Table 3 Reviewed articles summary
Authors Country | Methodology | Phenomena of interest | Factors associated with suicide | Findings/Outcomes | Quality |
|---|---|---|---|---|---|
Mathew et al. [12] India | -Qualitative -Purposive sampling -In-depth interviews -Each interview lasted about 30 min -Participants were recruited from in-patient wards of a tertiary care medical hospital -Sample size: 22 (Female: 11; Male: 11) -Age: 13–29 years -Thematic analysis was performed | Explored the family factors contributing to the suicide attempt | -Lack of family support -Low socioeconomic factors -Hostile environment within the household environment | -Lack of family support and a volatile home environment (i.e., conflictual interactions between family members, parental conflicts and separation, conflict with a sibling or other members of the family, and marital disharmony) leads to suicidal attempts among adolescents and young adults -Socioeconomic factors (such as financial issues, superstitious beliefs, disturbing neighbourhoods, interpersonal issues, and the stigma of having a mental illness) may lead to suicidal behaviour | Strong |
Akotia et al. [36] Ghana | -Qualitative - Purposive sampling -Narrative interviews -Interviews ranged from 12–80 min - Participants were recruited from five hospitals and clinics in Accra, the capital of Ghana - Sample size: 30 (Female: 18; Male: 12) -Age: 18–46 years -Interpretative Phenomenological Analysis was performed | Examined the role played by religion in the experiences of persons who attempted suicide | -Religion is related to suicidal behaviour | -Participants acknowledged God as the owner of life and death -Suicide attempts are considered as own responsibility and a crime against God -Participants experienced guilt and tried to restore the relationship with God by asking for forgiveness -Few of the participants seemed to understand God as a tyrant as he did not fulfil his promises even though they had fulfilled their religious duties | Strong |
Acheampong & Aziato [22] Ghana | -Qualitative -Purposive sampling -In-depth interviews -Interviews lasted 30–40 min -Participants were recruited from a major rehabilitation centre located in Accra, the capital city of Ghana -Sample size: 12 (Female: 12) -Age: 21–57 years -Data were analysed inductively using the content analysis technique | Explored suicidal ideations and coping strategies of mothers living with physical disabilities | -Social isolation -Separation from family and friends -Feeling of being discriminated | -Discrimination makes people living with disability feel isolated. -Eventually, isolation may lead to a sense of separation from the masses and separation may mean attempting suicide and leaving this world -Coping strategies to avoid suicide attempts include the reason for having children, self-motivation, counselling, assistance from relatives, and prayer | Strong |
Akotia et al. [13] Ghana | -Qualitative -Purposive sampling -Narrative interviews -The interviews lasted from 30 to 40 min (with one exception, 15 min) -Participants were recruited from five hospitals in Accra, the capital of Ghana -Sample size: 30 (Female: 18; Male: 12) -Age: 18–46 years -Interpretative Phenomenological Analysis was performed | Examined the reasons for suicide attempts among patients in Ghana | -Existential struggles -Lack of social support -Supernatural beliefs -Abandonment | -Lack of support, shame, abandonment, existential struggles, and supernatural reasons were reasons identified as contributing to the suicide attempt -Gender differences in the reasons for attempting suicide: (1) men resorted to suicidal behaviour when faced with shame, existential struggles, and supernatural reasons; (2) Women tried to kill themselves when they felt they lacked social support or faced abandonment. | Strong |
Asare-Doku et al. [17] Ghana | -Qualitative -Purposive sampling -Semi-structured interviews -Each interview lasted 40–60 min -Participants were recruited from the Psychiatry Department of Korle-Bu Teaching Hospital located in Accra, within the Greater Accra Region of Ghana -Sample size: 10 (Female: 4; Male: 6) -Age: 25–62 years -Interpretative Phenomenological Analysis was performed | To understand the experiences of the families of attempt survivors and how they cope with the aftermath of the attempt | -Shame to being survived the suicide attempt -Lack of institutionalized professional support for the suicide survivors | - Negative experiences and reactions towards the suicide attempts: experiencing shame and stigma, reactive affect, and surviving the stress of the attempt - Participants were experiencing shame with feared stigma following the suicide attempt of their relatives - Attempt survivor families did not receive much help following the attempt. This might reflect both self-stigma (which in some of the cases discouraged informants from seeking help), lack of credible institutionalized professional support and the generalized negative attitudes toward suicide in Ghana | Strong |
