Birthe Loa Knizek

• Mag.art.psych, PhD
• Professor (Full) at Norwegian University of Science and Technology

For people in suicidal crisis, referral to a psychiatric hospital is common. However, acute psychiatry is characterized by a lack of resources in terms of time and beds, making it challenging for therapists to provide person-centered care. In this qualitative study, we explored the experiences and positionings of therapists and suicidal patients in...

Introduction Suicide is globally a severe problem with an estimated 700.000 deaths annually. Six of the 10 countries with the highest suicide rates worldwide are in Africa, though, reliable statistics are scarce. Method In this qualitative interview study in Uganda, we analysed the stories of 16 people admitted to hospital following a serious suic...

Poor mental health is a leading contributor to the global burden of disease but there is poor understanding of how it is influenced by people's interactions with ecological systems. In a theory-generating case study we asked how interactions with ecosystems were perceived to influence stressors associated with psychological distress in a rural sett...

Introduction Victimisation of persons with severe mental illness is recognised as an urgent global concern, with literature pointing to higher rates of violent victimisation of persons with severe mental illness than those of the general population. Yet, for low income countries, there is a huge gap in the literature on the risk, character and vict...

Background: Ebola Virus Disease (EVD) presents significant global health challenges, including high mortality and substantial physical morbidity among patients and survivors. Beyond immediate health impacts, EVD survivors, frontline healthcare workers, and community members face profound mental health and psychosocial issues. Over 35 EVD outbreaks...

Janine Chasseguet-Smirgel: Kreativitet og perversionOversat fra engelsk af Lis Haugaard.Efterskrift af Tania Ørum.Rævens Sorte Bibliotek, 196 sider, Udsalgspris 175 kr.

En kort introduktion til kvindeforskning på baggrund af den Lacanianske psykoanalyse. Med udgangspunkt i J. Lacans "institutionskrig" søges vist, hvorfor denne psykoanalyse-retning er en frugtbar grobund for en blomstrende forskning omkring kvindeligheden. Som eksempler på denne forskning er valgt tre kvinders forskellige forsknings- metode: M. Mon...

This study explores the recovery processes of persons who had attempted suicide. Semi-structured interviews were conducted with eight persons who had attempted suicide and the data were analyzed by means of systematic text condensation. The participants described lifesaving turning points, which were connected to meaningful relationships, taking co...

Background The experiences of UK ethnic minority (UKEM) healthcare workers are crucial to ameliorating the disproportionate COVID-19 infection rate and outcomes in the UKEM community. We conducted a qualitative study on UKEM healthcare workers’ perspectives on COVID-19 vaccine hesitancy (CVH) in the UKEM community. Methods Participants were 15 UKE...

A known risk factor for suicide globally is substance use. Despite being public health problems across the globe, research on the association between suicide and substance use have often ignored the socio-cultural context in which these behaviors play out. This qualitative study examines bereaved persons’ perception of the roles of substance use in...

Background: Between 2015 and 2050, the aging population of Uganda (aged 50 years and older) will be nearly doubled. Therefore, later-life problems have become an area of increasing research and policy interest. This study aimed at exploring how aging people living in extreme poverty in a low-income country experience their everyday life and what ki...

Mental illness is a leading contributor to the global burden of disease, but there is limited understanding of how it is influenced by socio-ecological context, particularly in the global south. We asked how interactions with ecological systems influence stressors associated with psychological distress in a rural Ugandan case study. We conducted an...

Suicidal behavior is condemned by religions and tradition, and suicide attempts are criminalized by law in several African countries, including Ghana and Uganda. Suicide and suicide attempts may have severe consequences for both the entire family and the community. Religion is known to act as a protective coping force that helps people to make mean...

Background An estimated 8–30 % of people living with HIV (PLWH) have depressive disorders (DD) in sub-Saharan Africa. Of these, the majority are untreated in most of HIV care services. There is evidence from low- and middle- income countries of the effectiveness of both psychological treatments and antidepressant medication for the treatment of DD...

INTRODUCTION Contemporary societies are subject to ongoing profound changes, which involve increasing challenges related to new patterns of ill-health. More people suffer from psycho-social impairments, social exclusion and loneliness (WHO, 2013). Mental illness is prominent and affects especially vulnerable groups who are in transitional states o...

