Concerns and moral careers of parents of sons and daughters with suicidal behaviour

Background: This PhD study was part of iCare, a Danish programme aiming to develop web-based support for parents of sons and daughters with suicidal behaviour. Parents are deeply affected when their child exhibits signs of suicidal behaviour. Research provides insights into parents’ experiences concerning their child’s suicidal behaviour, predominantly focused on its psychological and emotional impact on parents. However, there is a paucity of knowledge about how such behaviour affects parents’identity. Moreover, existing qualitative reviews on parents’ experiences have offered few interpretive and theoretical explanations that may contribute to knowledge within this field. Parents are significant informal caregivers for their child with suicidal behaviour, but they lack sufficient support in coping with their situation. Web-based support may help them overcome some of their challenges. The PhD sub-studies of this dissertation were designed to strengthen the efficacy of the iCare programme. We specifically adopted a participatory orientation to shape and refine the website design. This meant that researchers collaborated with and learned from service users as part of the design processes. Although collaborative practices are assumed to facilitate a sense of ownership in service users, the psycho-social processes of ownership development appears to be under-researched.

PhD study aims:
Sub-study I: To identify original qualitative studies of relatives’ experiences of providing care for individuals with non-fatal suicidal behaviour and to systematically review and synthesize this research.
Sub-study II: To explore how parents re-constructed and negotiated their parental identity after realising that their offspring was suicidal.
Sub-study III: To explore how workshop participants developed and displayed feelings of ownership during the collaborative process of designing a website.

Methods: The PhD study employed a qualitative research design to data collection, analysis and interpretation in each sub-study. All sub-studies drew heavily on an interactionist perspective. In addition, the adopted participatory orientation influenced sub-study II and sub-study III. Sub-study I was designed as a meta-ethnography. A systematic and exhaustive literature search was undertaken. Thereafter, each included study was critically appraised for its quality and degree of data interpretation. Noblit and Hare’s methodological framework for translation and synthesis was followed. Extracted interpretative metaphors were then translated into one another and these translations were synthesised by drawing on the concept of moral career. Sub-study II was conceptualised as an interview study. Twenty-one semi-structured interviews with Danish parents were conducted and subsequently transcribed and analysed using a thematic approach and interpreted by drawing on the interactionist concepts of negotiated identity and moral career. Sub-study III was designed as a case study of eight workshops in which service users collaborated with researchers on website design. Workshops were audio recorded, transcribed and subjected to thematic analysis and interpreted by drawing on the concept of psychological ownership. 

Findings:
Sub-study I: Research findings from 12 studies were included in the meta-ethnography. The synthesis situated relatives on a moral career path comprising four stages. The stages depicted different socially negotiated perspectives that relatives could adopt regarding their life and identity after realising the severity of their family members’ suicidal behaviour.
Sub-study II: The findings interpreted parents’ perspectives on their parental identity as a moral career comprising three distinct stages. Each career stage reflected a perspective on parental identity that parents adopted by virtue of social interaction with other people and their social environment. While all parents passed through the first two stages of disrupted parental identity and impasse, only some parents were able to transition to the third stage of restored parental agency. 
Sub-study III: The results indicated that the workshop participants developed a sense of psychological ownership regarding the website design process during two phases. In the first phase, sense of ownership during the early design phase, only the website designer and the researchers displayed a sense of ownership, which was facilitated by the contextual conditions preceding the workshops. In the second phase, sense of ownership during the collaborative design phase, service users gradually developed parallel feelings of ownership, which were facilitated by the collaborative design activities adopted in the workshops.

Conclusions:
Sub-study I concluded that relatives negotiated different perspectives on themselves and their life in social interaction with other people and that peer interaction was particularly helpful in facilitating a shift in perspective. Sub-study II concluded that the suicidal behaviour of a son or daughter disrupted parents’ identity, and some parents were able to rebuild this identity through social interaction with others, while others were not. Sub-study III concluded that service users and researchers developed a sense of psychological ownership at different speeds because of contextual conditions. However, the adopted collaborative design activities gave service users increasing control over the process, allowed them to invest themselves and gain intimate knowledge of the process, ultimately facilitating a sense of ownership.