UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Comparative study of the self-acceptance of suicidal and non-suicidal youths Westwood, Catherine Ann 1976

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1976_A5_7 W48.pdf [ 3.9MB ]
Metadata
JSON: 831-1.0100110.json
JSON-LD: 831-1.0100110-ld.json
RDF/XML (Pretty): 831-1.0100110-rdf.xml
RDF/JSON: 831-1.0100110-rdf.json
Turtle: 831-1.0100110-turtle.txt
N-Triples: 831-1.0100110-rdf-ntriples.txt
Original Record: 831-1.0100110-source.json
Full Text
831-1.0100110-fulltext.txt
Citation
831-1.0100110.ris

Full Text

A COMPARATIVE STUDY OF THE SELF-ACCEPTANCE OF SUICIDAL AND NON-SUICIDAL YOUTHS by CATHERINE ANN WESTWOOD B.ScN., U n i v e r s i t y of Toronto, 1969 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING In the Department of Nursing We accept t h i s t h e s i s as conforming to the requ i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA JULY, 1976 (S\ Catherine Ann Westwood, 1 9 7 6 In p r e s e n t i n g t h i s t h e s i s in p a r t i a l f u l f i l m e n t o f the r e q u i r e m e n t s f o r an advanced degree at the U n i v e r s i t y o f B r i t i s h Co lumb i a , I a g ree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s tudy . I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y purposes may be g r a n t e d by the Head o f my Department o r by h i s r e p r e s e n t a t i v e s . It i s u n d e r s t o o d that c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d w i thou t my w r i t t e n p e r m i s s i o n . Department o f The U n i v e r s i t y o f B r i t i s h Co lumbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 i ABSTRACT A COMPARATIVE STUDY OF THE SELF-ACCEPTANCE OF SUICIDAL AND NON-SUICIDAL YOUTHS Youths who attempt s u i c i d e may have many negative f e e l i n g s about themselves which are manifested i n a low l e v e l of s e l f - a c c e p t a n c e . This f a c t o r i s often overlooked i n s p e c i f i c assessment and i n t e r v e n t i o n measures while socio-economic and s i t u a t i o n a l v a r i a b l e s are t r e a t e d . Nurses, because of t h e i r l o c a t i o n i n schools, are i n a unique p o s i t i o n to recognize and intervene with the p o t e n t i a l l y s u i c i d a l youth. Nurses however may have d i f f i c u l t y i n r e c o g n i z i n g the youth with poor s e l f - a c c e p t a n c e . This ex-p l o r a t o r y study was undertaken i n order to answer the question: ' i s a low l e v e l of self-acceptance i n youths age s i x t e e n to twenty-five c o r r e l a t e d with s u i c i d e attempts?' The answer was sought from information obtained from youths' s e l f - r e p o r t s on the Berger Scale of Self-Acceptance and the C a l i f o r n i a P s y c h o l o g i cal Inventory. These t e s t s were administered to t h i r t y youths d i v i d e d i n t o three groups. Group A were s u i c i d e attempters seen i n the emergency ward of a l a r g e general h o s p i t a l , group B were non-s u i c i d e attempters seen i n the emergency ward and group C were chosen from the community. An a n a l y s i s of variance was c a r r i e d out to d i s c o v e r i f there was a s i g n i f i c a n t d i f f e r e n c e i n self-acceptance among the three groups. The f i n d i n g s supported the o v e r a l l c o n c l u s i o n : youths between ages sixt e e n and twenty-five who attempted s u i c i d e had a s i g n i f i c a n t l y lower i i s e l f -acceptance than c o n t r o l group youths. The v a r i a b l e of h o s p i t a l i z a -t i o n d i d not e f f e c t s e l f - a c c e p t a n c e . (Thesis Chairman) i i i TABLE OF CONTENTS CHAPTER PAGE I INTRODUCTION 1 The Problem 2 D e f i n i t i o n of Terms Used 3 Assumptions 4 L i m i t a t i o n s 4 Objectives 5 Hypotheses 5 J u s t i f i c a t i o n of the Problem 5 Conclusion 8 Overview of the Remainder of the Study 8 II REVIEW OF THE LITERATURE 9 Scope of the Review of L i t e r a t u r e 9 H i s t o r i c a l Development of S u i c i d e 9 S o c i o l o g i c a l Studies of S u i c i d e 11 Psychodynamic Studies of S u i c i d e 13 C l i n i c a l Studies of S u i c i d e 18 The Development of S u i c i d a l Ideation 22 S e l f Theory Major T h e o r i s t s 26 C l i n i c a l Studies of S e l f - E v a l u a t i o n 30 Self-Acceptance and Adjustment Problems 33 Summary 35 III METHODOLOGY 36 Overview of Design 36 S e t t i n g 36 The Study Population 37 Tests 38 The C a l i f o r n i a Psych. Inventory 38 The Berger Scale of Self-Acceptance 40 Adm i n i s t r a t i o n of the Tests 43 A n a l y s i s o f the Data 44 IV DATA ANALYSIS AND RESULTS 46 Sampling 46 Demographic Data 46 Data i n Rel a t i o n ot Hypotheses 51 Hypothesis One 51 Hypothesis Two 54 Conclusion 56 i v V SUMMARY, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS 57 Summary 57 Conclusions 58 Implications and Recommendations 59 VI BIBLIOGRAPHY 61 VII APPENDIX 69 A. Correspondence with V.G.H. 70 B. Consent form 75 C. Berger Questional're 77 D. Computer P r i n t - o u t 84 LIST OF TABLES Education l e v e l of Subjects By Group A, B, C. Summary of Raw Scores on CPI and Berger by Group, I n d i v i d u a l , Sex and Education. CPI Comparison of Mean and Standard Deviation by Groups A, B, C. Berger Comparison of Mean and Standard Deviation by Groups A,. B, C. A n a l y s i s of Variance of Groups A, B, C, on Berger T e s t s . Scheffe Test f o r Groups A, B, C on Berger Test. A n a l y s i s of Variance of Groups A, B, C, on CPI Scheffe Test f o r Groups A, B, C on CPI v i ACKNOWLEDGEMENT The w r i t e r wishes to express her thanks to the s t a f f and p a t i e n t s at the Vancouver General H o s p i t a l , emergency ward f o r t h e i r cooperation i n the study. Thanks a l s o to Committee Chairman, B. McGuire f o r her patience and encouragement, to B. La Sor and H. E l f e r t f o r t h e i r advice and to J, Yensen f o r his c o n s u l t a t i o n i n the data a n a l y s i s . Most of a l l thanks to my husband Peter f o r h i s p r a c t i c a l advice and u n f a i l i n g patience without which t h i s study would not have been f i n i s h e d . 1 CHAPTER I INTRODUCTION A l l p r o f e s s i o n a l health workers regardless of t h e i r d i s c i p l i n e , i f t h e i r work touches even p e r i p h e r a l l y on the area of mental h e a l t h , are becoming i n c r e a s i n g l y concerned about the amount of emotional turmoil i n youth. Not only i s t h i s age group i n c r e a s i n g i n actual numbers but they are a l s o presenting an even greater challenge i n regard to mental health. One of the important aspects of t h i s problem i s youthful s u i c i d e J For the helping p r o f e s s i o n a l a s u i c i d e i s an e s p e c i a l l y unhappy 2 event. Although one can, i n p a r t , t r a i n and inure o n e s e l f to deal with the s i c k and dying p a t i e n t , the abruptness and needlessness of a s u i c i d e leaves the nurse, the p h y s i c i a n and other s u r v i v o r s with many unanswered questions, many troubled thoughts and f e e l i n g s . Why do people t r y to k i l l themselves? How can we recognize a s u i c i d a l i n d i v i d u a l e a r l y enough to intervene? It i s f a i r l y common knowledge that s u i c i d e i n c h i l d r e n i s a com-p a r a t i v e l y rare occurrence but that the rate r i s e s r a p i d l y f o l l o w i n g F. A. A l l o d i and M. R. Eastwood, "Suicide i n Canada - Trends and Preventive Aspects," Canada's Mental Health, 21:16, 1973. o S. M. S o r e f f , "The Impact of S t a f f S u i c i d e on a P s y c h i a t r i c Inpatient U n i t , " Journal of Nervous and Mental D i s o r d e r s , 161:130, 1975. 2 puberty. This dramatic increase makes s u i c i d e the second l e a d i n g cause 3 of death in the ages from ten to twenty-nine. Most st u d i e s of s u i c i d e seem to focus on assessment and treatment of the p o s s i b l e s u i c i d e attempter while f a c t o r s that may be important i n 4 e a r l y i d e n t i f i c a t i o n are often ignored. One of these f a c t o r s with which the present study i s concerned i s se l f - a c c e p t a n c e . The f e e l i n g s that a youth has about himself may have a c e n t r a l r o l e i n determining f u t u r e behavior and i s t h e r e f o r e an impor-tant area f o r study. The Problem The problem with which the present study i s concerned i s t h i s : Do youths between ages sixteen and twenty-five who have attempted s u i c i d e d i f f e r s i g n i f i c a n t l y i n t h e i r l e v e l of self-acceptance as measured by the Berger Scale and the C a l i f o r n i a Psychological Inven-t o r y . The problem w i l l be explored by a d m i n i s t r a t i o n of the Berger Scale of Self-Acceptance and the C a l i f o r n i a P s y c h o l o g i c al Inventory to three groups of youths: one group seen i n emergency f o l l o w i n g a s u i c i d e attempt; and 6 S t a t i s t i c s Canada,"Suicide M o r t a l i t y " 1950-1968, (Health and Welfare D i v i s i o n , November 1972), pp. 9-11. 4 E. S. Schneidman, (ed.), On the Nature of S u i c i d e , ( C a l i f o r n i a : Josey & Bass Inc., 1969), p. 111. 3 one group of non-suicide attempters in emergency; and, one group of non-s u i c i d e attempters, not i n the emergency ward. D e f i n i t i o n of Terms Used S u i c i d e Attempter f o r the purpose of t h i s study r e f e r s to any i n d i v i d u a l seen f o l l o w i n g a non-fatal s e l f - i n f l i c t e d i n j u r y . Youth f o r the purpose of t h i s study r e f e r s to any male or female between the ages of s i x t e e n and twenty-five. S e l f - A c c e p t i n g Youth f o r the purpose of t h i s study i s defined as the person possessing the f o l l o w i n g c h a r a c t e r i s t i c s : 1. has aqsense of personal worth and has f a i t h i n his c a p a c i t y to cope with l i f e 2. r e l i e s p r i m a r i l y on i n t e r n a l values r a t h e r than external pressures as a guide to behavior 3. assumes r e s p o n s i b i l i t y f o r h i s own behavior and accepts p r a i s e or c r i t i c i s m o b j e c t i v e l y 4. i s r e l a t i v e l y f r e e from self-doubt or d i s i l l u s i o n m e n t 5. considers himself a person of worth on an equal plane with others. This d e f i n i t i o n was adapted from The C a l i f o r n i a P sychological Inventory and the Berger Scale of Self-Acceptance. H. Gough, Manual f o r the C a l i f o r n i a P sychological Inventory, (Palo A l t o , C a l i f o r n i a : Consulting P s y c h o l o g i s t s Press, 1969), p. 10. 6 E, Berger, "The R e l a t i o n between Expressed Acceptance of S e l f and Expressed Acceptance of Others," Journal of Abnormal and S o c i a l  Psychology, 47:778, 1952. 4 Nursing i s defined as: the nur t u r i n g of man during c r i t i c a l periods i n his l i f e so that he may develop and u t i l i z e a range of coping behaviors which permit him to s a t i s f y h is basic human needs and thereby move toward optimal h e a l t h . 7 Assumptions of the Study The study was based on the f o l l o w i n g assumptions: 1. that s e l f - a c c e p t a n c e i s a c e n t r a l part o f the l i f e of an adolescent s i g n i f i c a n t l y a f f e c t i n g h i s thoughts, f e e l i n g s and behavior.8 2. that attempted s u i c i d e i s not merely a random response to u n c o n t r o l l a b l e f o r c e s and that a l t r u i s t i c s u i c i d e s were not present i n the sample. 3. that s i t u a t i o n a l and socio-economic f a c t o r s as causes of attempted s u i c i d e were random or non-operative. 4. t h a t the s e l f - i n f l i c t e d i n j u r i e s were made f o r the pur-pose of s u i c i d e . L i m i t a t i o n s of the Study The f o l l o w i n g were recognized as l i m i t a t i o n s to the study: 1. the sample population was l i m i t e d i n t h a t i t drew only those seen i n the emergency ward of a l a r g e urban general h o s p i t a l and t h e r e f o r e should be ge n e r a l i z e d c a u t i o u s l y to other s e t t i n g s . 2. the youths i n emergency answered the q u e s t i o n a i r e s i n a high s t a t e o f s t r e s s while those i n the community d i d not. Model f o r Nursing, U n i v e r s i t y of B r i t i s h Columbia, 1971. o A. Combs and D. Snygg, Indi v i d u a l Behavior, (New York: Harper & Brothers, 1959), p. 122. 5 S p e c i f i c O bjectives of the Study The s p e c i f i c o b j e c t i v e s of t h i s study were: 1. to determine whether youths who had attempted s u i c i d e had a lower l e v e l o f self-acceptance as measured by the Berger S c a l e , than youths who had not attempted s u i c i d e ; 2. to determine whether youths who had attempted s u i c i d e had a lower l e v e l o f self-acceptance as measured by the C a l i f o r n i a P s y c h o l o g i c a l Inventory Csubscale, self-acceptance) than youths who had not attempted s u i c i d e . Hypotheses Tested i n the Study The n u l l hypotheses test e d i n t h i s study were: 1. There i s no s i g n i f i c a n t d i f f e r e n c e i n the sel f - a c c e p t a n c e o f a group of s u i c i d a l youths compared to a group of non-s u i c i d a l youths as measured by the Berger S c a l e . 2. There i s no s i g n i f i c a n t d i f f e r e n c e i n the self-acceptance of a group o f s u i c i d a l youths compared to a group o f non-s u i c i d a l youths as measured by the C a l i f o r n i a P sychological Inventory, subscale s e l f - a c c e p t a n c e . J u s t i f i c a t i o n o f the Problem Twelve percent of a l l s u i c i d e attempts i n the nation are made by q adolescents. Estimates of the r a t i o of attempters who f i n a l l y complete a s u i c i d e have v a r i e d from 7:1 to 5 0 : 1 : 1 0 The p o t e n t i a l l y l e t h a l nature of the wide range of s e l f - d e s t r u c t i v e behavior manifested i n these attempts emphasizes the importance of e a r l y i d e n t i f i c a t i o n and immediate t h e r a u p e t i c B. Corder, and W. Shorr, "A Study of Psychological C h a r a c t e r i s t i c s o f S u i c i d e Attempters," Adolescence, 9:1, Spring 74. 1 0 E. Schneidman, and D. Swenson, "S u i c i d e Among Youth," Supplement, Bu l l e t i n , , o f Suicedology, December, 1969, p. 8. 6 i n t e r v e n t i o n with t h i s high r i s k group of adolescents. In recent years i n the Province of B r i t i s h Columbia the problem of s u i c i d e , p a r t i c u l a r l y among youths, has been of v i t a l concern. I t has prompted such e d i t o r i a l s as, " I f B.C. i s paradise, why i s the s u i c i d e rate the highest i n Canada?" 1 1 In the C i t y of Vancouver, the problem i s again magnified. The C i t y ' s rate of s u i c i d e i s more than twice the national average and in a l l 12 North America, only the C i t y o f San Francisco has a higher r a t e . Vancouver then i s a r i p e area f o r study. Of note i s the f a c t that these s t a t i s t i c s are only the o f f i c i a l r a t e s based on coroner's r e p o r t s , but i t i s known that because of under r e p o r t i n g the rate i s much higher. S u i c i d e i s s t i l l very much a taboo subject and r e f l e c t i n g on rates i s a t o t a l l y inadequate measure of the 13 extent of the r e a l problem. The r e a l problem l i e s i n the c o n d i t i o n s under which a young person takes his own l i f e . According to Jacobs i n his book Adolescent S u i c i d e : Adolescent s u i c i d e attempts r e s u l t from the adolescent f e e l i n g that he has been subject to a progres s i v e i s o l a t i o n from meaningful s o c i a l r e l a t i o n s h i p s . 1 4 C. Cocking, " I f B.C. i s paradise, why i s the s u i c i d e r a t e the highest i n Canada?" Saturday Night, September 1973, p. 23. 1 2 I b i d . , p. 24. 13 C.uJ. F r e d e r i c k , "The Present S u i c i d e Taboo i n the United S t a t e s , " Mental Hygiene, 55:179, 1971. 1 4 J . Jacobs, Adolescent S u i c i d e , (New York: John Wiley and Sons, 1971), p. 27. 