Background: An estimated 8-30% of people living with HIV (PLWH) have depressive disorders (DD) in sub-Saharan Africa. Of these, the majority are untreated in most of HIV care services. There is evidence from low- and middle- income countries of the effectiveness of both psychological treatments and antidepressant medication for the treatment of DD...

Purpose The purpose of the study is to explore how professionals working with suicide prevention experience the influence of the national guidelines on mental healthcare, and to gather recommendations for which steps to take next. Methods This is a qualitative study with an explorative design. We interviewed 22 professionals responsible for implem...

Currently, there is an overall focus on mental health as a global health priority in the United Nations (Sustainable developmental Goals), World Health Organization (WHO), and Global Mental Health (movement and study field). As “mental disorder” is constructed as universal, the consequence is that the focus is on the treatment gap as a result of th...

Norwegian clinical psychologists are subject to the principle declaration of evidence-based clinical practice. The principle of evidence-based practice has however been criticised as being insufficient as a regulator of clinical psychological practice. Research on actual psychological practices (as opposed to research on specific manuals or treatme...

This special issue of theoretical annals in psychology is focusing on ethics-based practice. ‘Ethics-based practice’ contrasts in many ways ‘evidence-based practice’, which has the following definition: ‘Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient c...

This book contrasts earlier textbooks on “evidence-based practices.” Whereas the latter is a slogan that call for scientific evidence to be used in standardized treatment manuals, ethics-based practices call for individualized treatment that makes the situation meaningful for the patient. The main argument for changing the treatment design from bei...

Background: The suicide rate in Norway has remained relatively stable despite 25 years of government-funded suicide prevention efforts. Aim: We aimed to gather experiences of the professionals responsible for implementing suicide prevention action plans and guidelines and/or involved in relevant research. Method: We conducted semistructured intervi...

Background: Little/no research has been conducted in Uganda in particular and sub-Saharan Africa in general on the health professional's perspectives on barriers to treatment seeking for formal health services among orphan children and adolescents with a double burden of HIV/AIDS and mental distress. Aim: To explore health professionals' perspec...

Purpose: The purpose of this study is to explore how patients experience their suicidality and how they experience being in a psychiatric hospital. Methods: This is part of a field study, and the article is based on data collected in interactions with 11 women who were admitted to a psychiatric hospital and were struggling with suicidality. Data we...

Background: Mental, neurological and substance use disorders are a public health burden in Uganda. Mental health service user involvement could be an important strategy for advocacy and improving service delivery, particularly as Uganda redoubles its efforts to integrate mental health into primary health care (PHC). However, little is known on the...

Background: Condemnatory reactions toward suicide are prevalent in Africa, yet no study has examined how society reacts to suicides from the perspective of suicide-bereaved persons. Aims: This qualitative study explored societal reactions to suicides so as to further our understanding of the problem in Ghana. Method: Using a semi-structured intervi...

This paper is a reply to Smith and colleagues’ response to our critique of the interpersonal theory of suicide (IPTS). They believe that we mischaracterize and misinterpret aspects of the IPTS. Here, we argue that the problem rather seems to be that we are discussing the IPTS from two different epistemological “planets.”

Based on a 10-year systematic review of suicide prevention strategies, “29 suicide prevention experts from 17 European countries” recommend 4 allegedly evidence-based strategies to be included in national suicide prevention programs. One of the recommended strategies is pharmacological treatment of depression. This recommendation is problematic for...

The Interpersonal Theory of Suicide currently seems to be the most popular theory in suicidology. It posits that suicide can be explained by the simultaneous presence of three risk factors only, namely acquired capability for suicide, thwarted belongingness, and perceived burdensomeness. Suicide is, however, widely accepted as a complex, multifacto...

This study examined the reasons for suicide attempts among patients in Ghana. Semi-structured interviews were conducted among 30 informants who had been hospitalized for attempted suicide. Interpretative Phenomenological Analysis (IPA) was used to analyse the transcribed narratives, and five main themes emerged: 1) lack of support; 2) abandonment;...

Background: Previous research has shown that men who adhere to traditional beliefs about masculinity have increased health risks compared to those who do not. Single marital status, unemployment, retirement, and physical illness are commonly known risk factors for male suicidal behavior. Most men struggling with these risk factors are, however, no...

