This doctoral project aims to develop a comprehensive theoretical model of the process through which the suicidal ideation framework is configured as a symbolic, narrative, and relational expression, adopting a multiperspective approach that spans the suicide attempt and the stages of care and recovery. Moving away from biomedical reductionisms, this investigation seeks to identify shared meaning-making nuclei and discursive fractures that reflect the inherent conflictuality of the suicidal act. Grounded in the integration of the theoretical frameworks previously outlined, this study adopts an interpretive-constructivist approach. Phase 1 will include studies conducted in OECD countries, providing a broad and conceptually diverse interpretive foundation. Phase 2, conducted in Catalonia, will deepen situated configurations, assuming that local sociocultural frameworks act as interpretive prisms for globally relevant phenomena. Overall, this theoretical-methodological architecture not only ensures conceptual robustness and coherence, but also articulates an ethical and epistemic commitment to understanding suicide through the complexity of its human textures. By centering suffering, listening to historically silenced voices, honoring the singularity of each life trajectory, and grounding the inquiry in an ethics of care, this study aims to transcend a merely technical-instrumental logic of knowledge.
Initial Analytical Premises: It is posited that the suicidal ideation framework constitutes a symbolic, relational, dynamic, and multiperspective configuration whose emergence cannot be understood apart from the narrative, contextual, and structural arrangements mediating experiences of exclusion, hopelessness, affective disconnection, loss of vital meaning, and extreme suffering. From this standpoint, a foundational premise is established: the suicidal ideation framework cannot be conceived as a static, universal, or univocal category. Rather, it is shaped as a constellation of meanings and signifiers in tension, woven through the interaction of ambivalences, silences, contradictions, and narrative ruptures. Such configuration emerges from complex subjective processes marked by structural inequalities, social stigma, institutional vulnerability, or care models that often render distress invisible or reduce it to pathologizing categories. It is therefore assumed that an in-depth understanding of lived experiences attributed to the configuration process of the suicidal ideation framework-through the semiotic complexity of each perspective involved-will not only allow the identification of narrative structures and shared meaning nodes, but also help unravel discursive fractures that reflect the inherent conflictuality of the voluntary death process as a response to suffering experienced as intolerable. Research Question: From the perspective of individuals who have attempted suicide, members of their support networks, and healthcare professionals involved in their care-within the mental health services of the autonomous community of Catalonia, and informed by qualitative evidence from OECD countries-how is the suicidal ideation framework configured as a symbolic, narrative, and relational expression, based on the lived experiences attributed by these actors in the sociocultural and healthcare settings where they interact throughout the period encompassing the suicide attempt and the subsequent stages of care and recovery? General Study Design: The methodological design unfolds across two sequential and complementary phases: * Phase 1 will adopt a qualitative systematic review methodology, using an interpretive qualitative metasynthesis design (Sandelowski \& Barroso). It will integrate findings from previous qualitative and mixed-methods studies through reflexive thematic analysis (Braun \& Clarke), supported by ATLAS.ti CAQDAS software. The process will follow PRISMA 2020, ENTREQ, and COREQ guidelines, selecting literature with high methodological quality (≥9/10 criteria of the JBI tool). The bibliographic search will be conducted across five international databases (PubMed, CINAHL, PsycINFO, Scopus, WoS), and screening will be performed by pairs of reviewers seeking ≥95% agreement and a Cohen's Kappa ≥0.80 to ensure inter-rater reliability. * Phase 2 will follow an inductive qualitative methodology using a constructivist grounded theory design (Charmaz), framed within the interpretive paradigm under a relativist ontology and a subjectivist epistemology. The study population will be structured into three complementary analytical groups: (a) Individuals who have made one or more suicide attempts in the 6 months-3 years prior to the interview; (b) Members of support networks (family, friends, community); and (c) Healthcare professionals directly involved in the care of individuals who have attempted suicide. Participant recruitment will be coordinated with mental-health professionals following principles of autonomy, non-maleficence, and dignity protection. Institutional agreements will support safe referrals. Sample size will be determined by theoretical saturation. Theoretical-evolutionary sampling will be employed, and data generation techniques will include in-depth individual interviews (30-45 min) and discussion groups (4-6 participants, 60-90 min). Sessions will be conducted in authorised hospital or community settings, with an observer noting field data. Qualitative material, collected through audio recording, will undergo inductive-interpretive qualitative content analysis informed by constructivist grounded theory: initial coding, focused coding, and theoretical integration. An abductive logic will guide movement between data and conceptualisation. Constant comparison, analytic memos, conceptual diagrams, and conditional matrices will ensure rigour. Triangulation, participant-involvement workshops, and external audit will strengthen quality. ATLAS.ti will support systematic data management. Data handling will follow the Declaration of Helsinki and GDPR. The PI is responsible for database creation and integrity. Phase 1 Biases and Limitations: Publication bias: mitigated through inclusion of qualitative systematic reviews and critical heterogeneity analysis. Language limitation: mitigated through inclusion of multicentric studies and triangulation with technical/institutional reports. Phase 2 Biases and Limitations: Researcher bias: mitigated through reflexivity, peer review, constant comparison, and participant validation. Selection bias: mitigated through diverse theoretical sampling and safe inclusion of vulnerable profiles. Participant response bias: mitigated through emotionally safe environments, rapport, neutral questioning, and professional accompaniment when needed. Quality Control: The PI will ensure accuracy and consistency in the Case Report Forms, maintain documentation for ≥10 years, and provide access to monitors, auditors, ethics committees, and regulatory authorities upon request. Conclusion: This innovative interpretive contribution represents an ethical commitment to restoring the agency of the actors involved. Ultimately, this research proposal acknowledges the role of the nursing profession as an operative agent of change and as a privileged epistemic subject in confronting one of the most complex and silenced phenomena of contemporary human experience.