7 Jacobs interviewed f i f t y adolescent s u i c i d e attempters and came up with a l i s t of common problems, however he d i d not explore the adolescents' f e e l -ings about himself. Most research studies a l s o avoid t h i s issue and f o r t h i s reason the researcher has chosen to explore the self-acceptance o f the youthful s u i c i d e attempter. As Termansen et al s t a t e i n t h e i r study on s u i c i d e i n Vancouver: S u i c i d e i s not a simple phenomenon that can be c o r r e l a t e d d i r e c t l y with one or several s o c i a l c h a r a c t e r i s t i c s . S u i c i d e i s an i n d i v i d u a l d e c i s i o n based on in t e r p e r s o n a l and i n the f i n a l a n a l y s i s i n t r a p s y c h i c events.15 Snygg and Combs i n d i c a t e from t h e i r s t u d i e s and w r i t i n g s that how a person perceives himself plays a tremendous part i n determining b e h a v i o r . ^ A s e l f defined i n negative terms lowers the i n d i v i d u a l ' s a b i l i t y to deal with a s t r e s s f u l s i t u a t i o n and may lead to s u i c i d e as a way out. The w r i t e r ' s i n t e r e s t as a nurse i n the area o f youthful s u i c i d e s was f i r s t stimulated from contacts with t r a n s i e n t youths i n a drop-in centre. These youths f e l t i s o l a t e d and alone and made negative statements about themselves, such as "what's the use, I'm no good to myself or anyone e l s e . " When these youths were faced with c r i s e s s i t u a t i o n s often a s u i c i d e attempt was made ensuring help f o r the immediate s i t u a t i o n but l e a v i n g the problem of low self-acceptance unresolved. The question that was l e f t unanswered was, "did t h i s low self-acceptance r e l a t e to subsequent s u i c i d e attempts?" Nurses do have a r o l e i n s u i c i d e prevention, and an important P. Termansen et a l , "Suicide and Attempted S u i c i d e i n Vancouver, " B r i t i s h Columbia Medical J o u r n a l , " 14:28, 1972. A. Combs, and D. Snygg, Indi v i d u a l Behavior (New York: Harper and Bros., 1959), p. 122. 8 aspect of t h i s r o l e i s e a r l y d e t e c t i o n of the p o t e n t i a l s u i c i d e r . 1 7 Schneidman, w r i t i n g in the American Journal of Nursing, f e e l s that because nurses come i n t o contact with persons i n numerous d i f f e r e n t s e t t i n g s at s t r e s s f u l periods of t h e i r l i v e s , they are i n a unique p o s i t i o n to i n t e r -1 o vene with the p o t e n t i a l l y s u i c i d a l i n d i v i d u a l . Conclusion The purpose of t h i s study then, i s to compare a group of s u i c i d a l youths with a group of n o n - s u i c i d a l youths using the Berger Scale of S e l f -Acceptance, and the C a l i f o r n i a P sychological Inventory to determine whether these t e s t s w i l l separate these s u i c i d a l youths from the n o n - s u i c i d a l youths. I f the Berger and C a l i f o r n i a Scales do detect the s u i c i d a l youth nurses are i n a unique p o s i t i o n to administer these screening t e s t s , thereby i d e n t i f y i n g and p r o v i d i n g remediation f o r the s u i c i d a l youth. Overview of the Remainder of the Study Chapter II i s a review of the l i t e r a t u r e . Two major areas are sur-veyed; s u i c i d e and s e l f - t h e o r y . Chapter III i s a d i s c u s s i o n of the methodo-logy used i n c a r r y i n g out the study. Chapter IV i s an a n a l y s i s of the data gathered. Chapter V contains the summary of the f i n d i n g s of the study, con-c l u s i o n s drawn and recommendation of areas f o r f u r t h e r i n v e s t i g a t i o n . N. B. Rykken, "The Nurse's Role i n Preventing S u i c i d e , " Nursing Outlook, 6:377, 1958. 1 o E. S. Schneidman, "Preventing S u i c i d e , " American Journal of  Nursing, 65:1114, 1965. 9 CHAPTER II REVIEW OF THE LITERATURE The Scope of the Review of L i t e r a t u r e The review of the l i t e r a t u r e w i l l be d i v i d e d i n t o two major areas. These are: the nature of s u i c i d e and attempted s u i c i d e , and theory r e l a t e d to the " s e l f . " 5 To f u r t h e r d e l i n e a t e these areas, the l i t e r a t u r e concerning s u i c i d e w i l l cover the h i s t o r i c a l development of s u i c i d e , and s u i c i d e as a s c i e n -t i f i c problem i n c l u d i n g s o c i o l o g i c a l psychodynamic and c l i n i c a l s t u d i e s . The development of s u i c i d a l i d e a t i o n and studies concerning s u i c i d e i n adolescents and c h i l d r e n w i l l a l s o be covered. The t o p i c of s e l f - t h e o r y w i l l be d i v i d e d i n t o a review of the w r i t i n g s o f major t h e o r i s t s and c l i n i c a l s t u d i e s regarding s e l f - a c c e p t a n c e . F i n a l l y , the r e l a t i o n s h i p between self-acceptance and adjustment problems such as s u i c i d e w i l l be examined. H i s t o r i c a l Development of S u i c i d e C u l t u r a l approaches to s u i c i d e have d i f f e r e d from time to time and from place to pla c e . S u i c i d e has been described among both c i v i l i z e d and p r i m i t i v e people, with s o c i a l a t t i t u d e s towards i t varying from formal i n s t i t u t i o n a l i z e d acceptance to r i g i d condemnation. I t i s well known that r i t u a l i z e d s u i c i d e such as h a r a - k i r i i n Japan was both widely p r a c t i c e d and an accepted and honourable way to d i e . In some c o u n t r i e s the Buddhist 10 f a i t h has encouraged voluntary death as a demonstration of i t s philosophy 19 of r e s i g n a t i o n and d e s p a i r . Modern r e v i v a l s of these p r a c t i c e s were seen i n World War I I , with the Japanese Kamikaze f l i g h t s and can be seen more r e c e n t l y i n the pro-t e s t s of self-immolations of the Vietnamese Buddhist monks. S u i c i d e has wavered between being the moral duty of a person and being a s i n . St. Augustine was one of the f i r s t o f the C h r i s t i a n s to writ e against the act of s u i c i d e . In the modern world John Donne con-ceived of s u i c i d e as morally wrong because i t was a g a i n s t the nature of man whose main aim i s the p r e s e r v a t i o n of l i f e . Although the 19th century saw a l i b e r a l i z a t i o n of these ideas and an i n t e r e s t was expressed at t h i s time by the medical p r o f e s s i o n , s u i -c i d e remained a c r i m i n a l a c t , punishable by imprisonment. Many c o u n t r i e s such as Spain, s t i l l enforce t h i s law and r e c e n t l y a man was j a i l e d f o r immolating himself to p r o t e s t the p o l i t i c a l system. Great B r i t a i n removed s u i c i d e from i t s c r i m i n a l code i n 1961. The United States has never con-sid e r e d s u i c i d e a crime although the attempt i s s t i l l a f e l o n y i n s i x s t a t e s . In Canada, s u i c i d e remains a c r i m i n a l act but although punishment i s not often enforced, the s o c i a l stigma attached to s u i c i d e i s very great. Most s c i e n t i f i c s tudies of s u i c i d e s i n c e the turn of the century have r e j e c t e d the e a r l i e r moral concepts, adopting instead the humanistic G. Z i l l b o r g , " D i f f e r e n t Diagnostic Types of S u i c i d e , " Archives of Neurology and P s y c h i a t r y , 35:270, 1936. 11 assumption that s u i c i d e i s a maladaptive act and t h e r e f o r e the person 20 i s seen as mentally i l l . S o c i o l o g i c a l Studies o f S u i c i d e 21 The f i r s t major work on s u i c i d e was Durkheim's "Le S u i c i d e . " This t r e a t i s e was s i g n i f i c a n t notoonly f o r i t s study of s u i c i d e but a l s o f o r the manner of s o c i o l o g i c a l i n q u i r y that has j u s t i f i e d t h i s pattern f o r s i m i l a r i n q u i r i e s f o r many yea r s . Durkheim's book c l a s s i f i e d s u i c i d e according to the i n d i v i d u a l ' s i n t e g r a t i o n with s o c i e t y . E g o i s t i c s u i c i d e was said to occur when the i n d i v i d u a l was suf-f i c i e n t l y i n t e g r a t e d with s o c i e t y , a l t r u i s t i c s u i c i d e when he was o v e r l y i n t e g r a t e d with s o c i e t y and anomic s u i c i d e when the i n d i v i d u a l f e l t deserted by s o c i e t y . S o c i a l pressures were considered to be the most im-portant f a c t o r s causing s e l f - d e s t r u c t i o n and the i n d i v i d u a l psychology 22 of the s u i c i d e was not examined. The work of Henry and Short i s a contemporary example of Durkheim's approach to the study of s u i c i d e . However they, as Durkheim, were unsuccessful i n r e c o n c i l i n g p s y c h o l o g i c a l explanations of s u i c i d e with the a e t o l o g i c a l approach. T h e i r explanation i s based on a f r u s t r a t i o n -aggression model. I t i s presumed that s u i c i d e and homicide emenate from ?n K. S. Adam, " S u i c i d e : A C r i t i c a l Review of the L i t e r a t u r e , " Canadian P s y c h i a t r i c A s s o c i a t i o n J o u r n a l , 12:420, 1967. 21 E. Durkheim, S u i c i d e : A Study i n Sociology (New York: The Free Press, 1951). ( 2 2 I b i d . pp. 20-31. 12 the same source, extreme forms of aggression stemming from f r u s t r a t i o n . It i s suggested that aggression turned inward w i l l r e s u l t i n s u i c i d e 23 while aggression turned outward leads to homicide. Gibbs and Martin, however, u n l i k e Durkheim, were able to d e f i n e s o c i a l i n t e g r a t i o n in terms of s t a b i l i t y of r e l a t i o n s h i p s and r e l a t e d i t 24 to s u i c i d e . Following Durkheim, numerous demographic stu d i e s have been done which have t r i e d to l i n k s u i c i d e rates in various areas to a wide 25 v a r i e t y of s o c i o l o g i c a l v a r i a b l e s . Some have attempted to c o r r e l a t e s u i c i d e rates with economic c y c l e s , the weather, seasonal changes and even phases of the moon. Jackson has noted of these t h e o r i e s that the s o c i o l o g i c a l data reported are s e l e c t i v e and incomplete and that 27 cause and e f f e c t r e l a t i o n s h i p s are almost impossible to s o r t out. In f a c t such con s t r u c t s as the time of year do not seem n e a r l y as important to the i n d i v i d u a l as his own perceptions, as i n f a c t l i t t l e can be done about the time of year. 23 A. F. Henry, and J . F. Short, S u i c i d e and Homicide, (Glencoe, I l l i n o i s . 24 J . P. Gibbs, and W. R. Martin, "A Theory of Status I n t e g r a t i o n and i t s R e l a t i o n s h i p to S u i c i d e , " American S o c i o l o g i c a l Review, 46:140, 1958. 25 F. F e r r a c u t i , "Suicide i n a C a t h o l i c Country," i n Clues to  S u i c i d e , N. L. Farberow and E. S. Schneidman (eds.) (Toronto: McGraw-H i l l Book Co., 1957), p. 70. G. L e s t e r , and D. L e s t e r , S u i c i d e the Gamble with Death, (New Jersey: P r e n t i c e H a l l , 1971), p. 144. 27 D. Jackson, i n Clues to S u i c i d e , N. L. Fareberow and E. S. Schneidman (eds.) (New York: Blakeston D i v i s i o n , 1957) p. 11. 13 Stengel, more r e c e n t l y , had a l s o questioned the r e l i a b i l i t y of these s o c i o l o g i c a l studies using s t a t i s t i c s . He has concluded "research must be more c r i t i c a l i n i t s use of s t a t i s t i c s than i t has been i n the 28 past." He c i t e s d i f f e r e n c e s in the r e l i a b i l i t y of r e g i s t r a t i o n procedures in various c o u n t r i e s as one important example. Psychodynamic Studies of S u i c i d e The psychodynamic c o n t r i b u t i o n s to the study of s u i c i d e mainly stem from Freud's d e s c r i p t i o n of one s u i c i d a l attempt and his paper on 29 30 Mourning and Melancholia. ' According to t h i s formulation the l o s s of a s i g n i f i c a n t love o b j e c t , whether r e a l or f a n t a s i e d , r e s u l t s i n a t u r n i n g inward of anger towards the i n t r o j e c t e d image of the love o b j e c t and consequently towards one s e l f . This inwardly turned aggression r e s u l t s in depression, and, i f the person has been e x c e s s i v e l y dependent or e x c e s s i v e l y ambivalent t o -31 wards t h e i r love o b j e c t , i t may r e s u l t in s u i c i d e . 28 E. Stengel, "Recent Research i n t o S u i c i d e and Attempted S u i c i d e , " American Journal o f P s y c h i a t r y , 18:725, 1961. 29 S. Freud, Mourning and Melancholia, V o l . VIV of Standard E d i t i o n of the Complete Psychological Works (London: Hogarth Press, L t d . , 1953). 30 S. Freud, "Psychoanalysis of a Case of Homosexuality in a Woman," Co l l e c t e d Papers, V o l . 11 (London: Hogarth Press, 1948). 3 1 I b i d . , p. 207. 14 Lindemann has w r i t t e n e x t e n s i v e l y on g r i e f and mourning. He f e e l s that acute g r i e f i s a d e f i n i t e syndrome with both somatic and p s y c h o l o g i c a l symptoms. From his study of the r e l a t i v e s of v i c t i m s of sudden death he concludes that the bereaved must r e a l i s t i c a l l y accept his new r o l e , come to g r i p s with h i s g u i l t f e e l i n g s and accept the mourning process or his 32 g r i e f w i l l be prolonged. In his a r t i c l e on " G r i e f : The Emotional Response to S u i c i d e " he f e e l s that the bereaved o f a s u i c i d e are faced with a t r i p l e l o s s : death, r e j e c t i o n and d i s i l l u s i o n m e n t . A l l those f a c t o r s operate to increase the p o t e n t i a l of h o s t i l i t y i n the mourner and the danger of h i s turning i t upon himself as the only a v a i l a b l e or most 33 appropriate t a r g e t . Z i l l b o r g , however, i n 1936 pointed out that t h i s psychodynamic c o n s t e l l a t i o n i s not present i n a l l s u i c i d e s and conversely that s u i c i d e 34 does not appear i n a l l cases where i t i s present. Menninger f u r t h e r emphasized the u b i q u i t y of the s u i c i d a l impulse on the basis of the 'death i n s t i n c t , ' d e s c r i b i n g a wide v a r i e t y of s e l f -d e s t r u c t i v e behavior from alc o h o l i s m to m u l t i p l e surgery i n terms such as c h r o n i c s u i c i d e , f o c a l s u i c i d e and organ s u i c i d e . He a l s o describes three components of the behavior of s u i c i d e , the wish to k i l l , the wish to be 35 k i l l e d and the wish to d i e . 32E. Lindemann, "Symptomatology and Management of Acute G r i e f , " American Journal of P s y c h i a t r y , 101:141, 1944. 33 E. Lindemann, and I. M. Greer, "A Study of G r i e f : Emotional Responses to S u i c i d e , " Pastoral Psychology, 4:9, 1953. 34 G. Z i l l b o r g , o£. c v t . , p. 273. 35 K. Menninger, Man Against Himself (New York: Harcourt Brace Co. 1938), pp. 30-35. 15 Apart from recent disenchantment with "thanatos" or the death i n s t i n c t Menninger has created confusion by his i n c l u s i o n of a l l acts of s e l f - d e s t r u c t i o n as a form of s u i c i d e . I t would be d i f f i c u l t to analyse the s t a t i s t i c s i f a l l a l c o h o l i c s who died were l a b e l l e d as s u i c i d e . Writers and c l i n i c i a n s of today t r y to i n c l u d e i n t e n t i n t h e i r concept of s u i c i d e , however, t h i s i s a very d i f f i c u l t f a c t to measure. The outcome and the l e t h a l i t y or seriousness of the method are other means to determine whether i n f a c t i t was an act of s u i c i d e . Most s u i c i d o l o g i s t s agree that 36 s u i c i d e i s only s u i c i d e when the aim o f the a c t i s death. In The End of Hope, the authors deal with the question of l e t h a l i t y i n the h o s p i t a l i z e d p a t i e n t . The authors s t a t e : For actual s u i c i d e to occur a necessary (although not s u f f i c i e n t ) aspect of the f i e l d i s the response c h a r a c t e r i z e d by helplessness and hopelessness. The helpless-hopeless response i s communicated through an i m p l i c i t o r . e x p l i c i t expectation that the troubled person w i l l k i l l h i m s e l f . 3 7 The expectation of the s t a f f that a p a t i e n t would commit s u i c i d e became f o r some p a t i e n t s a demand that they k i l l themselves. I t i s not j u s t the expectation of s u i c i d e that i s harmful but r a t h e r i t i s the f e a r and ap-prehension that may accompany the e x p e c t a t i o n . 36 E. S. Schneidman, N. L. Farberow, and R. E. Litman (eds.), The Psychology of S u i c i d e , (New York: Science House, 1970), p. 17. 37 A. L. Kobler, and E. Stat!and, The End of Hope, A S o c i o l o g i c a l Theory jof S u i c i d e , (New York: The Free Press 1964), p..' 252. 