Building Models for the Relationship Between Attitudes Toward Suicide and Suicidal Behavior: Based on Data from General Population Surveys in Sweden,Norway, and Russia

Our aim was to build a model delineating the relationship between attitudes toward suicide and suicidal behavior and to assess equivalence by applying the model on data from different countries. Representative samples from the general population were approached in Sweden, Norway, and Russia with the Attitudes Toward Suicide (ATTS) questionnaire. Data on experience of suicidal behavior among significant others and self‐reported suicidal expressions were also collected. Structural equation modeling resulted in gender and country specific models where experience of suicidal behavior among significant others and self‐reported suicidal expressions earlier in life predicted attitudes, and attitudes predicted current suicidal expressions. The models included the attitude factors acceptance of suicide, condemnation, and preventability; age and level of education were also incorporated. The different models reveal possible ways to better understand gender and culture‐specific paths between attitudes and suicidal behaviors, and their relevance in a suicide prevention context is considered.     

The association between adolescents' attitudes toward suicide and their psychosocial background and suicidal tendencies.

The present study examined the relationship between adolescents' attitudes toward suicide and their psychosocial background. It also evaluated the association between attitudes toward suicide and the subjects' own suicidal tendencies. A questionnaire assessing these issues was administered to 525 Israeli adolescents. Results indicated that significantly more females, nonreligious adolescents, those exposed to suicidal behavior, and those with increased suicidal risk held more accepting attitudes. Ethnic origin, socioeconomic status, and living in intact/nonintact families were not associated with adolescents' attitudes toward suicide.     

The effects of individualistic‐collectivistic value orientations on non‐fatal suicidal behavior and attitudes in Turkish adolescents and young adults

This study aimed at investigating the effects of individualistic‐collectivistic value orientations on non‐fatal suicidal behavior and attitudes in Turkish adolescents and young adults. A questionnaire containing measures of individualism, collectivism (INDCOL), non‐fatal suicidal behaviors and suicidal attitudes was used to collect the data. The results showed that both suicidal ideation and attempts were significantly more frequent in participants classified as individualist than those who were classified as collectivist on the basis of INDCOL scale scores. Participants with individualistic tendencies displayed more permissive attitudes toward suicide than those with collectivistic tendencies but collectivists believed to a greater extent than the individualists that people should communicate suicidal problems to others. Participants with collectivistic tendencies showed more accepting and helping reactions to an imagined suicidal friend than those with individualistic tendencies. Suicidal ideation and attempts were more common among adolescents than young adults. The findings suggest that individualistic and collectivistic value orientations and developmental status specific stressors play a role in the distribution of nonfatal suicidal behavior and the nature of suicidal attitudes.     

Cross‐national comparisons of attitudes towards suicide and suicidal persons in university students from 12 countries

This paper reports the results of a comparative investigation of attitudes to suicide and suicidal persons in 5,572 university students from 12 countries. Participants filled out two scales measuring attitudes towards suicide and suicidal persons, a measure of psychological distress together with the questions about suicidal behavior. Results showed that the highest suicide acceptance scores were observed in Austrian, UK, Japanese and Saudi Arabian samples and the lowest scores were noted in Tunisian, Turkish, Iranian and Palestinian samples. While the highest social acceptance scores for a suicidal friend were noted in Turkish, US, Italian and Tunisian samples, the lowest scores were seen in Japanese, Saudi Arabian, Palestinian and Jordanian samples. Compared to participants with a suicidal past, those who were never suicidal displayed more internal barriers against suicidal behavior. Men were more accepting of suicide than women but women were more willing to help an imagined suicidal peer. Participants with accepting attitudes towards suicide but rejecting attitudes towards suicidal persons reported more suicidal behavior and psychological distress, and were more often from high suicide rate countries and samples than their counterparts. They are considered to be caught in a fatal trap in which most predominant feelings of suicidality such as hopelessness or helplessness are likely to occur. We conclude that in some societies such as Japan and Saudi Arabia it might be difficult for suicidal individuals to activate and make use of social support systems.     

