Exploring the ambivalence model of suicidality among Iranian patients: a qualitative study with suicide attempters

The Ambivalence Model of Suicidality (ABS) posits that suicidal experiences are often accompanied by internal conflicts between the desire to live and the urge to die. The model further conceptualizes the suicidal process as consisting of three phases: the uncertainty phase, the transition phase, and the action phase. This qualitative study explores the experiences of Iranian suicide attempters through the lens of the ABS to assess its cross-cultural validity and clinical relevance.

Semi-structured interviews with 15 individuals at Qods Psychiatric Hospital in Sanandaj, Iran, who had recently attempted suicide were conducted. The interviews examined emotional states, internal conflicts, external influences, and decision-making processes aiming to test whether the narratives corresponded to the three ABS phases. A deductive qualitative content analysis was applied: data were transcribed verbatim and coded according to predefined categories (Ambivalence, Transition, Action). Coding was conducted by one author and reviewed by a second author to ensure consistency with the theoretical framework. Representative quotations were extracted to illustrate alignment with the model.

Evidence for all three phases of the ABS was found. Participants' narratives reflected each of the model's predefined phases. Ambivalence prior to the suicide attempt was reported in 13 interviews, often accompanied by exhaustion. The transition phase frequently involved a sudden shift into acute suicidality, with some participants describing dissociation. Ambivalence often persisted into the action phase.

Findings support the applicability of the ABS in the Iranian context, highlighting ambivalence as a fluctuating yet persistent state throughout the suicidal process and across cultures. Incorporating the ABS into clinical practice might enhance therapeutic approaches, supporting suicide prevention efforts.