Osafo et al. [33] Ghana | -Qualitative -In-depth interviews -Participants were recruited from a small village in the Eastern Region of Ghana with a population of about 500 inhabitants -Sample size: 10 (Male: 10) -Age: 30–41 years -Thematic analysis was performed | To understand the experiences of suicidal persons in Ghana | -Social taunting, hopelessness, and partner’s infidelity. -Suicidal persons reported stigma expressed through physical molestation and social ostracism, which left them traumatized | -Suicidal persons reported stigma expressed through physical molestation and social ostracism, which left them traumatized -Participants’ sense of hopelessness was linked to despair arising from their present living conditions, such as lack of job and hassles of living with a chronic illness -The analysis has further shown that the life of a suicidal person in the rural context is a traumatic experience. Community stigma increased their pain, causing further trauma -Coping strategy includes social support from relations, religious faith, and use of avoidance. | Moderate |
Shamsaei et al. [14] Iran | -Qualitative -Purposive sampling -In-depth interviews -Interviews ranged from 40 to 60 min -Participants were recruited from the Farshchian Psychiatric Hospital in Hamadan, Iran -Sample size: 16 (Female: 4; Male: 12) -Age: 19–57 years -Interpretative Phenomenological Analysis was performed | -Explored the lived experience of attempted suicide with the phenomenology approach | -Social isolation/lack of sense of belongingness -Social and economic factors -Mental pain | -Participants have talked about suffering and problems that has different dimensions including mental pain, family, social and economic factors, and the need for understanding and loving -Suicide risk is most commonly associated with mental illness. Mental disorders play an overwhelming role in the increased risk of suicide -The levels of mental pain are associated with an increased risk of suicide -The sociocultural factors that affect suicide rates operate at many different levels including demographic characteristics, life stressors, coping skills, and economic status linked to suicide -Love and a sense of belongingness would decrease suicidal behaviour | Strong |
Azizpour et al. [23] Iran | -Qualitative -Purposive sampling -Semi-structured interviews -Interviews lasted between 45 to 95 min - Participants were recruited from the Two teaching hospitals (referral centers for suicide attempters) in Ilam, Iran -Sample size: 7 (Female: 7) -Age: 20–37 years -Interpretative Phenomenological Analysis was performed | To understand the experience of women after suicide attempts | -Gender discrimination -Social pressure particularly on women | -Loved ones keeping an eye on them, i.e., families of suicide attempters had taken a very cautious approach toward them. Female suicide attempters were not allowed to be alone, and their families kept them under careful observation. For instance, “keeping suicide attempters under intensive supervision” made them feel as though their privacy rights were threatened by this careful observation. -Rain of love, i.e., families were worried about the possibility of the women’s sudden death resulting from suicide. This fear led to the emergence of the following reactions: “emotional reactions,” “emotional support,” “financial support,” and “accepting any demand.” The “rain of love,” and the unreasonable acceptance of any request and demand by the women in particular, gave them a sense of satisfaction regarding their suicidal behaviours. | Strong |
Rezaie et al. [21] Iran | -Qualitative -Purposive sampling -Semi-structured interviews -Interviews lasted between 20 to 60 min -Participants were recruited from the Kermanshah Imam Khomeini hospital, Iran -Sample size: 15 -Age: 22–50 years - Data were analyzed using the constant comparative method which is the Grounded Theory data analysis method | Explored motives for suicide by self-immolation in Kermanshah, Iran | -Depression -Chronic severe stress -Conflicts between family members | -Five categories of mental health problems, family problems, cultural context, self-immolation as a threat, and distinct characteristics of the method were explored as motives for attempting suicide by self-immolation. - Mental health problems including primary psychiatric disorders (depression) and adjustment psychiatric disorders (such as an impulsive act to self-immolation were reported as a reaction to chronic or severe stress seems more important) were among the motives for attempting suicide by self-immolation - Results also show that existed conflicts between the family members of self-immolated patients, especially wives–husbands, and parents–children problems were a mentioned motive for attempting self-immolation | Strong |
