A Critique Of Qualitative Research On Suicidal Ideations

Article 1: Factors Affecting Interventions for Suicidal Males

Suicidal ideations, commonly referred to as suicidal thoughts refer to the planning or thinking about suicides (Testa et al., 2017). Some of the frequent causes that lead to suicidal ideations are anxiety, depression, schizophrenia, substance abuse and eating disorders like anorexia nervosa. Furthermore, individuals with a family history of mental disorders are at an increased likelihood of facing such ideations. People who experience suicidal thoughts report feelings of being trapped and a persistent sense of hopelessness, emotional pain, mood swings, guilt feelings, and changes in personality (Kleiman et al., 2017). Qualitative research is exploratory in design and are primarily conducted for gaining a deeper insight into the opinions, motivations and reasons behind a phenomenon. This assignment will critique the research design and methodology of three qualitative articles that focus on different aspects of suicidal ideations.

The article by Player et al., (2015) was aimed at investigating the underlying factors that either assist, complicate or inhibit different interventions for males, who are at an increased risk for suicidal acts. The authors were correct in identifying the fact that suicide rates, although quite high among females, are significantly larger among their male counterparts. This was directly attributed to the fact that males have been found to cope with their distress and depression in a different manner, than females (Rotenstein et al., 2016). The authors recruited participants from all territory and state of Australia using the purposive sampling method. This is a form of non-probability sampling that depends on the characteristics of the entire population being investigated. Also referred to as selective sampling, some of the advantages of this technique employed by the researchers are that this is one of the most time-effective and cost-effective sample recruitment methods (Palinkas et al., 2015). Furthermore, this might be considered as the only accurate method in presence of limited sources of primary data. However, some of the drawbacks of the way by which the participants were recruited are related to the inability of purposive sampling to generalize the findings of the research to a larger population, reduced levels of reliability, increased level of bias, and vulnerability to researcher judgment errors (Merriam & Tisdell, 2015). Data collection was conducted via questionnaires namely, the Patient Health Questionnaire-9 (PHQ-9), Male Depression Risk Scale (MDRS), and the Generalized Anxiety Disorder 7-item (GAD-7). This was followed by development of an interview schedule. The authors clearly indicated the process of data collection and provided a justification for the same (Player et al., 2015).

Article 2: The Impact of HIV Diagnosis on Suicidal Ideation and Behaviour

In the next step, the authors conducted an interview for which the scheduling was based on a literature review and it was then piloted and adjusted based on the feedback that is collected from the participants (Player et al., 2015). The final schedule of the interview explored different factors that contribute to making a suicide attempt, along with the factors that prevent or interrupt from making any such attempt including the supportive factors of family and friends that help in preventing future attempt. Klonsky, May and Saffer, (2016) have opined that suicide or the tendency to commit suicide is stemmed from a complex mind-set, no two people suffering from such self-harming mental instability will have similar mind-set or triggers facilitating or accelerating the tendencies. Hence, it is very important for the research studies to focus on capturing the unique perspective of the different target groups and be able to address those issues adequately. The authors in this case have utilized the technique of qualitative interviews which is extremely helpful and advantageous to achieve the goal of the research question (Player et al., 2015). As discussed by Wolgemuth et al., (2015), qualitative interviews help the researchers to observe or capture the unique perspective of the different subjects and understand the exact experience of the subject and how it relates to the issue. In order to minimize the bias, all of the 35 interviews were conducted by the same research officer within 8 focus groups, and the participant consent had been taken before commencing with the interview. However, the only limitation of this study design can be the cost, time, and the quality of the data collection by the interviewer (Player et al., 2015).

The next article by Li, Tucker, Holroyd, Zhang and Jiang, (2017) is based on the conundrum of HIV diagnosis and the impact of the same on the suicidal intention and behaviour. On a more elaborative note, the HIV positive diagnosis generally leads to terror and confusion on the patient, especially for the culturally diverse populations. On a more elaborative, for a conventional Confucian culture like the Chinese culture, the risk and resilience associated with suicidal ideation is associated with cultural influences such as marriage obligations, obligation for parenthood and continuing the family name, providing financial support to families, and lastly protecting the family reputation. Hence, it has been hypothesized that the impact of a delimiting diagnosis such as HIV will have a far more deleterious impact on the psyche and will accumulate a stronger suicidal ideation for these target groups. This study has aimed to focus on the socially disadvantaged group of men who have sex with men or MSM in China and explore the psychosocial context immediately following a HIV diagnosis and explore coping and resilience among this group. Researchers are of the opinion that the MSM is a socially disadvantaged group that has higher chance of acquiring HIV and along with that they also are subjected to extreme social isolation and discrimination as well and hence the risk of suicidal ideation is also extremely high (Frye et al., 2015). Hence, the research question is valid and also relevant to the present public health issues. The research had been conducted in Shenzhen in China in the year of 2010 which had at least 100000 to 200000 MSMs and repeated in depth interviews have been conducted in a three month interval setting by taking the collaborative aid of a local nongovernment organization or NGO. The data collection process followed a semi structured interview process based on a life profile approach which takes into consideration the background research, lengthy interviews, and close collaborations with participants. As discussed by Kendall (2014), the life profile approach is excellent technique for understanding the exact impact of a life impact on the mind-set, psyche and behavioural patterns of the individuals. The life profiling approach to qualitative research allows the researchers to ensure that the testimonies have accurately reflected the depth of the life-world or the social themes and have a focussed approach to the individual life narratives.

