Looking Beyond Suicide: A Qualitative Content Analysis of Suicide Notes in a Rural Community

Background and Purpose: The World Health Organization (WHO) estimates that 800,000 individuals die by suicide every year (WHO, 2019). In addition, suicide rates have increased nationwide and most rapidly in rural counties. Within the United States, suicide and related behaviors account for approximately 40,000 deaths and 575,000 emergency room visits annually. For most non-suicidal people, it is hard to understand why someone would want to die by suicide. It has been argued that suicide notes are an invaluable starting point for assessing and predicting suicide and parasuicidal behavior. Consequently, researchers have recommended examining national mortality statistics, psychological autopsies, nonfatal suicide attempts, and records such as suicide notes to get insight into the suicidal mindset. Over the last six decades, studies of suicide notes have been a significant focus of suicide research, focusing on patterns in the notes' wording.

Methods: This research aimed to interpret the content and meaning of suicide notes to identify any valuable information for the purpose of suicide prevention in rural communities. To aid in developing the understanding of suicide, Leenaars and the Multidimensional Theory of Suicide (MTS) was utilized. This research used a qualitative content analysis approach to analyze the suicide notes which consisted of seven suicide notes obtained from a police department in a rural community in a southern state. A coding list was developed based on the MTS and consisted of eight discrete clusters grouped into five intrapsychic and three interpersonal aspects. The analysis included an account of the stories that the suicide notes told using a six-phase content analysis approach.

Results: This study's findings support the MTS, which identifies two components that explain suicidal behavior. Moreover, the model implies that the desire to die by suicide is linked to intrapsychic and interpersonal elements. Even though each decedent left a unique suicide note, all seven suicide notes coincided with one of the two elements. The warning sign themes that emerged from this study are ideation, hopelessness, and mood. In addition, the themes found in this study that correlate with suicide risk factors are themes of health, environment, and history.

Conclusions and Implications: The study results add to the growing research of suicide and may help better prepare social workers and mental health providers working with rural clients at risk for suicide or displaying warning signs with the perspective of individuals who have died by suicide. A more profound understanding was formulated for improving how individuals respond to suicide warning signs and risk factors in rural settings. This research further supports the need for a better understanding of recognizing the signs, particularly for underserved populations such as rural communities.