Material and method
In the period 2007–2009, material was gathered through in-depth interviews with a total of 61 close friends and relatives of ten young male suicides aged 18–30. The material was extensive, and was collected for the purpose of use in several research projects. Each interview consists of 30–50 A4 pages and sheds light on many different topics associated with the deceased, the reasons for the suicide and the relations of the bereaved with the deceased.
The young men had not previously been in contact with mental health care, nor had they sought help from the primary health service prior to committing suicide. Six of the ten left farewell letters. Ten of the bereaved were mothers, eleven were fathers/step-fathers, ten were siblings, 24 were friends and six were girlfriends or partners. All the bereaved individuals were over 18 years old. The interviews took place 6–18 months after the suicide.
We contacted district medical officers in Southern Norway with written information about the study. They identified relevant suicides through death notices and autopsy reports and contacted the next of kin by phone to inform them of the study. If the next of kin agreed to take part in the study, they received supplementary written information and a consent declaration. Only when the project manager received the consent declaration, were the interviewers given information about the bereaved person. The bereaved person was contacted by telephone, and the time and place of the interview agreed.
After the first interview, the bereaved persons were asked to mention others who had been close to the deceased. These people were sent information about the study, and the procedure of establishing contact after the consent declaration had been received by the project manager was maintained. The interviewers were the first and second authors and another experienced researcher, all with a high level of expertise in the field of suicide.
Our professional stance is rooted in psychological suicidology theory, where suicidal behaviour is perceived as a reaction to a great internal and external pressure, so that suicide is perceived by the suicidal person as the only way out of an insoluble crisis situation (6). This perception applies whether the deceased had a mental disorder or not.
In accordance with our professional methodology, the interviews started with an open question: "What are your thoughts about the circumstances that caused the deceased to take his life?" In this part we said as little as possible, and gave our informants free rein to recount their stories.
We then followed up with a problem-oriented part, based on Shneidman's method for carrying out in-depth interviews with those bereaved by a suicide, called psychological autopsies (6). In this part, the focus was on topics associated with the deceased's mental state prior to the suicide, negative events in the period prior to the suicide, general personality traits, the quality of interpersonal relations, substance abuse and life histories.
Finally, the bereaved were asked whether they had any thoughts as to what might possibly have averted the suicide. The interviews (1.5–3 hours) were recorded, transcribed and de-identified in accordance with the approval of the Ethics Committee.
The interviews were analysed using a flexible interpretative phenomenological method (7). In previous analyses of the material, we reported how the bereaved see the deceased and the suicide (8–10). We saw then that most of the bereaved persons went over the last conversations they had had with the deceased for answers to the questions "Why didn't I see the suicide coming?" and "Could I have done more to get hold of health assistance?"
In order to examine these questions, the entire material was reviewed again, and analysed with this as the principal theme. This meant that both authors individually reviewed all the interviews in each of the ten suicide cases, firstly in order to get a grasp of the whole picture, then to identify problems and needs associated with understanding the risk of suicide and motivating at-risk individuals to seek help. By reading through the transcribed material, we arrived at numerous different topics, which were then discussed and challenged at many author meetings. The analytical results were condensed into three main themes.
To strengthen the validity, we have tried to be clear as to how we have drawn conclusions on topics from the concrete material, to enable the reader to follow the analytical path as a basis for interpretation and conclusions. We also present many quotations from the material.
Research on qualitative data demands a high degree of reflectiveness with respect to our own preconceptions and our own engagement. Both authors are clinical psychologists, with long experience of working with persons in suicidal crises under both the municipal and the specialist health service. We have also worked for many years with the bereaved following suicides. Both authors also have long experience as suicide researchers.
The survey has been approved by the Regional Committee for Medical Research Ethics.