This qualitative study explored the role of religious faith, belief and practice systems in the coping mechanisms and strategies of essential hypertension patients in Accra, Ghana. Six participants were recruited for participation, of which five were Christians and one was a Muslim. Interviews were conducted and interpretative phenomenological anal...

Background Suicide is a public health problem in Uganda among indigenous societies, and different societies manage its aftermath differently. Aim To explore how the Acholi in Northern Uganda manage the aftermath of suicide. Methods We conducted a qualitative study in Gulu district, a post-conflict area in Northern Uganda. We conducted a total of...

Purpose: The purpose of this study is to explore how former suicidal inpatients experienced treatment and care in psychiatric wards in Norway following the implementation of the National guidelines for prevention of suicide in mental health care. The focus of the analysis was on aspects of treatment and care with potential for improvement. Method:...

In Ghana, some studies have reported a high rate for both fatal and non-fatal suicidal behaviours among men. The current study aimed at understanding the psychosocial circumstances involved in male suicides. We interviewed between two to seven close relations of each of 12 men who died by suicide. Interpretative phenomenological analysis of data in...

Engaging non-conventional gatekeepers such as the police presents both promises and perils. Although studies have relied on police data for researching suicide and other sensitive topics in Africa, there is a paucity of literature that explores or reflects on police gatekeeping and its research implications. This paper presents authors’ reflections...

Twelve persons with dementia were interviewed about their former work lives. Their motivation for choosing their past work was influenced by values of their contemporary culture. Those who had come to terms with their illness had positive feelings about their past contributions in their former paid work. However, they often felt that unpaid work wa...

Background Home-based care for HIV patients is popular in contexts severely affected by the epidemic and exacts a heavy toll on caregivers. This study aimed at understanding the experiences of caregivers and their survival strategies. Methods A total of 18 caregivers (3 males and 15 females) were interviewed using a semi-structured interview guide...

Background: This study is part of a longitudinal study among children and adolescents with HIV in both urban and rural Uganda: 'Mental health among HIV infected CHildren and Adolescents in KAmpala and Masaka, Uganda (CHAKA)'. Method: The study is constructed of both quantitative and qualitative components. In this article we report a qualitative...

One of the most well-established "truths" in suicidology is that mental disorders play a significant role in at least 90% of suicides, and a causal relationship between the two is often implied. In this essay, we argue that the evidence base for this "truth" is weak and that there is much research questioning the 90% statistic. Based on numerous ex...

The cultural context in which suicide occurs has been emphasized as critical in understanding the act and informing prevention. Yet the penchant of psychiatrizing suicidality in mainstream suicidology relegates cultural issues to the background. Through the lenses of critical cultural suicidology, we have re-emphasized the importance of culture by...

In this qualitative interview study, we investigated how therapists experience and view treatment and care for suicidal patients in psychiatric wards. The focus is on aspects that may contribute toward shaping and possibly constraining therapists’ connections with suicidal individuals. We conducted semi-structured interviews of four psychiatrists a...

This study explored and compared therapists' and mental health nurses' experiences of caring for suicidal inpatients in light of ethics of care and ethics of justice. Analysis of interview data from eight therapists and eight mental health nurses indicates two approaches: “connection and care” and “duty and control,” reflecting aspects of both ethi...

This chapter suggests that most of today's mainstream suicide research unilaterally focuses on explanations, very often in terms of linear cause-and-effect-type thinking. Suicide is by definition a conscious, intentional, purposeful act that is the end result of a complex process, which is unique for each individual. People are complex, relational,...

The purpose of the study is to investigate mental health nurses' experiences of recognizing and responding to suicidal behavior/self-harm and dealing with the emotional challenges in the care of potentially suicidal inpatients. Interview data of eight mental health nurses were analyzed by systematic text condensation. The participants reported aler...

The suicide research field is heavily dominated by repetitive quantitative (risk factor) research and a negative attitude toward qualitative research still is common. In this chapter we present findings from qualitative psychological autopsy studies (PA studies) conducted in different cultural contexts and demonstrate that such studies contribute n...

This qualitative study examined the role played by religion in the experiences of persons who attempted suicide in Ghana. Twelve men and 18 women on admission at various hospitals and clinics in Accra were interviewed. Interpretative Phenomenological Analysis was used to analyse the data. We found that religion provided a broad context within which...

