An exploration of the factors associated with suicide risk and self-harm in Jamaica

Powell-Booth, Karyl Tawina (2021) An exploration of the factors associated with suicide risk and self-harm in Jamaica. PhD thesis, University of Glasgow.

Abstract

Background

Suicide is the third leading cause of death among adolescents globally. Therefore, suicide is a global public health concern. The prevalence of suicidal behaviour has been steadily increasing over the past twenty years in the region of the Americas. Moreover, approximately 34.6 million years of life were lost in 2016 as a result of suicide globally. In the case of the Caribbean, of which Jamaica is a part, the age standardised mortality rate per 100,000 from suicide was 4000 between 1990 to 2016. More specifically, Jamaica has had among the largest statistically significant increases in the age standardised mortality rate from suicide, globally between 70.9% to 128.2% for the period 1990 10 2016. Therefore, this thesis aims to better understand (i) key risk and protective factors for suicidal behaviour among young people in Jamaica; (ii) how do persons make sense of their lived experiences of attempting suicide.

Methods

In order to address the aims of the thesis, a number of approaches were taken. First, a systematic review of the existing literature (n=16 studies) was conducted in order to assess the quality and extent of the research related to suicidal and non-suicidal behaviour in Jamaica. Four empirical studies were then conducted exploring the relationship between key psychological variables and suicidal and non-suicidal behaviour. Three of these utilised quantitative cross-sectional study designs. Study 1 (n=1667) was a secondary analysis of data from the Global School Health Survey among adolescents. The second study (n=36) is a pilot study exploring whether items on a survey were suitable and could provide meaningful data on the emotional wellbeing of looked-after and cared-for adolescents in residential childcare facilities. Once the findings from the pilot study were ascertained and modifications made, a third study was conducted. This was a large-scale, island-wide study among looked-after and cared for adolescents (n=221) so as to further investigate key risk and protective factors for suicidal behaviour, and to explore whether we were able to distinguish between those who think about suicide, those who act on their suicidal thoughts, and those who neither think about nor enact suicidal behaviours. The same was done for self-harm. The fourth study was qualitative in nature and data was obtained using semi-structured interviews. These were conducted among persons who had attempted suicide (n=4) and had presented to hospital. The main purpose of this study was to explore how persons who have attempted to take their lives make sense of their lived experience. In order to conduct a rigorous analysis of the data, all stages of the Interpretative Phenomenological Analysis (IPA) were applied.

Results

Findings from the systematic review of the literature showed that of the 16 papers included, half of them (n=8) were retrospective studies derived from either police or hospital records. In general, the studies were of low to medium quality, a factor which pointed to the need for more rigorous, in-depth research to be conducted on the topic. It was not possible to make generalizations about the population as the samples used were primarily convenience samples, many of which were clinical populations and were therefore not representative of the general population. Nevertheless, three of the main risk factors suggested for risk of suicide include conflicts in intimate relationships, being bullied and having a history of physical and/or sexual abuse. The empirical studies revealed that loneliness, being bullied and physical or sexual abuse placed adolescents at greatest risk of both suicidal ideation and suicide attempt. Emotional distress and exposure to adverse childhood experiences were associated with risk of selfharm ideation, while risk factors for self-harm included perceived stress, defeat, entrapment, emotional distress and adverse childhood experiences.

Conclusions

This thesis has not only contributed four empirical studies to the body of research on suicidal and non-suicidal behaviour in general, but it has helped to fill some critical gaps in our knowledge of suicidal behaviour among young people in Jamaica. Through the lens of the IMV model of suicidal behaviour, we have examine how certain key psychological factors have led to the emergence of suicidal ideation among some individuals and the process of yet other factors led others not only to contemplate suicide, but later, to act on those thoughts. Indeed, we have provided evidence to support and expand the model in part. The evidence presented herein has implications for policy as well as for clinicians working with adolescents, especially for those in adolescent and mental health. Finally, the findings from this thesis also have important implications for those who work in suicide prevention in Jamaica.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: B Philosophy. Psychology. Religion > BF Psychology; R Medicine > R Medicine (General)
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
• Supervisor's Name: O'Connor, Professor Rory and McLeod, Professor Hamish
• Date of Award: 2021
• Depositing User: Theses Team
• Unique ID: glathesis:2021-82443
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 21 Sep 2021 11:31
• Last Modified: 12 Dec 2022 13:28
• Thesis DOI: 10.5525/gla.thesis.82443
• URI: https://theses.gla.ac.uk/id/eprint/82443