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Extending our understanding of male suicide: Qualitative investigations into the factors associated with men’s suicide attempts

Mason, David 2020. Extending our understanding of male suicide: Qualitative investigations into the factors associated with men’s suicide attempts. ClinPsy Thesis, Cardiff University.
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Abstract

Close to 800,000 people die by suicide every year. There are various risk factors which increase suicidal risk, including having a mental health condition, physical illness, debt and unemployment. It is a global trend that men are at a greater risk of death by suicide. However, risk factors alone do not help us to understand why people die by suicide. Psychological models have attempted to conceptualise these risk factors into theories which help us to understand suicidal behaviour. However, they do not account for men’s elevated risk of death by suicide. It appears that the factors associated with male suicide are complex and warrants further research attention. This Large-Scale Research Project (LSRP) adds to the limited literature in this area. It is made up of two qualitative papers which aim to provide an in-depth exploration of the factors associated with male suicide. A prior suicide attempt is the biggest risk factor for a future death by suicide. Therefore, both papers present the findings of research using samples of men with lived experience of having attempted suicide. Paper one reports a systematic review of the qualitative literature which aimed to better understand the factors associated with men’s suicide attempts and to integrate these findings into a theoretical understanding of male suicide. Eleven studies were included in the review which were assessed for their quality and contribution to the literature. The findings from these studies were synthesised using a meta-ethnography approach. The synthesis identified that the men’s suicide attempts were experienced in the context of feeling disconnected from themselves, others and the world. Many interconnecting factors accounted for this disconnection, including feelings of loneliness, early adversities, substance use, psychological pain, feeling different, experiencing rejection and factors related to masculine gender norms. Feeling disconnected led to experiences of hopelessness. It was from this position that the men viewed suicide to be a solution to their distress. The synthesis identified how reconnection with the self and others provided turning points towards a more hopeful future. Paper two reports a grounded theory analysis examining the role of self-directed disgust in male suicide. Self-disgust, whereby aspects of the self are perceived as “revolting” or “contaminated”, has been associated with some mental health difficulties. To date, qualitative research has not examined self-disgust in males, nor in suicidality. This was the aim of paper two. Nine men who had attempted suicide took part in an interview which explored self-disgust and their suicidality. The interview data was analysed using constructivist grounded theory. This approach acknowledges the role of the researcher in the analysis process and fits with the researcher’s position on the social construction of knowledge and understanding. What emerged out of the analysis, was that self-disgust did not explain the participant’s suicide attempts in their entirety; instead, self-disgust interacted with other endured emotional experiences and feelings of worthlessness. The combination of this endured distress provided a context for the participants to perceive themselves as unable to cope and experience feelings of disconnection and hopelessness. It was from this position that suicide was seen as a solution to their psychological pain. During this process, many disgust-related properties (such as seeing oneself as repellent or fearing exposure of one’s “disgustingness”) increased the men’s suicide risk. Self-disgust appeared more pervasive in the lives, and suicidality, of men with a history of multiple traumas. The findings of this LSRP support current theoretical accounts of suicide (e.g. hopelessness, suicide as a solution to psychological pain), whilst also providing novel insights into male suicidality. What emerged out of both analyses was how the experience of being disconnected worsened men’s distress and exacerbated suicide risk. Paper two builds on our understanding of suicidal men’s disconnection and psychological pain by highlighting the prominence of self-disgust within these factors, particularly in those with a history of childhood abuse. The analyses provide some support for the theory that masculine gender rules and norms may increase men’s suicide risk (for example, leading men to conceal distress). However, it should be noted that men who conceal their distress may be unlikely to participate in research. Additional limitations are discussed in each paper. Despite this, there are methodological strengths to this LSRP, including methods to increased trustworthiness and quality. Furthermore, both papers used analytic methods which are grounded in their respective data sources. This LSRP has implications for clinical psychology and the wider healthcare context. This includes risk assessment and the benefits of exploring disconnection and fostering reconnection. Future research could explore the current findings and the effectiveness of intervening with high levels of self-disgust. Evaluating these interventions will further advance our understanding of working clinically with men at risk of suicide. By disseminating this LSRP, it is hopeful that the findings (and the voices and bravery of the research participants) will prompt further clinical and research exploration of male suicide.

Item Type: Thesis (DClinPsy)
Date Type: Completion
Status: Unpublished
Schools: Psychology
Uncontrolled Keywords: systematic review; meta-ethnography; meta-synthesis; qualitative; suicide; male; attempted suicide; emotion; grounded theory; male self-disgust; disgust
Date of First Compliant Deposit: 5 September 2020
Date of Acceptance: 5 September 2020
Last Modified: 05 Sep 2021 01:30
URI: https://orca.cardiff.ac.uk/id/eprint/134674

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