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Mental Disorders and Suicidal Intention
Abstract
This paper continues a previous report (Litman, 1984) in exploring the use of psychological autopsies to clarify intention in suicide; clinical experience is compared with courtroom experience. The certification of suicide requires a judgment that the deceased intended to use his or her own death to resolve his or her problems of living, as demonstrated by a preponderance of the evidence. Now that suicide has been decriminalized, the issue of "sane or insane" in insurance contracts has probably become irrelevant. Mental disorders are important as part of the suicide constellation, as one element of many interacting factors. The capacity to have the intent to commit suicide--that is, to understand the physical nature of one's own death--is lost due to mental disorders only under special and unique circumstances.
... (Appendix) This resource has helped medical examiners and criminal and civil law professionals and can also contribute for the identification of risk factors and sociodemographic correlates of suicide. [5][6][7][8][9][10][11][12][13][14][15][16] There are four basic questions to be answered in the psychological autopsy: What?, Why?, From what? and How has the subject died? And there are, respectively, four constructs underlying the psychological autopsy's strategy: precipitants and/ or stressors, motivation, lethality and intentionality. ...
... However, in our society this is a still scarcely divulged method and we may remind that it is a complex and multidimensional assessment strategy, to which scholars provide very general orientations, schemes of areas to be explored, but, up to the moment, without a structured instrument for data collection. [1][2][3][4]10,12,[16][17][18][19][20][21][22][23][24][25][26][27] Lacking this kind of instrument, the psychological autopsy can be considered as a subjective, unreliable resource, that leaves the professional insecure and without a reasonable degree of certainty to emit conclusions. de morte sendo suicídio. ...
... Starting with a review of the literature in the period from 1987 to 2000, in computer-based databases, it was possible to specify and render operative guiding criteria for a psychological autopsy as well as to define the basic items for the semistructured interview. [10][11][12]14,17,18,21,29 Therefore, the Semi-Structured Interview for Psychological Autopsy (SSIPA) is composed by four modules: Precipitants and/or stressors, Motivation, Lethality and Intentionality (Appendix). The option for these four modules, decided by the authors, as well as the organization of each module, tried to follow, besides what was found in the literature, a logical sequence of clinical reasoning. ...
To investigate the applicability and the interrater reliability of a Semi-Structured Interview for psychological autopsy in cases of suicide.
The Semi-Structured Interview for Psychological Autopsy (SSIPA) proposed in this paper consists of four modules which evaluate key-topics associated to suicide. In order to evaluate the instrument's applicability, a sample formed by 42 subjects related to 21 suicide cases was used. The interviews were tape-recorded first and then transcribed. The related material as well as the police inquiry data were presented to four judges. Evaluation of information has been performed with the help of a four-module formulary for decision making: precipitants and/or stressors, motivation, lethality, and intentionality. Data processing, whenever possible, has been accomplished using kappa statistics. When kappa statistic was not applicable, concordance percentage has been used.
The SSIPA is applicable because it provides information containing a significant degree of agreement between evaluators, found in one hundred and twenty measurements of judgements made by four judges. There has been significant statistical agreement between the judges in three modules (precipitants and/or stressors, motivation, and intentionality) of the model for decision, except in one step of each module, which did not interfere in the final agreement on the present evaluation. In the lethality evaluation module, there has been a 100% agreement between judges. The judgement made by the raters on the four modules have allowed to reach a final agreement regarding the death mode as suicide.
The results of this study show that it is possible to use a semi-structured instrument for psychological autopsy in cases of suicide, when the interviewees are relatives who accepted to provide information.
... O comportamento suicida pode ser definido como todo ato pelo qual um indivíduo causa lesão a si mesmo, qualquer que seja o grau de intenção letal e de consciência do verdadeiro motivo desse ato. Para Litman (1987Litman ( , 1988) a intenção é a chave psicológica para compreender o suicídio e existem estágios no desenvolvimento da intenção, que se inicia, na maior parte das vezes, com a idéia de morte, que se desloca para o desenvolvimento de um plano ou projeto, que passa a ser implementado por ensaios realísticos ou imaginários, culminando em uma ação autodestrutiva exitosa. ...
... Interessante lembrar que estudiosos do suicídio (Litman, 1987;Shneidman, 1999;Werlang, & Botega, 2003b) relatam que sujeitos do sexo masculino cometem suicídio com uma freqüência maior do que as mulheres; sendo entre indivíduos brancos a taxa maior do que entre não brancos. Constatam, ainda, o alarmante aumento dos índices de suicídio de pessoas jovens (entre 15 e 44 anos). ...
