多数自杀意念者从未尝试自杀,原因不得而知。为探索阻断自杀意念向自杀尝试演变的保护因子,采用扎根理论,访谈19名无自杀尝试史的自杀意念者。结果表明,保护因子有3个：（1）联结,其作用是减弱自杀意念。其中家庭联结最有用。（2）理智,其作用是降低自杀冲动。（3）自杀否定,其作用是预防自杀尝试。这3个因子形成阻断自杀意念向自杀尝试演变的“3道防线”。未来可充分利用3道防线,更好地阻断自杀演变。
Abstract
One of the reasons underlying the acute nature of suicide crisis is the limited understanding of the internal processes and the progression of suicidal ideation. Correspondingly, suicide interventions have limited efficacy. Most individuals with suicidal ideation do not attempt suicide, but the reasons are unknown. The present study adopted qualitative research methods to explore protective factors that prevent the progression of suicidal ideation to suicide attempt. This study aimed to elucidate the internal processes of suicide and to identify potential focuses of intervention efforts to prevent the progression of suicidal ideation.
In the current study, an intensive sampling method was adopted to recruit participants. The Suicidal Behavior Questionnaire-Revised (SBQ-R) and the 9-item Patient Health Questionnaire (PHQ-9) were distributed at a university to identify people without a history of suicide attempts but with suicidal ideation within the past year. The final sample was composed of 19 subjects, including 6 males and 13 females. In-depth structured interviews were conducted. All interviews were transcribed verbatim and then coded and analyzed in NVivo 11.0 based on the grounded theory. This format included data reduction and theme generation using open coding, axial coding and core coding. In addition, participant inspection and expert evaluation were adopted to improve the validity of the research results. In this study, a total of 199,918 words of interview transcripts were obtained, and 285 reference points were generated. The encoding result included 4 core categories, 11 axial categories, and 40 open categories.
The protective factors against the progression of suicidal ideation to suicide attempt were divided into the following three aspects. (1) Connection: Connection mainly refers to relationships between people and the world, including the horizontal connections between an individual and their family and society as well as the vertical connections between the individual and the present and future. Connection, especially family connection, is highly effective. (2) Sanity: Sanity refers to a rational approach to coping with suicide and has four aspects: cognition, emotion, behavior, and personality. Sanity helps individuals cope with suicidal ideation. (3) Refusal of suicide: This refers to a negative attitude toward suicide. By refusing the consequences, behaviors and objective conditions of suicide, the possibility of a suicide attempt is prevented.
Furthermore, connection, sanity and refusal of suicide seem to have protective effects against suicidal ideation, suicidal impulses, and suicide attempts, respectively, forming three “lines of defense" that prevent the progression of suicidal ideation to suicide attempt. Connection is the first and most important line of defense in the entire prevention process. Its function is to reduce the intensity of suicidal ideation. If the first line of defense fails, suicidal ideation escalates, and sanity acts as the second line of defense. Its function is mainly to reduce suicidal impulses in the presence of strong suicidal ideation. If the second line of defense fails and the individual is susceptible to suicidal impulses, refusal of suicide acts as the third line of defense. Its function is to prevent the individual from attempting suicide even with a strong suicidal impulse.
The findings of this study could help to better understand the internal processes of suicide, especially the key factors that prevent the progression of suicide, and to provide theoretical support for the prevention of suicide attempts. The focus of suicide intervention should shift to blocking suicidal ideation in the early stage.
关键词
自杀意念 /
自杀尝试 /
演变 /
保护因子
Key words
suicidal ideation /
suicide attempt /
progression /
protective factors
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 程翠萍, 黄希庭. (2021). 个人取向勇气对中学生学业成就的影响: 问题解决和求助应对方式的中介作用. 心理发展与教育, 37(1), 60-67.
[2] 程可心, 游雅媛, 叶宝娟, 陈志忠. (2022). 家庭功能与中学生自杀态度的关系. 心理发展与教育, 28(2), 272-278.
[3] 况利, 徐小明, 曾琪. (2022). 机器学习用于自杀研究的综述. 山东大学学报(医学版), 60(4), 10-16.
[4] 邝立平, 冯现刚. (2017). 大学生情绪调节策略在非适应完美主义与自杀风险关系中的调节作用. 中国心理卫生杂志, 31(11), 885-889.
[5] 林琳, 刘俊岐, 杨洋, 刘羽, 王晨旭, 刘拓, 贾绪计. (2019). 负性生活事件对大学生自杀意念的影响——反刍思维的中介作用和气质性乐观的调节作用. 心理与行为研究, 17(4), 569-576.
[6] 肖水源. (2019). 自杀行为研究中的若干问题. 中华疾病控制杂志, 23(11), 1334-1337.
[7] 杨莉萍, 亓立东, 张博. (2022). 质性研究中的资料饱和及其判定. 心理科学进展, 30(3), 511-521.
[8] Al-Dajani N., Horwitz A. G., & Czyz E. K. (2022). Does coping reduce suicidal urges in everyday life? Evidence from a daily diary study of adolescent inpatients. Depression and Anxiety, 39(6), 496-503.
[9] Arango A., Cole-Lewis Y., Lindsay R., Yeguez C. E., Clark M., & King C. (2019). The protective role of connectedness on depression and suicidal ideation among bully victimized youth. Journal of Clinical Child and Adolescent Psychology, 48(5), 728-739.
[10] Bantjes, J., & Swartz, L. (2019). "What can we learn from first-person narratives?" The case of nonfatal suicidal behavior. Qualitative Health Research, 29(10), 1497-1507.