Study Type
OBSERVATIONAL
Enrollment
45
In-depth interviews aimed at exploring participants' lived experiences, meaning-making processes, and contextual factors related to the configuration of the suicidal ideation framework. Interviews will last approximately 30-45 minutes and will be conducted by the Principal Investigator in a confidential, safe, and clinically monitored setting. No clinical treatment or diagnostic procedure is administered.
Non-directive discussion groups composed of 4-6 participants from the same analytic category (suicide attempt survivors, support network members, or healthcare professionals). Sessions will last 60-90 minutes and will facilitate the collective exploration of relational, contextual, and sociocultural dynamics associated with the suicidal ideation framework. The procedure is solely qualitative and involves no therapeutic intervention or clinical manipulation.
Hospital de la Santa Creu i Sant Pau
Barcelona, Barcelona, Spain
Conceptual Synthesis of Qualitative Findings.
Generation of a third-order conceptual synthesis integrating first- and second-order findings from qualitative and mixed-methods studies conducted in OECD countries. This synthesis will be developed through reflexive thematic analysis and will provide a high-order interpretative framework that will: 1. consolidate cross-contextual patterns and divergences in experiences attributed to suicide. 2. inform the initial theoretical orientation of Phase 2. 3. guide purposive and theoretical sampling. 4. support the development of initial coding strategies in the constructivist grounded theory phase. Measure Type: Qualitative interpretative meta-synthesis conceptual output.
Time frame: Through Phase 1 completion, an average of 12-18 months.
Emergent Theoretical Model.
Qualitative identification, comparative analysis and inductive-interpretive integration of the main categories, subcategories and theoretical relationships that explain how the suicidal ideation framework is configured as a symbolic, narrative and relational phenomenon. This outcome captures the core theoretical structure produced through initial coding, focused coding and theoretical integration, derived from the constructivist grounded theory analysis of interviews and discussion groups. Measure Type: Qualitative conceptual model (Grounded Theory).
Time frame: Through study completion, an average of 24-30 months.
Identified Narrative Structures and Meaning-Making Patterns.
Qualitative identification of narrative structures, ambivalences, silences, contradictions and discursive ruptures attributed by participants to the process of configuring the suicidal ideation framework, across the three analytic groups (individuals with suicide attempt history, members of support networks, healthcare professionals). Measure Type: Qualitative thematic patterns (Reflexive Thematic Analysis).
Time frame: Through study completion, an average of 24-30 months.
Influence of Socio-cultural and Biographical Factors.
Inductive analysis of how socioaffective bonds, sociocultural frames, structural inequalities and biographical trajectories shape and modulate the subjective and relational processes involved in the configuration of the suicidal ideation framework. Measure Type: Qualitative thematic and relational patterns.
Time frame: Through study completion, an average of 24-30 months.
Relational and Contextual Mechanisms.
Examination of how relational dynamics, contextual interactions and social environments contribute to modelling the configuration of the suicidal ideation framework across different participant groups. Measure Type: Qualitative category development.
Time frame: Through study completion, an average of 24-30 months.
Perceived Barriers and Facilitators in Healthcare.
Identification of perceived barriers, facilitators, protective factors and contextual conditions present in mental health and emergency care settings, as described by individuals with suicide attempt history, their support networks and healthcare professionals. Measure Type: Qualitative thematic analysis.
Time frame: Through study completion, an average of 24-30 months.
Sergio de la Hera Herrero RN, MSc, DS, Bachelor of Science in Nursing
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