Attempted suicide among South African adolescents living in a low resource environment : contested meanings, lived experience, and expressed support needs
| dc.contributor.advisor | Bantjes, Jason | en_ZA |
| dc.contributor.author | Pasche, Sonja Christine | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology. | en_ZA |
| dc.date.accessioned | 2020-11-25T08:11:30Z | |
| dc.date.accessioned | 2021-01-31T19:40:13Z | |
| dc.date.available | 2020-11-25T08:11:30Z | |
| dc.date.available | 2021-01-31T19:40:13Z | |
| dc.date.issued | 2020-12 | |
| dc.description | Thesis (DPhil)--Stellenbosch University, 2020. | en_ZA |
| dc.description.abstract | ENGLISH ABSTRACT: Adolescent suicide is a serious public health concern, yet we do not understand the reasons South African adolescents give for their suicide attempts and the meanings they attach to their behaviour. Nor do we know how the adolescents’ caregivers and clinicians perceive their attempts, or how these experiences and understandings are framed by the socio-cultural context. The aim of this research was to provide a contextualised understanding of the phenomenon of suicide attempts by South African adolescents living in a low resource environment. I used a multiperspectival research design situated within a theoretical framework of hermeneutic phenomenology. All participants were recruited via the Child and Adolescent Mental Health unit of a large psychiatric hospital located in Cape Town. In-depth semi-structured interviews were conducted with 10 adolescents, their caregivers (n=10), and the clinicians who treated them (n=9). The adolescents also took photographs to illustrate their experience, and these were discussed during a second interview using the technique of photo-elicitation. I analysed data using Interpretative Phenomenological Analysis. All participants foregrounded the relational context of the adolescents’ suicide attempts, especially relationships with family members, which were described as both a mitigating and contributing factor to the suicide attempt. The adolescents explained how caregivers’ failure to acknowledge sexual and physical abuse, which they perceived as betrayal, led to emotional disconnection and subsequently, to precipitating a suicide attempt. In contrast, adolescents said that attachment to younger siblings and pets ameliorated their suicidality. The adolescents recounted how bonding with other suicidal peers reduced feelings of isolation, but that they also learned about suicidal behaviours from each other. Participants also spoke about how the adolescents’ suicide attempts were shaped by the socio-economic context, including exposure to poverty and high levels of violence. Both caregivers and clinicians described feelings of anxiety, powerlessness, and helplessness elicited by the adolescents’ suicidality, echoing the powerlessness reported by the adolescents. Participants did not endorse a purely psychiatric understanding of adolescent suicidal behaviour; instead they described the adolescents’ suicide attempts as an escape from pain, or an attempt to alleviate perceived economic burdensomeness. The adolescents experienced admission to a psychiatric hospital as providing safety, but also as exacerbating a loss of autonomy. Participants discussed how improved connectedness, belonging, communication, and validation of the adolescents’ experiences, to counter the adolescents’ sense of isolation and invisibility, were important for support after the attempt, and for the prevention of adolescent suicide. The participants’ accounts of the adolescents’ suicide attempts were incongruent with existing theories of suicidal behaviour, highlighting the need for adolescent specific, contextualised theories of suicidal behaviour. These findings also suggest that adolescent suicide prevention cannot solely be the responsibility of the mental health care sector, that the wellbeing of caregivers is essential for adolescent suicide prevention, and they emphasise the importance of adolescent-specific services that enhance feelings of autonomy. Potential areas for future research in the field of adolescent suicide prevention include the role of siblings, pets, and feelings of betrayal. | |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Selfmoord onder adolessente is ’n kommerwekkende openbare gesondheidsbelang, maar ons verstaan nie die redes wat Suid-Afrikaanse adolessente vir hul selfmoordpogings bied asook die betekenisse wat hulle aan hul