[11] Gulbas L. E., Guz S., Hausmann-Stabile C., Szlyk H. S., & Zayas L. H. (2019). Trajectories of well-being among Latina adolescents who attempt suicide: A longitudinal qualitative analysis. Qualitative Health Research, 29(12), 1766-1780.
[12] Guo L., Wang W. X., Wang T., Li W. Y., Gong M. Q., Zhang S., & Lu C. Y. (2019). Association of emotional and behavioral problems with single and multiple suicide attempts among Chinese adolescents: Modulated by academic performance. Journal of Affective Disorders, 258, 25-32.
[13] Heckler W. F., de Carvalho J. V., & Barbosa, J. L. V. (2022). Machine learning for suicidal ideation identification: A systematic literature review. Computers in Human Behavior, 128, Article 107095.
[14] Horwitz A. G., Grupp-Phelan J., Brent D., Barney B. J., Casper T. C., Berona J., & Pediatric Emergency Care Applied Research Network. (2021). Risk and protective factors for suicide among sexual minority youth seeking emergency medical services. Journal of Affective Disorders, 279, 274-281.
[15] Ji S. X., Pan S. R., Li X., Cambria E., Long G. D., & Huang Z. (2021). Suicidal ideation detection: A review of machine learning methods and applications. IEEE Transactions on Computational Social Systems, 8(1), 214-226.
[16] Johnson D. R., Scheitle C. P., & Ecklund E. H. (2021). Beyond the in-person interview? How interview quality varies across in-person, telephone, and Skype interviews. Social Science Computer Review, 39(6), 1142-1158.
[17] Klonsky E. D., Dixon-Luinenburg T., & May A. M. (2021). The critical distinction between suicidal ideation and suicide attempts. World Psychiatry, 20(3), 439-441.
[18] Klonsky, E. D., & May, A. M. (2015). The three-step theory (3ST): A new theory of suicide rooted in the "ideation-to-action" framework. International Journal of Cognitive Therapy, 8(2), 114-129.
[19] Klonsky E. D., Pachkowski M. C., Shahnaz A., & May A. M. (2021). The three-step theory of suicide: Description, evidence, and some useful points of clarification. Preventive Medicine, 152, Article 106549.
[20] Lee, R. M., & Robbins, S. B. (1998). The relationship between social connectedness and anxiety, self-esteem, and social identity. Journal of Counseling Psychology, 45(3), 338-345.
[21] Littlewood D. L., Harris K., Gooding P., Pratt D., Haddock G., & Peters S. (2021). Using my demons to make good: The short- and long-term impact of participating in suicide-related research. Archives of Suicide Research, 25(2), 315-339.
[22] López-Goñi J. J., Fernández-Montalvo J., Arteaga A., & Haro B. (2019). Suicidal attempts among patients with substance use disorders who present with suicidal ideation. Addictive Behaviors, 89, 5-9.
[23] Mayer, F. S., & Frantz, C. M. (2004). The connectedness to nature scale: A measure of individuals' feeling in community with nature. Journal of Environmental Psychology, 24(4), 503-515.
[24] Niederkrotenthaler T., Gunnell D., Arensman E., Pirkis J., Appleby L., Hawton K., & International COVID-19 Suicide Prevention Research Collaboration (2020). Suicide Research, prevention, and COVID-19. Crisis, 41(5), 321-330.
[25] O' Connor, R. C. (2011). Towards an integrated motivational-volitional model of suicidal behaviour. In R. C. O' Connor, S. Platt, & J. Gordon (Eds.), International handbook of suicide prevention: Research, policy and practice (pp. 181-198). John Wiley & Sons.
[26] Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264.
[27] Stanley B., Green K. L., Ghahramanlou-Holloway M., Brenner L. A., & Brown G. K. (2017). The construct and measurement of suicide-related coping. Psychiatry Research, 258, 189-193.
[28] Substance Abuse and Mental Health Services Administration. (2021). 2020 NSDUH Annual National Report. https://www.samhsa.gov/data/report/2020-nsduh-annual-national-report
[29] Sun R. H., Ren Y. X., Li X. A., Jiang Y. Q., Liu S. H., & You J. N. (2020). Self-compassion and family cohesion moderate the association between suicide ideation and suicide attempts in Chinese adolescents. Journal of Adolescence, 79(1), 103-111.
[30] Sunderland M., Batterham P. J., Calear A. L., Chapman C., & Slade T. (2023). Factors associated with the time to transition from suicidal ideation to suicide plans and attempts in the Australian general population. Psychological Medicine, 53(1), 258-266
[31] Teismann T., Paashaus L., Siegmann P., Nyhuis P., Wolter M., & Willutzki U. (2019). Suicide attempters, suicide ideators, and non-ideators. Crisis, 40(4), 294-297.
[32] Thompson, A. R., & Russo, K. (2012). Ethical dilemmas for clinical psychologists in conducting qualitative research. Qualitative Research in Psychology, 9(1), 32-46.
[33] Van Orden K. A., Witte T. K., Cukrowicz K. C., Braithwaite S. R., Selby E. A., & Joiner T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575-600.
[34] World Health Organization. (2021). Suicide. https://www.who.int/en/news-room/fact-sheets/detail/suicide
基金
*本研究得到2022年度福建省高校以马克思主义为指导的哲学社会科学学科基础理论研究项目（FJ2023MGCA027）和2021年度福州大学大学生思想政治教育专项资助项目（21SKZ15）的资助
PDF(1183 KB)
