Experiences, Memories, and Exiting Suicidal States : A Meta-Ethnography and Case Series

Powell, Lexy and Kelly, James (2024) Experiences, Memories, and Exiting Suicidal States : A Meta-Ethnography and Case Series. PhD thesis, Lancaster University.

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Abstract

Suicidal ideation is linked to both risk and psychological distress in people with mental health difficulties. There is a need for further research around how suicidal thinking can be reduced. This thesis considers the role of suicide ‘exits’ – both how they are experienced, and how they can be used within a clinical intervention. The intervention explores this within the wider construct of ‘autobiographical memory’. Section one presents a meta-ethnographic literature review which considers how people with mental health difficulties experience suicidal thinking in the absence of an attempt. Five databases were searched (PsycINFO, CINAHL, MEDLINE, Web of Science, PubMed) and 12 studies were included in the review. Five overarching themes were synthesised: 1) Unbearable Beliefs, 2) Disconnection, 3) The Flow of Suicidal Thoughts, 4) In- The-Moment Exits, 5) Long-Term Attitudes. Themes 1-4 were presented temporally in a cycle, whilst theme 5 was placed adjacent to this. All themes were assimilated using a metaphorical depiction of a river. This aimed to support understanding of the relationship between themes. Section two presents a case series exploring the acceptability and feasibility of an autobiographical memory-based intervention for suicidality. A non-concurrent A-B multiple- baseline design was followed (3-5 baselines, 6 intervention sessions). Four people attended the initial assessment; one was assessed as ineligible at this stage. All eligible participants (n=3) completed the study, with a high attendance rate (93.10%). No adverse effects were reported. Clinical outcomes varied, with a marked improvement for one participant. Whilst the study was limited by its small sample size, it established the need for a fully powered trial to investigate this further. A critical appraisal of the process of conducting both the meta-ethnography and case series is included in section three. This summarises sections one and two, and makes suggestions about potential research for the future.