Middle Eastern Journal of Disability Studies

Abstract
Background & Objectives: Suicide attempts are a major challenge in the field of mental health, and in many countries, especially among individuals aged 15 to 19 years, they are the second or third leading cause of death. In Iran, despite the lack of precise statistics due to cultural and social considerations, evidence suggests that this phenomenon has been increasing in recent years, particularly among adolescents and young adults. One of the most important concepts in studying suicidal behaviors is "death intent," which determines the individual's severity and seriousness in wanting to end his or her life. This indicator can predict the likelihood of repeated suicide attempts and the methods used. Tools like the Beck Suicide Ideation Scale have been designed to assess death intent; however, these tools face cultural and linguistic challenges in non–Western societies. In Iran, there are no indigenous tools for measuring death intent, and research has mainly focused on the prevalence and risk factors. Therefore, the development and standardization of precise tools to assess death intent in Iran is essential. So, the present study was conducted to develop and standardize a suicide with death intent questionnaire among adolescents.
Methods: This research employed a sequential exploratory mixed–methods approach and a tool development framework. The first phase of the study was qualitative and utilized a descriptive phenomenological method to identify the components of suicide attempts with death intent. Participants in this phase included 16 high school students from Hamadan City, Iran, who had attempted suicide in 2023 and were selected through purposive sampling. The inclusion criteria were as follows: being enrolled in one of the second secondary schools in Hamadan, being referred to the Hamadan Province Counseling Center, visiting the counseling center, and being ready and providing informed consent to participate in the study. The exclusion criteria were as follows: not being mentally healthy enough to participate in the research and not cooperating with the researcher in the interview. Semi–structured interviews were conducted with these participants. In the quantitative phase of the study, a descriptive–correlational method was used. The statistical population consisted of 408 high school students in Hamadan Province who had been referred to counseling centers for assistance. Among them, 374 students (201 girls and 173 boys) were selected as the sample using convenience sampling. To collect data, the Suicide with Death Intent Questionnaire (SDIQ) was used, which consisted of 32 items based on a 5–point Likert scale. After performing exploratory factor analysis, the final questionnaire included 7 factors. Data analysis was conducted using exploratory factor analysis (EFA) and Bartlett's test of sphericity (KMO) in SPSS 25.
Results: After analyzing the qualitative data, 9 main themes were extracted: loneliness and isolation, choosing irreversible methods, reliable lethal tools, emotional detachment, lack of remorse for the decision, unwillingness to be saved, feelings of absolute despair, worthlessness and self–deprecation, and determination to end life. For factor analysis, the principal axis factoring (PAF) method and varimax rotation were used on the correlation matrix. The EFA revealed that the questionnaire, with 32 items and 7 main factors, achieves a simple structure. These 7 factors, after rotation, explained 67.37% of the total variance of the questionnaire (the first factor explained 14.13%, the second factor 13.265%, the third factor 12.007%, the fourth factor 8.538%, the fifth factor 6.789%, the sixth factor 6.66%, and the seventh factor 5.941% of the variance). Considering the 7 factors for the questionnaire, a simple structure can be achieved, with only 32.63% of the information lost. Therefore, the aforementioned factors explain a significant portion of the variance in suicidal intent, which indicates the validity of the questionnaire. The convergent validity of the questionnaire was 0.541 with the Beck Suicide Ideation Scale. Its reliability coefficient was 0.898 using Cronbach alpha, and 0.797 for test–retest reliability.
Conclusion: This study confirms that the Suicide with Death Intent Questionnaire (SDIQ) is a valid, accurate, and reliable tool for assessing suicidal tendencies in adolescents. The tool demonstrates high validity and reliability and can effectively measure various dimensions of suicidal ideation. This instrument can help counselors and parents gain a better understanding of the true intent of adolescents and young adults to attempt suicide.