An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents

Data from 390 high school students were collected to examine potential differences between adolescents who had attempted suicide and those who engaged in self-injurious behavior on measures of depression, suicidal ideation, and attitudes toward life and death. Significant differences were found between controls and the self-harm groups on all dependent variables. A significant difference on attitudes toward life was found between the self-injury and suicide attempt groups. Post-hoc regression analyses showed that measures of depression, suicide ideation, and attitudes towards life predicted participants' self-harm categorization. These findings provide preliminary evidence that self-injurious behavior is different from attempted suicide among a community sample of adolescents.     

Between Hippocrates and God: Ugandan mental health professional's views on suicide

A negative attitude towards suicide is generally assumed to be predominant in low-income countries. In order to understand the negative attitude in general it is necessary to look at how religion and morality influence the attitudes. Our aim in this qualitative interview study was to investigate what attitudes professional mental health workers in Uganda bear towards suicide and suicidal persons. The professionals argue for their attitude by employing religious, communal and medical ethics arguments, which draw both in a negative and positive direction. The professionals are in general unambiguously negative towards suicide and positive towards suicidal people who are mentally ill. In cases other than mental illness non-accepting attitudes surface. This is discussed against previous research showing that effective treatment of suicidal people is to be based on a trusting and accepting relationship.     

Young adults' reactions to gay and lesbian peers who became suicidal following "coming out" to their parents

Rates of nonfatal suicidal behavior among gay and lesbian youth surpass those recorded among their heterosexual peers. A frequently cited precipitant of gay and lesbian nonfatal suicidal behavior is the turmoil associated with coming out to one's family. This study investigated young adults' attitudes toward peers who engaged in suicidal behavior after coming out and being rejected by their parents, and compared them with attitudes toward persons who had become suicidal in response to other stressors (a physical illness, a relationship loss, or an academic failure). Our goal was to explore whether young persons hold beliefs that may encourage lesbian and gay suicidal behavior. We found that gays and lesbians who engaged in suicidal behavior following coming out were not viewed in particularly forgiving or empathic ways, as was the case for persons who became suicidal following an incurable illness. All suicidal persons were perceived as relatively feminine. At the same time, suicidal males were rated as more masculine if they engaged in suicidal behavior because of an academic failure or a physical illness, while suicidal females were viewed as more masculine only if their suicidal behavior followed an academic failure. Finally, we found that both respondent sex and respondent gender-identity influenced evaluations of suicidal persons. Building on these findings, future research should explore attitudes toward the permissibility of a suicidal decision by lesbian and gay persons.     

Adolescents' Attitudes About the Role of Mental Illness in Suicide,and Their Association with Suicide Risk

We examined teenagers' attitudes about the role of mental illness in suicidal behavior and the relationship between these attitudes and suicide risk. Serious suicidal ideation or behavior and associated risk factors (gender, depression, substance problems, and first‐hand experience with a suicidal peer) were assessed in 2,419 students at six New York high schools. Less than one fifth of students thought that mental illness was a major contributor to suicide. Suicidal adolescents and those at risk were less likely than their nonsuicidal and low‐risk counterparts to associate suicide with mental illness. Our findings contribute to the debate over whether accepting attitudes toward suicide increase suicide risk.     

Sex differences in peer responsiveness to suicide ideation

Two surveys assessing attitudes toward and beliefs about suicide were conducted with undergraduates. There were 473 participants in Survey I and 692 participants in Survey II. Sex differences were found in participants' receptivity to suicidal individuals, beliefs about the behavior of suicidal peers, attitudes concerning the worth of suicidal people, incidence of adolescent suicide, and morality of suicide. There was no sex difference in participants' own frequency or seriousness of suicide ideation or suicide attempts. Results are discussed in terms of hypotheses concerning traditional socialization of males and females, resulting in sex-role differentiation that may influence attitudes toward and beliefs about suicide.     

