Suicidal Ideation Framework: Grounded Theory Study, Catalonia

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.

Inclusion criteria

• Adults ≥18 years of age.
• 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

• Presence of acute clinical decompensation preventing safe participation.
• 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).