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Original Article

Recognition on Suicidal Intent of the Elderly among Caregivers: A Q-Methodological Application

Joon Ah Cho1, Boon Han Kim2
Korean Journal of Adult Nursing 2014;26(5):522-532.
Published online: October 31, 2014

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Corresponding author: Kim, Boon Han College of Nursing, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea. Tel: +82-2-2220-0705, Fax: +82-2-2220-1163, E-mail: bhkim@hanyang.ac.kr
• Received: January 10, 2014   • Accepted: October 9, 2014

Copyright © 2014 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study's purpose is to classify and analyze caregivers' recognition of the elderly suicidal intents.
  • Methods
    This study uses applied Q-methodology to measure human subjectivity in depth. Concretely, 35 statements are composed in depth interviews and literature investigation. Then, Q-cards and distributive chart of Q-sampling were given to 25 caregivers randomly-selected, who were asked to arrange them on a 7-score based. After coding Q-factor analysis is carried out with the PC-QUANL program.
  • Results
    Four types of indicators of the elderly suicidal intents were identified by the caregivers. These are Knowledge-based recognition, Behavioral measure based recognition, Negative comprehension and Sympathy.
  • Conclusion
    In this study, four types of recognition were yielded among the caregivers and the characteristics of each type were analyzed. These findings may be useful in assessing suicidal potential and nursing interventions.
  • Key Words: Elderly; Suicidal intent; Caregivers; Q-methodology
Figure 1.
Q-sample distribution.
kjan-26-522f1.jpg
Table 1.
Q-Statements and Z-Score for Type
No. Statements z-score
Type 1 (n=11) Type 2 (n=8) Type 3 (n=3) Type 4 (n=3)
1 Talks drastically less than usual. 0.75 0.38 -0.49 1.75
2 Frequently says "I shall die!" or "I have just a few days before dying!" 1.15 -1.01 0.46 -1.61
3 Abruptly cleans up after himself/herself, leaves a will, and is prepared for something weird. 1.50 0.74 1.38 1.19
4 Asks anyone if he/she should live or die. -0.03 -0.85 -1.42 0.49
5 Frequently asks people around whether he/she is useful. 0.80 -.13 0.06 -0.23
6 Says to his/her children not to be sad if he/she dies. 0.54 -0.98 0.77 -1.09
7 Abruptly spends money for anyone for free. 0.05 -0.66 0.48 -1.66
8 Eats expensive foods, and often travels alone. -0.59 -0.85 0.14 -1.45
9 Makes a phone call to relatives or friends who he/she does not usually keep touch with or meets them. 0.80 0.64 0.76 0.35
10 Shows excessively happier feelings or more exaggerated behavior than usual. -0.19 -0.35 -0.80 0.87
11 Never comes out of his/her room without having foods all day long. 0.42 -0.05 -1.71 0.66
12 Asks his/her pets about death in a way to talk to himself/herself. 0.11 -0.24 -0.29 -0.89
13 Asks people around how to die without pain. -0.03 0.13 -0.77 -0.49
14 Doesn't have a deep sleep but suffers insomnia. 0.53 -0.07 1.55 1.59
15 Doesn't show especially notable behavior. -0.50 0.46 -0.90 -0.16
16 Gets violent, hurls insults, and is frequently irritable. -0.54 -0.65 0.20 0.35
17 Asks people around how to purchase agricultural chemicals or sleeping pills. -0.10 -0.59 -0.32 -0.54
18 I think it is difficult to predict an elder's psychological and behavioral changes due to suicidal intention as I believe the number of elderly suicides is trivial. -0.96 -0.15 -1.24 0.40
