Patterns and motivations for method choices in suicidal thoughts and behaviour: qualitative content analysis of a large online survey

Article

Marzano, L., Katsampa, D., Mackenzie, J., Kruger, A., El-Gharbawi, N., Ffolkes-St-Helene, D., Mohiddin, H. and Fields, B. 2021. Patterns and motivations for method choices in suicidal thoughts and behaviour: qualitative content analysis of a large online survey. BJPsych Open. 7 (2), pp. 1-6. https://doi.org/10.1192/bjo.2021.15
TypeArticle
TitlePatterns and motivations for method choices in suicidal thoughts and behaviour: qualitative content analysis of a large online survey
AuthorsMarzano, L., Katsampa, D., Mackenzie, J., Kruger, A., El-Gharbawi, N., Ffolkes-St-Helene, D., Mohiddin, H. and Fields, B.
Abstract

Background
Choice of suicide method can strongly influence the outcome of suicidal behaviour, and is an important aspect of the process and planning involved in a suicide attempt. Yet, the reasons why individuals consider, choose or discard particular methods are not well-understood.
Aims
This is the first study to explore method choices amongst people with a history of suicidal behavior and individuals who have experienced, but not enacted, suicidal thoughts.
Methods
Via an online survey, we gathered open-ended data about choice of methods in relation to suicidal thoughts and behaviours, including reasons for and against specific means of harm.
Results
712 respondents had attempted suicide, and a further 686 experienced suicidal thoughts (but not acted on them). Self-poisoning was the most commonly contemplated and used method of suicide, but most respondents had considered multiple methods. Method choices when contemplating suicide included a broader range of means than used in actual attempts, and more unusual methods, particularly if perceived to be lethal, ‘easy’, quick, accessible and/or painless. Methods used in suicide attempts were, above all, described as having been accessible at the time, and were more commonly said to have been chosen impulsively. Key deterrents against the use of specific methods were the presence and impact on other people, especially loved ones, and fears of injury and survival.
Conclusions
Exploration of method choices can offer novel insights into the transition from suicidal ideation to behaviour. Results underscore the need for preventative measures to restrict access to means and delay impulsive behaviour.

Keywordsattempted suicide; self-harm; suicidal ideation; suicide; suicide method
PublisherCambridge University Press
JournalBJPsych Open
ISSN2056-4724
Publication dates
Online24 Feb 2021
Print31 Mar 2021
Publication process dates
Deposited11 Feb 2021
Accepted21 Jan 2021
Output statusPublished
Publisher's version
License
Accepted author manuscript
File Access Level
Restricted
Copyright Statement

Copyright and usage
© The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Digital Object Identifier (DOI)https://doi.org/10.1192/bjo.2021.15
Web of Science identifierWOS:000620988700001
LanguageEnglish
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Responding to repetitive, non-suicidal self-harm in an English male prison: staff experiences, reactions, and concerns
Marzano, L., Adler, J. and Ciclitira, K. 2013. Responding to repetitive, non-suicidal self-harm in an English male prison: staff experiences, reactions, and concerns. Legal and Criminological Psychology. https://doi.org/10.1111/lcrp.12025
Self-harm in prisons: dominant models and (mis)understandings
Marzano, L. 2010. Self-harm in prisons: dominant models and (mis)understandings. in: Adler, J. and Gray, J. (ed.) Forensic psychology: concepts, debates and practice Willan. pp. 486-507
Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners
Marzano, L., Rivlin, A., Fazel, S. and Hawton, K. 2009. Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners. Journal of Forensic and Legal Medicine. 16 (3), pp. 152-155. https://doi.org/10.1016/j.jflm.2008.08.011
The suicidal process in male prisoners making near-lethal suicide attempts
Rivlin, A., Fazel, S., Marzano, L. and Hawton, K. 2013. The suicidal process in male prisoners making near-lethal suicide attempts. Psychology, Crime and Law. 19 (4), pp. 305-327. https://doi.org/10.1080/1068316X.2011.631540
Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners
Marzano, L., Hawton, K., Rivlin, A. and Fazel, S. 2011. Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners. Social Science & Medicine. 72 (6), pp. 874-883. https://doi.org/10.1016/j.socscimed.2010.12.028
Near-lethal self-harm in women prisoners: contributing factors and psychological processes
Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2011. Near-lethal self-harm in women prisoners: contributing factors and psychological processes. The Journal of Forensic Psychiatry & Psychology. 22 (6), pp. 863-884. https://doi.org/10.1080/14789949.2011.617465
Impact on prisoners of participating in research interviews related to near-lethal suicide attempts
Rivlin, A., Marzano, L., Hawton, K. and Fazel, S. 2012. Impact on prisoners of participating in research interviews related to near-lethal suicide attempts. Journal of Affective Disorders. 136 (1), pp. 54-62. https://doi.org/10.1016/j.jad.2011.09.009
Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons
Rivlin, A., Fazel, S., Marzano, L. and Hawton, K. 2012. Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons. Forensic Science International. 220 (1), pp. 19-26. https://doi.org/10.1016/j.forsciint.2012.01.022
Comfort and challenge: A thematic analysis of female clinicians’ experiences of supervision
Starr, F., Ciclitira, K., Marzano, L., Brunswick, N. and Costa, A. 2013. Comfort and challenge: A thematic analysis of female clinicians’ experiences of supervision. Psychology and Psychotherapy: Theory, Research and Practice. 86 (3), pp. 334-351. https://doi.org/10.1111/j.2044-8341.2012.02063.x
Conversational spaces for learning and designing
Fields, B., Bardill, A. and Jones, S. 2010. Conversational spaces for learning and designing. CHI2010 Workshop on New Generation of HCI and Education. Atlanta, GA, USA 10 - 15 Apr 2010
A grounded theory approach towards conceptualizing CIS for heterogeneous work communities
Selvaraj, N. and Fields, B. 2009. A grounded theory approach towards conceptualizing CIS for heterogeneous work communities. Proceedings of the 23rd British HCI Group Annual Conference on People and Computers: Celebrating People and Technology. Cambridge, UK 01 - 05 Sep 2009 Swindon, UK British Computer Society. pp. 471-479
The roles of time, place, value and relationships in collocated photo sharing with camera phones
Stelmaszewska, H., Fields, B. and Blandford, A. 2008. The roles of time, place, value and relationships in collocated photo sharing with camera phones. England, D. and Beale, R. (ed.) The 22nd British HCI Group Annual Conference on People and Computers: Culture, Creativity, Interaction. Liverpool, UK 01 - 05 Sep 2008 Swindon, UK British Computer Society.
The cultural integration of knowledge management into interactive design
Sheikh, J., Fields, B. and Duncker-Gassen, E. 2011. The cultural integration of knowledge management into interactive design. HI'11 Proceedings of the 2011 international conference on Human interface and the management of information. Orlando, FL, USA 09 - 14 Jul 2011 Springer. https://doi.org/10.1007/978-3-642-21793-7_6
Mediation role of boundary objects in articulating common information spaces.
Selvaraj, N. and Fields, B. 2010. Mediation role of boundary objects in articulating common information spaces. Workshop held in conjunction with the 9th International Conference on the Designing Cooperative Systems (COOP 2010). Aix-en-Provence, France 18 - 21 May 2010
Design tribes and information spaces for creative conversations
Bardill, A., Griffiths, W., Jones, S. and Fields, B. 2010. Design tribes and information spaces for creative conversations. The 12th International Conference on Engineering and Product Design Education. Trondheim, Norway 02 - 03 Sep 2010
Women counsellors' experiences of personal therapy: A thematic analysis
Ciclitira, K., Starr, F., Marzano, L., Brunswick, N. and Costa, A. 2012. Women counsellors' experiences of personal therapy: A thematic analysis. Counselling and Psychotherapy Research. 12 (2), pp. 136-145. https://doi.org/10.1080/14733145.2011.645050
The impact of prison staff responses on self-harming behaviours: prisoners’ perspectives
Marzano, L., Ciclitira, K. and Adler, J. 2011. The impact of prison staff responses on self-harming behaviours: prisoners’ perspectives. British Journal of Clinical Psychology. 51 (1), pp. 4-18. https://doi.org/10.1111/j.2044-8260.2010.02007.x
Self-harm in a men's prison: staff's and prisoners' perspectives.