16 One e x c e l l e n t comprehensive study combining both s o c i o l o g i c a l and psychoanalytic approach i s S u i c i d e and Scandinavia. Using as a s t a r t i n g point the c o n s i s t e n t l y high s u i c i d e r a t e in the 1960's of twenty i n one hundred thousand in Denmark and Sweden, and a c o n s i s t e n t l y low rate of seven and one h a l f in one hundred thousand in Norway, he compared groups of s u i c i d a l p a t i e n t s f o l l o w i n g a study of each c u l t u r e . His conclusions were that a l l three groups seemed to s u i c i d e f o r d i f -f e r e n t psychodynamic reasons. In Sweden he found a high degree of emotional involvement i n occupational l i f e and a l e s s e r degree of i n -volvement i n personal r e l a t i o n s h i p s to be r e l a t e d to s u i c i d e . Such per-formance s u i c i d e was then p r e c i p i t a t e d by losses i n the s o c i a l and economic spheres. In Denmark where p a s s i v i t y and dependence on other persons i n encouraged in childhood, s u i c i d e was found to be r e l a t e d to losses i n personal r e l a t i o n s h i p s . The Norwegians, although tending to personal dependency l i k e the Danes, were found l e s s prone to s u i c i d e be-cause of t h e i r c h a r a c t e r i s t i c use of paranoid p r o j e c t i o n to c o n t r o l 3 9 anger a s s o c i a t e d with losses or threatened l o s s e s . In Meerloo's book e n t i t l e d S u i c i d e and Mass S u i c i d e , a wider view 40 i s taken. His main t h e s i s i s that there e x i s t s a very c l o s e r e l a t i o n -ship between personal s u i c i d a l f e e l i n g s and the mass emotions i n the H. Hendin, S u i c i d e and Scandinavia, (New York: Grune and S t r a t t o n , 1971). 3 9 I b i d . , pp. 206-209. 4 0 J . A. Meerloo, S u i c i d e and Mass S u i c i d e , (New York: Grune and S t r a t t o n , 1962). 17 world. Each i n d i v i d u a l , i n the personal s e l f - d e s t r u c t i v e f e e l i n g s and habits of which he i s u s u a l l y unaware, c o n t r i b u t e s a gr a i n o f s u i c i d a l tendency to the c o l l e c t i v i t y . Moreover, because of one man's f e e l i n g s of despair and f i n a l r e n u n c i a t i o n of l i f e i s often rooted i n i n f a n t i l e experience shared by a l l men there can be a tremendous contagion between i n d i v i d u a l f e e l i n g s and c o l l e c t i v e emotions. In Hillman's S u i c i d e and the Soul, another viewpoint i s taken 42 by t h i s l a y Jungian a n a l y s t . Unlike Stengel, who views death as a physi c a l s t a t e and s u i c i d e as a behavioral event, Hillman sees death as an experience, a t r a n s i t i o n from one r e a l i t y i n t o another r e a l i t y , and s u i c i d e i s only a symbol. He provides no case material and h i s view of s u i c i d e i s seen to f u r t h e r Jungian psychology, but does not c o n t r i b u t e 43 much to a theory o f s u i c i d e . In general the numerous psychodynamic stu d i e s have f a i l e d to ex-p l a i n s u i c i d a l behavior i n non-depressive i l l n e s s , and have o f f e r e d no explanation as to why c e r t a i n psychodynamic s t a t e s lead to s u i c i d e i n some instances and not i n others. H 1 I b i d . , pp. 306-320. 42 J. Hillman, S u i c i d e and the Soul, (New York: Harper and Row, 1965). 4 3 I b i d . , pp. 25-37. 18 C l i n i c a l Studies of S u i c i d e The primary goal of c l i n i c a l s tudies on s u i c i d e over recent years has been the d i s c o v e r y of r e l i a b l e i n d i c a t o r s f o r p r e d i c t i n g i n t e n t i n persons threatening or attempting s u i c i d e . The main method used has been that of the r e t r o s p e c t i v e a n a l y s i s of the f a c t o r s and circumstances l e a d i n g up to and surrounding the s u i c i d a l behavior. Most of the studies have been c a r r i e d out on groups of p a t i e n t s who a c t u a l l y s u i c i d e d with some st u d i e s comparing the attempter with the completer. Studies with c o n t r o l populations are r a r e . The f i n d i n g s have d e l i n e a t e d c e r t a i n 'high r i s k ' groups who are f e l t to be prone to actual s u i c i d e . High r i s k has been found c o r r e l a t e d with male sex, i n c r e a s i n g age, widowhood, s i n g l e and divorced s t a t e , c h i l d l e s s n e s s , high d e n s i t y of population, residence i n big towns, alcohol consumption, a h i s t o r y of a broken home 44 i n childhood and the presence of p h y s i c a l i l l n e s s . C l a s s i f i c a t i o n according to p s y c h i a t r i c c a t e g o r i e s has y i e l d e d high r i s k groups i n severe depression, schizophrenia and organic brain d i s o r d e r . Psycho-pathic and h y s t e r i c a l character d i s o r d e r s have a high frequency of 45 s u i c i d a l attempts but are low i n r i s k f o r actual s u i c i d e . G. L e s t e r , and D. L e s t e r , S u i c i d e : The Gamble With Death, (New Jersey: P r e n t i c e H a l l , 1971), p. 200. 45 E. Schmidt, P. O'Neal, and E. Robins, "Evaluation of S u i c i d e Attempts as a Guide to Therapy," Journal of the American Medical  A s s o c i a t i o n , 155:549, 1954. 19 The methodological problems encountered i n doing c l i n i c a l research 46 i n s u i c i d e are f o r m i d i b l e and have been well o u t l i n e d by Neuringer. He notes the obvious d i f f i c u l t i e s involved i n the choice of subjects f o r study, as the successful s u i c i d e i s u n a v a i l a b l e f o r study, and the use of s u b s t i t u t e subjects such as s u i c i d e attempters or those who have threatened may not be g i v i n g the same r e s u l t s . Also the s e l e c t i o n of a c o n t r o l group may contain those with l a t e n t tendencies. Farberow and Schneidman were among the f i r s t to suggest that p a t i e n t s with s u i c i d a l thoughts, those attempting s u i c i d e and those com-p l e t i n g s u i c i d e may have fundamental d i f f e r e n c e s . In an e a r l y study using the Minnesota M u l t i p h a s i c P e r s o n a l i t y Inventory, they found a group of p a t i e n t s threatening s u i c i d e to be more d i s t u r b e d than a group attempting s u i c i d e . Further a n a l y s i s of the records of a group of p a t i e n t s who had a c t u a l l y succeeded, revealed t h e i r MMPI data to resemble more c l o s e l y a normal c o n t r o l population than the previous group attempting or threaten-47 ing s u i c i d e . The s i g n i f i c a n c e i n t h i s study l i e s i n the f a c t that most s u i c i d o l o g i s t s view attempted s u i c i d e not as an e f f o r t to die,but r a t h e r as a f r a n t i c plea f o r hope and help from others. Whether the i n d i v i d u a l C. Neuringer, "Methodological Problems i n S u i c i d e Research," Journal of Consulting Psychology, 2:154, 1962. ^ N. L. Farberow, and E. S. Schneidman, "Attempted, Threatened and Completed S u i c i d e , " Journal of Abnormal and S o c i a l Psychology, 50:230, 1955 20 then a c t u a l l y commits s u i c i d e seems to depend i n a l a r g e part on the 48 49 nature of the responses by other people to h i s p l e a . ' The a p p l i c a t i o n of t h i s to the w r i t e r ' s proposed study i s seen i n the s i g n i f i c a n c e of the attempter's f e e l i n g s about himself that r e s u l t i n t h i s c r y f o r help. Erwin Stengel, more r e c e n t l y has emphasized the d i f f e r e n c e s between attempted and completed s u i c i d e , and f e e l s that attempted s u i c i d e should not simply be regarded as s u i c i d e that has f a i l e d . This approach he s t a t e s , has l e d to i g n o r i n g many important motivations i n the s u i c i d a l attempt which should be regarded as a behavioral pattern i n i t s 50 own r i g h t . The assumption that s u i c i d a l thoughts, s u i c i d a l attempts and accomplished s u i c i d e can be placed on a simple continuum f o r purposes of study may t h e r e f o r e be i n c o r r e c t . Thus, a study of s u i c i d e attempters seems to be a v a l i d d i s t i n c t i o n to be c a r r i e d out. Many of the studies on attempted s u i c i d e deal with the i d e n t i f y i n g c h a r a c t e r i s t i c s of the s u i c i d e attempter. Farber found that the attempter often i s l i v i n g i n a s t a t e of s o c i a l confusion c h a r a c t e r i z e d by d i s t u r b e d E. Stengel, "The Complexity of Motivation to Attempt S u i c i d e , " Journal of Abnormal and S o c i a l Psychology, 50:230, 1955. 4 9 E. Stengel, Attempted S u i c i d e : I t s S o c i a l S i g n i f i c a n c e and  E f f e c t s , (London: Chapman, and Hal 1 Lt d . , 1958), pp. 5-8. 5 0 E. Stengel, S u i c i d e and Attempted S u i c i d e , (Toronto: Penguin Books, 1964), p. 725. 21 f a m i l y r e l a t i o n s h i p s and overcrowded l i v i n g c o n d i t i o n s . Often the 51 attempter i s impulsive and habituated to d r i n k and drugs. Motto found f i v e c h a r a c t e r i s t i c patterns could be i d e n t i f i e d and r e l a t e d to the seriousness of the p r i o r attempt and the status of the subject regarding subsequent s u i c i d e . One i d e n t i f i a b l e c h a r a c t e r i s -t i c of the successful s u i c i d e was the absence of c o n t i n u i n g contact with 52 a p s y c h i a t r i c f a c i l i t y . Pokarney was concerned with the i n d i c a t o r s of f u t u r e s u i c i d e and found s u i c i d a l behavior (attempts, t h r e a t s , and ideas) to be a more r e -53 l i a b l e i n d i c a t o r than the p s y c h i a t r i c d i a g n o s t i c grouping. In the follow-up study, G r i e r and Lee devised a t h r e e - p o i n t s c a l e assessing p s y c h i a t r i c symptoms (frequency, s e v e r i t y ) of s o c i a l adjustment i n four areas: work; i n t e r p e r s o n a l r e l a t i o n s ; sexual adjustment; and m a r i t a l r e l a t i o n s . They u t i l i z e d t h i s s c a l e i n determining the psychosocial 54 adjustment of the p a t i e n t one to four and a h a l f years a f t e r discharge. In summary then, these numerous c l i n i c a l s t u d i e s seem to have o f f e r e d the most valuable information thus f a r on the s u i c i d a l i n d i v i d u a l . 51 M. L. Farber, Theory of S u i c i d e , (New York: Funk and Wagnalls, 1968), p. 37. 5? Motto, "Suicide Attempts, A Longitudinal View," Archives of  General P s y c h i a t r y , 13:517, 1965. 5 3 A. D. Pokarney, "A Follow-up Study of 618 S u i c i d a l P a t i e n t s , " The American Journal of P s y c h i a t r y , 122;1115. 54 S. Greer, and H. A. Lee, "Subsequent Progress of P o t e n t i a l l y Lethal Attemptee S u i c i d e s , " ACTA P s y c h i a t r i c Scandinavia, 43:361, 1967. 22 The Development of S u i c i d a l Ideation Although the l i t e r a t u r e i s scarce on the development and f u n c t i o n of s u i c i d a l i d e a t i o n , a review of the material on s u i c i d e i n adolescence and c h i l d r e n reveals some data. Some authors f e e l that the c h i l d ' s concept of death may o r i g i n a t e 55 as e a r l y as the f i r s t year of l i f e . By the age of two to f o u r , death f a n t a s i e s are a c t i v e l y used i n expressing anger towards offending persons. By school age, f a n t a s i e s of death or dying are extremely common, being 56 found i n seventy percent of a group of c h i l d r e n i n one recent study. According to Toolan, i n hi s a r t i c l e of s u i c i d e i n c h i l d r e n , "The c h i l d 57 p r e f e r s to consider himself bad than admit his parents' badness." Actual s u i c i d e i n childhood, although r a r e , seems to r e f l e c t such miscon-58 ceptions as, "death i s j u s t sleep from which everyone r e t u r n s . " S u i c i d a l acts i n c h i l d r e n increase i n frequency with age, u n t i l i n the f i f t e e n to nineteen year o l d age group they are the second lea d i n g cause 59 of death i n the United States and Canada. 55 K. S. Adam, op. c i t . , p. 416. 56 H. Von-Hug Hellmuth, "The C h i l d ' s Concept of Death," t r a n s l a t e d by A. K r i s , Psychoanalytic Q u a r t e r l y , 34:449, 1965. 57 J . M. Toolan, "Suicide and S u i c i d e Attempts i n Ch i l d r e n and Adolescents," American Journal o f P s y c h i a t r y , 118:719, 1962. 58 R. H. Shaw, and R. F. S c h e l k i n , " S u i c i d a l Behavior i n C h i l d r e n , " P s y c h i a t r y , 18:157, 1965. 59 H. Bakwin, "Suicide i n Adolescents and C h i l d r e n , " Journal o f  P e d i a t r i c s , 50:749, 1957. 23 There are several exceptions to the r u l e that youthful s u i c i d e rates p a r a l l e l ' . t o those f o r the t o t a l population both g e n e r a l i z e d and r e l a t i v e to sex and race. In the l a s t decade the s u i c i d e r a t e f o r non-white g i r l s which had p r e v i o u s l y exceeded the a d u l t r a t e has now dropped below the t o t a l non-white female r a t e s . In more alarming c o n t r a s t i s the f a c t that i n the l a s t ten years there has been a s t r i k i n g increase i n the rate f o r young non-white males, and that t h i s r a t e c u r r e n t l y exceeds the rat e f o r a d u l t males as a whole and even the ra t e f o r the total);population. A f i n a l s t a t i s t i c i s the f a c t that the rates f o r teenagers who marry are cons i d e r a b l y higher than that f o r those who do not, and the trend con-tinues though i n dim i n i s h i n g f a s h i o n through age twenty-four. This i s i n marked c o n t r a s t to the a d u l t p a t t e r n , i n which the s u i c i d e r a t e s are lower fif) f o r married than f o r s i n g l e persons. According to Mintz, i n h i s study, the sex r a t i o , f o r attempters to completers i s three females to one male, and f o r completers i s the opposite, three males to one female. His study a l s o suggests that the attempter was apt to be somewhat younger than the com-61 p l e t e r with a modal age range from f i f t e e n to twenty-four years. The high incidence of s u i c i d e i n t h i s group has been l i n k e d with the i n t e n s i f i c a t i o n o f sexual urges and the i d e n t i t y c r i s i s of the adolescent M. King, op_. c i t . , p. 346. 61 R. S. Mintz, A P i l o t Study of the Prevelance of Persons i n the C i t y of Los Angeles who have Attempted S u i c i d e (unpublished manuscript), U n i v e r s i t y of C a l i f o r n i a at Los Angeles, Neuro-Psychiatric I n s t i t u t e , 1964, p. 10. 24 period of development, although no explanation has been given f o r the a c t i t s e l f . 6 2 Jacobs i n his doctoral d i s s e r t a t i o n studied adolescent s u i c i d e attempts to t e s t whether or not the l i f e h i s t o r i e s of adolescent s u i c i d e attempters adhered to any sequential o r d e r i n g that was not found i n a CO c o n t r o l group. He has since published a book on adolescent s u i c i d e o u t l i n i n g the process which l e d to the adolescent s u i c i d e attempters pro-g r e s s i v e i s o l a t i o n from s i g n i f i c a n t others and f i n a l l y to the attempt. TU- - 6 4 This process i s : 1. A long-standing h i s t o r y of problems i n general (from childhood to the onset of adolescence). 2. A period of " e s c a l a t i o n of problems" (since the onset of adolescence and in excess of those normally a s s o c i a t e d with adolescence). 3. The progressive f a i l u r e of a v a i l a b l e adaptive techniques f o r coping with o l d and i n c r e a s i n g new problems which leads to the adolescent to a p r o g r e s s i v e s o c i a l i s o l a t i o n from meaningful s o c i a l r e l a t i o n s h i p s . 4. The f i n a l phase c h a r a c t e r i z e d by the chain r e a c t i o n d i s -s o l u t i o n of any remaining meaningful s o c i a l r e l a t i o n s h i p s i n the weeks and days preceeding the s u i c i d e attempt. v c B. Parker, "The Risk of S u i c i d e , " i n My Language i s Me, (Toronto: Basic Books, Inc., 1962), p. 28. 63 J . Jacobs, "Adolescent S u i c i d e Attempts," [Unpublished doctor's di s s e r t a t i on, Uni vers i t y of C a l i f o r n i a , 1967), p. 2. 64 J . Jacobs, Adolescent S u i c i d e , (Toronto: Wiley Inter-Science Books, 1971) p. 64. 25 In the s p e c i a l s e t t i n g of the u n i v e r s i t y , i t has been shown that CC CC s u i c i d e i s the second or t h i r d most common cause of death. ' Some c r i s e s that increase t h i s r a t e according to Knight are: l o s s or m o d i f i -c a t i o n of values, separation anxiety, i d e n t i t y c o n f u s i o n , excessive competitiveness, u p h e a v a l s i n love attachments, depressive episodes, and fears about m a s c u l i n i t y or f e m i n i n i t y . Of extreme importance i n adolescent s u i c i d e seems to be the 67 r o l e o f s o - c a l l e d broken homes. A recent study by Dorpat et_ al_. com-pared groups of actual and attempted s u i c i d e s from t h i s p o i n t of view and found that f i f t y percent of the actual s u i c i d e s and s i x t y four percent of the attempted s u i c i d e s had a d e f i n i t e h i s t o r y of separation from one or CO both parents i n childhood. Of f u r t h e r i n t e r e s t was the f i n d i n g that completed s u i c i d e s had the highest incidence o f l o s s of a parent through death, whereas attempted s u i c i d e s had the highest incidence of l o s s through divorce or separation. In a l l these s t u d i e s , the most common p r e c i p i t a t i n g f a c t o r l e a d i n g to the s u i c i d a l behavior was that of actual or threatened 69 l o s s of some s i g n i f i c a n t object or person i n the environment. 