ANNALS OF IBADAN POSTGRADUATE MEDICINE
This paper examines the merits of the qualitative and quantitative methods of suicide research in the elderly using two studies identified through a free search of the Pubmed database for articles that might have direct bearing on suicidality in the elderly. The studies have been purposely selected for critical appraisal because they meaningfully reflect the quantitative and qualitative divide as well as the social, economic, and cultural boundaries between the elderly living in sub-Saharan Africa and Europe. The paper concludes that an integration of both the qualitative and quantitative research approaches may provide a better platform for unraveling the complex phenomenon of suicide in the elderly.
Keywords: Psychological autopsy, Suicidal behaviours, Thematic analysis, Phenomenology
Dr. A. Ojagbemi
Department of Psychiatry,
College of Medicine,
University of Ibadan, Ibadan.
Suicide may be considered a common and devastating emergency in the general practice of mental health. It is a phenomenon that is largely complex and inherently difficult to predict. Suicidality, which is the spectrum of psychological activities that culminates in the eventual death of the individual, may be especially complicated in the elderly. This is because people of that age group are known to traverse the continuum of suicidal behaviour with extraordinary secrecy, determination and lethality. Thus, there may be up to three new cases of elderly suicide for every one below the age of 25 years in many countries.1,2 Given the intricate nature of the phenomenon in the elderly, understanding the immediate and remote factors that may be suggestive of imminent death by suicide may be an important step towards setting up targeted interventions before it is too late.
In the context of suicide research, immediate pointers to an impending suicide may, on the one hand, include the subjective ‘experience’ of suicidal ideas or the wish to die. This very personal experience may sometimes be expressed in signs and symptoms such as talking or writing about the end. A phenomenon often referred to as suicidal warnings.3 In this regards, immediate factors for imminent suicide may encompass the ‘meanings’ attached to such notices by their recipients. The understanding of people’s experiences and meanings may be strengthened by the qualitative research framework.4 In contrast to the meanings and experiences of the individual, the more remote pointers to imminent suicide may include correlates of suicidality within the larger population. The investigation of such independent risk factors within the population, or a systematically generated sample from it, may be underpinned by the quantitative research model.5
To provide a portrayal of how an integration of the qualitative and quantitative paradigms may assist in deepening the understanding of suicidality in the elderly, this review aims to critically compare two studies using contrasting approaches in elucidating the factors related to suicide in older adults.
The two studies were purposively selected for this review, among 29 articles dealing with various aspects of the phenomenon, because they meaningfully reflect the quantitative and qualitative divide, as well as the social, economic, and cultural boundaries that may be relevant for suicide research in the elderly. Details of both papers are presented in table 1. The first study, hereafter referred to as Kjolseth and Ekeberg,6 was an investigation of the experiences and reactions of people to warnings they have received about the suicidal intention of their elderly wards. The authors relied on the technique of psychological autopsy7. Wherein, they re-created the circumstances of the suicide through interviews of formal and informal carers of individuals who had died in that manner aged 65 years or over. The second study, hereafter referred to as Ojagbemi, et al,8 examined the predictive relationship between several health-related variables and three suicidal behaviours occurring on a continuum. The authors relied on a multi-stage probability sample of participants aged 65 years or above living in communities spread across a geographical area with a total population of about 25 million inhabitants.