Developing Suicide Safety Protocols for Qualitative Research as a Universal Equity Practice

Abstract

Qualitative research offers a range of approaches to elucidate the health and social experiences of populations and communities that are historically oppressed and repressed, yet is not without ethical and practical challenges that may have unintended consequences and added risks for certain individuals and communities. As a result of experiences of trauma and environmental factors, many oppressed and repressed populations have disproportionately high rates of suicide, but there are no widely accepted standards or best practices for addressing suicidality while conducting qualitative research. We describe an example of a qualitative interview during which a participant reported thoughts of suicide, even though the study topic was not directly related to mental health or suicide. We describe how the research team responded and present a framework for developing suicide safety protocols when conducing qualitative research with oppressed and repressed populations.

Keywords

Commentary suicide qualitative methodology equality inequality social issues USA

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References

Anderson

J. C.

Glass

N. E.

Campbell

J. C.

(2017). Conducting clinically based intimate partner violence research: Safety protocol recommendations. Nursing Research, 66(5), 405–409. https://doi.org/10.1097/nnr.0000000000000235

Biddle

Cooper

Owen-Smith

Klineberg

Bennewith

Hawton

. . . Gunnell

(2013). Qualitative interviewing with vulnerable populations: Individuals’ experiences of participating in suicide and self-harm based research. Journal of Affective Disorders, 145(3), 356–362. https://doi.org/10.1016/j.jad.2012.08.024

Blades

C. A.

Stritzke

W. G. K.

Page

A. C.

Brown

J. D.

(2018). The benefits and risks of asking research participants about suicide: A meta-analysis of the impact of exposure to suicide-related content. Clinical Psychology Review, 64, 1–12. https://doi.org/10.1016/j.cpr.2018.07.001

Brown

V. M.

Strauss

J. L.

LaBar

K. S.

Gold

A. L.

McCarthy

Morey

R. A.

(2014). Acute effects of trauma-focused research procedures on participant safety and distress. Psychiatry Research, 215(1), 154–158. https://doi.org/10.1016/j.psychres.2013.10.038

Btoush

Campbell

J. C.

(2009). Ethical conduct in intimate partner violence research: challenges and strategies. Nursing Outlook, 57(4), 210–216. https://doi.org/10.1016/j.outlook.2008.10.005

Butler

A. E.

Copnell

Hall

(2019). Researching people who are bereaved: Managing risks to participants and researchers. Nursing Ethics, 26(1), 224–234. https://doi.org/10.1177/0969733017695656

Chang

J. C.

Decker

M. R.

Moracco

K. E.

Martin

S. L.

Petersen

Frasier

P. Y.

(2005). Asking about intimate partner violence: Advice from female survivors to health care providers. Patient Education and Counseling, 59(2), 141–147. https://doi.org/10.1016/j.psychres.2013.10.038

Coulter

Henderson

Corey

Gagnon

Chugani

Egan

. . . Miller

(2020). Exploring how U.S. high school staff support, protect, and affirm sexual and gender minority youth: A qualitative interview study [Manuscript submitted for publication].

Creighton

Oliffe

Ogrodniczuk

Frank

(2017). “You’ve gotta be that tough crust exterior man”: Depression and suicide in rural-based men. Qualitative Health Research, 27(12), 1882–1891. https://doi.org/10.1177/1049732317718148

10.

Cristancho

Garces

D. M.

Peters

K. E.

Mueller

B. C.

(2008). Listening to rural Hispanic immigrants in the Midwest: A community-based participatory assessment of major barriers to health care access and use. Qualitative Health Research, 18(5), 633–646. https://doi.org/10.1177/1049732308316669

11.

Dazzi

Gribble

Wessely

Fear

N. T.

(2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44, 3361–3363.

12.

DePiro

Henderson

Gupta

Corey

Chugani

Egan

. . . Coulter

(March 2020). The good, the bad, and the harmful: Sexual and gender minority youth’s views of how schools respond to bullying and harassment [Paper presentation]. The Society for Research on Adolescence Biennial Meeting, San Diego, CA, United States.

13.

Ellsberg

Heise

, & World Health Organization. (2005). Researching violence against women: Practical guidelines for researchers and activists. World Health Organization.

14.

Ferlatte

Oliffe

J. L.

Louie

D. R.

Ridge

Broom

Salway

(2019). Suicide prevention from the perspectives of gay, bisexual, and Two-Spirit men. Qualitative Health Research, 29(8), 1186–1198. https://doi.org/10.1177/1049732318816082

15.

Gould

M. S.

Marrocco

F. A.

Kleinman

Thomas

J. G.

Mostkoff

Cote

Davies

(2005). Evaluating iatrogenic risk of youth suicide screening programs: A randomized controlled trial. Journal of the American Medical Association, 293(13), 1635–1643. https://doi.org/10.1001/jama.293.13.1635

16.

Graham

Berkowitz

Blum

Bockting

Bradford

de Vries

Makadon

(2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Institute of Medicine.

17.

Kisely

Alichniewicz

K. K.

Black

E. B.

Siskind

Spurling

Toombs

(2017). The prevalence of depression and anxiety disorders in indigenous people of the Americas: A systematic review and meta-analysis. Journal of Psychiatric Research, 84, 137–152. https://doi.org/10.1016/j.jpsychires.2016.09.032

18.

