This summary is split into four areas: rationale, methods, results and conclusions
The increase of suicide in young people is a matter of concern in many countries and
a priority area for prevention activities and programmes. Italy, as other South
European countries, is characterized for having a very low rate of suicide,
especially among youth. In contrast, Australia in recent decades has experienced an
increase in youth suicide rate, particularly in males. In India suicide is
predominantly a problem of the youth, approximately equally distributed between men
and females, with some states registering higher female rates.
Given cross-national differences in suicide rates, research has focused on
identifying factors that increase suicide risk. As underlined by various scholars,
relatively few of these studies have addressed the impact of culture on suicidal
behaviour, and cross-cultural research has generally been neglected. In particular
there is scarce understanding of the variations in the meaning of suicide across
cultures. The present study attempted to redress this deficit, focusing on the social
representations, values, beliefs, attitudes and meanings that young Italians, Indians
and Australians express in relation to suicide.
The specific aims of the study were to investigate:
- the similarities and differences in participants' spiritual beliefs on suicide,
suicide explanatory models, attitudes towards youth suicide, opinions on suicide
deterrents/protective factors, help-seeking behaviour and on youth suicide
- participants' feelings towards death, cultural meanings of the words 'suicide'
and 'suicide attempt', mental representations and stereotypes of suicidal youth
(considering also gender issues); and
- the impact of participants' previous experience and exposure to suicide,
gender, spiritual/religious affiliation, and ethnic identity on these
Qualitative methodology, given its phenomenological
epistemology, is particularly apposite for the study of cultural meanings. It is also
recognized for its exploratory value, namely for examining a topic or problem that
has not previously been researched. As the study of cross-cultural meaning of suicide
in young people is a hitherto unexplored area that requires an in-depth
understanding, a qualitative methodological approach was seen as appropriate for the
present project. However, to date various researchers are aware of the advantages of
triangulating methods to reach a deeper and multi-perspective understanding of a
Therefore, the author opted to use a mixture of qualitative and quantitative
methods, although the phenomenological-constructivist approach constitutes the
epistemology that informed much of the research process (from the initial research
questions to the research design, methods of data collection, data analysis and its
With respect to the data collection, the sample consisted of at-least second
generation Italian, Indian and Australian University students, 18-24 years old,
enrolled in the University of Padua (Veneto, Italy), various colleges in Bangalore
(Karnataka, India) and two universities in Brisbane (Queensland, Australia). Veneto,
Karnataka and Queensland are among the regions/states of the respective countries
with the highest rates of youth suicide. Participants who matched the sampling
criteria were given an envelope containing the questionnaires and forms. Almost 700
students across the three countries volunteered to fill in the questionnaire. Of
these, 96 also participated in tape-recorded focus groups (two sessions for each
group for a total of 24 sessions).
The questionnaire titled 'Exploring the Meaning of Suicide' was developed by the
author specifically for this project and it was pilot-tested and back-translated
(together with two bilingual psychologists). It included questions about reasons for
suicide, exposure to suicide and history of suicidal ideation/behaviour, a suicide
attitude questionnaire, case scenarios, and the 'Cultural Identification Battery'.
Open-ended questions explored the mental constructions of 'suicide', the meanings of
the words 'suicide attempt' and 'suicide', their mental representations and
stereotypes on 'the kind of youth' who self-harm or kill themselves, gender-related
issues, feelings towards death, their beliefs on suicide deterrents/protective
factors, help-seeking behaviour and suggestions for suicide prevention. The focus
group questions were similar to the open-ended questions included in the
questionnaire, and the aim of the focus groups was to go into those issues in more
depth. The session design followed a 'funnel pattern' beginning with a fixed set of
core questions and then proceeding to a variable set of issues specific to the group.
The focus group also included some activity-oriented questions, such as
Quantitative data was analysed using SPSS 13.0 software. Qualitative data was
analysed separately and then evaluated by two bilingual psychologists and the author.