Studies on attitudes towards suicide are important in the designing of suicide prevention efforts. However, relatively little research has been conducted on attitudes toward suicide in low-income countries as compared to high-income countries. This study was conducted in Uganda and is based on discourse analysis of data collected from 28 focus-grou...

Background: Attempted suicide is still considered a crime in Ghana. Aims: The purpose of this study was to investigate the attitudes toward this law held by health workers and police officers in Ghana so as to provide culture-sensitive arguments to aid in abolishing the law. Method: Qualitative interviews were conducted with eight clinical psycholo...

n this symposium we want to explore creativity in different stages of research in mental health research. In research with vulnerable groups power relations are central, as well is culture which constructs the moral and formal universe where the power relations unfold. How far can creativity be pushed without violating ethical rules due to an in-bu...

Relatively little research has been conducted on religion and suicide in Africa, yet religion has a lot of influence on people's way of life in Africa. To study religious views on suicide among the Baganda, Uganda, we used grounded theory and discourse analysis on a total of 28 focus groups and 30 key informant interviews. Suicide is largely seen a...

The psychosocial circumstances surrounding men's suicide in postconflict Central Northern Uganda were investigated using qualitative psychological autopsy interviews. Records of 17 men who died by suicide were identified through police and local leaders in Internally Displaced Peoples' camps of Amuru and Gulu Districts. Two to five significant othe...

We set out to investigate suicide among women in a post-conflict context in Northern Uganda using qualitative psychological autopsy interviews. Three to five relatives and friends for each of the three suicides recruited were interviewed (N=11). Through interpretative phenomenological analysis (IPA) we found that the women all had been through trau...

One of the most established "truths" in suicidology is that almost all (90% or more) of those who kill themselves suffer from one or more mental disorders, and a causal link between the two is implied. Psychological autopsy (PA) studies constitute one main evidence base for this conclusion. However, there has been little reflection on the reliabili...

Attempted suicide is still criminalized in Uganda. However, the Ministry of Health has asked the psychiatric community to help in the work to abolish this law. The purpose of this study was to investigate how Ugandan mental health workers view this law. We conducted a qualitative interview study of 30 mental health workers (psychiatrists, psycholog...

Alcohol has been noted to be an important factor in nearly 68% of the suicides in Northern Uganda, yet exactly how alcohol contributes to suicide in this region has not been studied. To determine how alcohol contributes to suicide in this region. Qualitative psychological autopsy interviews were conducted with bereaved relatives and friends of 20 s...

A negative attitude towards suicide is generally assumed to be predominant in low-income countries. In order to understand the negative attitude in general it is necessary to look at how religion and morality influence the attitudes. Our aim in this qualitative interview study was to investigate what attitudes professional mental health workers in...

One way of furthering our understanding of suicidal behaviour is to examine people's attitudes towards it and how they conceive the act. The aim of this study was to understand how lay persons conceive the impact of suicide on others and how that influences their attitudes towards suicide; and discuss the implications for suicide prevention in Ghan...

One way of furthering our understanding of suicidal behaviour is to examine people's attitudes towards it and how they conceive the act. The aim of this study was to understand how lay persons conceive the impact of suicide on others and how that influences their attitudes towards suicide; and discuss the implications for suicide prevention in Ghan...

Participants' perceptions of psychological autopsy interviews were investigated in post-conflict Northern Uganda. Data were derived out of their responses in the debriefing session after the formal interviews. These responses were subjected to Interpretative Phenomenological Analysis (IPA). The majority of the participants were positive about the i...

This qualitative study investigated attitudes and cultural responses to suicide among the Baganda in Uganda using both focus group discussions and key-informant interviews. Interviews indicate that suicide is perceived as dangerous to the whole family and the entire community. Communities and family members adopt various ritual practices to distanc...

The objective of this study was to examine psychology students' attitudes toward suicidal behaviour and the meanings they assign to the act. In-depth interviews were conducted with 15 final year psychology students at a university in Ghana. Interpretative Phenomenological Analysis (IPA) was used to analyze the data. The results indicated that the s...

Too often ethical boards delay or stop research projects with vulnerable populations, influenced by presumed rather than empirically documented vulnerability. The article investigates how participation is experienced by those bereaved by suicide. Experiences are divided into 3 groups: (a) overall positive (62%), (b) unproblematic (10%), and (c) pos...

