This work will compare
the qualitative and quantitative approach on suicide research screening carried
out in America which identified suicide risk for psychiatric outpatients.
Including will be a literature review to argue around suicide topics to show if
there are other approaches in carrying out a suicide screening research other
than using qualitative or quantitative (Finch, 1986). The qualitative and
quantitative research papers were produced by the same writers; Lang, Uttaro,
et al. Both papers had similar outcomes as ‘low risk of suicide in the chosen
demographic and geographic area’. The subject for the key word was the public mental health system, risk screening
suicide prevention by: (Lang, M. Uttaro, T et al, 2009).



The qualitative paper
shows that a screening method was used to collect data, based on an incident
reporting system, to monitor patients and establish if there is an increase in attempting
suicide to a complete suicide. The focus was based on dynamic risk factors such
as “Change in mood and thoughts or recent
stressors based of family history, suicidal childhood emotional, physical and
sexual abuse” (Lang, M. Uttaro, T
et al, 2009). Part of this method was to send an invitation email to collect
data through a secure intranet system. Some ethical issues were identified; the
assessment of the site to whether it was going to cause issue, location was not
a problem as this was the aim of the researcher to target this particular area,
the risk development of screening and duration of the pilot period was also
considered. This was considered as low risk as information was collected
anonymously, the effectiveness of staff showing that patients were low risk in
suicidal behaviours in chosen geographical areas (Lang, M. Uttaro, T et al, 2009). The ethical barrier was overcome
through the assessment and also consent was granted by mental health
authorities prior to starting the screening that made it easy for the material
to be published. (Lang, M. Uttaro, T et al, 2009).




Quantitative paper
shows that 153 clinicians were provided with a list of randomly selected
patients for a 6 month pilot period. 719 clients were randomly selected for
screening but only 471 were actually screened. The
percentage breakdown of the ethnicities of the participants is as follows:

56% female 44% male  78% White17% Black 5% Asian 18% Other 

Each clinician screened
5 of their clients monthly, for a 6 month period (Lang, Uttaro, et al, 2009).



There are advantages and disadvantages of using qualitative and
quantitative. It has been recognised that research is formed to study human
behaviours and understand the world. Regardless of what approach is used it
will always strive to use the appropriate research method to utilise their
strengths and minimise weaknesses. (Bryman, 1988).


In the United Kingdom many
professionals believe that the official statistics on suicide are not always
accurate, this is not limited to just the United Kingdom,but also in other countries
(Samaritan, 2017). For many different reasons the under reporting of suicide is
prevalent especially in ethnic and minority groups because of
misclassification. The explanation for this is due to cultural and religious beliefs,
and how reports are presented to the coroners (Journal of medical ethics and
history of medicine, 2014). This can
cause associated stigma for families and can be additionally attached to
cultural or religious taboo. Therefore when carrying out quantitative research,
considerations should be made to find an appropriate approach to include people
of varying cultures and religious beliefs as such mixed methods can improve
data. (Leo 2002; 2009).


According to the Suicide
in the UK report there were 23.9 deaths per 100,000 males aged 45 to 59.
However men between the ages of 30 to 45 were not included from 2000 to 2001
even though the age 45 to 59 was still increasing in numbers. Reports shows
that 6,122 suicides of people aged 10 and above were reported in the UK in
2014, 120 lower than, 2013 which makes a 2% decrease (National Statistics,
2016).. The UK average suicide rate over all demographics was 10.8 deaths per
100,000 people in 2014. The male suicide was 3 times more than the female rate,
with 16.8 male deaths per 100,000 in comparison to 5.2 female deaths. (National
Statistics, 2016).



Suicide among patients with serious mental
disorders like schizophrenia is a significant clinical problem (Shields et al. 2007, Haukka et al. 2008) and a major cause of injury and mortality in the world
(Limosin et al. 2007), ranking as the
14th most common cause of death by the World Health Organisation
(WHO), (WHO, 2014). Studies in China show that suicide is the fifth most common
cause of death (Phillips MR, Li X, Zhang Y.2002) in contrast to the United
States, where suicide is the tenth most common cause of death (Agarwal et al.2016). Psychiatric disorders are a
well-established risk factor for suicidality (Whittier et al. 2016). Evidence suggests that suicide has been strongly
associated with suicide attempts (Carlborg et
al. 2010).



It was good to use qualitative as it was
specialised in the screening, which was the process of sending anonymous emails
and collected data from the intranet. The enquiries were broad which allowed
open ended investigations and included the values of behaviours and assumptions
(Bryman, 1988).

There are also downsides with using qualitative research
methods on suicide screening; it was not easy to demonstrate the research to be
accurate even though it was justified in the conclusion as a low risk for
clients who went through screening. They did not evaluate the type of
interviews that clinicians who provided the screening did. The data was
selected from an intranet which may suggest to have known how this information
was obtained and risk assessed before creating the file to store on client
information. It has shown that there was no time recorded to how long the
interview process took individually, even although the screening period took 6
months period. (Carr, 1994).


The quantitative
proves that selection of the sampling was generalized to study its population
because the researcher mixed gender, and other demographics which means that
they had mixed religion and sexual orientations (Western Michigan
University, (2017).  The paper of the screening was easy to understand
and it looks precise and reliable. Disadvantages included some
context which was difficult to understand on the table of data. (Carr,1994).