65 H. M. P a r i s h , "Causes of Death Among College Students," P u b l i c  Health Reports, 71:1081, 1965. M. Peck, and A. Schrut, "Suicide Among College Students," i n Proceedings Fourth I n t e r n a t i o n a l Conference, p. 356. 67 J . Jacobs, and T. D. T e i c h e r , "Broken Homes and S o c i a l I s o l a t i o n i n Attempted S u i c i d e , " I n t e r n a t i o n a l Journal of S o c i a l P s y c h i a t r y , 13:139, 1967. 68 T. L. Dorpat, J . Jackson, and H. .Ripley, "Broken Homes and Attempted and Completed S u i c i d e , " Archives of General P s y c h i a t r y , 12:213, 1965. 69 T. L. Dorpat, et a l . , op. c i t . , p. 215. 26 Self-Theory - Major T h e o r i s t s Perhaps the most s i g n i f i c a n t c o n t r i b u t i o n to the t o p i c of s e l f - t h e o r y was made by George Herbert Mead. As a s o c i a l philosopher he was concerned with the process by which the i n d i v i d u a l becomes a compatible and i n t e g r a t e d member of his s o c i a l group. Mead stated that the i n d i v i d u a l comes to respond to himself and develops s e l f - a t t i t u d e s c o n s i s t e n t with those ex-pressed by s i g n i f i c a n t others i n h i s w o r l d . 7 ^ Coopersmith defined the s e l f as: an a b s t r a c t i o n that an i n d i v i d u a l develops about the a t t r i b u t e s , c a p a c i t i e s , objects and a c t i v i t i e s which he possesses. This ab-s t r a c t i o n i s represented by the symbol, 'me,' which i s a person's idea of himself. I t i s an a b s t r a c t i o n that i s formed and e l a b o r a -ted i n s o c i a l i n t e r c o u r s e , p r i v a t e r e a c t i o n s to himself, mastery i n s o l v i n g developmental tasks and competence i n d e a l i n g with l i f e s i t u a t i o n s . ' * Snygg and Combs, the phenomenologists, have been the most thorough i n t h e i r w r i t i n g s concerning s e l f - t h e o r y , self-esteem, and s e l f - a c c e p t a n c e . According to them everyone has a need to possess an adequate s e l f . These s e l f - p e r c e p t i o n s have a tremendous r o l e i n determining behavior. For them the phenomenal s e l f i s the s e l f defined by the i n d i v i d u a l s as his own unique way of o r g a n i z i n g and regarding his comments of s e l f . I t gives c o n t i n u i t y G. H, Mead, Mind, S e l f and S o c i e t y , (Chicago: U n i v e r s i t y of Chicago Press, 1934), pp. 29-41. 7 1 S. Coopersmith, The_Antecedents of Self-Esteem, (San F r a n c i s c o : W. H. Freeman and Company, 1967), p. 20. 27 and consistency to the person and provides the c e n t r a l core around which 72 a l l other perceptions are organized. Snygg and Combs see the person's conceptual f i e l d as having three component p a r t s : the self-image, the self-demand, and the self-judgment. The self-judgment of the i n d i v i d u a l i s the r e l a t i o n s h i p between the s e l f -image (what am I) and the self-demand (what should I be). I f these two are congruent i n the i n d i v i d u a l s perception then he i s s e l f - a c c e p t i n g . Self-acceptance may be measured e m p i r i c a l l y and i s r e l a t e d to s e l f -. 73 esteem. A high degree of self-acceptance and self-esteem leads to a r e l a t i o n s h i p between the s e l f and s o c i e t y c h a r a c t e r i z e d by mutual en-hancement with a minimum of f r i c t i o n , h o s t i l i t y or d e s t r u c t i v e n e s s . A s e l f - d e f i n e d i n negative terms i s a poor instrument f o r de a l i n g with l i f e . The poorer self-esteem lowers the i n d i v i d u a l s ' a b i l i t y to handle new s i t u a t i o n s and he i s i n constant danger from 74 c r i s e s . Three neo-Freudians, S u l l i v a n , Horney and A d l e r , have al s o t h e o r i z e d on the o r i g i n s of self-esteem. As c l i n i c i a n s , they have de-r i v e d t h e i r formulations from the r e t r o s p e c t i v e reports of p a t i e n t s i n treatment. S u l l i v a n accepts Mead's i n t e r p r e t a t i o n of the s o c i a l o r i g i n s A. Combs, and D. Snygg, I n d i v i d u a l Behavior, (New York: Harper and Brothers, 1959), p. 122. 7 3 I b i d . , p. 240. 7 4 I b i d . , p. 124. 28 of p e r s o n a l i t y and then proceeds to a more extended a n a l y s i s o f the i n t e r -personal processes i n v o l v e d . The i n d i v i d u a l i s c o n t i n u a l l y guarding him-s e l f against a l o s s of self-esteem, f o r i t i s t h i s l o s s that leads to anxiety. Anxiety i s an int e r p e r s o n a l phenomenon that occurs when an i n -d i v i d u a l expects to be or i s r e j e c t e d or demeaned by himself or others. Persons with low self-esteem u s u a l l y have been devalued by s i g n i f i c a n t others and expect or a n t i c i p a t e derogation i n the present. The a b i l i t y to minimize or avoid l o s s of self-esteem i s important i n maintaining a 75 r e l a t i v e l y high l e v e l o f esteem. Karen Horney a l s o focuses on the i n t e r p e r s o n a l processes and on ways of warding o f f self-demeaning f e e l i n g s . She l i s t s a wide range of adverse f a c t o r s that might produce f e e l i n g s o f helplessness and i s o l a t i o n . The common antecedent of these f a c t o r s i s a disturbance i n the r e l a t i o n -ship between parent and c h i l d . Her major c o n t r i b u t i o n i s i n the area of defences. She i n d i c a t e s that one method of coping with anxiety i s the formulation of an i d e a l i z e d self-image. This i d e a l has the e f f e c t of b o l s t e r i n g self-esteem while at the same time leading to d i s s a t i s f a c t i o n when i t s u n r e a l i s t i c l e v e l s are not a c h i e v e d . 7 ^ A l f r e d A dler places greater s t r e s s on the importance of actual weakness and i n f i r m i t i e s i n producing low self-esteem than the other H. S. Sul1ivan,'The Inter-Personal Theory of P s y c h i a t r y , (New York: W. W. Norton and Company, T n c , 1953), pp. 1-10. 7 6 K. Horney, Neurosis and Human Growth, (New York: W. W. Norton and Company T n c , 1950J, pp, 10-30. 29 t h e o r i s t s do. Adler notes three antecedent c o n d i t i o n s that may have un-fortunate consequences on the development of self-esteem. The f i r s t are the organ i n f e r i o r i t i e s , d i f f e r e n c e s i n s i z e and s t r e n g t h . These condi-t i o n s are unavoidable and whether they e f f e c t the person depends on the support of s i g n i f i c a n t others. These experiences represent the second major antecedent c o n d i t i o n . Whereas Adler b e l i e v e s i n the b e n e f i c i a l e f f e c t o f support, he warns against the d e s t r u c t i v e e f f e c t s o f over-indulgence, the t h i r d antecedent. He b e l i e v e s that pampered c h i l d r e n have an u n r e a l i s t i c concept of t h e i r esteem and are unable to engage i n mature s o c i a l r e l a t i o n s h i p s . 7 7 Fromm and Rogers a l s o speak of self-esteem. Fromm emphasizes the p o s s i b l e d e b i l i t a t i n g e f f e c t s of s o c i a l i s o l a t i o n . I f the c h i l d and a d u l t gain freedom from others, he has the opportunity to pursue h i s own paths. By j o i n i n g a group he gains s h e l t e r but i s subject to t h e i r a u t h o r i t y . 7 7 Carl Rogers discusses the c o n d i t i o n s that f a c i l i t a t e s e l f -acceptance and diminish c o n f l i c t . Rogers proposes that a l l persons develop a self-image of themselves which serves to guide and maintain t h e i r adjustment to the external world. Since t h i s image develops out of i n t e r -a c t i o n with the environment, i t r e f l e c t s the judgements, and shortcomings A. A d l e r , The P r a c t i c e and Theory of In d i v i d u a l Psychology, [New York: Harcourt Brace Company, 1927), pp. 1-25. 78 E. Fromm, Man f o r Himself, (New York: H o l t , Rhinehard Company, Lt d . , 1947), pp. 20-25. 30 of the f a m i l y and s o c i a l s e t t i n g . He f e e l s the most important concern 79 f o r growth i s acceptance of the s e l f . In summary then,the major f a c t o r s c o n t r i b u t i n g to the develop-ment of self-esteem and s e l f - a c c e p t a n c e , according to previous t h e o r i s t s , were: 1. the amount of r e s p e c t f u l , accepting and concerned treatment that an i n d i v i d u a l r e c e i v e s from the s i g n i f i c a n t other i n his l i f e , 2. a h i s t o r y of success, 3. experiences i n accord with values and a s p i r a t i o n s , and 4. the i n d i v i d u a l manner of responding to d e v a l u a t i o n . C l i n i c a l Studies of S e l f - e v a l u a t i o n The f o l l o w i n g are some research s t u d i e s concerning self-esteem, and s e l f - a c c e p t a n c e . The major empirical study of the antecedents of self-esteem r e l a t e d to the youth i s that of Rosenberg. His i n v e s t i g a t i o n represents a s i g -n i f i c a n t step i n e x p l i c a t i n g many of the s o c i a l c o n d i t i o n s a s s o c i a t e d with 80 enhanced and diminished self-esteem. Some of the f i n d i n g s r e l a t e d to self-esteem were: s o c i a l c l a s s i s C. R. Rogers, C I i e n t Centred Therapy, (Boston: Houghton M i f f l i n Co., 1945), p. 305. ^° M. Rosenberg, S o c i e t y and the Adolescent Self-image, ( P r i n c e t o n , New Jersey: Princeton U n i v e r s i t y Press, 1965), p. 39. 31 only weakly r e l a t e d and e t h n i c group a f f i l i a t i o n i s unrelated to s e l f -esteem, thus i t appears that the s o c i a l context does not p l a y an important 81 r o l e i n i n t e r p r e t i n g one's own successes. In recent years p s y c h i a t r i s t s and others have observed a r e l a t i o n -ship between the a t t i t u d e toward the s e l f and his a t t i t u d e to others. 8 Adler noted a d e p r e c i a t i o n of others i n those who f e l t themselves i n f e r i o r . Horney asserted that the person who does not love himself i s incapable of 83 l o v i n g others. Rogers sai d that the person who accepts himself w i l l have 84 b e t t e r i n t e r p e r s o n a l r e l a t i o n s with o t h e r s . Berger's studies on s e l f - a c c e p t a n c e , other acceptance have given d e f i n i t e g u i d e l i n e s f o r d e l i n e a t i n g the s e l f - a c c e p t i n g i n d i v i d u a l and i n demonstrating that there i s a p o s i t i v e c o r r e l a t i o n between self-acceptance 85 and other acceptances. Further to t h i s , Omwake i n her study, "The R e l a t i o n Between Acceptance of S e l f and Acceptance of Others Shown by Three P e r s o n a l i t y I n v e n t o r i e s , " concluded that there i s a marked r e l a t i o n between the way an i n d i v i d u a l sees himself and the way he sees others; those who accept themselves tend to be acceptant of others and f e e l others accept them. Those who r e j e c t themselves hold a correspondingly low opinion O A I b id . . , p. 40. op A. A d l e r , op_. c i t . , p. 29. K. Horney, qp_. c i t . , p. 101. 84 ° ' ° C. Rogers, op_. c i t . , p. 302. 85 E. M. Berger, "The R e l a t i o n s h i p Between Expressed Acceptance of S e l f , and Expressed Acceptance of Others," Journal of Abnormal and  S o c i a l Psychology, 47:778, 1952. 32 of o t h e r s , and perceive others as being s e l f - r e j e c t a n t . * ^ Self-Acceptance and Adjustment Problems A number of c l i n i c a l s t u d i e s have p o s i t i v e l y c o r r e l a t e d low s e l f -87 88 acceptance with adjustment problems. •'» A low s e l f - c o n c e p t has been 89 one of the axiomatic assumptions of s u i c i d o l o g i s t s . Perry i n 1961, in her'doctoral d i s s e r t a t i o n found that those who showed the poorest adjust-90 ment patterns were a l s o the lowest in s e l f - a c c e p t a n c e . In a study done by Farnham-Diggery i n 1969, i t was found that there was no simple r e l a t i o n s h i p between s e l f - e v a l u a t i o n and s u b j e c t i v e l i f e expectancy of s u i c i d a l and n o n - s u i c i d a l p s y c h o t i c males; however i t was found that the major value of the s e l f i s i t s u t i l i t y or estimated 86 K. T. Omwake, "The R e l a t i o n s h i p Between Acceptance of S e l f and Acceptance of Others as Shown by Three P e r s o n a l i t y I n v e n t o r i e s , " Journal of Consulting Psychology, 18:443, 1954. 87 M. Zuckerman, and I. Monashkin, "Self-Acceptance and Psycho-pathology," Journal of Consulting Psychology, 21:145, 1967. oo C. T a y l o r and A. W. Combs, " S e l f Acceptance and Adjustment," Journal of Abnormal and S o c i a l Psychology, 16:89, 1952 89 N. L. Farberow, " P e r s o n a l i t y Patterns of S u i c i d a l Mental Hospital P a t i e n t s , " Genetic Psychology Monographs, 42:79, 1950. 90 D. C. Perry, "Self-Acceptance i n R e l a t i o n to Adjustment," D i s s e r t a t i o n A b s t r a c t s , 22:317, 1961. 33 goodness as a goal-achieving instrument. Self-concept was lowered by an i n a b i l i t y to achieve a f i x e d goal and decreasing opportunity f o r goal achievement.^ 1 In her doctoral d i s s e r t a t i o n i n 1967, concerning s u i -c i d e and s e l f - e v a l u a t i o n , M i l l e r developed a symbolic i n t e r a c t i o n theory of s u i c i d e and then t e s t e d t h i s framework using a t o o l she developed to measure a t t i t u d e towards the s e l f and others. She found that those who were s u i c i d a l , tended to be overcommitted to a hero-image that they could not a t t a i n , they f e l t they were to blame f o r t h e i r f a i l u r e s . She a l s o found the s u i c i d a l person tended to be r i g i d and a u t h o r i t a r i a n in 92 t h e i r t h i n k i n g and prone to c r i s e s s i t u a t i o n s . Two studies which r e l a t e d i r e c t l y to the i n v e s t i g a t o r s are those by Wilson i n 1971, and Neuringer i n 1973. Wilson et al studied the severe s u i c i d e attempter and s e l f -concept and concluded that there i s a d i f f e r e n c e i n s e l f - c o n c e p t between p a t i e n t s who attempt s u i c i d e and those who do not, and that an i n d i v i d u a l ' s concept of s e l f , assessed p r i o r to a s u i c i d a l a c t , i s a 93 h i g h l y e f f e c t i v e p r e d i c t o r of that a c t . 91 S. Farnham-Diggery, " S e l f Evaluation and S u b j e c t i v e L i f e Expec-tancy Among S u i c i d a l and Non-Suicidal Psychotic Males," Journal of Abnormal  and S o c i a l Psychology, 69:688, 1964. qp D. H. M i l l e r , " S u i c i d a l Careers" (unpublished Doctor's d i s s e r t a t i o n , U n i v e r s i t y of C a l i f o r n i a , Los Angeles, 1968), p. 10. L. T. Wilson, and G. N. Braucht, "The Severe S u i c i d e Attempter and Se!f-Concept," Journal of C I t n i cal Psychology, 27:307, 1971. 34 In Neuringer's study, an attempt was made to gather data about s e l f - a p p r a i s a l s from s u i c i d a l , psychosomatic and normal h o s p i t a l i z e d p a t i e n t s and compare these to t h e i r a p p r a i s a l of others. The i n v e s t i g a t o r was i n t e r e s t e d i n e v a l u a t i n g the common assumptions t h a t : a. a negative a t t i t u d e toward o n e s e l f i s a common c o n d i t i o n f o r s u i c i d e , and that b. these i n d i v i d u a l s view others more p o s i t i v e l y than themselves. The r e s u l t s i n d i c a t e d that the s u i c i d a l i n d i v i d u a l s s i g n i f i c a n -t l y rated themselves more n e g a t i v e l y on the e v a l u a t i v e and potency 94 f a c t o r s than d i d the other s u b j e c t s , i n c l u d i n g the other p a t i e n t s . These studies although concerned with s e l f - c o n c e p t and s u i c i d e d i d not s p e c i f i c a l l y c o r r e l a t e s e l f - a c c e p t a n c e with s u i c i d e and d i d not examine the age group f i f t e e n to twenty-five years with which the pre-sent study i s concerned. In summary, s e l f - t h e o r y i n d i c a t e s that w i t h i n each i n d i v i d u a l there i s a continual process of s e l f - e v a l u a t i o n . Self-acceptance i s one aspect of t h i s v a l u i n g process which seems to be lower i n s u i c i d a l i n -d i v i d u a l s . The s u i c i d a l youth seems to perceive himself as 'one down' and when he compares himself to o t h e r s , the p o s s i b i l i t y o f c l o s i n g the gap may seem to be impossible and s u i c i d e the only answer. C. Neuringer, "Self-Other A p p r a i s a l s by S u i c i d a l , Psychosomatic and Normal H o s p i t a l i z e d P a t i e n t s , " Journal of Consulting and C l i n i c a l Psy- chology, 42:306, 1974. 