“I think I am worth it. I can give up committing suicide”: Pathways to recovery for Chinese-Canadian women with a history of suicidal behaviour

Abstract

This qualitative study explored the experiences and patterns of recovery of Chinese-born women living in Canada with a history of suicidal behaviour. It explores a number of dimensions of recovery including clinical, existential, functional, physical, and social. The women described engaging in “survival” recovery in the short term and “thriving” recovery in the long term, with survival strategies extending into the thriving phase of recovery during their complex path to it. The survival recovery phase included accessing culturally sensitive mental health care and obtaining social and instrumental support to help ensure safety, manage stress, and treat psychiatric symptoms. The thriving phase of recovery was described as involving six components: developing an explanatory model with their health care provider; undertaking a process of narrative reflection and prioritizing self-care; engaging in interdisciplinary care team support; engaging the support of family and friends; exploring spiritual and existential supports; and creating goals for the future and a sense of mastery. Through these six avenues, the women began to experience a sense of self-efficacy and agency that improved their ability to cope with stress and pressure, leading to building a life with meaning. The interviews provided insights into how clinical care can be improved and how practitioners can implement a more recovery-oriented approach to practice.

“I thought that I had to be alive to repay my parents”: Filial piety as a risk and protective factor for suicidal behavior in a qualitative study of Chinese women

“…Education can be provided to families around how a positive supportive family environment and increased perceived receipt of filial piety can be protective for future suicidal behavior (Liu et al, 2017;Simon et al, 2014), combined with clinical efforts to apply these concepts to the specific family context. This is consistent with previous findings that family involvement in treatment of mental illness can be helpful in Chinese populations with severe mental illness (Chow et al, 2010;Zhao et al, 2015) or suicidal behavior (Zaheer et al, 2019). The intervention can involve clinicians asking individuals how they define filial piety so that families can engage in tangible acts of filial piety.…”

“…These factors, if inquired about as part of the individual's overall goals of recovery, could be evaluated regularly after suicidal behavior and be clinically useful in fostering recovery. This is consistent with a dimensional approach to recovery that moves beyond clinical recovery to a focus on recovery that encompasses functional, existential, and social recovery (Zaheer et al, 2019).…”

“…Chinese women who describe rigid parental expectations of filial piety, a harsh or unsupportive family environment, low personal value placed on filial piety, painful consequences of rebelling against their family, and low perceived receipt of filial piety may have a higher suicide risk than women lacking some of these factors. Conversely, a suicide risk assessment of Chinese women could also include questions around inverse protective factors, some of which have been found to be helpful to foster in recovery in Chinese-Canadian women with suicidal behavior (Zaheer et al, 2019). The majority (86%) of the Chinese women in this study spontaneously discussed family factors and filial piety in their interviews, suggesting that these factors could improve the cultural adaptedness and clinical usefulness of the psychiatric assessment if confirmed in future studies.…”

“…Treatment could involve the family, specifically having parents and children describe the importance of the participant's role in their family. Communicating one's value in the family was similarly found to be important in the recovery of Chinese-Canadian women with suicidal behavior (Zaheer et al, 2019). Education can be provided to families around how a positive supportive family environment and increased perceived receipt of filial piety can be protective for future suicidal behavior (Liu et al, 2017;Simon et al, 2014), combined with clinical efforts to apply these concepts to the specific family context.…”

Suicide resilience: A concept analysis

“…Across studies, individuals who have higher levels of social support are less likely to consider suicide and can recover from being suicidal faster. Social support can come from various sources, including family, partners, friends, relatives, healthcare professionals, community, religion, and pets ( 43 , 46 , 59 ). The social support system for people at high risk of suicide has been identified as a significant influencer on resilient outcomes.…”