Worldwide, suicide among young men is a major public health concern in most countries. In Norway, as well as abroad, in spite of great efforts invested, we still have scarce scientific evidence of effective prevention strategies, and suicide rates among young men remain high. The failure of effective prevention may be partly related to the fact that most studies of suicide are based on clinical populations, and the detection and treatment of mental disorder is the main focus in suicide prevention strategies. Yet, a large portion of suicides are not preceded by symptoms of mental disorder (i.e. non-clinical suicides). However, research on non-clinical suicide is almost totally lacking.
The present study was undertaken to provide a deeper understanding of the role of age, gender and the underlying psychological mechanisms, such as self-esteem, that regulate the dynamics in suicide among young non-clinical men, and thereby to provide knowledge that may lead to new issues for prevention.
The three studies included in this dissertation utilised a unique data set, consisting of 120 in-depth interviews and 12 suicide notes related to 20 suicides among individuals with no prior psychiatric treatment and no previous suicide attempts. A sub-sample, consisting of ten cases of young men, aged 18-30, was the focus of this study. All studies are qualitative, phenomenological and hermeneutical, utilising the competence of those close to the deceased; i.e. how they themselves were trying to understand how “he” so suddenly and unexpectedly could end his own life. In-depth interviews with mothers, fathers, male friends, siblings and (ex-)-girl friends brought forward how each one of them experienced the deceased and his conduct in all its complexity. In total 61 interviews, as well as six suicide notes, were analysed guided by Interpretative Phenomenological Analysis (IPA).
The findings show that for these young men, the transition to young adulthood, a period of major life challenges, seemed to be associated with deficiencies in the affective capacity to regulate personal defeats. A main finding was that the understanding of these suicides was linked to how a discrepancy between ideal and actual self-performances appeared unsolvable. The analyses pointed to a psychological logic of suicide as a way out of unbearable mental pain; pain that was related to a collapse in the regulation of self-esteem. Developmentally, these young men appeared to have compensated for their lack of self-worth by exaggerating the importance of success and being successful and thus developed a fragile adult achievement based self-esteem, which left them vulnerable in the face of rejections and perceptions of failures.
Contrary to previous research, suggesting that mental illness, and in particular depression, in the period prior to death is an important risk factor for suicide, few of the informants in our study mentioned depression or other mental illnesses in their narratives. Thus, the analysis of the role of self-esteem regulation in the suicidal process of young men who in spite of accomplishments and successes, unexpectedly took their lives in young adulthood (papers 1 and 2) provides knowledge that may increase our understanding of non-clinical suicides, which is of importance for tailoring better prevention strategies.
A major challenge in this respect is related to the fact that most young men who take their own lives are not in contact with, nor seek help from, any health professionals prior to their death. Despite a vast amount of research on clinical risk factors for suicide, research on warning signs is scarce. Thus, the last part of this study was conducted to identify possible warning signs of non-clinical suicides among young men. According to the informants, the young men did not disclose any plans of suicide or make any direct request for help prior to death. Four indirect signs, related to the psychological condition of the young men in the period prior to ending their life, were identified: 1) repeatedly pointing to the irreversibility of a mistaken decision; 2) the desperation they felt in this respect; 3) using their own death as a threat; and 4) and referring to death as a place to go (paper 3).
In summary, because non-clinical suicides are not preceded by identifiable symptoms of mental disorder, and most young men who take their life do not seek help prior to death, the present findings underscore that talk or actions indicating suicidality, as well as worrisome indirect appeals for emotional support, should not be left unquestioned, but rather explored directly with the person.