35 Summary The L i t e r a t u r e reviewed i n t h i s chapter has shown that many f a c t o r s c o n t r i b u t e to the 'career' of a s u i c i d a l youth, not the l e a s t of which i s how that youth f e e l s about himself i n r e l a t i o n to others. Nurses are i n a unique and envious p o s i t i o n i n the s c h o o l , and the community to work with, youths, at a l l stages of t h e i r l i v e s . The researcher was i n t e r e s t e d i n e x p l o r i n g these ideas f u r t h e r to add to the body of nursing knowledge concerning the youthful s u i c i d e attempter. 36 CHAPTER III METHODOLOGY Overview of Design The problem that was addressed i n t h i s study was: do adoles-cents who attempt s u i c i d e have a l e v e l of self-acceptance that i s d i f f e r e n t from other adolescents? In order to answer t h i s question two t e s t s were used to measure self - a c c e p t a n c e . This measure was then obtained from a group of s u i c i d e attempters and from a matched group of non-suicide attempters. Since the s u i c i d e group was t e s t e d i n the h o s p i t a l emergency ward, a t h i r d group of youths was a l s o t e s t e d from the population of medical emer-gency p a t i e n t s to c o n t r o l f o r the v a r i a b l e of h o s p i t a l i z a t i o n . These t e s t s r e s u l t s were then analyzed i n order to determine whether there was a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e i n the l e v e l s of self-acceptance among the three groups. S e t t i n g The s e t t i n g that was chosen f o r the study was the emergency ward of the Vancouver General H o s p i t a l . I t was chosen because of the high number of s u i c i d e attempters who are admitted to the emergency ward. The researcher wrote to the h o s p i t a l ' s business and nursing a d m i n i s t r a t o r s to request permission to use the h o s p i t a l . F u l l d e t a i l s 37 of the study were given and a f t e r the medical committee examined the pro-posed study the researcher was appointed to the paramedical s t a f f of the h o s p i t a l f o r s i x months to c o l l e c t the data. A copy of correspondence i s found i n Appendix A. The data c o l l e c t i o n was c a r r i e d out i n the emergency ward i n Vancouver General H o s p i t a l , between March 1973 and September 1973. Group A ( s u i c i d e attempters) and Group B (emergency) were ad-m i n i s t e r e d the t e s t s both while l y i n g i n bed and up i n wheelchairs. Patients were o f t e n , because of lack of space, seen i n c o r r i d o r s or l a r g e common wai t i n g areas as the emergency ward was i n the process of expan-si o n and change. There were a number o f d i s t r a c t i v e noises and a c t i v i t i e s surrounding the p a t i e n t s and t e s t s were administered under l e s s than i d e a l c o n d i t i o n s . As t h i s h o s p i t a l i s a t e r t i a r y care f a c i l i t y p a t i e n t s may come from anywhere i n the Province of B r i t i s h Columbia, however, most were from the Vancouver Metropolitan Area. The Study Population The t o t a l study population c o n s i s t e d of t h i r t y - t w o youths. Twenty youths were drawn from the emergency ward, while twelve were chosen from v i s i t o r s to the h o s p i t a l . Two subjects i n the t h i r d or c o n t r o l group f a i l e d to complete the Berger t e s t which was administered second and so the f i n a l sample contained ten subjects i n each group; f i v e male and f i v e female. The sample was s e l e c t e d to meet the f o l l o w i n g c r i t e r i a : 38 ( i ) e t h i c a l c o n s i d e r a t i o n s C i i ) p h y s i c a l c a p a b i l i t y , i n c l u d i n g o r i e n t a t i o n to time, p l a c e , and person ( i i i ) between ages si x t e e n and twenty-five ( i v ) E n g l i s h speaking (y) consent o f the p a t i e n t ' s p h y s i c i a n ( v i ) informed consent of the p a t i e n t as defined by the Ad Hoc Committee on the Rights of Human S u b j e c t s . ^ Most of the p a t i e n t s i n the emergency u n i t were under a great deal of p h y s i c a l and emotional s t r e s s . This v a r i a b l e was u n c o n t r o l l a b l e and assumed to be a l i m i t a t i o n to the study. Tests In t h i s study s e l f - r e p o r t q u e s t i o n a i r e s were used to obtain i n f o r -mation on the youths' f e e l i n g s of acceptance of himself. The t e s t s used were Berger's Scale of Self-Acceptance and the subscale of Self-Acceptance of the C a l i f o r n i a P s y c h o l o g i c al Inventory. These t e s t s were s e l e c t e d on the grounds that they seemed well s u i t e d to the purpose of the study; they o f f e r e d a means o f c o l l e c t i n g data i n a standardized way and v a l i d comparisons could be made among groups. These t e s t s were easy to adminis-t e r and s c o r i n g was q u i c k l y accomplished. The C a l i f o r n i a P sychological Inventory The f i r s t t e s t given i n t h i s study was the C a l i f o r n i a P s y chologi-cal Inventory, developed by Gough i n 1957 to devise b r i e f , accurate and 1 95 General Statement by the Ad Hoc Committee on the Rights of Human Subjects, U n i v e r s i t y of B.C., School of Nursing, November 18, 1971. 39 dependable subscales f o r the i d e n t i f i c a t i o n and measurement of the v a r i a b l e s chosen f o r i n c l u s i o n i n the inventory. The t e s t i s r e a l l y made up of eighteen subscales each corresponding to one important f a c e t of p e r s o n a l i t y . The t e s t booklet contains 480 i t e m s . 9 6 The eighteen subscales were addressed p r i n c i p a l l y to p e r s o n a l i t y c h a r a c t e r i s t i c s important f o r s o c i a l l i v i n g . These subscales were: dominance, c a p a c i t y f o r s t a t u s , s o c i a b i l i t y , s o c i a l presence, s e l f - a c c e p t a n c e , sense of w e l l - b e i n g , r e s p o n s i b i l i t y , s o c i a l i -z a t i o n , s e l f - c o n t r o l , t o l e r a n c e , good impression, communality, conforming, independence, i n t e l l i g e n c e , . . p s y c h o l o g i c a l -mindedness, f l e x i b i l i t y and f e m i n i n i t y . 9 7 For the purpose of t h i s study only the self-acceptance subscale of t h i r t y - f o u r items was scored although the e n t i r e t e s t was administered. The C a l i f o r n i a Psychological Inventory i s e s s e n t i a l l y s e l f adminis-t e r i n g . Questions are p r i n t e d i n a twelve page reusable booklet. Answers were recorded on an answer sheet by the subject p l a c i n g an "X" i n the appropriate true or f a l s e box. Subjects a l s o placed t h e i r code number on the answer sheet and f i l l e d i n t h e i r sex and education l e v e l . T e s t i n g time was u s u a l l y 45 minutes to one hour p r o v i d i n g there were no i n t e r r u p t i o n s . Scoring of the s p e c i a l handscoring answer sheet was a s t r a i g h t -forward task. The raw score f o r the self-acceptance s c a l e was obtained by p l a c i n g a s c o r i n g template on the answer sheet, and counting the X's that show through the holes. The C a l i f o r n i a Psychological Inventory does 200 of these items o r i g i n a l l y appeared i n the Minnesota M u l t i -phasic P e r s o n a l i t y Inventory. (Copyright, 1943, by the U n i v e r s i t y of Min-nesota Press) ,97 H. G, Gough, Manual for the C a l i f o r n i a Psychological Inven- t o r y , CPalo A l t o , C a l i f o r n i a , Consulting P s y c h o l o g i s t s Press, 1957), p. 5. 40 provide a p r o f i l e sheet on which to p l o t a l l eighteen subscale raw scores but t h i s procedure was,not followed i n t h i s study. Two r e l i a b i l i t y s tudies are reported with c o r r e l a t i o n s of .72 or b e t t e r . ^ ' ' 9 9 ' The v a l i d i t y of each s c a l e i s reported f o r t h i s widely used t e s t and f u r t h e r r e i n f o r c e d by a s i x page b i b l i o g r a p h y of studies using the C a l i f o r n i a Psychological Inventory. Berger's Self-Acceptance Scale The second t e s t administered was the Berger SeaTe of Self-Acceptance. The Berger s c a l e of s e l f - a c c e p t a n c e , other-acceptance i s composed of two s c a l e s ; one to measure a t t i t u d e toward the s e l f and one to measure a t t i -tude towards others, but i t i s administered as a s i n g l e t e s t . For the purpose of t h i s study only the self-acceptance s c a l e was scored. I t was developed by Berger i n 1952 using the L i k e r t procedure. The s e l f -acceptance s c a l e i s made up of t h i r t y - s i x items and the acceptance o f others s c a l e o f twenty-eight items. These items were s e l e c t e d from an i n i t i a l pool o f forty-seven statements on self-acceptance and f o r t y statements on acceptance o f others on the basis of an item a n a l y s i s . The top and bottom twenty-five percent of a sample of two hundred were s e l e c t e d , and the d i f f e r e n c e between the mean scores of these c r i t e r i o n groups was used as an index of the d i s c r i m i n a t i n g power of the item. '•'"' E. K e l l e y , In 0. K. Buros (Ed.) S i x t h Mental Measurements Year- book, (New Jersey: Gryphon Press, 1955) pp. 168-170. " H. G. Gough, Manual f o r the C a l i f o r n i a Psychological Inventory, (Palo A l t o , C a l i f o r n i a ' , Consulting P s y c h o l o g i s t s Press, 1957) pp. 19-21. 41 A l l the items were based on Berger's d e f i n i t i o n of the s e l f - a c c e p t i n g person which f o l l o w s : He defined the s e l f - a c c e p t i n g person as: 1. One who r e l i e s p r i m a r i l y upon i n t e r n a l i z e d values and standards r a t h e r than on external pressure as a guide f o r his behavior. 2. Has f a i t h i n his c a p a c i t y to cope with l i f e . 3. Assumes r e s p o n s i b i l i t y f o r and accepts the consequences of h i s own behavior. 4. Accepts p r a i s e or c r i t i c i s m from others o b j e c t i v e l y . 5. Does not attempt to deny or d i s t r a c t any f e e l i n g s , motives, l i m i t a t i o n s , a b i l i t i e s or favourable q u a l i t i e s which he sees i n himself, but rather accepts a l l without condemnation. 6. Considers himself a person of worth on an equal plane with o t h e r s . 7. Does not expect others to r e j e c t him whether he gives them any reason to r e j e c t him or not. 8. Does not regard himself as t o t a l l y d i f f e r e n t from others, "queer" or g e n e r a l l y abnormal i n h i s r e a c t i o n s . 9. Is not shy or s e l f - c o n s c i o u s The response mode was a modified L i b e r t type. The subject responds to each item by e n t e r i n g a one f o r "not at a l l true o f myself," a two f o r " s l i g h t l y true of myself," a three f o r "about half-way true of myself, a f o u r f o r "mostly true of myself," and a f i v e f o r "true of myself." The score of any item ranges from one to f i v e . For items expressing a favourable a t t i t u d e toward s e l f or others, a score of f i v e i s assigned E. M. Berger, "The R e l a t i o n s h i p Between Expressed Acceptance of S e l f and Expressed Acceptance o f Others," Journal of Abnormal and S o c i a l  Psychology, 47:778, 1952. 42 to a "true o f myself" response, and down to a score o f one f o r "not at a l l true of myself," The d i r e c t i o n of the sc o r i n g i s reversed f o r n e g a t i v e l y worded items. A f t e r t h i s adjustment has Been made, the acceptance-of-s e l f score i s computed by summing the item scores f o r a l l items on the s c a l e . A high score i n d i c a t e s . a favourable a t t i t u d e toward s e l f or others. S p l i t - h a l f r e l i a b i l i t t e s were obtained f o r f i v e groups ranging i n s i z e from eighteen to 183. These were reported to be .894 or bet t e r by the Spearman-Brown formula.'' 0 1 Several estimates o f v a l i d i t y were reported at .897 or greater 1 no using the Pearson Product-moment c o r r e l a t i o n . According to Shaw e t al t h i s was the most c a r e f u l l y developed s c a l e to measure a t t i t u d e s towards the s e l f found i n the l i t e r a t u r e . Each subject had as much time as he wished to respond to a question. The f o l l o w i n g i s a statement t y p i c a l of an item on the ques-t i o n a i r e : I. r e a l i z e t h at I'm not l i v i n g very e f f e c t i v e l y but I j u s t j u s t don't b e l i e v e I've got i t i n me to use my energies i n be t t e r ways.t'04 101)6 ^ ^ shaw, and J . M. Wright, Scales f o r the Measurement of  A t t i t u d e s , (Toronto: McGraw, H i l l Book Company, 1967) p. 432. 1 0 2 1 7 I b i d . , p. 433. 1 0 3" J I b i d . , p. 433 104'° A copy of the qu e s t t o n a i r e i s i n Appendix C. 43 The t e s t was mimeographed with no t i t l e so as not to bias r e s u l t s . I n s t r u c t i o n s were p r i n t e d on the t e s t which took approximately twenty minutes to complete. A d m i n i s t r a t i o n of the Tests Three undergraduate nursing students were used to administer the q u e s t i o n a i r e s f o r the s^udy. The researcher, by phone, would determine i f there were s u i t a b l e subjects f o r the study and i f so would go to the h o s p i t a l and approach the person d i r e c t l y . I f the subject agreed to par-t i c i p a t e the research a s s i s t a n t s would administer the t e s t s and c o l l e c t the completed q u e s t i o n a i r e s . A l l subjects were introduced to the study by the researcher using the form i n Appendix B. Care was taken not to mention s u i c i d e or s e l f -acceptance so as not to i n f l u e n c e the responses. Subjects were t o l d that the study was concerned with a t t i t u d e s people had towards themselves while in the emergency ward. A l l p a r t i c i p a t i n g subjects signed a form consenting to complete the t e s t s . Subjects were assured that they could d i s c o n t i n u e p a r t i c i p a t i o n at any time and that a l l answers would be s t r i c t l y c o n f i d e n t i a l . I f subjects consented they were assigned a code corresponding to Group A, B, or C which they placed on the f i r s t t e s t . The subject a l s o f i l l e d i n h i s sex, age and education l e v e l . Completion of both t e s t s u s u a l l y took one hour or more depending on the person's reading a b i l i t y and concentration span. 44 An a l y s i s of the Data A computer program was w r i t t e n using the S t a t i s t i c a l Package f o r  the S o c i a l Sciences on an I.B.M. computer. The parametric a n a l y s i s of variance subprogram ONEWAY was se l e c t e d to analyze the d a t a . ' ^ This ONEWAY technique i s designed to t e s t the premise that the several groups being compared a c t u a l l y do not d i f f e r and that a l l samples are from the same population. The parametric F - t e s t was chosen because i t i s more powerful than the non-parametric t e s t s such as the Kruskal-Wal1 i s and when i t gives a high degree of s i g n i f i c a n c e the non-parametri'c t e s t w i l l also.''07 The parametric testsdassume a normal population and approximately 108 the same variance. This appeared to hold true f o r the data i n t h i s study. To v a l i d a t e t h i s , Cochran's C and B a r t l e t t ' s Box t e s t s f o r homogeneity o f variances gave a measure i n excess o f s i x t y - f i v e percent (65%) p r o b a b i l i t y . 1 0 5 W.H. Nie e t a l , S t a t i s t i c a l Package f o r the S o c i a l Sciences, Second e d i t i o n , (New York: McGraw H i l l Book Company, 1970), p. 422. f 06 1'. D. J . Fox, Fundamentals of Research i n Nursing, (New York: Meredith P u b l i s h i n g Company, 1966), p. 151. 1 1 0 7 B. J . Turney, S t a t i s t i c a l Methods f o r Behavioral Science, (New York: Intext Educational P u b l i s h e r s , 1973), p. 177. ^ ° ^ B. W. Tuckerman, Conducting Educational Research, (New York: Harcourt, Brace Jovanowich, Incorporated, 1972) p. 226. 