In Their Own Words Understanding Suicide Motives in Adolescents and Young Adults: a Qualitative Inquiry of the Lived Experience
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In Their Own Words Understanding Suicide Motives in Adolescents and Young Adults: A Qualitative Inquiry of the Lived Experience Alexandra Nicolopoulos A thesis in fulfilment of the requirements of the degree of Doctor of Philosophy School of Psychiatry Faculty of Medicine 20th January 2020 Thesis/Dissertation Sheet ii Originality Statement I hereby declare that this submission is my own work and to the best of my knowledge it contains no materials previously published or written by another person, or substantial proportions of material which have been accepted for the award of any other degree or diploma at UNSW or any other educational institution, except where due acknowledgement is made in the thesis. Any contribution made to the research by others, with whom I have worked at UNSW or elsewhere, is explicitly acknowledged in the thesis. I also declare that the intellectual content of this thesis is the product of my own work, except to the extent that assistance from others in the project’s design and conception or in style, presentation and linguistic expression is acknowledged. iii Copyright Statement I hereby grant the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all proprietary rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350-word abstract of my thesis in Dissertation Abstract International (this is applicable to doctoral theses only). I have either used no substantial portions of copyright material in my thesis of I have obtained permission to use copyright material; where permission has not been granted, I have applied/will apply for a partial restriction of the digital copy of my thesis or dissertation. iv Authenticity Statement I certify that the Library deposit digital copy is a direct equivalent of the final officially approved version of my thesis. No emendation of content has occurred and if there are any minor variations in formatting, they are the result of the conversion to digital format. v Acknowledgements My family and friends. You wonderful humans! This PhD has consumed my time, emotions, energy and passion for the better part of 4 years and yet you have all remained supportive, patient and encouraging throughout. Thank you! I love you all! Special mention to my F04 office buddies – Lara, Vic, Celeste, Lauren and Hannah – who managed to survive some extremely turbulent and emotionally charged years in the same office as a high-energy, highly stressed, and easily agitated PhD candidate! You are great friends. This extends, of course, to my PhD family – Jen, Joe and Laura – who have been by my side throughout this entire journey. What a team! Without you, I honestly do not think I would’ve made it through. Love you guys. Katherine, Fiona and Helen… my tremendously clever, supportive, encouraging supervisors. Words are not enough. You persevered with me throughout every trial and tribulation – every single tear, every moment of self-doubt, every minute of the dreaded ‘imposter syndrome’ – and I will be forever grateful. Being your student, I have not only learnt how to be a quality researcher, but also, a quality human. I have been truly humbled to be surrounded by strong, intelligent, confident women on this journey, and I am so thankful that you chose me. Aliza and Michelle, thank you for your mentorship and willingness to help whenever you could, with whatever you could. You have been so generous with your time. Kim – you, too! At a time when my identity as a passionate, qualitative researcher was questioned… I met you, and you instilled in me a desire to never let that passion die… no matter what. I am so grateful. Finally, to the inspiring young individuals who shared your stories with me. Thank you for your courage, honesty and rawness. With your resilience and strength, the future of the world is bright. The future of YOUR world is bright. Never forget it. vi Abstract In the quest to effectively understand what motivates adolescents and young adults to attempt suicide, it is imperative to examine the interplay between factors pertaining to suicide risk, suicidal ideation, and suicide attempt. While current psychological models of suicide have captured this interplay proficiently, they have predominantly been informed by research undertaken in adult populations. Further, these studies have largely been epidemiological and/or clinical in nature, with a diminutive focus on capturing the lived experience of suicide via qualitative methods. The first study in this thesis systematically reviewed and examined qualitative studies conducted between 1995 and 2015, which had investigated motives for suicide in individuals aged 12-25. Results indicated disparity between current suicide models and participants’ lived experience accounts of suicide. Additionally, the review found a lack of research rigour and comprehensiveness among studies which were identified. The second study in this thesis undertook a rigorous, comprehensive qualitative study informed by the findings of the first. Robust theoretical underpinnings, rigorous analytical frameworks, and novel approaches to recruitment and data collection, were employed to explore the multiple complex factors which motivate young individuals to take their own lives. An extensive thematic network analysis revealed interpersonal dysfunction, environmental factors and compromised identity served as the highest risks for suicide in this population. Further investigation of thoughts, emotions and feelings present while ideating, and at the time of attempt, highlighted different themes to those reported in existing suicide models, particularly regarding the linearity of the suicide trajectory endorsed by the models. vii The overall findings of this research suggest the frameworks of current suicide models - predominantly informed by quantitative studies and investigating adult populations - have not reflected some of the vital themes which characterise the suicide experience of younger populations. Further identified is the capacity of comprehensive qualitative inquiry to highlight richly detailed lived experience and contextual factors, not accessible via clinical and epidemiological studies. Drawing upon qualitative inquiry to inform both extant and future theoretical models, can provide important new insights into understanding suicide in adolescent and young adult populations. viii Table of Contents Thesis/Dissertation Sheet ............................................................................................. ii Originality Statement ................................................................................................. iii Copyright Statement .................................................................................................. iv Authenticity Statement ................................................................................................. v Acknowledgements ..................................................................................................... vi Abstract ...................................................................................................................... vii Table of Contents ........................................................................................................ ix List of Tables.............................................................................................................. xv List of Figures ........................................................................................................... xvi Chapter 1 – Introduction and Review of Literature .......................... 1 1.1 Background ....................................................................................................... 1 1.2 Psychological Theories of Suicide ................................................................... 3 1.3 Epidemiological and Risk Factor Research ................................................... 7 1.3.1 What Do We Know About the Factors That Contribute to Suicide Behaviour? .... 8 1.4 Qualitative Research Investigating Youth Suicide Motives ......................... 9 1.5 Systematic Review .......................................................................................... 13 1.6 The Present Project ....................................................................................... 30 1.7 Study Aim and Research Questions .............................................................. 31 1.7.1 Study Aim ............................................................................................................. 31 1.7.2 Research Questions ............................................................................................... 31 ix 1.8 Organisation of Thesis ................................................................................... 31 Chapter 2 – Method and Methodology .............................................. 33 Chapter Overview ...................................................................................................... 33 2.1 Theoretical Underpinnings ............................................................................ 33 2.2.1 Interpretive Interactionism ...................................................................................