Suicidal Ideation Framework: Grounded Theory Study, Catalonia
NCT ID: NCT07284238
Last Updated: 2025-12-16
Study Results
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Basic Information
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NOT_YET_RECRUITING
45 participants
OBSERVATIONAL
2026-03-31
2027-09-30
Brief Summary
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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.
Detailed Description
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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.
Conditions
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Study Design
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OTHER
CROSS_SECTIONAL
Study Groups
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Individuals with a history of suicide attempt
Participants aged ≥18 years residing in Catalonia who have made one or more suicide attempts within the past 6 to 36 months. They will take part in in-depth interviews or discussion groups to explore their attributed experiences related to the configuration of suicidal ideation. No clinical intervention will be delivered as part of the study. Data collection will focus on participants' narratives, contextual factors, and meaning-making processes connected to the suicide attempt and subsequent care and recovery pathways.
In-Depth Qualitative Interview
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.
Discussion Group
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.
Members of their support networks
Individuals who are family members, friends, or significant others providing support to a person who has attempted suicide within the past three years. They will participate in interviews or discussion groups to describe their experiences, perceptions, and relational roles in the care, crisis management, and meaning-making processes surrounding the suicide attempt. No interventions will be administered. Data collection will focus on relational dynamics, contextual influences, and perceived barriers and facilitators in support and healthcare interactions.
In-Depth Qualitative Interview
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.
Discussion Group
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.
Healthcare professionals involved in their care
Licensed healthcare professionals (e.g., mental health nurses, psychiatrists, psychologists, emergency clinicians) directly involved in the care of individuals who have attempted suicide. Participants will contribute through interviews or discussion groups exploring their clinical experiences, interpretive frameworks, and perceptions of care processes. No intervention is provided. Data collection will examine professional roles, institutional contexts, and factors shaping the configuration of suicidal ideation during assessment, treatment, and recovery trajectories.
In-Depth Qualitative Interview
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.
Discussion Group
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.
Interventions
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In-Depth Qualitative Interview
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.
Discussion Group
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.
Eligibility Criteria
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Inclusion Criteria
* Usual residence in Catalonia (Spain).
* Ability to understand, speak, read, and write in Catalan or Spanish.
* Belonging to one of the three defined analytical groups:
(A) Individuals who have attempted suicide within the past 6 months to 3 years. (B) Members of their family, social, or community support networks. (C) Healthcare professionals directly involved in the care of individuals who have attempted suicide.
* Demonstrated clinical/emotional stability ensuring safe participation, as confirmed by the referring clinician.
* For individuals with lived experience (Group A): at least 6 months since the last suicide attempt or acute clinical crisis.
* For support networks (Group B): having maintained meaningful proximity or involvement during or after the suicide attempt.
* For healthcare professionals (Group C): minimum of 1 year of professional experience in mental health care.
Exclusion Criteria
* Active suicidal risk or acute crisis at the time of recruitment.
* Acute vulnerability identified during screening.
* Inability to provide informed consent.
* Direct hierarchical dependence or conflict of interest with the research team (for Group C).
18 Years
ALL
No
Sponsors
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Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau
OTHER
Responsible Party
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Sergio de la Hera Herrero
Mental Health Nurse Specialist and PhD Candidate at the Autonomous University of Barcelona (UAB)
Principal Investigators
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Sergio de la Hera Herrero, Bachelor of Science in Nursing
Role: PRINCIPAL_INVESTIGATOR
Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau
Locations
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Hospital de la Santa Creu i Sant Pau
Barcelona, Barcelona, Spain
Countries
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Central Contacts
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Sergio de la Hera Herrero RN, MSc, DS, Bachelor of Science in Nursing
Role: CONTACT
Facility Contacts
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Sergio de la Hera Herrero RN, MSc, DS, Bachelor of Science in Nursing
Role: primary
References
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Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007 Dec;19(6):349-57. doi: 10.1093/intqhc/mzm042. Epub 2007 Sep 14.
Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012 Nov 27;12:181. doi: 10.1186/1471-2288-12-181.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hrobjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71. doi: 10.1136/bmj.n71.
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Ministerio de Sanidad. Estrategia de Salud Mental del Sistema Nacional de Salud 2022-2026. Madrid: Ministerio de Sanidad; 2022.Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI; 2020.
Talseth AG, Gilje F, Norberg A. The significance of meaningful and confirming relationships as protective factors in suicidal patients: a qualitative study. Scand J Caring Sci. 2001;15(4):257-64.
Cutcliffe JR, Santos JC. Involving individuals who have experienced suicide: a call to action. Issues Ment Health Nurs. 2012;33(4):244-8.
Kral MJ. Suicide and the transformation of identity: A psychosocial approach. In: White J, Marsh IB, Kral MJ, Morris J, editors. Critical Suicidology. Vancouver: UBC Press; 2016. p. 71-87.
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Hjelmeland H, Knizek BL. Why we need qualitative research in suicidology. Suicide Life Threat Behav. 2010 Feb;40(1):74-80. doi: 10.1521/suli.2010.40.1.74.
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Talseth AG, Gilje F, Norberg A. Being met - a passageway to hope for relatives of suicidal people: A hermeneutic perspective. Perspect Psychiatr Care. 2003;39(2):61-70.
Cutcliffe JR. The differences and commonalities between United Kingdom and Canadian Psychiatric/Mental Health nursing: a personal reflection. J Psychiatr Ment Health Nurs. 2003 Jun;10(3):255-7. doi: 10.1046/j.1365-2850.2003.00637.x. No abstract available.
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Klonsky ED, May AM. The three-step theory (3ST): A new theory of suicide rooted in the "ideation-to-action" framework. Int J Cogn Ther. 2015;8(2):114-29.
O'Connor RC, Kirtley OJ. The integrated motivational-volitional model of suicidal behaviour. Philos Trans R Soc Lond B Biol Sci. 2018 Sep 5;373(1754):20170268. doi: 10.1098/rstb.2017.0268.
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White J, Marsh IB, Kral MJ, Morris J. Critical Suicidology: Transforming Suicide Research and Prevention for the 21st Century. Vancouver: UBC Press; 2016.
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Related Links
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Registered protocol for the qualitative meta-synthesis (Phase 1) in PROSPERO-CRD420251036324
Full preregistered study protocol and supplementary methodological materials hosted on the Open Science Framework (OSF).
Other Identifiers
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IIBSP-PCS-2025-176
Identifier Type: -
Identifier Source: org_study_id