Life after loss : a theory-based investigation into the impact of bereavement by suicide or other causes on adolescents in Scotland

del Carpio, Laura Elina

Thesis

Life after loss : a theory-based investigation into the impact of bereavement by suicide or other causes on adolescents in Scotland

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Creator

del Carpio, Laura Elina

Rights statement

Strathclyde Thesis Copyright

Awarding institution

University of Strathclyde

Date of award

2022

Thesis identifier

T16379

Person Identifier (Local)

201650944

Qualification Level

Doctoral (Postgraduate)

Qualification Name

Doctor of Philosophy (PhD)

Department, School or Faculty

School of Psychological Sciences and Health

Abstract

Suicide is a leading cause of preventable death among adolescents worldwide, and engagement in self-harm, which is common among young people in Scotland, is a strong predictor of completed suicide. Research also suggests that knowing somebody who self-harms or has died by suicide may increase propensity to self-harm, although the specific impact of experiencing a suicide loss compared to other deaths on adolescents is yet to be established. Furthermore, how this impact compares to that for other deaths has also remained unclear. Theoretically informed work is crucial to advance the field of suicidology, and this can be achieved through testing and refinement of existing models. The Integrated Motivational-Volitional (IMV) model of suicidal behaviour (O'Connor, 2011; O'Connor & Kirtley, 2018) makes predictions about the factors that differentiate those who think about suicide from those who engage in suicidal behaviours, and as a relatively new addition to the field of suicidology, requires further testing with diverse populations and age groups. Guided by predictions from the IMV model, this mixed methods thesis set out to explore the experiences of adolescents who have been bereaved by suicide or other deaths, and investigate factors related to the development of adverse outcomes including suicidal or self harming thoughts and behaviours. Chapter 1 provides a background review of the literature on suicide and self-harm among adolescents, and explores the importance of applying theoretical frameworks to understanding behaviours. The next introductory chapter (Chapter 2) examines bereavement more closely, and details how and why adolescents’ experiences of loss, and specifically suicide loss, may contribute to increased risk of harm. Chapter 3 presents results from a systematic review of the evidence in this area, exploring adolescent experiences of suicide versus other losses and self-harm or suicidal outcomes, and highlights the gaps in our knowledge that this PhD will address. Chapter 4 then provides an account of the methodological underpinnings of this thesis, explaining the development of each of the three empirical studies to follow. Chapter 5 presents findings from a secondary analysis of data collected from Scottish schools, concerning experiences of death and self-harm outcomes (Study 1). A total of 2008 pupils took part (mean age = 15.4 years, SD = 0.8). Findings showed that almost 8% of participants reported having been exposed to a suicide death, and a further 58% to a non-suicide death. Self-harm was also common among the sample (14% reporting self-harm behaviours and 6% ideation). Importantly, suicide loss was found to be significantly associated with outcomes, with experiences of exposure predicting self-harm. Bereavement more generally was not related to the outcomes measured. Chapter 6 presents a prospective quantitative schools-based investigation carried out with pupils from secondary schools across the country (n = 185 at baseline, mean age = 13.2 years, SD = 1.5) (Study 2). This study investigated the relationship between bereavement and self-harm more closely, with a consideration of other theoretically informed variables. Findings showed similar rates of self-harm (21% behaviours and 24% ideation) as well as experiences of death (11% suicide exposure and 62% other deaths) among the sample as in Study 1. Furthermore, several factors were highlighted as being significant in predicting cross-sectional and/or longitudinal outcomes. These included factors such as maladaptive coping styles, lack of family social support, and holding stigmatising beliefs about suicide. On the other hand, experiences of any death or death by suicide specifically did not predict outcomes. Chapter 7 describes a mixed methods study developed on the basis of the results of Study 2. The components were i) qualitative interviews, which aimed to explore lived experiences of life after someone important has died, and ii) a quantitative card sorting task component to understand more about the factors leading to self-harm. This study offered detailed insights into how Scottish youth face a bereavement, analysing interview data from 13 individuals (mean age = 17.7 years, SD = 0.6). A thematic analysis identified a varied range of reactions to loss, systems of support which can help or hinder the process of dealing with grief, the concept of agency and power, and gaining of new perspectives and personal growth – regardless of the specific cause of death experienced. Findings from the card sorting task also offered novel insights into how adolescents experience self-harm within the context of a bereavement This PhD offers important contributions to knowledge regarding how adolescents in Scotland understand and experience death as well as self-harm. Furthermore, this thesis contributes to the important task of testing and refining suicide theory, which is crucial for suicide prevention, intervention, and postvention efforts going forward. A consideration of the implications for research and theory, policy, and practice is provided, while acknowledging the strengths and challenges of these studies, and recommendations for future research.

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