Research which has been undertaken with humans has a
certain level of complexity involved, which is unique with such studies due to
ethical issues, beliefs and bias (Mason, J, 1994). Preventing
these issues and preventing them from impacting the results negatively  is vital (Stanley, 1990). There
is evidence to show some clinicians declined to be involved in the research
itself. Clinician’s response was positive in theory but in practice there was
concern for triggering more negative responses in patients and reluctant to get
involved (Neuman, 2000). A number of people and patients stated this is a good
thing to do to minimise the risk of suicide. Others did not feel strongly
towards the questionnaire either way, but some people did feel it may trigger
the risk of suicide. Both qualitative and quantitative show that the results are
low risk (Everitt, and Hay,1992).


To evaluate the
qualitative and quantitative papers there is no right or wrong way of carrying
out the research depending on the target, geographical area, location and the
subject (Mcdowell and Maclean, 1998). The topic as complex as suicide may suggest
the use of a different method such as a mixed method. This is because
qualitative and quantitative would join together from different angles and use
triangulation for an effective outcome, aiming for the bigger picture (Cassell
and Symon, 1994).


Literature Review:
Carrying out the
screening of suicide as a subject, is already anticipated to be difficult to
engage the public because of ethical issues such as social engagements,
environmental, political matters and also legal aspect of things. (Rocha,

DSM V and
ICD10 state that suicide is not classed as an
illness however it has some serious consequences of mental disorder which can be
managed and treated.  Some mental
disorders linked to suicide include; depression, personality disorder, bipolar,
substance misuse, eating disorder and more. People who are suicidal normally
experience, hopelessness, withdraw, change in appearance, self-harming behaviors,
life crisis and many others (Mann, et al 1999). Research shows 50% to 75% of
people who are suicidal provide a warning sign to a sibling or close friend.
There is no evidence indicating that families and friends are included in
research although this may influence data as bias but this can contribute in
the fact of preventing suicide. (Mann, et al,1999).


It may suggest that a
researcher should have used the focus groups to cover the missing gaps which
disadvantaged both qualitative and quantitative. This can use both questioners
and interviews depending on the clients (Graham, 1984).

Interviews would
require a very competent researcher and a significant amount of time to
complete but it can also affect the research as some people do not like to be
interviewed or speaking to a stranger. It also requires building of a good
relationship with a client to enable the client engagement. Ochieng ,(2009).

Questioners are easy
and fast to distribute however clients may not have time to complete and return
them, they may have difficulty questions to understand as well as may target
wrong populations and influence the research. Graham, H (1984).



Focus group will
include 1, 2 and 3 as follow.  

Group one of the populations,
which is never attempted or thought about any suicidal ideation using both
interviews and questioners asking why these people have never been affected by
what affect others to become suicidal. Graham, H (1984).


Group two of a
population of people who have attempted suicide and not succeed with it or
thought about it. According to (Graham,1984) Some people do think about suicide
but because of religious beliefs, cultural belief and other protective factors of
leaving family members straggling, pets, close friends and many more facts.
(Leo 2002; 2009).


Finally third group
of a population of people who are at higher risk and actively suicidal and have
attempted before. These groups research shows that because of severe mental
health issues, diagnosis of other medical conditions, victims of abuse, family
history of suicidal, social issues, environmental issues and possibly fed up
with life. (Samaritan, 2017).


Current state research;

History of suicide has come a very long way from the time
it was classed as a criminal offence in all countries (Mcdowell, I. and
Maclean, L, 1998). Some countries still see it as a criminal offence, therefore
a stigma is still attached and this should be considered as part of the ethical
issue to identify when carrying out a research looking at geographical area,
religious belief, cultural background, gender age and many other factors in
recent years most of the mentioned ethical issues have been identified by many
researchers especially when population is involved in some particular research
such as quantitative. (Neuman, 2000). Now suicide is being recognised that it
can be linked to many other issues; including, family history, social issues
and mental health problems and many more contributing factors  (Western Michigan University, 2017).


Existing knowledge:

Social science
researchers like Lincoln and Guba, and Schwandt
accept qualitative and quantitative approaches as incompatible with each other (Lincoln
and Guba, 1994). Whereas Patton and Reichardt and Cook believe that approaches
can be combined if the researcher is competent and skilled (Patton, 1990), (Reichardt
and Cook, 2003). These arguments are
based on different philosophical nature of different paradigm as others
concentrate on the compatibility of each research these arguments can be
muddled between parties. Qualitative data can be scrutinised because
statistical tests can allow for comparing between the data gathered for the
final conclusion (Atieno, 2009).


It may be argued that
a disproportionate number females were involved in the screening program in the
quantitative study despite in the United Kingdom and Ireland research shows
that white males of the middle age are at higher risk of suicide than females.
To prove thisit would have been good to balance the genders to test this
statistic (Cantor, Leenaars & Lester, 1997). To determine if there is
definitely suicide attempt or ideation requires a lot of evidence for a solid
conclusion. Even Coroners judge if there is suicide involved in deaths or not  requires more work to come out with an
effective way approach which will surely lightened clarity to statistics




Future study;

For the product development research will require mixed method especially
for a wider topic like suicide screening research (Journal
of medical ethics and history of medicine, 2014). Each of the approaches has strengths and limitations as
such they both can benefit from combining together forming a mixed method to
enable findings from a different perspective (Blaxter, Hughes, and Tight,1996).


There are many debates about qualitative and quantitative
approach, however they both have been chosen for research purposes (Difference between
Qualitative and Quantitative Research, 2016). Critics and comments will always
appear regardless of what methodology is used because they all have advantages
and disadvantages. The effectiveness of each approach depends on the competence
of the researcher and the purpose of the research. For a subject such as
suicide and its nature, it may suggest that using a mixed method to come up
with a solid outcome would benefit the researcher.


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