Sukhawaha et al. [15] Thailand | -Qualitative -Purposive sampling -In-depth interviews -Interviews ranged from 45 to 60 min -Sample size: 18 -Content analysis was performed | To describe attempted suicide triggers in Thai adolescents | -Unwanted Pregnancy -Harsh familial relationships -Depression -Poverty and low socioeconomic status -Domestic violence -Alcoholic family | -Regarding attempted suicide, there is a gender difference: females are more engaged in the suicidal attempt but are less likely to complete suicide than males. -The problems of relationships and harsh criticisms expressed with anger by important people in their lives, whether they are family members (especially mothers) or lovers greatly influenced adolescent’s emotions and the decision to attempt suicide - Females in this study are disappointed in love and unwanted pregnancy, both of which lead to the decision to attempt suicide - Pregnancy is a risk factor among women and most women who attempted suicide during pregnancy in the first period were young with lower socioeconomic status who had not finished their schooling - In terms of mental health, problems including depression lead to attempted suicide which is also found in this study -Family context may be the predisposing risk factor to adolescents’ attempted suicide; poverty or low socioeconomic, living apart from parents, living with a single mother or stepfather, having alcoholic parents, domestic violence and dysfunctional family | Strong |
Wang et al. [37] China | Qualitative -Purposive sampling -Semi-structured and individual in-depth interviews -Interviews lasted between 20 to 60 min -Participants were recruited from a tertiary referral hospital in China -Sample size: 15 (Female: 14; Male: 1) -Age: 22–50 years -Thematic analysis was performed | Explored the impact of inpatient suicides on nurses working in front-line, the patterns of regulation and their needs for support | -Being inpatient -Psychological health vulnerabilities | -Inpatients were highly likely to die by suicide; considered difficult to prevent -Nurses lacked the necessary suicide prevention skills -Psychological responses mainly included shock and panic, self-accusation or guilt, sense of fear, and frustration -The impacts on practice were stress, excessive vigilance, and burnout -Avoidance and sharing of feelings played key roles in the regulation patterns of nurses - High levels of emotional distress and negative impact on practice in nursing staff working in the general hospitals. Their patterns of regulation to cope with inpatient suicide should be improved | Strong |
Amin et al. [16] Iraq | -Qualitative -Purposive sampling -Semi-structured in-depth interviews -Participants were recruited from urban and rural areas of Soran District, Iraq Sample size: 24 (Female: 24) -Age: 21–45 years - Data were analysed using conventional content analysis | Explored probable issues which might lead to self-immolation in young Kurdish Iraqi women | Causes of self-immolation are: -Not having control over personal life, and marital conflicts (Some participants revealed that they chose to do self-immolation to get rid of marital conflicts) -Seeking attention (they tried to seek others’ attention and send them a persuasive message. By using the bravado of fire, they want to voice their complaints, so that those who have shut their eyes and ears and ignored them for so many years can hear what they have to say) -Instilling guilt in the family members (Ignoring the personal and social rights of women in some societies, especially in rural ones, due to their dominant culture, is likely to lead to such consequences as mental problems and depression), and -Resentment toward male dominant community (Most Kurdish women’s rights activists believe that, in these regions, self-immolation and suicide are a kind of protest against the male-dominated society and the discriminations and limitations imposed by the father, brothers, and the husband’s family.) | Moderate | |
Medina et al. [38] Nicaragua | -Qualitative -Purposive sampling -In-depth interviews - Participants were recruited from León municipality, Nicaragua -Sample size: 12 (Male: 12) -15-24 years -Data were analysed with a grounded theory approach | To understand the pathways leading to attempted suicide of young men in León, Nicaragua | -Frustration -Traumatic life experience -Experience antagonistic relationships within the family atmosphere | -Overall, suicide attempts can be viewed as a response to frustration caused by negative structural conditions both in terms of material circumstances and unfulfilled normative expectations -In all cases, the decision to attempt suicide was found to be an expression of frustration with the present conditions of life. Combined with this was the traumatic influence of a troubled childhood within an unloving, unstable family -Traumatic life experiences, exposure to suicidal behaviour among close relatives and interpersonal conflicts all served as triggering factors further fuelled by alcohol and drug intake -Attention has been paid to the ambivalent and antagonistic relationships that the informants experienced within their own families from childhood onwards, and the subsequent inability to establish any meaningful relationships in later life | Strong |