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Exploring the relationship between suicide-related stigma and suicide risk
Get PDFBackground: Suicide is a major public health concern with around 727,000 people dying by suicide globally each year. Research in the field of suicide aims to understand the risk factors associated with suicide and how best to prevent suicide. However, despite growing research in the area, suicide-related stigma remains under researched as a potential risk factor for suicide. Although there has been an increase in research and a growth in the conversations around suicide, it is still seen as taboo within society and remains illegal in some countries. Progress has been made to better understand suicide, with theories investigating biological, psychological and sociological factors associated with suicide risk. Recent reviews also highlight that suicide-related stigma is associated with several negative outcomes for those bereaved by suicide. Therefore, it is important for further research to understand whether similar outcomes exist among those who have attempted or thought about suicide. It is also important to understand how suicide-related stigma differs across demographic characteristics and how best to mitigate this stigma. Therefore, this thesis aims firstly to examine group differences in suicide-related stigma and experiences, and secondly to understand its impact on those with lived experience.
Methods: This PhD thesis comprises five research chapters. It begins with a scoping review which aimed to understand the associations between suicide-related stigma and help-seeking, grief, mental health and suicide risk (n = 100 studies). Chapters 3 and 4 present the findings from a quantitative study. Chapter 3 investigated associations between suicide-related stigma, help-seeking, mental health and suicide risk, and whether stigma levels differed by age, gender, education and suicidal history. Chapter 4 examined mechanisms behind stigma within the Integrated Motivational-Volitional (IMV) Model using mediation analyses. Chapters 5 and 6 relate to qualitative interviews (n = 30) which were conducted as part of this thesis. Chapter 5 used the Framework analysis method to understand whether the experiences of those who had attempted suicide differed from those who had thought about suicide with regards to suicide-related stigma. Finally, Chapter 6 aimed to provide recommendations for the reduction of suicide-related stigma based upon suggestions of those with lived experiences using Reflexive Thematic Analysis.
Results: The scoping review (Chapter 2) highlighted the negative effects of suicide-related stigma, such as a higher risk of suicidality, poor mental health, lowered help-seeking intentions/behaviours and grief-related difficulties among those bereaved by suicide. Suicide-related stigma was found to be related to feelings of isolation, shame and secrecy. A small number of studies discussed the protective nature of suicide-related stigma in that it can encourage help-seeking. The scoping review allowed for the development of a novel model of suicide-related stigma which displays the directionality of these associations. In the first quantitative study (Chapter 3, n = 470 participants), males were found to stigmatise those who die by suicide more than females. The analyses in Chapter 3 also found that individuals with a history of suicide (thoughts or attempts) held fewer stigmatising attitudes towards those who die by suicide but more stigmatising attitudes towards those bereaved by suicide and suicide attempts compared to those without a suicidal history. Chapter 3 found significant associations between suicide-related stigma and higher levels of depression, anxiety and suicidal ideation as well as lower help-seeking intentions. In Chapter 4 (additional analyses from the survey reported in Chapter 3), serial mediation analyses revealed that defeat and entrapment fully mediated the relationship between the glorification of suicide, suicide-related stigma measures and suicidal ideation. Chapter 5 explores the findings from the qualitative study. A key finding was that those with a history of suicide attempts had similar experiences regarding suicide-related stigma to those with a history of suicidal thoughts. Five themes were developed from the interviews: 1) “suicide is stigmatised;” 2) “it’s like the elephant in the room, nobody wants to talk about it;” 3) “I was so ashamed;” 4) “I think generally people think suicide is selfish, cowardly, inexplicable, mad;” and 5) “So I guess it’s about being taken seriously and being believed almost.”. These themes captured the silence and secrecy around suicide, the negative labels attached to those who experience suicidality and the shame associated with these experiences as well as the experience of their reasons for their suicidality being questioned. Finally, Chapter 6 (further analyses from the interviews described in Chapter 5) explored the consequences of suicide-related stigma and yielded suggestions from those with lived experience regarding how to reduce the stigma related to suicide. These analyses identified three themes related to the impact of suicide-related stigma: negative consequences, positive and supportive reactions, and no impact. Most of the participants described the negative consequences of suicide-related stigma such as lowered help-seeking and poor mental health outcomes. Regarding how suicide-related stigma could be reduced, two themes emerged from the transcripts: education and open conversations. Most of the participants described the importance of education in schools and workplaces to mitigate suicide-related stigma as well as the importance of having open and non-judgmental conversations around suicide.
