Terms and Definitions for Suicide: Steps Towards the Elaboration of an International and Intercultural Nomenclature for Suicidal Behaviours

Abstract

Variability in terms and definitions to describe suicidal behaviours and ideation may have led researchers to duplicate their efforts in suicidology thereby possibly wasting valuable resources in a field where funding is scarce. Published nomenclatures appear not to reach a global use. This situation pushed some scholars to advocate for the use of a common nomenclature and a common classification to describe suicidal behaviour that would appeal to the majority of users, whatever their background and whichever their country. A first step towards a universal nomenclature could be to assess the variability of use of definitions and terms. The aims of this dissertation are to describe the published background in the field of nomenclatures, definitions and classifications, and provide a historical and cultural context to the use of terms and definitions to describe suicidal behaviours and ideation. The experimental part of this research consists in a worldwide study of definitions and terms for suicidal behaviours, the results of which were used to elaborate a universal English-language nomenclature of suicidal behaviours. A systematic literature review of contemporary English language nomenclatures found them to be logically organized according to outcome and intent. It appeared that the range of the nomenclatures was fundamental in how the nomenclature were logically organized. A systematic review of terms and definitions was performed based on the four most common characteristics of the definition of suicide found in the literature, i.e. outcome, intent, knowledge of the consequences of the act, and agency (self- or other-inflicted). These four characteristics appeared to cover the vast majority of the concepts underpinning existing definitions, enabled an explanation of the variability of published definitions and were considered for use as tool for research. Intent to die in the definition of suicide was quite agreed upon. However, some authors suggested that intent should refer to something other than death. A systematic review of contemporary classifications of suicidal behaviour revealed they were becoming increasingly precise and operational for clinical and research purposes. On the other hand, the development of new classification systems despite lack of international consensus on definitions and terms related to suicidal ideation and behaviour could potentially lead to an increased level of confusion. An examination of historical context revealed that the term ‘suicide’ appeared in Europe in a period of deep moral change during the seventeenth century, when attitudes toward suicide became more tolerant. A review in the Pacific Islands suggested that local traditional terms often referred to a method having close ties with the cultural context. The methodology of the Worldwide Study of Definitions and Terms for Suicidal Behaviors© (WSDTSB) was then described. The study rationale was to overcome the confusing landscape and poor agreement among authors of nomenclatures, definitions, terms, and classifications in the field of suicidology. The study questionnaire was developed on the basis of the four main criteria of the definition of suicidal behaviour: outcome, intent, knowledge (of the consequences of the act), and agency (self- or other-inflicted). Two types of participants were invited in the study. ‘Experts’, each representing a country, were recruited through international organizations. IASP members that were not national representatives comprised the comparison sample. Methodological limitations were that the study was conducted in the English-language only, and ‘experts’ were designated among IASP national representatives and in six cases among other international associations; in some cases, it is possible that these persons did not have more expertise than IASP members. The results of the WSDTSB were then analysed. Levels of agreement to statements enabled comparison between responses of samples (‘experts’ vs. IASP members), and countries’ language and income background groups, occupation and professional background groups. Regarding the definition of suicide, the highest levels of agreement and similarities between samples and groups were found for fatal outcome, non-clear-cut statements regarding intent and knowledge, and self-infliction. Regarding non-fatal suicidal behaviour and ideation, the highest levels of agreement and similarities between samples and groups were found for definitions of ‘suicide attempt’, ‘suicidal ideation’, ‘death wishes’, ‘suicide plan’, and ‘interrupted suicide attempt’. The results of the WSDTSB were discussed and a nomenclature of suicidal behaviours and ideation was proposed as a baseline for further steps towards a universal classification of suicidal behaviours and ideation. Other limitations of this study were a relatively low participation rate and the low representation of low- and middle-income countries, especially those of the African continent. The necessity to go further in the search of a universal nomenclature was discussed. It was suggested that further research should move on with the aim of elaborating a universal classification of suicidal behaviours possibly based on the results of the present study. Suggestions were made regarding further steps to take.