis have used content analysis, clas- Rate indicator (+61.9% for the period 81-83/93-95), fol- sification analysis and theoretical-conceptual analysis. lowed by countries such as India (+54%, 80-95 period), Each of these approaches has had utility, although Brazil (+13.2% 79-81/93-95 period) and Russia (+5.3% Frederick suggested that simple content analysis has 80-82/96-98 period). limitations (such as noting that the word “love” occurs At the same time, several domestic studies have frequently). Classification schemes use data such as confirmed the rise in suicide in Mexico.9,10 Since 1997, age, sex, marital status, educational level, employment suicide has become the fourth cause of death amongst status and mental disorder.21 Ho and his colleagues22 people from 15 to 29 years of age. In 2000 it was the developed the most widely used classification scheme; third cause of death amongst women from 15 to 19 years they studied suicides notes in Hong Kong. A similar of age and in 2005 it was the second for the 10-19 age classification scheme has been used in India,23 Mexico13 group. Ever since 2001, suicide has been the ninth cause and Turkey.24 However, there are limitations; the data of death within the working age group (15 to 64 years are not entirely consistent and differences in collection of age), increasing its toll on a yearly basis: from a 5.17 occur. Yet, the studies have also supported the value rate in 2001, to a 5.5 one in 2005.11 of the data, the notion that suicide is complex and the Most of the studies related to suicide in Mexico validity of generalizing from suicide note writers to all focus on socio-demographical account, such as on sui- suicides,22,25,15 warranting, among other things, more cides, suicidal ideation and attempts.12 Studies on the in-depth study of suicide notes in different cultures. psychological dynamics of the suicidal individual are Only a very few studies have utilized a theoretical- scarce. There is only one study on suicide notes.13 Fur- conceptual analysis,26 despite the assertion in the first thermore, there are only two cross-cultural studies with formal study of suicide notes21 that such an approach Mexico on suicide. Hijar, Chu & Kraus14 presented an offers much promise. To address this lack, over 30 years epidemiological study between two cities: Mexico and ago, Leenaars25-28 et al. Has applied a logical, empirical Los Angeles. They found that in Los Angeles suicide was analysis to suicide notes. The method permits a theoreti- more prevalent in all age groups, except in the elderly, cal analysis of suicide notes, augments the effectiveness where there were similar rates. This sparsity warrants of controls, and allows us to develop some theoretical greater cross-cultural study, especially between Mexico insight into the vexing problem of suicide that may have and the USA, given their geographical similarity, but cross-cultural application. also great cultural differences (e.g., language, religion, The method has been previously described in de- education). The other study was conducted by Nock et tail.25,2,26 It treats suicide notes as an archival source. This al (2008)15 and the aim was to report the prevalence and source is subjected to the scrutiny of control hypotheses, risk factors for suicidal behaviors across 17 countries. following an ex post facto research design. This would call Understanding the act of suicide and motives for suicide protocol, such as notes to be recast in differ- behind suicide behaviour seems extremely important ent theoretical contexts (hypotheses, theories, models) worldwide,4 and in order to do so, many researchers for which lines of evidence of each of these positions from around the world have used different methods to can then be pursued in the data. Carnap’s logical and study suicide. Shneidman and Farberow,16 Maris,17 and empirical procedures29 can be utilized for such investiga- others have suggested the following avenues: national tions. To date, the theories of 10 suicidologists, as noted mortality statistics, retrospective psychological inves- earlier, have been investigated: A. Adler, L. Binswanger, tigations (often called psychological autopsies), the S. Freud, C. G. Jung, K. A. Menninger, G. Kelly, H. A. study of nonfatal suicide attempts and the analysis of Murray, E. S. Shneidman, H. S. Sullivan and G. Zilboorg. documents (such as suicide notes). All of them have their In order to test the formulations, Carnap’s positivistic limitations and there are problems in obtaining them procedure29 calls for the translating of theoretical formu- in many countries, including Mexico. Yet, each of these lations into observable (specific) protocol sentences.30 methods has been shown to develop our understanding To summarize from a series of empirical studies of suicide and suicidal behaviour. Furthermore, from a (e.g., age, sex, method used, nation) of the theories of salud pública de méxico / vol. 51, no. 4, julio-agosto de 2009 315 ARTÍCULO ORIGIN A L Chávez-Hernández AM y col. the 10 suicidologists, a number of theoretical proposi- Studies of suicide in different cultures and nations tions/implications (or protocol sentences) have been show differences, despite also similarities,36 for example, identified to be observable in various samples of notes. a study by Gonzalez-Forteza et al,37,38 in Mexico. Suicide In his model, Leenaars isolated 100 protocol sentences has different meanings for different people. There are from each of the 10 theorists and reduced them to only a few studies, for example, on suicide notes from 35 sentences; 23 protocol sentences were found to be different countries.
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