Conclusion: To my knowledge this thesis includes the first literature review of its kind, a scoping review investigating the associations between suicide-related stigma and help-seeking, mental health, grief, and suicide risk among different groups of individuals. This review led to the development of a model explaining the directionality of the associations between suicide-related stigma and the outcomes explored within the review. The quantitative and qualitative studies provided novel findings, such as defeat and entrapment mediating the stigma–ideation relationship and lived-experience accounts of the impacts of suicide-related stigma and potential interventions to reduce stigma. The findings reveal possible groups for intervention, such as men (Chapter 3) while also highlighting the similarities in the way those affected by suicide experience stigma. The evidence presented in this thesis has important implications for policy and clinical practice
Towards a better understanding of confidence: evaluation and advancement of confidence models
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Macrovascular aspects of hypertension mediated organ damage
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S-palmitoylation and regulation of the cardiac transient outward current
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Three essays on information and behavioral economics
Get PDFThis thesis comprises three essays that explore the interplay between strategic behavior, information transmission, and welfare-enhancing policy interventions.
The first chapter develops a multi-receiver incomplete information coordination game with unbiased and biased agents. Unbiased agents aim to align with the underlying state of nature and coordinate with others, while biased agents favor a specific collective outcome. A randomly selected sender observes the state and communicates strategically to the group. I show that truthful communication and full social learning can be sustained in equilibrium provided the degree of conformity among unbiased agents does not exceed one-half and the share of biased agents remains below fifty percent.
The second chapter examines rumor propagation on networks by modifying the communication–coordination game introduced in the previous chapter so that conformity depends on local interactions only. I demonstrate that introducing a small degree of conformity enlarges the parameter space in which truthful communication occurs, thereby relaxing the constraints on biased participation compared to existing models.
The third chapter shifts focus to consumer behavior and welfare by analyzing optimal taxation of sin goods under self-control problems. Using the temptation model of Gul and Pesendorfer (2001) in a monopoly setting, I characterize an endogenous quality–price ceiling and derive welfare-maximizing tax policies. I show that optimal ad valorem taxes decline with market size, potentially turning into subsidies, while specific taxes are not optimal for domestically produced goods. By contrast, for imported goods, both ad valorem and specific taxes improve welfare, with ad valorem taxes yielding substantially larger gains
Police adoption of body-worn video technology in England and Wales: a socio-technical analysis of change
Get PDFUsing qualitative methods in the context of policing in England and Wales, this doctoral research examines how police and body-worn video (BWV) technology shape one another. It explores the impact of the technology, the technology as a product, and the process of interaction between police and BWV systems. The research responds to both the rapid development of BWV technology systems and their widespread adoption across UK policing organisations since their first trial in 2005.
Most studies on police adoption of BWV technology have been conducted in the United States, are quantitative and experimental in design, and focus primarily on behavioural outcomes (Lum et al., 2019; O’Neill et al., 2024). Consequently, there remains a need for qualitative inquiry into how BWV technology adoption has influenced policing in England and Wales, at organisational and potentially regional levels. As Flight (2020) notes, when it comes to body-worn video and policing, technology matters. It is therefore necessary to identify and understand significant shifts in BWV technology development and use within policing organisations, including potential diffusion (Rogers, 2003) to new users and function creep into new applications shaped by these technological developments. Moreover, the design and functionality of BWV systems, and their patterns of police use, have broader implications for public interaction, institutional arrangements, and academic research on police technology adoption (Fan, 2017; 2018a; 2018b).
To address these questions, the research combines qualitative data collection with secondary sources to examine the impact of BWV technology adoption and to describe the mutual shaping process between police organisations and BWV technology in England and Wales. In-depth semi-structured interviews were conducted with members of police organisations, a BWV technology vendor, and a third-sector organisation, complemented by field observations of officers responding to emergency calls. Data were analysed thematically using a socio-technical analytic framework to describe how BWV technology and police organisations influence one another and to examine the implications that may result for society.