Educating parents about youth suicide: knowledge, response to suicidal statements, attitudes, and intention to help

This study evaluated the video Youth Suicide: Recognising the Signs as a parent educational medium. Before and after viewing the video, parents (N = 112) of young people answered questionnaires measuring their (1) knowledge of suicidal signs, (2) responses to a young person showing suicidal signs, (3) attitude to suicide, and (4) intentionalitv toward suicidal people. After the video, parents' knowledge of suicidal signs, responses toward a suicidal person, and intention to help improved. Their attitude was more rejecting of suicide. Knowledge and intentionality predicted response to suicidal statements, but no relationships existed between attitude and the other variables. Implications for youth suicide education programs are discussed.     

Turkish Imams’ Experience with and Their Attitudes Toward Suicide and Suicidal Persons

This study investigated the experience with and attitudes toward suicide and suicidality in 70 consenting imams serving in mosques in the province of Aydin which is located at the southwest part of Turkey. A self-report questionnaire was used to collect the data. Attitudes of imams to suicide and suicidality were compared with attitudes of male university students. Only 4 imams (5.7 %) reported having had suicidal thoughts in past, and none reported having attempted suicide. Almost 50 % said that someone in communities they serve has commited suicide and nearly 40 % reported leading funeral ceremony for someone who committed suicide. Majority of imams (64.3 %) were of the opinion that a funeral ceremony should be arranged for people who suicide and 87.1 % were of the opinion that people who suicide can be buried in a common cemetery, but only 21.4 % said that someone who attempted suicide can be appointed as imam. Compared to male medical students, imams saw suicide as an unacceptable option and those engaging in suicidal behavior to be punished after death. But they displayed socially accepting and helping reactions to an imagined close friend who attempted suicide. Therefore, it was concluded that imams might exhibit preventive reactions to suicide when they offer counseling for persons from their congregations during times of suicidal crises.     

Personal and professional factors and suicide intervention skills

This research investigated the relationship of professional and personal factors to the ability of counselors to respond appropriately to suicidal verbalizations using the Suicide Intervention Response Inventory (SIRI). Level of training, experience with suicidal clients, and death acceptance were positively related to suicide intervention competencies. A personal history of suicidality and a belief that suicide is a personal right were negatively related to such skills. Regression analysis revealed that personal history of suicidality and attitude toward suicide as a personal right accounted for a modest, but significant, percentage of the variance in SIRI scores, beyond that accounted for by professional factors. Post hoc analysis indicated that the negative relationship between personal history of suicidal behaviors and suicide counseling skills was significant in the professionally trained participants. These results highlight the importance of attitudes toward suicide and personal history of suicidality, as well as training and experience, in effectively counseling potentially suicidal clients.     

Adolescents' attitudes toward suicide, and a suicidal peer: A comparison between Swedish and Turkish high school students

The present paper first presents the attitudes toward suicide and a suicidal classmate among 98 female and 69 male (N = 167) Swedish high school students. Secondly, the Swedish sample was compared with 167 (89 female and 78 male) Turkish high school students from a previous study. Among Swedish students, more males than females said that people have the right to commit suicide and suicide can be a solution to some problems. More females than males expressed a belief in life after death. Swedish adolescents were found to be holding more liberal attitudes toward suicide than Turkish adolescents. However, Turkish adolescents showed greater acceptance for a suicidal peer than Swedish adolescents. The results are discussed in terms of socio-cultural factors and related literature. The need for educational programs to provide basic knowledge about suicide and, effective ways of dealing with and helping suicidal peers is implicated.     

Does a Gatekeeper Suicide Prevention Program Work in a School Setting? Evaluating Training Outcome and Moderators of Effectiveness

The suicide prevention gatekeeper training program QPR (Question, Persuade, and Refer) was evaluated among school personnel using a nonequivalent control group design. Substantial gains were demonstrated from pre- to post-test for attitudes, knowledge, and beliefs regarding suicide and suicide prevention. Exploratory analyses revealed the possible moderating effects of age, professional role, prior training, and recent contact with suicidal youth on QPR participants' general knowledge, questioning, attitudes toward suicide and suicide prevention, QPR quiz scores, and self-efficacy. The need for replication using a more rigorous experimental design in the context of strong community collaboration is discussed.     