45 In order to f u r t h e r probe the between group variance and t e s t the nu l l hypothesis, an extension of the ONEWAY F - t e s t was used; the Scheffe method f o r m u l t i p l e comparisons. This method has been termed the best by Turney et al to compute the necessary d i f f e r e n c e between group means to 1 go obtain s i g n i f i c a n c e , " I t provides an estimate of the s i z e of the d i f f e r e n c e between groups and permits the t e s t i n g of a s e r i e s of compara-t i v e hypotheses at a standard l e v e l of confidence. The Scheffe formula i s as f o l l o w s : d = 2 ( K - l ) ( t a b l e d F ) ( M S w g ) N where d = d i f f e r e n c e i n group means required f o r s i g n i f i c a n c e K = number of groups t a b l e d F = F - r a t i o .from t a b l e F, using df=K-l, N + Q +-K M S . . m =mfche size ' -ofAeabhtiof '. thesequal samples Turney, op. c i t . p. 133. 46 CHAPTER IV DATA ANALYSIS AND RESULTS The f i n d i n g s of the study w i l l . b e examined independently i n terms of the two hypotheses that were t e s t e d . Samp!ing Thirty-two subjects p a r t i c i p a t e d i n the study, however, two sub-j e c t s i n Group C f a i l e d to complete the Berger t e s t and so the f i n a l sample c o n s i s t e d of 30 s u b j e c t s . These subjects, were d i v i d e d i n t o Group A ( s u i c i d e attempters), Group B (emergency) and Group C (normal). Demographic Data Age The age range of the sample was s i x t e e n to twenty-five years. A l l three groups had a median age of twenty-one years. Sex Each group was made up of f i v e male and f i v e female s u b j e c t s . Education Level The range of education l e v e l was from Grade 5 to four years U n i v e r s i t y t r a i n i n g . Table 1 presents a comparison of education l e v e l by groups. Table 2 presents a summary of the raw scores obtained on the Berger and CPI t e s t s by group, i n d i v i d u a l , sex and education. TABLE 1 EDUCATION LEVEL OF SUBJECTS BY GROUPS A, B, C. 47 GROUP A CSUTCIDE) GROUP B (EMERGENCY) GROUP C (NORMAL) Elementary School Secondary School Post-Secondary Degree Obtained 1 7 2 1 4 3 2 4 5 1 TABLE 2 RAW SCORES FOR BERGER AND CPI TESTS BY GROUP, AGE, SEX AND EDUCATION GROUP AGE SEX EDUCATION BERGER SCORE CPI SCORE A 22 M Grade 12 99 10 18 M Grade 10 97 15 Su i c i d e 17 M Grade 10 63 12 Attempters 19 M U n i v e r s i t y 74 15 22 M U n i v e r s i t y 54 17 24 F Grade 9 142 19 25 F Grade 12 46 12 23 F Grade 10 70 12 17 F Grade 8 57 18 19 F Grade 11 44 18 B 16 F Grade 10 64 12 25 F U n i v e r s i t y 77 09 Emergency 21 F U n i v e r s i t y 149 25 20 F Grade 5 100 28 23 F Grade 9 111 29 20 M U n i v e r s i t y 134 23 25 M Grade 11 81 24 19 M U n i v e r s i t y 125 32 21 M Grade 12 100 22 20 M U n i v e r s i t y 122 29 C 19 F U n i v e r s i t y 140 28 18 F U n i v e r s i t y 115 28 Normal 22 F Grade 10 106 28 22 F Grade 12 74 23 23 F Grade 10 63 22 20 M U n i v e r s i t y 96 20 21 M U n i v e r s i t y 131 16 24 M U n i v e r s i t y 128 23 24 M U n i v e r s i t y 135 32 21 M Grade 12 127 28 49 For the C a l i f o r n i a Psychological Inventory as seen i n Table 3, the group mean scores were as f o l l o w s : Group A - mean score 14.8 Group B - mean score 23.3 Group C - mean score 24.8 As can be seen the s u i c i d a l group achieved o v e r a l l a lower score on the self-acceptance subscale thereby i n d i c a t i n g these i n d i v i d u a l s to possess a lower l e v e l o f se l f - a c c e p t a n c e . TABLE 3 CALIFORNIA PSYCHOLOGICAL INVENTORY COMPARISON OF MEAN AND STANDARD DEVIATION BY GROUP A, B, C. STANDARD MINIMUM MAXIMUM GROUP MEAN DEVIATION SCORE SCORE (A) SUICIDE 14.8000 3.1552 10.000 19.000 (B) EMERGENCY 23.3000 7.4543 9.000 32.000 (C) NORMAL 24.8000 4.8028 16.000 32.000 50 For the Berger s c a l e o f self-acceptance the mean scores by group as seen i n Table 4 were as f o l l o w s : Group A - mean - 74.6 Group B - mean - 106.3 Group C - mean - 111.5 As can be seen the mean score was much lower f o r the s u i c i d e attempters group than the two non-attempter groups, thereby i n d i c a t i n g that Group A have a lower l e v e l of se l f - a c c e p t a n c e . TABLE 4 GROUP BERGER SCALE OF SELF-ACCEPTANCE COMPARISON OF MEAN AND STANDARD DEVIATION BY GROUP A, B, C. MEAN STANDARD DEVIATION!: MINIMUM SCORE MAXIMUM SCORE (A) SUICIDE (B) EMERGENCY (C) NORMAL 74.6000 106.3000 111.5000 30.3396 27.0311 26.4544 44.000 64.000 63.000 142.000 149.000 140.000 51 Data i i i R e l a t i o n to Hypotheses Hypothesis 1. There i s no s i g n i f i c a n t d i f f e r e n c e i n the self-acceptance of a group of s u t c i d a l youths as compared to a group of non- s u i c i d a l youths, as measured by the Berger S c a l e . The F r a t i o 5.090 as shown i n Table 5 i s greater than 3.35 which i s the c r i t i c a l value of F at the 5 percent CO.05%) s i g n i f i c a n c e l e v e l f o r 2 degrees o f freedom between groups and 27 degrees of freedom w i t h i n groups. TABLE. 5 15 ANALYSIS OF VARIANCE-OF GROUPS A, B, C ON THE BERGER TEST SOURCE SUM OF SQUARES DEGREESOOF FREEDOM MEAN SQUARES Between Within 7978.4375 21159.0625 2 27 3989.2187 783.6689 5.090* Total 29137.5000 29 S t a t i s t i c a l l y s i g n i f i c a n t , F Q I-(2,27) = 3.35 52 The F r a t i o o f 5.090 f o r the above degrees of freedom i s s i g n i f i -cant at 1.3 per cent, Thfs means that there i s more than one i n a hundred chances that these samples were from the same population. This a n a l y s i s r e j e c t s the n u l l hypothesis number one and shows that there i s a s i g n i f i c a n t d i f f e r e n c e among groups i n self-acceptance as measured by the Berger Scale. The data was f u r t h e r analyzed using the Scheffe method f o r m u l t i p l e comparisons. Table 6 shows th a t : 1. When Group A ( s u i c i d e ) was compared with B (emergency) there was s i g n i f i c a n c e at the 1.7 p e r c e n t t l e v e l (1.7%) thereby showing i t was u n l i k e l y these two samples came from the same pop u l a t i o n . 2. When Group A ( s u i c i d e ) was compared with Group C (normal) there was s i g n i f i c a n c e at the 0.7 percent (0.7%[ l e v e l thereby showing i t was u n l i k e l y that these two samples came from the same population. 3. When Group A ( s u i c i d e was compared with both Group B (emergency) and Group C (normal) there was s i g n i f i c a n c e at the 0.4 percent CO.4%)level thereby showing there was l i t t l e chance that the s u i c i d e r s and non-suiciders came from the same population. 4. When Group B Cemergency) was compared with Group C (normal) there was s i g n i f i c a n c e at the 68.1 percent (68.1%) l e v e l thereby showing i t was l i k e l y they came from the same pop u l a t i o n . These conclusions f u r t h e r support r e j e c t i o n o f the n u l l hypothesis number one and suggest there i s a s i g n i f i c a n t e d i f f e r e n c e i n self-acceptance between s u i c i d e attempters and non-suicide attempters as measured by the 53 Berger Scale. I t i s of i n t e r e s t to note item 4 which i n d i c a t e s as a n t i c i p a t e d that the s e t t i n g of Group B i n emergency f o r a n o n - p s y c h i a t r i c problem does not s i g n i f i c a n t l y e f f e c t the Berger Self-Acceptance Score. TABLE 6 SCHEFFE TEST FOR GROUPS A, B, C ON BERGER SCALE DEGREES GROUPS COMPARED T VALUE OF FREEDOM T PROBABILITY A vs B s u i c i d e vs emergency -2.532 27 0.017 A vs C s u i c i d e vs normal -2.947 27 0.007 A vs B, C s u i c i d e vs emergency, normal -3.164 27 0.004 B vs C emergency vs normal -0.415 27 0.681 54 Hypothesis 2. There i s no s i g n i f i c a n t d i f f e r e n c e i n the self - a c c e p t a n c e of a group of s u i c i d a l youths as compared to a group o f non - s u i c i d a l youths, as measured by the C a l i f o r n i a Psychological Inventory, subscale of se l f - a c c e p t a n c e . The F r a t i o 9.849 as shown i n Table 7 i s greater than 3.34 which i s the c r i t i c a l value of F at the 5 percent (5%) s i g n i f i c a n c e l e v e l f o r 2 deg-rees of freedom between groups and 27 degrees of freedom w i t h i n groups. The F r a t i o f o r the above degrees of freedom i s a c t u a l l y s i g n i f i c a n t at (0.01%). This means there i s l e s s than one i n one thousand chance that the above samples were from the same population. This a n a l y s i s r e j e c t s the n u l l hypothesis number 2 and shows that there i s a s i g n i f i c a n t d i f f e r e n c e among groups i n self-acceptance as measured by the C a l i f o r n i a P sychological Inventory. TABLE 7 ANALYSIS OF VARIANCE OF GROUPS A, B, C. ON CALIFORNIA PSYCHOLOGICAL INVENTORY SOURCE Between Within Total SUM OF SQUARES 581.6602 797.3125 1378.9727 DEGREES OF FREEDOM 2 27 29 MEAN SQUARES 290.8301 29.5301 F 9.849* * S t a t i s t i c a l l y s i g n i f i c a n t F . g 5 (2,27) = 3.35. The data was f u r t h e r analyzed using the Scheffe method f o r m u l t i p l e comparisons. Table 8 shows t h a t : 1. When Group A ( s u i c i d e ) was compared with Group B (emergency) there was s i g n i f i c a n c e at the 0.2 percent (0.2% l e v e l thereby showing i t was u n l i k e l y these two samples came from the same population. 55 TABLE 8 SCHEFFE TEST FOR GROUPS A, B, C. ON CALIFORNIA PSYCHOLOGICAL INVENTORY GROUPS COMPARED T VALUE DEGREES OF FREEDOM T PROBABILITY A vs B -3.498 27 0.002 s u i c i d e vs emergency A vs C -4.115 27 0.000 s u i c i d e vs normal A vs B,C -4.395 27 0.000 s u i c i d e vs emergency, normal B vs C emergency vs normal -0.617 27 0.542 2. when Group A ( s u i c i d e ) was compared with Group C (normal) there was s i g n i f i c a n c e at the 0.00 percent l e v e l (0.0%) thereby showing those two samples would not come from the same population. 3. when Group A ( s u i c i d e ) was compared with both B (emergency) and C (normal) there was s i g n i f i c a n c e at the 0.00 percent (0.0%) l e v e l thereby i n d i c a t i n g there was no chance these two samples came from the same population. 4. when Group B (emergency) w a s compared to Group C (normal there was s i g n i f i c a n c e at the 54.2 percent l e v e l (54.2%) thereby i n d i -c a t i n g i t was l i k e l y these two samples came from the same population. These conclusions f u r t h e r support r e j e c t i o n o f n u l l hypothesis number two and suggest that there i s a s i g n i f i c a n t d i f f e r e n c e i n 56 self-acceptance between s u i c i d a l youths and n o n - s u i c i d a l youths as measured by the C a l i f o r n i a Psychological Inventory. It i s of i n t e r e s t to note as seen i n item 4 that as a n t i c i p a t e d the s e t t i n g o f emergency Group B had no s i g n i f i c a n t e f f e c t on the subjects self-acceptance score on the C a l i f o r n i a Psychological Inventory. Conclusion The f i n d i n g s of t h i s study suggest that self-acceptance i s h i g h l y c o r r e l a t e d with the youthful s u i c i d e attempter and d i s t i n g u i s h e s him from a l l other youths by his low l e v e l of sel f - a c c e p t a n c e . 57 CHAPTER V SUMMARY, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS Summary Youths who attempt s u i c i d e may have p a r t i c u l a r l y low l e v e l s o f sel f - a c c e p t a n c e . This f a c t o r i s of t e n overlooked i n s p e c i f i c assessment and i n t e r v e n t i o n measures to t r e a t the s u i c i d a l youth. Nurses are i n a unique p o s i t i o n to intervene with the p o t e n t i a l l y s u i c i d a l youth as they are i n c l o s e contact with them, both i n the school and the community. Nurses, however, may have d i f f i c u l t y i n r e c o g n i z i n g the youth with poor se l f - a c c e p t a n c e . This e x p l o r a t o r y study was undertaken i n order to show that self-acceptance was a f a c t o r i n the youth's s u i c i d e attempt by means of a simple screening procedure. The s p e c i f i c purpose of the study was to answer the question, 'Do youths between the ages of f i f t e e n and twenty-five who have attempted s u i c i d e d i f f e r s i g n i f i c a n t l y i n t h e i r l e v e l o f self-acceptance as measured by the Berger Scale and the C a l i f o r n i a Psychological Inventory?' In order to answer t h i s question two n u l l hypotheses were posed: 1. There i s no s i g n i f i c a n t d i f f e r e n c e i n the self-acceptance o f a group of s u i c i d a l youths as compared to a group of non - s u i c i d a l youths as measured by the Berger S c a l e ; 2. There i s no s i g n i f i c a n t d i f f e r e n c e i n the self-acceptance of a group of s u i c i d a l youths as compared to a group of no n - s u i c i d a l youths as measured by the C a l i f o r n i a Psychological Inventory. 58 The problem was explored by administering the Berger Scale of Self-Acceptance and the C a l i f o r n i a P sychological Inventory to three groups of youths: Group A c o n s i s t e d of youths seen i n the emergency ward of a general h o s p i t a l f o l l o w i n g a s u i c i d e attempt, Group B c o n s i s t e d . of youths admitted to the h o s p i t a l ' s emergency department f o r problems other than a s u i c i d e attempt and group C c o n s i s t e d of v i s i t o r s to the emergency u n i t who met the study c r i t e r i a . Both t e s t s were administered to each subject taking a t o t a l of one hour. On the basis of raw scores r e c e i v e d an a n a l y s i s of variance was done to determine i f there was a d i f f e r e n c e i n self-acceptance among the groups. I t was found that the youthful s u i c i d e attempters had a s i g n i f i -c a n t l y lower l e v e l of self-acceptance than the other two groups of non-s u i c i d e attempters. Therefore, the n u l l hypotheses were r e j e c t e d . Conclusions On the basis of the f i n d i n g s of t h i s study the f o l l o w i n g conclu-sions were made: 1. youthful s u i c i d e attempters do have a s i g n i f i c a n t l y lower l e v e l o f s e l f - a c c e p t a n c e than non-suicide attempters. 2. h o s p i t a l i z a t i o n f o r n o n - p s y c h i a t r i c problems does not s i g n i f i c a n t l y e f f e c t a youth's l e v e l of s e l f - a c c e p t a n c e . 3. the s t r e s s f u l s i t u a t i o n of the emergency u n i t does not seem to e f f e c t the youths' c a p a b i l i t i e s f o r completing a demanding task. 59 4. The Berger Scale of Self-Acceptance and the C a l i f o r n i a Psychological Inventory subscale self-acceptance are useful t o o l s i n screening f o r low l e v e l s of self-acceptance which are p o s i t i v e l y c o r r e l a t e d to s u i c i d e . 5. The Berger Scale i s recommended f o r use as a screening measure as i t i s much short e r i n length than the C a l i f o r n i a Psychological Inventory and i t provides r e l i a b l e r e s u l t s . Implications and Recommendations The f i n d i n g s of t h i s study imply that the m a j o r i t y of youthful s u i c i d e attempters have a low l e v e l of s e l f - a c c e p t a n c e . Nurses and others who are in contact with youth should be a l e r t e d to watch f o r the youth who expresses negative f e e l i n g s about himself. The s i g n i f i c a n t f i n d i n g s of t h i s study suggest that f u r t h e r research be c a r r i e d out to d i s c o v e r the f o l l o w i n g : 1. A l o n g i t u d i n a l study should be c a r r i e d out to a s c e r t a i n how i n d i c a t i v e t h i s low l e v e l of self-acceptance i s of a subsequent s u i c i d e attempt. 2. A f u t u r e study might a l s o determine whether there i s some e m p i r i c a l l y measurable c u t - o f f point in the l e v e l of s e l f -acceptance that could be determined to be necessary before a s u i c i d e attempt i s made. 3. How are the youths with low l e v e l s of self-acceptance who do not attempt s u i c i d e accounted f o r ? 60 4. Does t h i s low self-acceptance r e l a t e to other behavior a d j u s t -ment problems such as drug a d d i c t i o n . 5. What s p e c i f i c i n t e r v e n t i o n therapy might be used to r a i s e the youths l e v e l of s e l f - a c c e p t a n c e . 1 1 0 6. Although other f a c t o r s are present i n the youth's d e s i r e to take h i s own l i f e negative f e e l i n g s about himself such as a low l e v e l o f self-acceptance seems to be a major f a c t o r i n the s u i c i d e attempt. 7. Therapy aimed at r a i s i n g the l e v e l o f s e l f - c o n c e p t and s e l f -acceptance seems of v i t a l importance i n working with y o u t h s . 