Heidi Hjelmeland

• 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...

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...

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...

Etter et kvart århundre med nasjonale handlingsplaner for selvmordsforebygging har ikke selvmordsraten gått ned. I boken utfordres det rådende "sannhetsregimet", der kun kvantitativ forskning aksepteres og suicidalitet hovedsakelig forstås innenfor rammen av individuell psykopatologi. Hovedbudskapet er at for å kunne forebygge selvmord, må vi forst...

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...

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...

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...

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: 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...

Suicide is a major public health issue across the Arctic, especially among Indigenous Peoples. The aim of this study was to explore and describe cultural meanings of suicide among Sámi in Norway. Five open-ended focus group discussions (FGDs) were conducted with 22 Sámi (20) and non-Sámi (2) participants in South, Lule, Marka, coastal and North Sám...

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;...

The World Health Organization estimates that there are more than 800,000 suicides across the globe every year; at least ten to twenty times as many engage in nonfatal suicidal behavior. Suicidal behavior is culturally patterned in that rates, risk factors, forms, scenarios, methods, and meanings vary greatly across age, gender, and cultural context...

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...

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...

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...

This study explores barriers to help-seeking among young men prior to suicide. We analysed 61in -depth interviews with parents, siblings, friends, and ex-partners of ten young men (aged 18-30) with no record of mental illness, as well as six suicide notes, using Interpretative Phenomenological Analysis. Three barriers emerged: (a) A total defeat; (...

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...

Background Suicide is a major cause of premature mortality worldwide, but data on its epidemiology in Africa, the world’s second most populous continent, are limited. Methods We systematically reviewed published literature on suicidal behaviour in African countries. We searched PubMed, Web of Knowledge, PsycINFO, African Index Medicus, Eastern Med...

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...

This study investigates 122 people's descriptions of their self-harm experiences using thematic analysis. Analysis revealed four themes: What counts as self-harm, What leads to self-harm, Intentions and Managing stigma. Our participants challenged commonly accepted understandings in terms of method, outcome and intentions. Several difficulties asso...

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...

A total of thirty-two women admitted to a general hospital for medical treatment after self-harming completed measures of conventional positive and negative masculinity and femininity. Comparisons were made with two control groups with no self-harm history; 33 women receiving psychiatric outpatient treatment and a nonclinical sample of 206 women. M...

Suicide mortality in a population has long been thought to be sensitive to social, economic and cultural contexts. This review examined research on the relationship between social-environmental variables and suicide mortality published over a ten-year period. The main areas covered in the review included: the economy and income, unemployment, relat...

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...

This study investigates whether positive and negative conventional gender roles relate to suicidal ideation and self-harming in different ways among young adults. Participants completed an online survey about previous self-harm, recent suicidal ideation, and positive and negative aspects of conventional masculinity and femininity. Logistic regressi...

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

Suicide was investigated in the urban setting of Kampala, Uganda. Firstly, to explore the use of two research methodologies, a retrospective review of patient records and the psychological autopsy methodology in suicide research in Uganda. Secondly to investigate the characteristics and correlates of urban suicide in Uganda. A male to female ratio...

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...

In the period 1990-2006, strong and almost equivalent increases in sales figures of selective serotonin re-uptake inhibitors (SSRIs) were observed in all Nordic countries. The sales figures of tricyclic antidepressants (TCAs) dropped in Norway and Sweden in the nineties. After 2000, sales figures of TCAs have been almost constant in all Nordic coun...

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...

Cultural research in suicidology is crucial in order to develop our understanding of the meanings of suicidalbehaviour in different cultural contexts. In this essay, I will first elaborate why it is important to focus on cultural issues insuicidological research and thereafter discuss what it actually means to have a cultural focus/perspective on t...

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...

Our aim was to build a model delineating the relationship between attitudes toward suicide and suicidal behavior and to assess equivalence by applying the model on data from different countries. Representative samples from the general population were approached in Sweden, Norway, and Russia with the Attitudes Toward Suicide (ATTS) questionnaire. Da...

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...

Objective: The aim of the study was to examine the relationship between suicide attempts and major public holidays in Europe. Method The analysis was based on data on 24388 suicide attempts by persons aged 15 years or older in the period 1989–1996. Data from 13 centres (representing 11 countries) participating in the WHO/EURO Multicentre Study on P...

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 associations between life events in the 12 months preceding an episode of self-poisoning resulting in hospital attendance (the index episode), and the suicide intent of this episode were compared in individuals for whom the index episode was their first, episode and in individuals in whom it was a recurrence of DSH. Results indicated a signific...

Background. While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH. Method. As part of the WHO/EURO...

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...

Psychological factors associated with deliberate self-harm (DSH) as seen in an African population in Uganda are described. A case-control study design was employed in which a Luganda version (predominant language in the study area) of the modified European Parasuicide Interview Schedule I (EPSIS I) was used to collect data. The controls were patien...

Research has shown that the prevalence of deliberate self-harm (DSH) is higher in adolescents than in adults, but little is known about other differences. In this study we compare adolescent and adult DSH-patients regarding factors contributing to the suicidal act. In two regions in Norway, 98 persons under 20 years of age and 83 older persons were...

Described is the presentation of repetition of deliberate self-harm (DSH) as seen in an African population in urban Uganda. A Luganda version (local language in study area) of the modified European Parasuicide Interview Schedule I (EPSIS I) was used to collect the data. An univariate analysis was conducted. Results indicated that repeaters of DSH d...

Negative life events associated with deliberate self-harm (DSH) were investigated in an African context in Uganda. Patients admitted at three general hospitals in Kampala, Uganda were interviewed using a Luganda version (predominant language in the study area) of the European Parasuicide Study Interview Schedule I. The results of the life events an...

A study to investigate deliberate self-harm (DSH) in an African context was undertaken in Uganda. A case-control study in which 100 cases of DSH and 300 controls matched on age and sex were recruited from three general hospitals in Kampala and subjected to a structured interview using a modified version of the European Parasuicide Study Interview S...