Development of a Questionnaire on Attitudes Towards Suicide (ATTS) and Its Application in a Swedish Population

Abstract

An instrument measuring attitudes toward suicide was developed through two postal questionnaire surveys, 1986 and 1996, approaching general population samples of 700 and 1,000 persons, respectively, and with response rates of 75% and 64%. A 10-factor model was obtained and comparisons between waves revealed an overall more permissive and pro-preventional attitude in 1996. The results implied complex relationships at the aggregated level between attitudes and suicidal behavior, depending on type of suicidal behavior, attitude factor, and subgroup. At the individual level, persons answering affirmative on own suicidal behavior, as compared to the nonsuicidal group, held a more permissive and understanding attitude toward suicide.

The Acceptability of Suicide Among Rural Residents, Urban Residents, and College Students from Three Locations in China

“…Similar to our study, most studies from other countries find more accepting attitudes about suicide among those with more education (Salander Renberg & Jacobsson, 2003; Singh, Williams, & Ryther, 1986) so this appears to be a robust relationship cross-nationally. The higher acceptability of suicide among females found in our study is also found in some, but not all, studies from other countries (Agnew, 1998; Beautrais, Horwood, & Fergusson, 2004; Hjelmeland et al, 2008; Joe, Romer, & Jamieson, 2007; Kocmur & Dernovšek, 2003; Parker, Cantrell, & Demi, 1997; Salander Renberg & Jacobsson, 2003; Zemaitiene & Zaborskis, 2005); the finding in China could be related to the relatively high rate of suicide in Chinese females compared to that in other countries (WHO, 2002).…”

“…Similar to our study, most studies from other countries find more accepting attitudes about suicide among those with more education (Salander Renberg & Jacobsson, 2003; Singh, Williams, & Ryther, 1986) so this appears to be a robust relationship cross-nationally. The higher acceptability of suicide among females found in our study is also found in some, but not all, studies from other countries (Agnew, 1998; Beautrais, Horwood, & Fergusson, 2004; Hjelmeland et al, 2008; Joe, Romer, & Jamieson, 2007; Kocmur & Dernovšek, 2003; Parker, Cantrell, & Demi, 1997; Salander Renberg & Jacobsson, 2003; Zemaitiene & Zaborskis, 2005); the finding in China could be related to the relatively high rate of suicide in Chinese females compared to that in other countries (WHO, 2002). Controversy remains about the relationship of age to attitudes about the acceptability of suicide (Salander Renberg et al, 2008; Salander Renberg & Jacobsson, 2003; Segal, Mincic, Coolidge, & O’Riley, 2004); the decreasing acceptability of suicide as individuals age (after adjusting for educational level) found in our study may be a reflection of an underlying culturally conditioned conservatism that results in increasing intolerance to all forms of social deviance (including suicidal behavior) as one ages.…”

“…There are several possible explanations this unexpected finding. Attitudes may be positively related to the prevalence of suicidal ideation and non-fatal suicidal behavior but not to suicidal deaths (Salander Renberg et al, 2008; Salander Renberg & Jacobsson, 2003); thus the rates of ideation and attempts could be higher in students and urban residents but the case-fatality of the behavior may be higher in rural areas because rural residents are more likely to ingest highly lethal pesticides in their suicide attempts and have less access to the high-tech services needed to manage pesticide poisoning (Yang et al . 2005).…”

“…2004; Eskin, 2004; Colucci & Martin, 2007; Etzersdorfer, Vijayakumar, Schöny, Grausgruber, & Sonneck, 1998; Gibb et al, 2006; Joe et al . 2007; Kocmur & Dernovšek, 2003; Salander Renberg & Jacobsson, 2003; Stein, Brom, Elizur, & Witztum, 1998; Stein et al, 1992; Zemaitiene & Zaborskis, 2005), but some studies find no clear association between attitude changes and changes in suicidal behavior (Cleary & Brannik, 2007; Robertson & Cochrane, 1976) and other studies find a negative relationship (Platt, 1989; Sale, Williams, Clark, & Millis, 1975). …”

“…Early beliefs that there was a direct causal link between suicidal behavior and attitudes about suicide (Farberow, 1989) have given way to a more nuanced understanding of the complex interactions between attitudes and behavior. For example, the social acceptability of suicide or permissiveness towards suicide-- one of the most commonly assessed attitudinal dimensions-- can have different or even contradictory effects on suicide rates: it can increase or decrease community members’ consideration of suicide as a solution to life problems, it can increase or decrease the willingness of suicidal individuals to seek help, and it can affect the accuracy of reports of suicide as a cause of death (Goldsmith et al, 2002; Ramsay & Bagley, 1985; Salander Renberg & Jacobsson, 2003). Thus countries with strong religious or legal prohibitions that make suicide socially unacceptable tend to report low rates of suicide and low rates of care-seeking for suicide-related behaviors, but they may also have much higher rates of missing or misclassified deaths by suicide (Gajalakshmi & Peto, 2007).…”