1 1 1 I f f u r t h e r research supports the f i n d i n g s o f t h i s study a screening to o l f o r nurses could be developed. The Berger Scale of Self-Acceptance adequately screens out the youth who i s r e j e c t i n g of himself, however, i t does not determine why a s u i c i d e attempt i s made. It i s t h e r e f o r e r e -commended that an experimental study be undertaken i n youths to d i s c o v e r i f the l e v e l o f self-acceptance can be s p e c i f i c a l l y increased i f they r e c e i v e therapy subsequent to the s u i c i d e attempt. In t h i s way prevention of f u r t h e r s u i c i d e attempts may be accomplished. C D . M a r s h a l l , "The Indigenous Nurse as Community C r i s i s Intervener," Seminars i n P s y c h i a t r y , 3:264, 1971. 1 1 1 C. W. Cole " S e l f Concept Therapy f o r Adolescent Females," Journal of Abnormal Psychology, 47: 642, 1969. 61 BIBLIOGRAPHY 62 BIBLIOGRAPHY Books A d l e r , A. The P r a c t i c e and Theory o f I n d i v i d u a l Psychology. New York Harcourt Brace Company, 1927. Combs, A. and D. Snygg. Ind i v i d u a l Behavior. New York: Harper and Brothers, 1959. Coopersmith, S. The Antecedents of Self-Esteem. San F r a n c i s c o : W. H. Freeman and Company, 1967. Douglas, J . The S o c i a l Meanings of S u i c i d e . P r i n c e t o n , New Jersey: Princeton U n i v e r s i t y Press, 1967. Dublin, L . I . S u i c i d e : A S o c i o l o g i c a l and S t a t i s t i c a l Study. New York: The Ronald Press Co., 1963. Durkheim, E. S u i c i d e : A Study i n Sociology. New York: The Free Press, 1951. Farber, M.L. Theory of S u i c i d e . New York: Funk and Wagnalls, 1968. Farberow, N.L. (ed.). Proceedings Fourth I n t e r n a t i o n a l Conference f o r  S u i c i d e Prevention. Los Angeles, C a l i f o r n i a : Delmar P u b l i s h i n g Company, 1968. Farberow, N.L. and E.S. Schneidman. The Cry f o r Help. New York: McGraw-Hill Book Co., 1961. Fox, D.J. Fundamentals of Research i n Nursing. New York: Meredith P u b l i s h i n g Co., 1966. Friedman, P. On S u i c i d e . New York: I n t e r n a t i o n a l U n i v e r s i t y Press Inc., 1967." Gough, H.G. Manual f o r the C a l i f o r n i a P sychological Inventory. Palo A l t o C a l i f o r n i a : Consulting P s y c h o l o g i s t s Press, 1969. Freud, S. Mourning and Melancholia. V o l . XIV of Standard E d i t i o n of the Complete Psychological Works. London: Hogarth Press L i m i t e d , 1953. . "Psychogenesis of a Case of Homosexuality i n a Woman," C o l l e c t e d Papers, V o l . I I , London: Hogarth Press, 1958. . Psychopathology of Everyday L i f e . New York: Modern L i b r a r y , 1938. 63 Fromm, E. Man f o r Himself. New York: Holt Rinehart Company L t d . , 1947. Gibbs, J.P. and W.I. Martin. Status I n t e g r a t i o n and S u i c i d e . Eugene: U n i v e r s i t y of Oregon Press, 1964. Hendin, H. Sui c i d e and Scandinavia. New York: Grune and S t r a t t o n , 1964. . " P s y c h i a t r i c Emergencies," i n Freeman, A.M., H.I. Kaplan (eds.) Comprehensive Testbook of P s y c h i a t r y , Baltimore: The Williams & Wilkins Co., T%T. Henry, A.F. and J.F. Short. S u i c i d e and Homicide. Glencoe, I l l i n o i s ; The Free Press, 1954. Hillman, J . S u i c i d e and the Soul. New York: Harper and Row, 1965. Horney, K. Neurosis and Human Growth. New York: W.W. Norton and Company, 1950. Jacobs, J . Adolescent S u i c i d e . Toronto, Wiley-Inter Science Books, 1971. Kobler, A.L. and E. S t a t l a n d . The End o f Hope, A S o c i o l o g i c a l Theory o f  S u i c i d e . New York: The Free Press, 1964. L e s t e r , G. and D. L e s t e r . S u i c i d e : The Gamble with Death. Englewood C l i f f s , New Jersey: P r e n t i c e H a l l Inc., 1971. Mead, G.H. Mind, S e l f and S o c i e t y . Chicago: U n i v e r s i t y of Chicago Press, 1934. Meerloo, J.A. S u i c i d e and Mass S u i c i d e . New York: Greene & S t r a t t o n , 1962. Menninger, K. Man Against Himself. New York: Harcourt Brace, 1938. Nie, N.H., et al S t a t i s t i c a l Package f o r the S o c i a l Sciences, 2nd e d i t i o n , New York: McGraw H i l l Book Co., W O . Parker, B. "The Risk of S u i c i d e , " i n My Language i s Me. Toronto: Basic Books, 1962. Resnik, N.L.P. S u i c i d a l BehayriiOKs. Boston: L i t t l e , Brown and Company, 1968. Rogers, C R . CIient-Centered Therapy. Boston: Houghton M i f f l i n Company, Ltd . , IMF. Rosenberg, M. So c i e t y and the Adolescent Self-image. P r i n c e t o n , New Jersey: Princeton U n i v e r s i t y Press, 1965. 64 Schneidman, E.S. On the Nature of S u i c i d e . C a l i f o r n i a : Jossey-Bass Inc., 1969. Schneidman, E.S. and N.L. Farberow. Clues to S u i c i d e . Toronto: McGraw-Hill Book Company, Inc., 19577 Schneidman, E.S., N.L. Farberow and R.E. Litman. The Psychology of  S u i c i d e . New York: Science House, 1970. Shaw M.E. and J.M. Wirght. Scales f o r the Measurement o f A t t i t u d e s , Toronto: McGraw H i l l Book Co., 1967! Stengel, E. Attempted S u i c i d e : Its S o c i a l S i g n i f i c a n c e and E f f e c t s . London: Chapman and Ha 11 L t d . , 1958"! . S u i c i d e and Attempted S u i c i d e . Toronto: Penguin Books, 1964. Ste n g e l , E., N.G. Cook and I.S. Kreeger, "Attempted S u i c i d e , " Mauds!ey  Monograph No. 4_, London: Oxford U n i v e r s i t y Press, 1958. S u l l i v a n , H. S. The Inter-Personal Theory of P s y c h i a t r y . New York: W.W. Norton and Company, Inc., 1953. Tuckman, B.W. Conducting Educational Research, New York: Harcourt Brace Jovonavich Inc., 1972. Turney, B.J. S t a t i s t i c a l Methods f o r Behavioral Sciences, New York: Intent Educational P u b l i s h e r s , 1973. Journals Adams, K.S., " S u i c i d e : A C r i t i c a l Review of the L i t e r a t u r e " Canadian  P s y c h i a t r i c A s s o c i a t i o n J o u r n a l , 12 (1967), 413-420. A l l o d i , F.A. and Eastwood M.R. S u i c i d e i n Canada, Trends and Preventative Aspects, Canada's Mental Health, 2"lt^"(1973)", 16. ~ Bakwin, H., "Suicide i n C h i l d r e n and Adolescents," Journal of P e d i a t r i c s , 50, 6(1957), 749-769. Ba l s e r , R.H. and J.F. Masterson, " S u i c i d e i n Adolescents," American Journal of P s y c h i a t r y , 116, 5 (1959), 400-404. B e l l , K.K. "The Nurse's Role i n S u i c i d e Prevention: Some Aspects," B u l l e t i n of S u i c i d o l o g y 8 (1971), 70-73. Berger, E.M., "The Relatiionshjip Between Expressed Acceptance of S e l f and Expressed Acceptance of Others," Journal of Abnormal and S o c i a l  Psychology, 47, 4 (1952), 778-782. 65 Block, J . and H. Thomas, "Is S a t i s f a c t i o n with S e l f a Measure of Adjustment," Journal of Abnormal and S o c i a l Psychology, 51 (1955), 254-259. Blomquist, R.B. "Nurse I Need Help: The School Nurses Role i n S u i c i d e Prevention," Journal o f P s y c h i a t r i c Nursing, 12 (1974) 22. Chodarkoff, B., "Adjustment and the Discrepency Between Perceived and Ideal S e l f , " Journal of C l i n i c a l Psychology, 10 (1954), 266-270. » " S e l f - P e r c e p t i o n , Perceptual Defence and Adjustment," Journal o f Abnormal and S o c i a l Psychology, 49 (1954), 508-512. Cole, C.W. et a l . , "Self-Concept Therapy f o r Adolescent Females," Journal o f Abnormal Psychology, 47, 6 (1969), 642-645. Cocking, C. " I f B.C. i s paradise why i s the s u i c i d e r a t e the highest i n Canada, Saturday Night, September 1973. Corder, B. and Shore W. "A Study of Psychological C h a r a c t e r i s t i c s of S u i c i d e Attempters, Adolescence, 9, (Spring 1974) 1-20. C r o c i t t i , G.M., "Suicide and P u b l i c Health - An Attempt at Reconceptuali-z a t i o n , " American Journal of P u b l i c Health, 49 (1959), 881-887. Cunningham R., "What do Nurses do to Help P a t i e n t s Who Attempt S u i c i d e , " Canadian Nurse, 71 (1975) 21. Dorpat, T.L. and J.W. Boswell, "An Evaluation of S u i c i d a l Intent i n S u i c i d a l Attempts," Comprehensive P s y c h i a t r y , 4, 2 (1963), 1117-1125. Dorpat, T.L., Jackson and H. R i p l e y , "Broken Homes and Attempted and Compdieibed S u i c i d e , " Archieves of General P s y c h i a t r y , 12 (1965) 213-216. Farberow, N.L., " P e r s o n a l i t y Patterns of S u i c i d a l P a t i e n t s , " Genetic  Psychological Monographs, 42 (1950), 3-79. Farberow, N.L. and E.S. Schneidman, "Attempted, Threatened and Completed S u i c i d e , " Journal of Abnormal and S o c i a l Psychology, 50 (1955), 230. Farnham-Diggary, S., " S e l f - E v a l u a t i o n and S u b j e c t i v e L i f e Expectancy Among S u i c i d a l and Non-Suicidal Psychotic Males," Journal o f Abnormal  and S o c i a l Psychology, 69. (1964), 688. F r e d e r i c k , C.J., The Present S u i c i d e Taboo i n the U.S.A., Mental Hygiene, 55 (1971) 179. 66 F r e d e r i c k , C.J., "The Role of the Nurse i n C r i s i s I ntervention and S u i c i d e Prevention," The Journal of P s y c h i a t r i c Nursing 11, 1 (1973) 27-31, Greer, S. and H.A. Lee, "Subsequent Progress of P o t e n t i a l l y Lethal Attempted S u i c i d e s , " ACTA P s y c h i a t r i c Scandinavia, 43, 4 (1967), 361-371. Jacobs, J . and J.D. T e i c h e r , "Broken Homes and S o c i a l I s o l a t i o n i n Attempted S u i c i d e , " I n t e r n a t i o n a l Journal of S o c i a l P s y c h i a t r y , 13 (1967), 139-149. King, M., "Evaluation and Treatment of S u i c i d e Prone Youth," Mental Hygiene, 55 (1971), 344-350. Lindemann, E. and I.M. Greer, "A Study of G r i e f : Emotional Responses to S u i c i d e , " Pastoral Psychology, 4 (1953), 9. Lindemann, E. et a l . , "A Study of Major and Minor Disorders as they A f f e c t People, Based on an Epidemiologic A n a l y s i s of S u i c i d e and Other P s y c h i a t r i c Disease," Archives of Neurological P s y c h i a t r y , 66 (1951), 648-650. ~ Lindemann, E., "Symptomatology and Management of Acute G r i e f , " American  Journal of P s y c h i a t r y , 101 (1944), 141. Long, B., R. Z i l l e r and J . Banks, "Self-Other O r i e n t a t i o n of I n s t i t u t i o n a l Behavior Problem Adolescents," Journal of Consul t i n g and C I i n i c a l  Psychology, 34, 1 (1970), 143-147: M a r s h a l l , CD., Finan J.L. "The Indigenous Nurse as C r i s i s Counselor," B u l l e t i n o f S u i c f d o l o g y , National I n s t i t u t e o f Mental Health No. 8, FaTT (1971) 45-47. M i l l e r , D.H., " S u i c i d a l Careers: Case A n a l y s i s of Mental P a t i e n t s , " S o c i a l Work J o u r n a l , 20 (1970), 27-36. Motto, J.A., "Suicide Attempts, A Longitudinal View," Archives of General  P s y c h i a t r y , 13 (1965), 516-520. Neuringer, C , "Self-Other A p p r a i s a l s by S u i c i d a l , Psychosomatic and Normal Hospital P a t i e n t s , " Journal o f Consulting and C l i n i c a l  Psychology 42 (1974) 306. Neuringer, C , "Methodological Problems i n S u i c i d e Research," Journal of Consulting Psychology, 2, 1 (1962), 154-58. 67 Omwake, K.T., "The Rel a t i o n Between Acceptance of S e l f and Acceptance of Others as Shown by Three P e r s o n a l i t y I n v e n t o r i e s , " Journal o f  Consulting Psychology, 18 (1954), 443-446. P a r i s h , H.M., "Causes of Death Among College Students," P u b l i c Health  Reports, 71, 1 (1965), 1081. Pokarny, A.D., "A Follow-up Study of 618 S u i c i d a l P a t i e n t s , " The American  Journal o f P s y c h i a t r y , 122, 10 (1966), 1109-1116. Powell, E.H., "Occupational Status and S u i c i d e , Toward a R e d e f i n i t i o n o f Anomie," American S o c i o l o g i c a l Review, 23 (1950), 131-319. Rykken, M.B., "The Nurses' Role i n Preventing S u i c i d e , " Nursing Outlook, 6, 7 (1958), 377-378. Schmidt, E., P. O'Neal and E. Robins, "Evaluation o f S u i c i d a l Attempts as a Guide to Therapy," Journal o f the American Medical A s s o c i a t i o n , 155 (1954), 549-557. Schneidman, E.S., "Preventing S u i c i d e , " American Journal of Nursing, 65 65 (1965), 1111. Shaw, R.H. and R.F. S c h e l k i n , " S u i c i d a l Behavior i n C h i l d r e n , " P s y c h i a t r y , 28, 2 (1965), 1578168. S o r e f f , S.M., The Impact of S t a f f S u i c i d e on a P s y c h i a t r i c In-Patient U n i t , Journal of Nervous and Mental Di s o r d e r s ; 161 (1975), 130. Steng e l , E., "Recent Research i n t o S u i c i d e and Attempted S u i c i d e , " American  Journal of P s y c h i a t r y , 18 (1961-62), 725-728. Steng e l , I., "The Complexity o f Mot i v a t i o n to Attempt S u i c i d e , " Journal of Mental Science, 106 (I960), 1388-1393. Termansen, P., "Su i c i d e and Attempted S u i c i d e i n Vancouver," B r i t i s h  Columbia Medical J o u r n a l , 14 (1972) 28. Toolan, J.M., "Suicide and S u i c i d e Attempts i n Ch i l d r e n and Adolescents," American Journal o f P s y c h i a t r y , 118, 8 (1962), 719-724. Turner, R.H. and J . Vanderlippe, "Self-Image Congruence as an Index of Adjustment," Journal o f Abnormal and S o c i a l Psychology, 57 (1958), Von Hug-Hellmuth, H., "The C h i l d ' s Concept of Death," t r a n s l a t e d by A. K r i s , Psychoanalytic Q u a r t e r l y , 34 (1965), 449-516. 68 Wilson L.T. and C.N. Braucht, "The Severe S u i c i d e Attempter and S e l f Concept," Journal of C l i n i c a l Psychology, 27 (1971) 307. Winn, D. and R. H a l l a , "Observations of C h i l d r e n Who Threaten to K i l l Themselves," Canadian P s y c h i a t r i c A s s o c i a t i o n , Journal Supplement 11 (1966), 283-294. Z i l l b o r g , G., " D i f f e r e n t i a l Diagnostic Types of S u i c i d e , " Archives of Neurology and P s y c h i a t r y , 35 (1936), 270-291. Zuckerman, M. and I. Monashkin, "Self-Acceptance and Psychopathology," Journal of Consulting Psychology, 21, 2 (1975), 145-48. Government Documents B r i t i s h Columbia. D i v i s i o n of V i t a l S t a t i s t i c s , Special Reports No. 1. Death by S u i c i d e i n B.C., 1949-1953. Health Branch, Department of Health and Welfare, Vancouver, B.C., 1954. Canada. V i t a l S t a t i s t i c s . S u i c i d e M o r t a l i t y , 1950-1968. Queens P r i n t e r , Health and Welfare D i v i s i o n , November, 1972. Unpublished Works B u l l e t i n of The S u i c i d e Prevention Centre of Los Angeles, Los Angeles: U.C.L.A. Press, 1966. Jacobs, J . "Adolescent S u i c i d e Attempts." Unpublished Doctor's d i s s e r -t a t i o n , U n i v e r s i t y of C a l i f o r n i a , 1967. (microfilm) Jan-Tausch, J . , "Suicide of C h i l d r e n , " 1960-1963, New Jersey P u b l i c School S t u d i e s , b u l l e t i n of S t a t e of New J e r s e y , Dept. of Education. M i l l e r , D.H. " S u i c i d a l Careers: Toward a Symbolic I n t e r a c t i o n Theory of S u i c i d e . " Unpublished Doctor's d i s s e r t a t i o n , U n i v e r s i t y of C a l i f o r n i a , Los Angeles, 1968. (microfilm) Mintz, R.S. A P i l o t Study o f the Prevelence o f Persons i n the C i t y of Los Angeles who haye Attempted S u i c i d e . U n i v e r s i t y of C a l i f o r n i a at Los Angeles, Neuro-psychiatric I n s t i t u t e , 1964. Perry, D.C, "Self-Acceptance i n R e l a t i o n to Adjustment," Unpublished Doctor's D i s s e r t a t i o n , U n i v e r s i t y of F l o r i d a , 1961. (microfilm) Sieden, R.H. "Youthful S u i c i d e : A Review of the L i t e r a u t r e . " The J o i n t Commission on the Mental Health of C h i l d r e n Task Force I I I , U n i v e r s i t y of C a l i f o r n i a , School of P u b l i c Health, 11, 1967. 69 APPENDICES APPENDIX A CORRESPONDENCE WITH THE VANCOUVER GENERAL HOSPITAL 72 (Mrs.) C. Ann Westwood c/o U n i v e r s i t y of B r i t i s h Columbia School of Nursing Wesbrook B u i l d i n g , #236 Vancouver 8, B.C. December 1, 1972. (Mrs.) Mary McBean D i r e c t o r of Nursing Vancouver General Hospital 10th and Heather Vancouver, B.C. Dear Mrs. McBean: I am w r i t i n g to you to request permission to use the p a t i e n t s of Vancouver General Hospital i n an i n v e s t i g a t i o n which i s an i n t e g r a l part of my education at the U n i v e r s i t y of B r i t i s h Columbia. I r eceived a Bachelor of Science i n Nursing degree from the U n i v e r s i t y of Toronto i n 1969 and am c u r r e n t l y i n the second year of the Masters of Science i n Nursing program at the U n i v e r s i t y of B r i t i s h Columbia. The purpose and method of t h i s i n v e s t i g a t i o n are attached. S p e c i -f i c a l l y the study w i l l r e q u i r e access to 10 male and 10 female pat-ents between the ages of 15 and 24. These p a t i e n t s w i l l be seen w i t h i n 48 hours f o l l o w i n g contact with the Vancouver General Emergency department a f t e r a s u i c i d e attempt has been made. The p a t i e n t s w i l l be seen by the i n v e s t i g a t o r , f o r the purpose of administering two p s y c h o l o g i c a l t e s t s r e q u i r i n g approximately one hour. The i n v e s t i g a t o r w i l l a l s o examine the p a t i e n t s c h a r t . Permission w i l l be sought from the p r i v a t e p h y s i c i a n of the p a t i e n t when necessary. The data c o l l e c t i o n period w i l l extend from December to January 31, 1973. Dr. S l e i g h has given his w r i t t e n permission. Your signature on the t e a r sheet below w i l l i n d i c a t e your favour-able response to my request, I f you r e q u i r e f u r t h e r information please suggest what information you need before making your d e c i s i o n . I f per-mission cannot be granted and you care to make the reasons e x p l i c i t , i t would be most h e l p f u l to me to know why. Thanking you again, I remain, S i n c e r e l y , (Mrs.) C. Ann Westwood Graduate Student. 