19 Would rather pretend not to notice an elder's suicidal intention if I do. -1.71 -1.95 -1.52 -2.01
20 It will be good for an elder to pass away after living quietly without causing harm to his/her sons or daughters. -1.93 -1.32 1.57 0.44
21 Elders happen to have suicidal intention from thin air as they have nothing to do. -0.68 0.37 0.31 -1.12
22 I am anxious about an elder's suicidal intention when he or she abruptly repeats words like "I wanna die." 0.89 0.30 -0.27 0.40
23 Noticing an elder has suicidal intention, we should at once bring him/her to psychiatry. 0.96 2.06 0.28 -0.28
24 Make conversations to clarify what his/her worries and problems are when noticing an elder has suicidal ideation. 1.25 1.31 -0.60 0.47
25 It is desirable to encourage an elder to have some hobbies or to leave on a family trip when noticing an elder has suicidal intention. 0.59 1.61 2.01 1.24
26 When an elder has suicidal ideation, we inform it of other family members and set up some measures. 1.28 1.67 0.59 0.47
27 I think it is just stupid of an elder to have suicidal intention. -1.76 1.18 0.51 0.35
28 A sign of suicidal intention is a phenomenon showing the wish that someone noticed it and gave help. 1.46 0.67 -0.66 1.24
29 Noticing an elder tries to commit suicide, we should at once make a contact with a suicide prevention center to request help. 0.56 1.47 -0.46 -.05
30 I don't know why I should be informed of someone else's suicidal intention. -1.75 -0.47 -1.70 -0.98
31 It is alright for an elder to die or not and I have no concern about it. -2.02 -1.79 -0.52 -1.43
32 A caregiver of an elder might have no concern about the elder's suicidal intention, but might wish the elder died by committing suicide. -1.05 -1.90 -0.79 -0.33
33 I believe it is because a caregiver does not take sincere care of an elder that the elder has come to have suicidal intention. -0.66 -0.09 0.37 -0.14
34 The more severe an elder's depression, the more expressions of suicide he/she makes. 0.41 0.72 0.88 0.35
35 Elders' suicidal intention can occur when they find no reason to live as they have got old and sick. 0.45 0.38 2.16 1.87
Table 2.
Demographic Characteristics and Factor Weight by Type (N=25)
Type (n) ID Factor weight Gender Age (year) Educational Background Duration of caregiving (year/month) Experience of suicide education Experience of relative's suicide
Type 1 (11) 10 1.9766 Female 35 Grad school 2y 2m Yes No
11 1.7834 Female 54 High school 1y Yes No
07 1.7706 Female 29 College 1y Yes No
14 1.2970 Female 65 High school 43y Yes No
12 1.0496 Female 43 High school 4y 5m Yes No
21 1.0245 Female 54 College 8y No No
05 0.9857 Female 49 High school 4y No No
08 0.9247 Female 46 Grad school 4y No No
22 0.9002 Female 44 College 8y No Yes
24 0.7595 Female 57 College 1y No No
02 0.7080 Female 37 College 10y No No
Type 2 (8) 25 1.7597 Female 54 College 6y No No
09 1.4849 Female 48 Grad school 4y No Yes
16 1.1333 Male 40 High school 7y 4m No No
04 0.9970 Female 61 College 15y No No
20 0.8775 Female 56 High school 17y 2m No No
13 0.7103 Female 55 High school 31y 2m No No
19 0.6809 Female 66 High school 8y 1m No No
03 0.5886 Female 48 High school 1y No No
Type 3 (3) 18 1.0916 Female 61 High school 1y No No
15 0.9931 Female 62 High school 30y 6m No No
01 0.5214 Female 68 Elem. school 10y No Yes
Type 4 (3) 06 1.3785 Female 55 High school 3y No No
17 1.1547 Female 51 High school 6y No No
23 0.7414 Female 57 High school 9y 1m No No

Elem. school=elementary school.