Article 3: Experience of GPs Dealing with Bereaved Parents of Suicide Victims

The sampling had been purposeful, which is a selective and non-probability sampling that is reported to be the most time saving and cost effective sampling technique that takes into consideration into the entire population that is being studied (Benoot, Hannes & Bilsen, 2016). The data collection was initiated by ethics approval followed by the nominated NGO contacting the potential participants conducting the interview which was digitally recorded and then transcribed verbatim and in the data analysis was based on the emerging themes. The advantages of this approach is accurate screening, capturing both verbal and nonverbal cues, keeping focus and capturing emotions and behaviours, hence the choice is commendable (Powney & Watts, 2018). The only limitation had been unintended intervention effect, recruitment bias, lack of standardized scales to measure suicidal ideation and the participants not opening up due to use of digital recorders.

This research study by Foggin et al. (2016) have attempted to explore the experience of the general practitioners dealing with the parents suffering from bereavement of the suicide. It has to be mentioned that even though, many research studies have focussed on the risk factors of suicide but there is very limited knowledge and understanding of the impact of suicide on parents of the suicide victim, how the GPs handle these grief stricken parents and how it impacts the GPs. Hence, it can be mentioned that this a very important area of concern and the research aim is valid and relevant.

The research follows a qualitative interview based research technique involving 13 general physicians or GPs. Sampling was based on coroners’ reports, poster advertisements, newspaper articles, and suicide bereavement self-help groups and all the parents and then the parents were interviewed and then approached for their GPs to be contacted. The data collection was based on semi-structured interviews which incorporated individual perspectives of the patients to be incorporated into the data which enhances the quality and diversity of the data, the data collected had been analysed thematically (McIntosh & Morse, 2015).

 The limitations of this study include participation bias which was although reduced to some extent due to the recruitment via bereaved parents, but for the general physicians that were extremely uncomfortable of their experience with the bereaved parents and could have been less likely to participate. Along with that GPs selected represented a very small sample size which might not have incorporated all of the GPs in practice with a variety of different issues.

Conclusion: 

Suicidal thoughts can most commonly range from detailed and comprehensive plans to transitory considerations. These thoughts are extremely common and most people report experiencing them during periods of mental distress and/or stress. Such events often increase the vulnerability of such individuals to attempt suicide for ending their life. These three articles have been successful in understanding the extent of suicidal ideation and how it develops however there have been considerable drawbacks in all of the studies. For the first article, the limitation had been time, cost and the originality or quality of the data collected as the interviewer had been the same. For the second article the drawbacks had been unintended intervention effect, recruitment bias, lack of standardized scales to measure suicidal ideation and the participants not opening up due to use of digital recorders which could have affected the nature or quality of the data collected. The third and final article had been limited by small sampling and participation bias. Hence, these drawbacks limit the generalizability of these studies and there is need for further research in this area with emphasis to address these limitations.

References: 

Benoot, C., Hannes, K., & Bilsen, J. (2016). The use of purposeful sampling in a qualitative evidence synthesis: A worked example on sexual adjustment to a cancer trajectory. BMC medical research methodology, 16(1), 21. Doi: 10.1186/s12874-016-0114-6

Foggin, E., McDonnell, S., Cordingley, L., Kapur, N., Shaw, J., & Chew-Graham, C. A. (2016). GPs’ experiences of dealing with parents bereaved by suicide: a qualitative study. Br J Gen Pract, bjgpoct-2016. Doi: 10.3399/bjgp16X686605

Frye, V., Nandi, V., Egan, J., Cerda, M., Greene, E., Van Tieu, H., … & Koblin, B. A. (2015). Sexual orientation-and race-based discrimination and sexual HIV risk behavior among urban MSM. AIDS and Behavior, 19(2), 257-269. Doi: 10.1007/s10461-014-0937-2

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Li, H., Tucker, J., Holroyd, E., Zhang, J., & Jiang, B. (2017). Suicidal ideation, resilience, and healthcare implications for newly diagnosed HIV-positive men who have sex with men in China: a qualitative study. Archives of sexual behavior, 46(4), 1025-1034. Doi: 10.1007/s10508-016-0894-0

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