73 TO: Name Address FROM: TITLE OF STUDY: Permission i s granted to conduct t h i s study at Signature The f o l l o w i n g information i s needed to reach a d e c i s i o n : Permission cannot be given because: 74 TITLE OF INVESTIGATION: A Comparative Study of the S e l f - E v a l u a t i o n o f S u i c i d a l and Non-Suicidal Youth. INVESTIGATOR: (Ms) C. Ann Westwood, BScN (Toronto) THESIS COMMITTEE (Ms) Jaye Horrocks, S of N MS ( C a l i f o r n i a , S.F.) (Ms) Barbara Lee, S of N MN ( C a l i f o r n i a , L.A.) (Mr) John O'Connor, Ph.D. (Michigan) (Sociology) THE PURPOSE AND METHOD OF INVESTIGATION ARE: 1. Purpose: The general aim of the study i s to compare a group of s u i c i d a l youths with a group of no n - s u i c i d a l youths on measures r e l a t e d to t h e i r s e l f -acceptance. T h i s w i l l be accomplished by using s e l e c t e d s c a l e s of the ' C a l i f o r n i a Psychological Inventory' and the 'Berger Scale of Self-Acceptance': Other Acceptance. I t i s f e l t that such a comparison w i l l y i e l d data of importance to the health p r o f e s s i o n s . It i s a l s o f e l t that the nurse with her unique p o s i t i o n i n r e l a t i o n to the p a t i e n t w i l l gain some knowledge from t h i s study and then use t h i s to a i d her in the d e t e c t i o n and prevention of youthful s u i c i d e . 2. Methodology: 1. The i n v e s t i g a t o r w i l l be i n V.G.H. emergency department 2 days a week to s e l e c t p a t i e n t s . 2. Written consent w i l l be obtained from the p a t i e n t or guardian. P r i v a t e p h y s i c i a n s w i l l be n o t i f i e d . S t a f f p h y s i c i a n and nurses w i l l be n o t i f i e d 3. The t e s t s w i l l be administered to the p a t i e n t at his bedside. 4. The p a t i e n t ' s chart w i l l be examined f o r admission data, age, and sex. 5. A l l information w i l l be c o n f i d e n t i a l . APPENDIX B CONSENT FORM 76 My name i s ANN WESTWOOD and I am a graduate nurse taking my masters i n nursing science a t the U n i v e r s i t y o f B r i t i s h Columbia. I am doing some research here i n the emergency department on how people f e e l about themselves. This information w i l l be useful to nurses working with p a t i e n t s and others. I would l i k e you to complete two t e s t s f o r me. This w i l l take about one hour. You w i l l be f r e e to stop at any time, but I w i l l be unable to use your answers unless you complete a l l the questions. Do not sign your name on the answer sheet. I f you wish to p a r t i c i p a t e I w i l l g i v e you a code number. Are you w i l l i n g to p a r t i c i p a t e ? Do you have any questions? APPENDIX C BERGER SCALE OF SELF-ACCEPTANCE 73 QUESTIONNAIRE This i s a study of some of your a t t i t u d e s . Of course, there i s no r i g h t answer f o r any statement. The best answer i s what you f e e l i s true o f y o u r s e l f . You are to respond to each question by c i r c l i n g one of the numbers on the answer sheet that best describes how you f e e l . 1 2 3 4 5 Not at a l l true of myself S l i g h t l y t rue of myself About h a l f -way true of myself Mostly true of myself True o f myself Remember, the best answer i s the one which a p p l i e s to you. QUESTION ANSWER EXAMPLE: 1. C 1, 2, 3, 4, 5 ) 1. I'd l i k e i t i f I could f i n d someone who would t e l l me how to solve my personal problems. ( 1, 2, 3, 4, 5 ) 2. I don't question my worth as a person, even i f I think others do. C 1, 2, 3, 4, 5 ) 3. I can be f r i e n d l y with people who do things which I consider wrong. 4. I can become absorbed i n the work I'm doing that i t doesn't bother me not to have any intimate f r i e n d s C 1, 2, 3, 4, 5 ) C 1, 2, 3, 4, 5 ) QUESTTON ANSWER 5. I don't approve of spending time and ( 1, 2, 3, 4 energy i n doing things f o r other people. I B e lieve i n looking to my f a m i l y and myself more and l e t t i n g others s h i f t f o r themselves. 6. When people say nice things aBout me, I ( 1, 2, 3, 4 f i n d i t d i f f i c u l t to Believe they r e a l l y mean i t . I think mayBe they're kidding me or j u s t aren't Being s i n c e r e . 7. I f there i s any c r i t i c i s m or anyone says ( 1, 2, 3, 4 anything aBout me, I j u s t can't take i t . 8. I don't say much at s o c i a l a f f a i r s Because ( 1, 2, 3, 4 I'm a f r a i d that people w i l l c r i t i c i z e me or laugh i f I say the wrong t h i n g s . 9. I r e a l i z e that I'm not l i v i n g very ( 1, 2, 3, 4 e f f e c t i v e l y But I j u s t don't Believe I've got i t i n -me to use my energies i n Better ways. 10. I don't approve of doing favors f o r ( 1, 2, 3, 4 people. I f you're too agreeaBle t h e y ' l l take advantage of you. 11. I look on most of the f e e l i n g s and im- ( 1, 2, 3, 4 pulses I have toward people as Being q u i t e natural and acceptaBle. 12. Something i n s i d e me j u s t won't l e t me Be ( 1, 2, 3, 4 s a t i s f i e d with any joB I've d o n e — i f i t turns out w e l l , I get a very smug f e e l i n g t h at t h i s i s beneath me, I shouldn't Be s a t i s f i e d with t h i s , t h at t h i s i s n ' t a f a i r t e s t . 13. I f e e l d i f f e r e n t from other people. I'd ( 1, 2, 3, 4 l i k e to have the f e e l i n g of s e c u r i t y t h a t comes from knowing I'm too d i f f e r e n t from others. 14. I'm a f r a i d f o r people that I l i k e to f i n d out ( 1, 2, 3, 4 what I'm r e a l l y l i k e , f o r f e a r they's Be disappointed i n me. QUESTION ANSWER 15. I am f r e q u e n t l y bothered by f e e l i n g s o f i n f e r i o r i t y . 16. Because of other people, I haven't been able to achieve as much as I should have. 17. I am qui t e shy and s e l f - c o n s c i o u s i n s o c i a l s i t u a t i o n s . 18. In order to get along and be l i k e d , I tend to be what people expect me to be ra t h e r than anything e l s e . 19. I u s u a l l y ignore the f e e l i n g s of others when I'm accomplishing some important end. 20. I seem to have a re a l inner strength i n handling t h i n g s . I'm on a p r e t t y s o l i d foundation and i t makes mei p r e t t y sure o f myself. 21. There's no sense i n compromising. When people have values I don't l i k e , I j u s t don't care to have much to do with them. 22. The person you marry may not be p e r f e c t , but I b e l i e v e i n t r y i n g to get him (or her) to change along d e s i r a b l e l i n e s . 23. I see no o b j e c t i o n to stepping on other people's toes a l i t t l e i f i t ' l l help me get what I want i n l i f e . 24. I f e e l s e l f - c o n s c i o u s when I'm with people who have a su p e r i o r p o s i t i o n to mine i n business or at school, 25. T t r y to get people to do what I want them to do, i n one way or another. 26. I often t e l l people what they should do when they're having t r o u b l e i n making a d e c i s i o n . 27. I enjoy myself most when I'm alone, away from other people. 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 U 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 QUESTION 28. I think I'm n e u r o t i c or something. 29. T f e e l n e i t h e r above nor below the people I meet. 30. Sometimes people misunderstand me when I I t r y to keep them from making mistakes that could have an important e f f e c t on t h e i r l i v e s . 31. Very often I don't t r y to be f r i e n d l y with people because I think they won't l i k e me. 32. There are very few times when I compliment people f o r t h e i r t e l e n t s or jobs they've done. 33. I enjoy doing l i t t l e f avors f o r people even i f I don't know them w e l l . 34. I f e e l that I'm a person of worth, on an equal place with others. 35. I con't avoid f e e l i n g g u i l t y about the way I f e e l toward c e r t a i n people i n my l i f e . 36. I p r e f e r to be alone r a t h e r than have c l o s e f r i e n d s h i p s with any of the people around me. 37. I'm not a f r a i d o f meeting new people. I I f e e l that I'm a worthwhile person and there's no reason they should d i s l i k e me. 38. I s o r t of only h a l f - b e l i e v e i n myself. 39. T seldom worry about other people. I'm r e a l l y p r e t t y s e l f - c e n t e r e d . 40. T'rn very s e n s i t i v e . People say things and I have a tendency to t h i n k they're c r i t i c i z i n g me or i n s u l t i n g me i n some way and l a t e r when I think of i t , they may not have meant anything l i k e that at a l l . ANSWER 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 QUESTIONS 41. I t h i n k I have c e r t a i n a b i l i t i e s and other people say so too, but I wonder f f I'm not g i v i n g them an importance way beyond what they deserve. 42. I f e e l c o n f i d e n t that I can do something about the problems that may a r i s e i n the f u t u r e . 43. I b e l i e v e that people should get c r e d i t f o r t h e i r accomplishments, but I very seldom come across work that deserves p r a i s e . 44. When someone asks f o r advice about some personal problem, I'm most l i k e l y to say.. " I t ' s up to you to decide," r a t h e r than t e l l him what he should do. 45. I guess I put on a show to impress people. I know I'm not the person I pretend to be. 46. I f e e l t hat f o r the most part one has to f i g h t his way through l i f e . That means that people who stand i n the way w i l l be hurt. 47. I can't help f e e l i n g s u p e r i o r Cor i n f e r i o r ) to most of the people I know. 48. I do not worry or condemn myself i f other people pass judgement against me. 49. I don't h e s i t a t e to urge people to l i v e by the same high set of values which I have f o r myself. 50. I can be f r i e n d l y with people who do things which I consider wrong. 51. I don't f e e l very normal, but I want to f e e l normal. 52. When T'm i n a group I u s u a l l y don't say much f o r f e a r o f saying the wrong t h i n g . 53. I have a tendency to sidestep my problems. 54. I f people are weak and i n e f f i c i e n t I'm i n c l i n e d to take advantage of them. I be l i e v e yau must be strong to achieve your goals. ANSWERS 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 1, 2, 3, 4, 5 QUESTION ANSWER 55 I'm e a s i l y i r r i t a t e d by people who argue ( 1, 2, 3, 4 with me. 56. When I'm d e a l i n g with younger persons, I C 1, 2, 3, 4 expect them to do what I t e l l them. 57. I don't see much point of doing things f o r ( 1, 2, 3, 4 others unless they can do you some good l a t e r on. 58. Even when people do think well of me, ( 1, 2, 3, 4 I f e e l s o r t of g u i l t y because I know I must be f f o o l i n g them-- that i f I were r e a l l y to be myself, they wouldn't think well of me. 59. I f e e l t h at I'm on the same l e v e l as other ( 1, 2, 3, 4 people and that helps to e s t a b l i s h good r e l a t i o n s with them. 60. I f someone I know i s having d i f f i c u l t y i n ( 1, 2, 3, 4 working things out f o r himself, I l i k e to t e l l him what to do. 61. I f e e l t h at people are apt to re a c t ( 1, 2, 3, 4 d i f f e r e n t l y to me than they would normally r e a c t to other people. 62. I l i v e too much by other people's standards. ( 1, 2, 3, 4 63. When I have to address a group, I get ( 1, 2, 3, 4 s e l f - c o n s c i o u s and have d i f f i c u l t y i n saying things w e l l . 64. I f I d i d n ' t always have such hard l u c k , ( 1, 2, 3, 4 I'd accomplish much more than I have. APPENDIX D COMPUTER PRINT-OUT > rS"M-r-hS-T-I-e*t-P-ACr-A-GE—1= OR - T H E - S O C ' I - A L-"SeiENC^ - S ^ P S^M^ ^ E^^e— F I C E NONAME ( C R E A T I O N D A T E = 07/07/76) * " ' • * ""I -" - - - - - - - - - - - - - - - - - - - - - - O N E W A Y -V A R I A B L E C P I -t»T/07-/Ttr- -pflTGE-C O N T R A S T C O E F F I C I E N T M A T R I X S U I C I D E S NORMAL E M E R G E N C C O N I R A S T 1 1 .0 -1 .0 0 . 0 C O N T R A S T 2 t . 0 0 .0 -1 .0 C O N T R A S T 3 1 .0 -0 .5 -0 5 CON TRAST 4 0 . 0 1 . 0 -1. 0 C O N T R A S T C O N T R A S T CONTR-AST— C O N T R A S T V A L U E -8.5000 - 10.0000 —•-•9T?5Cro--1 .5000 S . ERROR 2.4302 2.4302 2TT0-4-6-P O O L E O V A R I A N C E E S T I M A T E T V A L U E D.F. •3.498 •4.115 •'4.395-27.0 27.0 27.0 T P R O B . 0.002 0.000 0 .000 S E P A R A T E V A R I A N C E E S T I M A T E S . ERROR T V A L U E D . F . 2.5597 1.SI 72 2.4302 •0.617 27.0 0.542 -TT7209" 2.8042 -3.321 -5.503 -=•5X375--0.535 1 2 . 1 15.5 -T9TO-1 5 .4 P R O B . 0 . 0 0 6 0 . 0 0 0 ~0~. 0 0 0 • 0 . 6 0 1 T E S T S FOR H O M O G E N E I T Y OF V A R I A N C E S C O C H R A N S C = MAX• V A R I ANCE/SUM<VARI A N C E S) = 0.6272, P "ETA RT L F/TT - ETOX -F—= 3.016, P MAXIMUM V A R I A N C E / M IN IMUM V A R I A N C E = 5.5B2 0.027 < A P P R O X . ) 0.048 >" ' ; • ; : •. CO •cn ^-S^ftTlSTlC*tr-P*CK-AGE FOR TWE—SeC-I-Atr-S€-teN€^S-SPSSH - RELEASE 6.02 F I L E NONAME (CREATION DATE = 0 7 / 0 7 / 7 6 ) - ----- - - . - - > - . - ' - . - ' . - - - - d N E~V» A Y • VARIABLE CPI -0-7/07/7^- -PAGE-AN AL Y SIS OF VARIANCE SOURCE BETWEEN GROUPS TM !N "GPUUPS— TOTAL D.F . 2 — t r -SUM OF SOUARES-5 8 1 . 6 6 0 2 7 9 7 . 3 1 ? 5 MEAN SQUARES 290.8301 g9.5301 F RATIO 9.849 F PROB. 0.001 29 1378.9727 STANDARD S T ANDARB GROUP COUNT MEAN DEVIATION ERROR MINIMUM MAX I MUM 95 PCT C.0NF INT FOR MEAN SUICIDES 10 14.8000 3 .1552 0 .9978 10. 0000 19 .0000 12.5429 TO 1 7 .0571 EMERGENC 10 23 .3000 7 .4543 2 . 3S73 9 . 0000 32 .0000 17.967b TO 28 .6325 - • — NORMAL 10 24 .8000 4 .8028 1 .51 88 16 . 0000 32 .0000 21 .3642 TO 28 .2357 TOTAL 30 2 0 . 9 6 6 7 6 .8957 1 .2590 9 . 0000 32 .0000 18.3918 TO 23 .5415 FIXED EFFECTS MODEL 5 .4342 0 .9921 18.9310 TO 23 .0023 RANDOM EFFECTS MODEL 5 .3929 3.1136 7 .5698 TO 3 4 . 3 6 3 5 -•'CO v,v°V > F I L E frf-feAtr"PAt**GE F O P THE SOCIO t — S CIENCES SP3SM NONAME (CREATION DATE = 07/07/76> RELEASE 6.08- O ( / 0 / / 7 D -P-AGE-VARIA8LE BERGER CONTRAST COEFFICIENT MATRIX 'SUICIDES NORMAL EMERGENC CONTRAST 1 1.0 -1.0 0.0 CONTRAST 2 1 .0 0.0 -1.0 CONIRAST 3 1.0 -0.5 -0.5 CONTRAST 4 0 . 0 1 .0 -1.0 CONTRAST 1 CONTRAST 2 t-C0NTffAS1 3 ' CONTRAST 4 VALUE "31.7000 -36.9000 •34 . 3TJOO-S. ERROR 12i5193 12.5193 — 1 0TB<r2r-POOLEO VARIANCE ESTIMATE T VALUE D.F. '2.532 •2.947 r r r t 6 - 4 — " 2 7 .0 27.0 -5.2000 12.5193 •0.415 r t r 2 7 . 0 T P R O B . — 0 . 0 1 7 0.007 0.004 SEPARATE VARIANCE ESTIMATE S. ERROR T VALUE D.F. 12.8498 12.7292 1 1 .305-4--2.467 -2.899 •3.034 17.8 17.7 0.681 1 1 .9604 -0.435 18.0 T PROB. 0 .024 0.010 0 .669 TESTS FOR HOMOGENEITY OF VARIANCES COCHRANS C = MAX. VARIANCE/SUM(VARIANCES) BARTLETT-UOX-F—= MAXIMUM VARIANCE / MINIMUM VARIANCE 0.3915. P —OTO-9 5 » p-1.315 0.618 (APPROX.) 0.903 .CO -S^^i-ST-rc-A t - P * CK-ft-G e-F-OR-THC-SOCI-At-SCI-eWCES SPSSM - RCLE-A-SE 6.02 F I L E NONAME (CREATION DATE = 0 7 / 0 7 / 7 6 ) U 7 / 0 7 / 7 6 PAGE O N E W A Y VARIABLE BERGER ANALYSIS OF VARIANCE SOURCE B E T « E E N GROUPS -1TTT MIN"GPOOPS— TOTAL O . F . SUM OF SQUARES 2 7 9 7 8 . 4 3 7 5 Zl 21 159 .0625 29 2 9 1 3 7 . 5 0 0 0 MEAN-SQUARES ~ 3989.2187 783.6689 F"RATIO ' 5.090 F -PROB'. 0 .013 GROUP SUICIDES EMEPGENC NORMAL TOTAL COUNT 10 10 10 30 MEAN 7 4 . 6 0 0 0 106 .3000 111.5000 9 7 . 4 6 6 7 FIXED EFFECTS MODEL RANDOM EFFECTS MODEL —S IANUARD DEVI AT ION 3 0 . 3 3 9 6 27.031 I 26 .4544 31 .6976 27.9941 19.9731 SIANDARD ERROR 9 .5942 8 .5480 8 .3656 5 .7872 MINIMUM 44 .0000 64 .0000" 63 .0000 44 .0000 MAXIMUM 142 .0000 l 49 .0000 140.0000 149.0000 95 PCT CONF INT FOR MEAN 9 6 . 3 0 3 6 125.636 8 130 .4243 109.3027 52 .8964 " 8 6 . 9 6 3 1 92 .5757 TO TO TO 85 .6306 TO 5 .1110 11 .5315 86 .9798 47 .8503 TO TO 107 .9536 147.0830 -•co-co" 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0100110/manifest

Comment

Related Items