  • Cheon J. S.. 2006;Suicide in the Korean elderly. Journal of Korean Geriatric Psychiatry. 10(1):14–-19.
  • Choi H. I.. 2008;A study on factors affecting elderly suicidal ideation Unpublished master's thesis, Daegu University, Daegu..
  • Choi S. H., Choi Y. H., Kim H. S.. 2008;Suicidal ideation and associated factors of the elderly in urban areas. Journal of Korean Academy of Community Health Nursing. 19(1):5–-12.
  • Choi Y. H., Kim S. H.. 2008;Suicide ideation and related factors according to depression in older adults. Korean Journal of Research in Gerontology. 28(4):345–-355.
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  • Kim B. H.. 1993;An exploratory study on casual perception of cancer: A Q-methodological application Unpublished doctoral dissertation, Ewha Womans University, Seoul..
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  • Kim J. H.. 2010;A study on the perspective typologies of senior citizen's suicide: Based on the people who work in the Seoul city's social centers for the old Unpublished master's thesis, Kyungwon University, Seongnam..
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    Recognition on Suicidal Intent of the Elderly among Caregivers: A Q-Methodological Application
    Korean J Adult Nurs. 2014;26(5):522-532.   Published online October 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.5.522
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    Recognition on Suicidal Intent of the Elderly among Caregivers: A Q-Methodological Application
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    DOI: https://doi.org/10.7475/kjan.2014.26.5.522
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    Recognition on Suicidal Intent of the Elderly among Caregivers: A Q-Methodological Application
    Image
    Figure 1. Q-sample distribution.

    Figure 1.

    Recognition on Suicidal Intent of the Elderly among Caregivers: A Q-Methodological Application

    Q-Statements and Z-Score for Type

    No. Statements z-score
    Type 1 (n=11) Type 2 (n=8) Type 3 (n=3) Type 4 (n=3)
    1 Talks drastically less than usual. 0.75 0.38 -0.49 1.75
    2 Frequently says "I shall die!" or "I have just a few days before dying!" 1.15 -1.01 0.46 -1.61
    3 Abruptly cleans up after himself/herself, leaves a will, and is prepared for something weird. 1.50 0.74 1.38 1.19
    4 Asks anyone if he/she should live or die. -0.03 -0.85 -1.42 0.49
    5 Frequently asks people around whether he/she is useful. 0.80 -.13 0.06 -0.23
    6 Says to his/her children not to be sad if he/she dies. 0.54 -0.98 0.77 -1.09
    7 Abruptly spends money for anyone for free. 0.05 -0.66 0.48 -1.66
    8 Eats expensive foods, and often travels alone. -0.59 -0.85 0.14 -1.45
    9 Makes a phone call to relatives or friends who he/she does not usually keep touch with or meets them. 0.80 0.64 0.76 0.35
    10 Shows excessively happier feelings or more exaggerated behavior than usual. -0.19 -0.35 -0.80 0.87
    11 Never comes out of his/her room without having foods all day long. 0.42 -0.05 -1.71 0.66
    12 Asks his/her pets about death in a way to talk to himself/herself. 0.11 -0.24 -0.29 -0.89
    13 Asks people around how to die without pain. -0.03 0.13 -0.77 -0.49
    14 Doesn't have a deep sleep but suffers insomnia. 0.53 -0.07 1.55 1.59
    15 Doesn't show especially notable behavior. -0.50 0.46 -0.90 -0.16
    16 Gets violent, hurls insults, and is frequently irritable. -0.54 -0.65 0.20 0.35
    17 Asks people around how to purchase agricultural chemicals or sleeping pills. -0.10 -0.59 -0.32 -0.54
    18 I think it is difficult to predict an elder's psychological and behavioral changes due to suicidal intention as I believe the number of elderly suicides is trivial. -0.96 -0.15 -1.24 0.40
    19 Would rather pretend not to notice an elder's suicidal intention if I do. -1.71 -1.95 -1.52 -2.01
    20 It will be good for an elder to pass away after living quietly without causing harm to his/her sons or daughters. -1.93 -1.32 1.57 0.44
    21 Elders happen to have suicidal intention from thin air as they have nothing to do. -0.68 0.37 0.31 -1.12
    22 I am anxious about an elder's suicidal intention when he or she abruptly repeats words like "I wanna die." 0.89 0.30 -0.27 0.40
    23 Noticing an elder has suicidal intention, we should at once bring him/her to psychiatry. 0.96 2.06 0.28 -0.28
    24 Make conversations to clarify what his/her worries and problems are when noticing an elder has suicidal ideation. 1.25 1.31 -0.60 0.47
    25 It is desirable to encourage an elder to have some hobbies or to leave on a family trip when noticing an elder has suicidal intention. 0.59 1.61 2.01 1.24
    26 When an elder has suicidal ideation, we inform it of other family members and set up some measures. 1.28 1.67 0.59 0.47
    27 I think it is just stupid of an elder to have suicidal intention. -1.76 1.18 0.51 0.35
    28 A sign of suicidal intention is a phenomenon showing the wish that someone noticed it and gave help. 1.46 0.67 -0.66 1.24
    29 Noticing an elder tries to commit suicide, we should at once make a contact with a suicide prevention center to request help. 0.56 1.47 -0.46 -.05
    30 I don't know why I should be informed of someone else's suicidal intention. -1.75 -0.47 -1.70 -0.98
    31 It is alright for an elder to die or not and I have no concern about it. -2.02 -1.79 -0.52 -1.43
    32 A caregiver of an elder might have no concern about the elder's suicidal intention, but might wish the elder died by committing suicide. -1.05 -1.90 -0.79 -0.33
    33 I believe it is because a caregiver does not take sincere care of an elder that the elder has come to have suicidal intention. -0.66 -0.09 0.37 -0.14
    34 The more severe an elder's depression, the more expressions of suicide he/she makes. 0.41 0.72 0.88 0.35
    35 Elders' suicidal intention can occur when they find no reason to live as they have got old and sick. 0.45 0.38 2.16 1.87