Marzano, L. 2007. Self-harm in a men's prison: staff's and prisoners' perspectives. PhD thesis Middlesex University School of Health and Social Sciences
Visuo-spatial ability and dyslexia: is there a male global advantage?
Brunswick, N., Martin, G. and Marzano, L. 2008. Visuo-spatial ability and dyslexia: is there a male global advantage? British Dyslexia Association International Conference, 2008 [Dyslexia: making links]. Harrogate, York 27 - 29 Mar 2008
Visuo-spatial ability, handedness and developmental dyslexia: just how sinister was Andy Warhol?
Brunswick, N., Martin, G. and Marzano, L. 2007. Visuo-spatial ability, handedness and developmental dyslexia: just how sinister was Andy Warhol? 25th European Workshop on Cognitive Neuropsychology. Bressanone, Italy 21 - 26 Jan 2007
To be or not to be … a psychologist: critical and feminist dilemmas.
Ciclitira, K., Capdevila, R., Marzano, L. and Adams, E. 2008. To be or not to be … a psychologist: critical and feminist dilemmas. 2008 BPS Annual Conference.. Dublin 04 Feb 2008
Counsellors’ experiences of working as volunteers at a women’s service.
Costa, A., Ciclitira, K. and Marzano, L. 2008. Counsellors’ experiences of working as volunteers at a women’s service. 2008 Psychology of Women Section 21st Anniversary Conference on 'Rights and Changes'.. Cumberland Lodge, The Great Park, Windsor.
The impact of personal psychotherapy and supervision on volunteer counsellors.
Ciclitira, K., Marzano, L., Starr, F., Brunswick, N., Costa, A. and Berger, S. 2009. The impact of personal psychotherapy and supervision on volunteer counsellors. 2009 BPS Annual Conference. Brighton, UK 01 - 03 Apr 2009
Supporting staff working with prisoners who self harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales
Marzano, L. and Adler, J. 2007. Supporting staff working with prisoners who self harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales. International Journal of Prisoner Health. 3 (4), pp. 268-282. https://doi.org/10.1080/17449200701682501
Afghan nationals in the UK: professional capacity and views on return
Sales, R., Blitz, B. and Marzano, L. 2002. Afghan nationals in the UK: professional capacity and views on return. Research commissioned by Refugee Action and the International Organization for Migration, London..
Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study
Rivlin, A., Hawton, K., Marzano, L. and Fazel, S. 2010. Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study. The British Journal of Psychiatry. 197 (4), pp. 313-319. https://doi.org/10.1192/bjp.bp.110.077883
Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study
Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2010. Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study. The British Journal of Psychiatry. 197 (3), pp. 219-226. https://doi.org/10.1192/bjp.bp.109.075424
Lo-fi prototyping to design interactive-tabletop applications for children
Rick, J., Francois, P., Fields, B., Fleck, R., Yuill, N. and Carr, A. 2010. Lo-fi prototyping to design interactive-tabletop applications for children. The 9th International Conference on Interaction Design and Children. Barcelona, Spain 09 - 12 Jun 2010 New York, NY, USA Association for Computing Machinery (ACM). pp. 138-146
Developing a framework of common information space (CIS): grounded theory analysis of airport CIS
Selvaraj, N. and Fields, B. 2010. Developing a framework of common information space (CIS): grounded theory analysis of airport CIS. Kolfschoten, G., Herrmann, T. and Lukosch, S. (ed.) 16th Collaboration Researchers' International Working Group Conference on Collaboration and Technology. Maastricht, The Netherlands 20 - 23 Sep 2010 Berlin, Germany Springer. pp. 281-296 https://doi.org/10.1007/978-3-642-15714-1_21
Visuospatial superiority in developmental dyslexia: myth or reality?