Given that technical components (materiality) of BWV technology have been largely neglected in prior research (Flight, 2020; see also Ariel et al., 2016; Willis, 2022), a socio-technical analytic framework was adopted to give equal consideration to social arrangements and technical systems. A dual-nature view of technology (treating it as both a product and process) was used to ensure that the technical components were examined in theory and in practice. Recognising that analytic approaches grounded in relational ontologies, such as actor-network theory and ‘new’ materialism, tend to focus narrowly on the process of organisational technology use (Roberts and Grabowski, 1999), this research integrates insider interview data, BWV guidance documents, and policy analysis to extend the focus by examining impact. In so doing, this research describe shifts within policing organisations and, where relevant, in regional policing more broadly.
The data are analysed and the findings articulated to narrate the story of change arising from BWV technology adoption and to explain the mutual shaping of police organisations, officers, and the BWV technologies they select, implement, and use. Empirically, the research identifies shifts in policing in England and Wales relating to transparency, accountability, and police protection. Theoretically, it contributes by synthesizing and critically analysing existing BWV technology research to reveal conceptual and methodological imbalances, advancing criminological debates on the relationship between police and technology. It also introduces a conceptual toolkit that integrates socio-technical theory and dual-nature perspectives of technology, providing analytic categories for examining both the design and material components of BWV systems (technology as product) and the social arrangements that shape their use (technology as process). Central to this framework is the concept of (mis)alignment, which highlights how certain organisational practices and interpretations correspond more closely than others with the technology’s design and intended purpose. Together, these insights support future research on police technology adoption and the mutual development of technical and organisational systems
Performance generalization and offline excitability are tied to task structure awareness
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An illustration and interrogation of the spectrum of Robert Burns's masculinity
Get PDFThis MPhil dissertation is an illustration and interrogation of the spectrum of Robert Burns's expressions of masculinity. Through a historicised approach, this study accounts for the eighteenth-century literary and social conditions which influenced Burns's understanding and subsequent enactment of masculinity. Surveying the influence of sentimentalism and Adam Smith’s notion of ‘sympathy’ on Burns’s life and work, the ‘spectrum of masculinity’ which is outlined begins with Burns’s significantly portrayal of himself as a 'Man of Feeling'. Furthermore, an examination of the social, cultural, and intellectual spheres which Burns produced writing for provides fruitful insight into the varied self-fashioning of his masculinity, which he tailors to his diverse audiences. Ultimately, this demonstrates that his unique access to multiple spheres produced a uniquely nuanced spectrum of masculine expressions. Notably, these spheres spanned socio-economic boundaries as Burns formed friendships with both economically struggling working men and men of a higher socioeconomic status. While this study has a central focus on homosocial spheres, it also addresses Burns's awareness of the discourse on women's rights which was contemporary to him with the publication of Mary Wollstonecraft's pioneering feminist work A Vindication of the Rights of Woman (1792). This is situated in a wider evaluation of Burns's interaction with the concept of masculine authority, which features his bawdy work which ostentatiously celebrates male sexuality – lying at the other end of the ‘spectrum’ which is laid out. Burns's attitude towards masculine authority was varied - he upheld that authority through his expression of dominance in his writing while he also critically engaged with the futility of male dominance in his narrative masterpiece ‘Tam o’ Shanter’. Overall, this study utilises Robert Burns's complex expressions of masculinity to address contemporary anxieties concerning its nature – demonstrating that, for the poet, masculinity encompasses a wide range of traits which result from a fusion of cultural, social and biographical factors
Speaking of power: politicisation, hierarchy, and language ideologies in post-23J Spain
Get PDFThis thesis explains the increasing politicisation of Spain’s minoritised languages during and after the 2023 general elections, and what this reveals about language ideologies and hierarchies. Bringing state and regional materials into one framework, it analyses party manifestos (2023, 2024), Spanish parliamentary debates (2023, 2025), and briefly discusses the bid for EU recognition of co-official languages (2023-2025). It asks how languages and speakers are discursively constructed in these texts, and how these discourses reproduce or disrupt hierarchy. Using the Discourse-Historical Approach within Critical Discourse Analysis, the study links textual strategies to socio-historical context. Findings show that the explicit positioning of language in party politics reorders or cements the asymmetries codified in Article 3 of the 1978 Spanish Constitution. Hierarchy persists where Castilian functions as the unmarked common medium and recognition of other languages remains largely symbolic. It is challenged where co-official languages are normalised as civic infrastructure, backed by enforceable obligations, budgets, and routine institutional use. The thesis models hierarchy across state, regional, and EU institutional scales, showing why recognition without material responsibility fails to shift practice
Using a precision public health approach to inform the prevention and management of obesity
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