The categories developed were compared with those of a third psychologist, to create
a final list of codes. The coding process was supported with the software for
qualitative analysis ATLAS.ti 5.0.
Three sets of data were collected: answers to structured and open-ended questionnaire
items, and focus group verbatim transcripts. Quantitative and qualitative findings
were presented for the overall sample and compared between countries.
The comparisons highlighted differences and similarities across cultures in
meanings and social representations of suicide. First, there were differences on
prevalence: more than half of the total sample reported suicide ideation but this was
higher among Italian and Australian students, compared to Indians. In contrast, the
latter reported more suicide attempts, followed by Australians and then Italians.
Other questions inquired about reasons for young people to attempt suicide or to
indeed suicide. There were statistically significant differences on almost all
suicide attempt reasons between cultures. For example, Indians agreed more that some
youth attempt suicide to force others to do what they want. Compared with the other
two samples, Italian students disagreed more that youth who attempt suicide are
mentally ill. Another question asked to rank a list of fourteen reasons for youth
suicide. Participants presented statistically significant differences on all of them.
For example, financial problems were among the most important reasons for Indians.
Mental illness, depression or anxiety were more important for Australians and
loneliness or interpersonal problems were so for Italians.
The questionnaire also included a 21-item attitudes scale. Both mean scores on the
single items and subscales scores showed cross-cultural differences. For example,
Indians, followed by Australians, had more negative attitudes towards youth suicide
compared to Italians.
The open-ended section of the questionnaire was composed of various parts -word
association, questions and case scenarios - investigating participants' mental
associations with the word "suicide" and interpretations of both this word and
"attempted suicide", feelings about death, stereotypes of the "kind of" youth who
attempt suicide or kill themselves, reasons for living and suicide prevention
strategies. For instance, when asked for which reasons they would not suicide,
students from the three countries wrote similar motivations, referring to the value
and love for life, loved ones and the belief that difficulties are part of life and
can be overcome. But there were also differences. In India, for instance,
participants more frequently mentioned God as a deterrent against suicide compared to
participants in Italy and Australia. Italians rarely expressed negative judgments
towards suicide (e.g. suicide is selfish) to justify the choice not to suicide,
whereas this was quite frequent in Indians, followed by Australians. Furthermore,
Australians more often expressed the hope that they would get some help and support
compared with the other groups.
In relation to help-seeking, overall the majority of students reported that, if they
were thinking about killing themselves they would talk to no one or friends, followed
by someone in the family. Some students, especially in Australia, referred to
Focus group transcripts helped to further understand questionnaire answers and
pointed out issues such as altruistic suicide in India (i.e. suicide to not be a
burden on the family), the pressure to be "macho" (i.e. conform to the male-role)
thus not expressing emotions and sharing problems and the conflict of expectations
between friends and adults in Australian men, and the "involvement" in other people's
life in Italian youth.
Conclusions and implications
Many culture-related issues were addressed in this project, which concluded with a
range of implications and suggestions for future research and the development of
youth suicide prevention strategies. For instance, it is vital that suicide
prevention strategies consider cultural (and sub-cultural) issues, including gender
issues; that such strategies should be based on the voices of the people for whom
these services are developed, and that clinically-based approaches should be one
option rather than "the" main strategy (also because they might not meet the person's
explanatory model and professionals might not be included in the person's "list" of
helpers). Suicide prevention also needs to be oriented towards increasing people's
reasons for being alive (e.g. organization of creative activities and increasing
sense of community are few examples of what some participants requested) rather than
just reducing reasons to die. Furthermore, as also suggested by other scholars,
spirituality should play a greater role in suicide prevention and gender-related
issues (including women's rights) must be considered when addressing suicide in its
In conclusion, this work highlighted that cultural determinants, systems of meanings,
and beliefs cannot be neglected in suicide research and prevention because they are
powerful influences on people's way of approaching suicide, both in regard to their
own life and other people's lives.
This PhD dissertation is currently under preparation for a book