Brunswick, N., Martin, G. and Marzano, L. 2010. Visuospatial superiority in developmental dyslexia: myth or reality? Learning and Individual Differences. 20 (5), pp. 421-426. https://doi.org/10.1016/j.lindif.2010.04.007
Justice and care: theorising the 'new man' and the 'caring father.'
Marzano, L., Capdevila, R., Ciclitira, K. and Lazard, L. 2009. Justice and care: theorising the 'new man' and the 'caring father.'. Psychology of Women Secton Review. 11 (2), pp. 11-20.
Theoretical and ethical issues in conducting research at a women’s centre.
Ciclitira, K. and Marzano, L. 2004. Theoretical and ethical issues in conducting research at a women’s centre. Proceedings of the British Psychological Society. 12 (2).
Being a man: justice and care.
Capdevila, R., Ciclitira, K., Lazard, L. and Marzano, L. 2006. Being a man: justice and care. Psychology of Women Section Annual Conference 2005.. University of Huddersfield. The British Psychological Society.
Theoretical and ethical issues in conducting research at a women’s health centre.
Ciclitira, K., Marzano, L., Brunswick, N., Starr, F. and Berger, S. 2004. Theoretical and ethical issues in conducting research at a women’s health centre. Psychology of Women Section Review. 6 (1), pp. 60-69.
3D-in-2D Displays for ATC.
Wong, B., Rozzi, S., Boccalatte, A., Gaukrodger, S., Amaldi, P., Fields, B., Loomes, M. and Martin, P. 2007. 3D-in-2D Displays for ATC. in: Brochard, M. and Jurgens, M. (ed.) 6th EUROCONTROL innovative research workshop & exhibition. Eurocontrol. pp. 47-62
A framework for considering spatial-temporal representation design needs in air traffic control.
Wong, B., Rozzi, S., Amaldi, P., Woodward, P. and Fields, B. 2006. A framework for considering spatial-temporal representation design needs in air traffic control. in: Proceedings of the Human Factors and Ergonomics Society 50th annual meeting: October 16 - 20, 2006, San Francisco. Santa Monica, CA. HFES. pp. 250-254
Research into EMD at the London ambulance service: stage 1 report requirements, priorities and projects.
Wong, B., Fields, B. and Blandford, A. 2000. Research into EMD at the London ambulance service: stage 1 report requirements, priorities and projects. London Middlesex University.
Emergency medical dispatch at the London ambulance service.
Wong, B., Blandford, A. and Fields, B. 2000. Emergency medical dispatch at the London ambulance service. Middlesex University.
Evaluating combined 2D/3D displays for ATC.
Rozzi, S., Woodward, P., Amaldi, P., Fields, B. and Wong, B. 2006. Evaluating combined 2D/3D displays for ATC. in: 5th EUROCONTROL innovative research workshop & exhibition: proceedings. Eurocontrol: [http://inoworkshop.eurocontrol.fr/]. pp. 167-174
Developing visualisations to support spatial-temporal reasoning in ATC.
Rozzi, S., Wong, B., Woodward, P., Amaldi, P., Fields, B. and Panizzi, E. 2006. Developing visualisations to support spatial-temporal reasoning in ATC. in: Pejcic-Tarle, S. (ed.) Second international conference on research in air transportation. Belgrade, Serbia University of Belgrade: Faculty of Traffic and Transport Engineering.
Operational potential for 3D displays in air traffic control
Rozzi, S., Amaldi, P., Wong, B. and Fields, B. 2007. Operational potential for 3D displays in air traffic control. in: Brinkman, W., Ham, D. and Wong, B. (ed.) ECCE 2007: European conference on cognitive ergonomics, 2007. New York Association for computing machinery.
Next generation 4D HMI concepts. Deliverable 14. Report prepared for AD4: 4D virtual airspace management system, sixth framework programme, priority 1.4 aeronautics and space.