IntroductionA Critical Look at Mainstream Suicidological ResearchThe Kind of Research We Need TodayState of Affairs in Suicidological JournalsConclusions References

The objective of this qualitative study was to understand how religion influences lay persons' attitudes towards suicide in Ghana. Twenty-seven adults from both rural and urban settings were interviewed. Interpretative phenomenological analysis was used to analyse the data. Results showed that the participants are committed to core and normative re...

This article describes and discusses the challenges faced by researchers who conducted a qualitative interview study on attitudes toward suicide among the Baganda, Uganda. Many of the challenges addressed in this article have not been described earlier in suicide research conducted in the developing world. The aim of this study was to explore attit...

Suicidal behavior is illegal in Uganda. There are no reliable public suicide statistics, but studies indicate that the rates of both suicide and nonfatal suicidal behavior are higher for men than for women. This study examined Ugandan men's perceptions of what causes and what prevents suicide as well as their attitudes towards suicide and suic...

Using the differentiation between explanations and understanding from philosophy of science as the point of departure, a critical look at the current mainstream suicidological research was launched. An almost exclusive use of quantitative methodology focusing on explanations is demonstrated. This bias in scope and methodology has to a large extent...

The aim of this study was to compare attitudes towards suicide among regional politicians in fiveEuropean countries, namely Austria, Hungary, Lithuania, Norway and Sweden. Attitudes of politicians areimportant as they are key persons in a suicide prevention context. All these countries differ significantly withrespect to suicide rates and suicide p...

Few studies directly address vulnerable populations' motivation for participating in research. Often motives are expressed spontaneously and typically given post-interview. This article investigates motivation for research participation among informants who have been bereaved by suicide. Informants were specifically asked for their motivation eithe...

The purpose of the present study was to investigate attitudes toward suicide and suicide prevention among psychology students in Ghana by means of a qualitative analysis of open-ended questions about causes of suicide and how suicide best can be prevented. The students mainly saw the causes as intra-personal and almost all of them believed that sui...

To describe patients' experiences when diagnosed with psychogenic non-epileptic seizures (PNES). The study was based on in-depth interviews with ten patients, previously diagnosed with epilepsy and treated with antiepileptic drugs (AEDs) whose seizures were subsequently defined as PNES. The empirical material was analyzed by systematic text condens...

The purpose of the present study was to compare county council politicians' attitudes toward suicide and suicide prevention in five European countries. A questionnaire was distributed and here the responses to the open-ended questions are analyzed qualitatively. Considerable differences were found in what the politicians in the five countries belie...

In this study, we attempt to even out some of the imbalance in suicide research caused by the fact that most such research has been conducted in the Western part of the world with the corresponding common disregard of the potential problems in generalizing findings to different cultural settings. Our point of departure was to look at suicidal behav...

Self-reported suicidal behavior and attitudes toward suicide in psychology students are reported and compared in Ghana, Uganda, and Norway. Small differences only were found in own suicidal behavior. However, experience of suicidal behavior in the surroundings was more common in Uganda than in Ghana and Norway. Although differences were found betwe...

Theoretical publications have been relatively few and far between in suicidology. This paper is a contribution to the theoretical development of this field. A model of suicidal behaviour as communication (MoSBaC) is elaborated through a combination of Scandinavian theories within the framework of communication theory and semiotics. The model is fun...

The main purposes of this study was to test the psychometric properties of a questionnaire on attitudes towards suicide in a cross-cultural setting, and to discuss the value of cross-cultural studies in the search of meaning(s) of suicidal behavior as well as the methodological challenges encountered in such studies. Data on attitudes towards suici...

The aim of the presented study was to investigate whether common myths about suicide still prevail, what people in general think are the most common causes for suicide, whether suicide can be prevented, and if so, how. How subjects perceived their participation in a study on attitudes towards suicidal behavior, was also investigated. The Attitudes...

Data from the Norwegian part of the WHO/EURO Multicenter Study on Suicidal Behavior were used to investigate gender differences in the communicative aspect of nonfatal suicidal behavior by means of analyzing precipitating factors, intentions involved in and effects of the suicidal act within the frame of Qvortrup's interpretation of speech-act theo...