Religion and spirituality along the suicidal path

The inner experience of spiritual and religious feelings is an integral part of the everyday lives of many individuals. For over 100 years the role of religion as a deterrent to suicidal behavior has been studied in various disciplines. We attempt to systematize the existing literature investigating the relationship between religion/spirituality and suicide in this paper. After an overview of the attitudes of the dominant religions (e.g., Catholicism, Islam, and Buddhism) toward suicide, the three main theories that have speculated regarding the link between religion and suicide are presented: "integration theory" (Durkheim, 1897/1997), "religious commitment theory" (Stack, 1983a; Stark, 1983), and "network theory" (Pescosolido & Georgianna, 1989). Subsequent to this theoretical introduction, we report on studies on religion/spirituality keeping the suicidal path as a reference: from suicidal ideation to nonlethal suicidal behavior to lethal suicidal behavior. Studies presenting indications of religious beliefs as a possible risk factor for suicidal behavior are also presented. The last section reviews possible intervention strategies for suicidal patients and suicide survivors. Indications for future research, such as more studies on nonreligious forms of spirituality and the use of qualitative methodology to achieve a better and deeper understanding of the spiritual dimension of suicidal behavior and treatment, are offered.     

Attitudes toward suicide among Chinese people in Hong Kong

Since suicide in Chinese people exhibits certain distinctive characteristics, it is important to develop indigenous measures to assess Chinese attitudes toward suicide that may be used to inform suicide reduction programs. Combining qualitative and quantitative methods, we developed a Hong Kong version of the Chinese Attitude toward Suicide Questionnaire (CASQ-HK) which assesses attitudes toward suicide, suicidal inclination under 12 hypothetical scenarios, and prior suicidal experience. A convenience sample of 1,226 people completed the self-report questionnaire. In keeping with Chinese tradition, respondents revealed both tolerant and condemning attitudes that varied with their sociodemographic characteristics. Generally, they were not strongly inclined to consider suicide in the presence of difficult scenarios. Female gender, older age, and the presence of suicidal ideation were associated with more contemplation of suicide.     

Body attitudes and body experiences in suicidal adolescents

The relationships between cognitive and affective attitudes toward the body, body experiences (dissociation, insensitivity, and lack of control), and suicidal tendencies were examined as a derivative of the hypothesis that bodily attitudes and experiences may facilitate suicidal acting out. Three groups of adolescents (aged 14-18), including suicidal (made a suicide attempt) and nonsuicidal inpatients and controls, were compared with regard to suicidal tendencies, various body aspects, and depression and anxiety. A series of MANOVAs, discriminant analysis, Pearson correlations, and regressions were employed. The results show that the suicidal group differed from the two nonsuicidal groups in feelings toward the body, body protection, and body dissociation. Some aspects of bodily measures discriminated between suicidal and nonsuicidal subjects. In addition, various bodily measures were associated with and statistically predicted suicidal tendencies. The discussion focuses on the web of associations between body attitudes and experiences and their role in suicidal behavior.     

Suicide and the suicidal body. 2002 Dublin Award Address

This paper focuses on the bodily experiences and attitudes toward the body in suicidal individuals. It is argued that bodily experiences and attitudes toward the body, such as rejection of the body, detachment, numbness, physical anhedonia, and lack of protection can facilitate acts of self-destruction. This argument is supported by theories of developmental psychology, theories on suicide, and empirical data. It is demonstrated that suicidal individuals experience their body differently from other populations and that these are related to suicidal behavior.     

Suicide and suicide attempts in the European Economic Community: an analysis of trends, with special emphasis upon trends among the young

An attempt is made to explain the increase in adolescent suicidal behavior reported for most countries in the European Economic Community over the last two decades, within the framework of a social learning theory. A typology of suicidal acts based on an outcome-expectancy model is proposed that would make intelligible the observed positive correlation between the incidence of lethal and nonlethal suicidal acts, the latter having grown to epidemic proportions among the young. This epidemic can be attributed to the interplay of three groups of factors, namely, the socialization of a specific problem-solving behavior repertoire, socioeconomic conditions, and attitudes toward suicide. The implications for suicide prevention are briefly discussed.