Wong, B., Panifici, E., Lot, D., Amaldi, P., Fields, B. and Rozzi, S. 2005. Next generation 4D HMI concepts. Deliverable 14. Report prepared for AD4: 4D virtual airspace management system, sixth framework programme, priority 1.4 aeronautics and space. Rome NEXT Sistems Ingegeria o..
Operational concepts report Vol.2: tower control deliverable 12.
Amaldi, P., Fields, B., Rozzi, S., Woodward, P. and Wong, B. 2005. Operational concepts report Vol.2: tower control deliverable 12. Middlesex University Press.
Operational Concepts Report Vol.1: Approach Control.
Amaldi, P., Fields, B., Rozzi, S. and Wong, B. 2005. Operational Concepts Report Vol.1: Approach Control. London Middlesex University Press.
Cultural representation for multi-culture interaction design
Sheikh, J., Fields, B. and Duncker-Gassen, E. 2009. Cultural representation for multi-culture interaction design. Aykin, N. (ed.) 3rd International Conference on Internationalization, Design and Global Development. San Diego, CA, USA 19 - 24 Jul 2009 Berlin, Heidelberg Springer. https://doi.org/10.1007/978-3-642-02767-3_11
Non voluntary return? The politics of refugee return to Afghanistan
Sales, R., Blitz, B. and Marzano, L. 2005. Non voluntary return? The politics of refugee return to Afghanistan. Political Studies. 53 (1), pp. 182-200.
Representing collaborative work: the airport as common information space
Fields, B., Tassi, A. and Amaldi-Trillo, P. 2005. Representing collaborative work: the airport as common information space. Cognition Technoogy and Work. 7 (2), pp. 119-133. https://doi.org/10.1007/s10111-005-0177-3
Editorial: In use, in situ: extending field research methods
Fields, B., Amaldi, P., Wong, B. and Gill, S. 2007. Editorial: In use, in situ: extending field research methods. International Journal of Human-Computer Interaction. 22 (1-2), pp. 1-6. https://doi.org/10.1080/10447310709336952
Disrupting digital library development with scenario informed design
Fields, B., Blandford, A., Furniss, D. and Keith, S. 2007. Disrupting digital library development with scenario informed design. Interacting with Computers. 19 (1), pp. 70-82. https://doi.org/10.1016/j.intcom.2006.07.003
Design sketching for space and time
Rozzi, S., Wong, B., Amaldi, P., Woodward, P. and Fields, B. 2006. Design sketching for space and time. Clemmensen, T., Orngreen, R., Pejtersen, A. and Wong, B. (ed.) 1st IFIP Working Conference on Human Work Interaction Design. Madeira, Portugal 13 - 15 Feb 2006 New York, NY Springer. pp. 161-183 https://doi.org/10.1007/978-0-387-36792-7_10
Claims analysis "in the wild": a case study on digital library development
Fields, B., Blandford, A. and Keith, S. 2006. Claims analysis "in the wild": a case study on digital library development. International Journal of Human-Computer Interaction. 21 (2), pp. 197-218. https://doi.org/10.1207/s15327590ijhc2102_5
A study into the effect of digitisation projects on the management and stability of historic photograph collections
Davis-Perkins, V., Butterworth, R., Curzon, P. and Fields, B. 2005. A study into the effect of digitisation projects on the management and stability of historic photograph collections. Rauber, A., Christodoulakis, S. and Tjoa, A. (ed.) 9th European Conference on Research and Advanced Technology for Digital Libraries. Vienna, Austria 18 - 23 Sep 2005 Berlin, Heidelberg Springer. pp. 278-289 https://doi.org/10.1007/11551362_25
Dynamic digital libraries for children
Fields, B., Buchanan, G., Mohd-Nasir, N. and Theng, Y. 2001. Dynamic digital libraries for children. in: JCDL '01: Proceedings of the 1st ACM/IEEE-CS joint conference on Digital libraries New York, NY, United States. Association for Computing Machinery (ACM). pp. 406-415