Langford

D. R.

(2000). Developing a safety protocol in qualitative research involving battered women. Qualitative Health Research, 10(1), 133–142. https://doi.org/10.1177/104973200129118192

19.

Littlewood

D. L.

Harris

Gooding

Pratt

Haddock

Peters

(2019). Using my demons to make good: The short- and long-term impact of participating in suicide-related research. Archives of Suicide Research, 1–25. Advance online publication. https://doi.org/10.1080/13811118.2019.1663330

20.

Lucas

M. S.

Brawner

B. M.

Hardie

T. L.

Beacham

Paidipati

Diaz

. . . Deatrick

J. A.

(2015). Assessing suicidal ideation and behaviors among survivors of childhood brain tumors and their mothers during sociobehavioral research. Oncology Nursing Forum, 42(5), E319–E329. https://doi.org/10.1188/15.ONF.42-05AP

21.

Meyer

H. M.

Mocarski

Holt

N. R.

Hope

D. A.

King

R. E.

Woodruff

(2019). Unmet expectations in health care settings: Experiences of transgender and gender diverse adults in the central great plains. Qualitative Health Research, 30(3), 409–422. https://doi.org/10.1177/1049732319860265

22.

Miller

McCauley

H. L.

Decker

M. R.

Levenson

Zelazny

Jones

K. A.

. . . Silverman

J. G.

(2017). Implementation of a family planning clinic–based partner violence and reproductive coercion intervention: Provider and patient perspectives. Perspectives on Sexual and Reproductive Health, 49(2), 85–93. https://doi.org/10.1363/psrh.12021

23.

Morse

J. M.

(2007). Ethics in action: Ethical principles for doing qualitative health research. Qualitative Health Research, 17(8), 1003–1005. https://doi.org/10.1177/1049732307308197

24.

Owen

Gooding

Dempsey

Jones

(2016). The experience of participation in suicide research from the perspective of individuals with bipolar disorder. The Journal of Nervous and Mental Disease, 204(11), 840–844.

25.

Parker

Ulrich

(1990). A protocol of safety: Research on abuse of women. Nursing Research Consortium on Violence and Abuse. Nursing Research, 39(4), 248–250. https://doi.org/10.1097/00006199-199007000-00016

26.

Pendse

S. R.

Nugent

N. R.

(2017). Mental health challenges and opportunities in rural communities. The Brown University Child and Adolescent Behavior Letter, 33(6), 1–7. https://doi.org/10.1002/cbl.30217

27.

Plenn

Corey

Roig

Routh

Henderson

Chugani

. . . Coulter

(March 2020). Going the extra mile: A social ecological understanding of how high school staff support, protect, and care for LGBTQ students [Paper presentation]. The Society for Research on Adolescence Biennial Meeting, San Diego, CA, United States.

28.

Polacsek

Boardman

G. H.

McCann

T. V.

(2020). A theory on the components of depression self-management in older adults. Qualitative Health Research, 31(1), 160–171. https://doi.org/10.1177/1049732320961060

29.

Posner

Brent

Lucas

Gould

Stanley

Brown

. . . Oquendo

(2008). Columbia-suicide severity rating scale (C-SSRS). New York, NY: Columbia University Medical Center, 10 (2008).

30.

Rivlin

Marzano

Hawton

Fazel

(2012). Impact on prisoners of participating in research interviews related to near-lethal suicide attempts. Journal of Affective Disorders, 136(1–2), 54–62. https://doi.org/10.1016/j.jad.2011.09.009

31.

Routh

Corey

Plenn

Roig

Henderson

Chugani

. . . Coulter

(March 2020). “Is that a boy or a girl?” School staff’s perspectives on misgendering, deadnaming, and gender minority-affirming school policies [Paper presentation]. The Society for Research on Adolescence Biennial Meeting, San Diego, CA, United States.

32.

Salway

Gesink

(2018). Constructing and expanding suicide narratives from gay men. Qualitative Health Research, 28(11), 1788–1801. https://doi.org/10.1177/1049732318782432

33.

Sullivan

C. M.

Cain

(2004). Ethical and safety considerations when obtaining information from or about battered women for research purposes. Journal of Interpersonal Violence, 19(5), 603–618. https://doi.org/10.1177/0886260504263249

34.

Tingey

Cwik

M. F.

Goklish

Larzelere-Hinton

Lee

Suttle

. . . Barlow

(2014). Risk pathways for suicide among Native American adolescents. Qualitative Health Research, 24(11), 1518–1526. https://doi.org/10.1177/1049732315576709

35.

United Health Foundation. (2019). America’s health rankings annual report. https://www.americashealthrankings.org/explore/annual

36.

United States National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1978). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research (Vol. 2). The Commission.

37.

Weniger

Young

Hernandez

(2020). Risk and protective factors with Native American Indian and Alaska Native children who have a history of suicidal behavior. Journal of Indigenous Research, 8(2020), Article 2. https://doi.org/10.26077/6qnp-z328

38.

Werbart Törnblom

Werbart

Rydelius

P.-A

. (2015). Shame and gender differences in paths to youth suicide: Parents’ perspective. Qualitative Health Research, 25(8), 1099–1116. https://doi.org/10.1177/1049732315578402