    Demographic Characteristics and Factor Weight by Type (N=25)

    Type (n) ID Factor weight Gender Age (year) Educational Background Duration of caregiving (year/month) Experience of suicide education Experience of relative's suicide
    Type 1 (11) 10 1.9766 Female 35 Grad school 2y 2m Yes No
    11 1.7834 Female 54 High school 1y Yes No
    07 1.7706 Female 29 College 1y Yes No
    14 1.2970 Female 65 High school 43y Yes No
    12 1.0496 Female 43 High school 4y 5m Yes No
    21 1.0245 Female 54 College 8y No No
    05 0.9857 Female 49 High school 4y No No
    08 0.9247 Female 46 Grad school 4y No No
    22 0.9002 Female 44 College 8y No Yes
    24 0.7595 Female 57 College 1y No No
    02 0.7080 Female 37 College 10y No No
    Type 2 (8) 25 1.7597 Female 54 College 6y No No
    09 1.4849 Female 48 Grad school 4y No Yes
    16 1.1333 Male 40 High school 7y 4m No No
    04 0.9970 Female 61 College 15y No No
    20 0.8775 Female 56 High school 17y 2m No No
    13 0.7103 Female 55 High school 31y 2m No No
    19 0.6809 Female 66 High school 8y 1m No No
    03 0.5886 Female 48 High school 1y No No
    Type 3 (3) 18 1.0916 Female 61 High school 1y No No
    15 0.9931 Female 62 High school 30y 6m No No
    01 0.5214 Female 68 Elem. school 10y No Yes
    Type 4 (3) 06 1.3785 Female 55 High school 3y No No
    17 1.1547 Female 51 High school 6y No No
    23 0.7414 Female 57 High school 9y 1m No No

    Elem. school=elementary school.
    Table 1. Q-Statements and Z-Score for Type

    Table 2. Demographic Characteristics and Factor Weight by Type (N=25)

    Elem. school=elementary school.

    Table 1.

    Table 2.

    Korean J Adult Nurs : Korean Journal of Adult Nursing

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