gedrag heg nie. Ons weet verder ook nie hoe die adolessente se voogde en klinici hul pogings verstaan of hoe hierdie ervarings en insigte deur die sosio-kulturele konteks geraam word nie. Die doel van hierdie navorsing was om ʼn gekontekstualiseerde begrip van die verskynsel van selfmoordpogings deur Suid-Afrikaanse adolessente woonagtig in ’n lae hulpbron-omgewing te bied. Ek het gebruik gemaak van ʼn multi-perspektiewelike navorsingsontwerp binne die teoretiese raamwerk van hermeneutiese fenomenologie. Al die deelnemers is gewerf via die Geestesgesondheidseenheid vir kinders en adolessente van ʼn groot psigiatriese hospitaal in Kaapstad. In-diepte semi-gestruktureerde onderhoude is gevoer met 10 adolessente, hul voogde (n=10), en die klinici wie hulle behandel het (n=9). Die adolessente het ook foto’s geneem om hul ervaring te illustreer, wat tydens ʼn tweede onderhoud bespreek is met behulp van die foto-ontlokkingstegniek. Ek het data geanaliseer met behulp van Interpretatiewe Fenomenologiese Analise. Al die deelnemers het klem geplaas op die verhoudingskonteks van die adolessente se selfmoordpogings, veral verhoudings met familielede, wat as beide ʼn versagtende en bydraende faktor tot die selfmoordpoging beskryf is. Die adolessente het verduidelik dat die voogde se versuiming om seksuele en fisieke mishandeling te erken – wat hulle as verraad beskou het – gelei het tot emosionele afkoppeling en gevolglik tot ʼn selfmoordpoging. In teenstelling hiermee het adolessente beweer dat gehegtheid aan jonger broers en susters asook troeteldiere hul selfmoordneigings verlig het. Die adolessente het vertel hoe die saambinding met ander in ’n portuurgroep met selfmoordneigings hul gevoelens van isolasie verminder het, maar dat hulle ook van selfmoordgedrag by mekaar geleer het. Deelnemers het ook gepraat oor die maniere waarop die adolessente se selfmoordpogings beïnvloed was deur die sosio-ekonomiese konteks, insluitend hul blootstelling aan armoede en hoë vlakke van geweld. Beide voogde en klinici het beskryf hoe gevoelens van angs, magteloosheid en hulpeloosheid ontlok was deur die adolessente se selfmoordneigings. Dit word verder weerspieël in die magteloosheid wat deur die adolessente gerapporteer is. Deelnemers het nie ʼn suiwer psigiatriese begrip van selfmoordgedrag by adolessente beaam nie; hulle het eerder die adolessente se selfmoordpogings beskryf as ʼn ontsnapping van pyn, of ʼn poging om hul waargenome bydrae tot huishoudelike ekonomiese las te verlig. Die adolessente het die opname in ʼn psigiatriese hospitaal as ʼn bron van veiligheid ervaar, maar ook as ʼn verlies van outonomiteit. Deelnemers het bespreek hoe verbeterde verbondenheid, aanvaarding, kommunikasie en geldigmaking van die ervarings van die adolessente dien as teenwerking tot die adolessente se gevoel van isolasie en onsigbaarheid. Hulle beaam verder dat hierdie faktore belangrik was vir ondersteuning ná die poging, asook vir die voorkoming van selfmoord onder adolessente. Die deelnemers se verhale van die adolessente se selfmoordpogings was strydig met bestaande teorieë van selfmoordgedrag, wat sodoende die behoefte aan adolessente-spesifieke, gekontekstualiseerde teorieë van selfmoordgedrag beklemtoon. Hierdie bevindinge dui ook eerstens daarop dat adolessente-selfmoordvoorkoming nie alleenlik die verantwoordelikheid van die geestesgesondheidsektor kan wees nie, dat die welstand van voogde tweedens noodsaaklik is vir adolessente-selfmoordvoorkoming, en dit beklemtoon laastens die belangrikheid van adolessente-spesifieke dienste wat die gevoel van outonomie versterk. Die rol van broers en susters, troeteldiere, en gevoelens van verraad word geïdentifiseer as potensiële terreine vir toekomstige navorsing in die veld van selfmoordvoorkoming onder adolessente. | |
| dc.description.version | Doctoral | |
| dc.format.extent | 273 pages | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/10019.1/109223 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | en_ZA |
| dc.rights.holder | Stellenbosch University | en_ZA |
| dc.subject | Multiperspectival research design | en_ZA |
| dc.subject | UCTD | en_ZA |
| dc.subject | Attempted suicide | en_ZA |
| dc.subject | Adolescent psychology | en_ZA |
| dc.subject | Phenomenological psychology -- Analysis | en_ZA |
| dc.title | Attempted suicide among South African adolescents living in a low resource environment : contested meanings, lived experience, and expressed support needs | en_ZA |
| dc.type | Thesis | en_ZA |