O objetivo deste trabalho foi caracterizar o perfil dos indivíduos que cometeram homicídio, seguido de suicídio em Porto Alegre num período de oito anos. As informações sobre esse evento foram localizadas em matérias jornalísticas, inquéritos policiais e entrevistas com informantes. Nos 14 casos localizados, o evento parece ser um fenômeno de gênero, já que os homens são os assassinos/suicidas, e mulheres e crianças, as vitimas. O método mais utilizado para o homicídio e o suicídio foi a arma de fogo. A casa da vítima foi o local em que o homicídio e o suicídio foram efetuados, na maior parte das vezes, no período da manhã. Em cinco casos, os precipitadores do evento foram ciúme, ameaça ou término da relação amorosa. O agressor era um sujeito que tinha problemas com seu grupo de apoio primário, com indicativos de impulsividade, agressividade, depressão, dependência de álcool e antecedentes criminais, principalmente, por violência contra a família.
... O comportamento suicida pode ser definido como todo ato pelo qual um indivíduo causa lesão a si mesmo, qualquer que seja o grau de intenção letal e de consciência do verdadeiro motivo desse ato. Para Litman (1987Litman ( , 1988) a intenção é a chave psicológica para compreender o suicídio e existem estágios no desenvolvimento da intenção, que se inicia, na maior parte das vezes, com a idéia de morte, que se desloca para o desenvolvimento de um plano ou projeto, que passa a ser implementado por ensaios realísticos ou imaginários, culminando em uma ação autodestrutiva exitosa. ...
... Interessante lembrar que estudiosos do suicídio (Litman, 1987;Shneidman, 1999;Werlang, & Botega, 2003b) relatam que sujeitos do sexo masculino cometem suicídio com uma freqüência maior do que as mulheres; sendo entre indivíduos brancos a taxa maior do que entre não brancos. Constatam, ainda, o alarmante aumento dos índices de suicídio de pessoas jovens (entre 15 e 44 anos). ...
O objetivo deste trabalho foi caracterizar o perfil dos indivíduos que cometeram homicídio, seguido de suicídio em Porto Alegre num período de oito anos. As informações sobre esse evento foram localizadas em matérias jornalísticas, inquéritos policiais e entrevistas com informantes. Nos 14 casos localizados, o evento parece ser um fenômeno de gênero, já que os homens são os assassinos/suicidas, e mulheres e crianças, as vitimas. O método mais utilizado para o homicídio e o suicídio foi a arma de fogo. A casa da vítima foi o local em que o homicídio e o suicídio foram efetuados, na maior parte das vezes, no período da manhã. Em cinco casos, os precipitadores do evento foram ciúme, ameaça ou término da relação amorosa. O agressor era um sujeito que tinha problemas com seu grupo de apoio primário, com indicativos de impulsividade, agressividade, depressão, dependência de álcool e antecedentes criminais, principalmente, por violência contra a família.
... Estudiosos del tema (Litman, 1987;Shneidman, 1999;Werlang, & Botega, 2003b) relatan que sujetos del sexo masculino cometen suicidio con una frecuencia mayor que las mujeres, y entre individuos blancos la tasa es también mayor que entre no-blancos. Registran, por otra parte, la constatación alarmante del aumento de los índices de suicidio entre personas jóvenes (entre 15 y 44 años). ...
... La intencionalidad señalada porLitman (1987Litman ( , 1988 y la unidad descrita porBerman (1996) ...
Homicide followed by suicide (H/S) is a complex and poorly studied phenomenon. This research aims at identifyingH/S cases occurred in Porto Alegre from 1996 throughout 2004. Information on H/S was extracted from newspapers,police reports and interviews with the informants. From the 14 identified cases, men were the killers/suicides andwomen and children their victims. The most frequently used weapons were firearms. In general, the aggressor was animpulsive, aggressive individual showing problems within its primary supporting group, possibly suffering depressionand alcohol-addicted with criminal backgrounds (violence against the family). Events were mainly triggered by jealousy,threats or the end of a love relationship.
... Sajnos az öngyilkosok vagy kísérletezôk között igen magas a fel nem ismert és kezeletlen szorongásos zavarok ará-nya. Poszttraumás stressz zavar esetén az ön-gyilkosság szintén komorbid depresszióval és szerabúzussal mutat összefüggést (32,33,(81)(82)(83)(84)(85)(86)(87). ...
... In Los Angeles County for example, all suicide deaths as well as equivocal deaths (those in which suicide is suspected but not certain) are followed up by staff from the Los Angeles Suicide Prevention Centre. Suicidologists then do a 'psychological autopsy' (Litman 1987). This is an intensive examination to determine whether the death was by suicide and, if it was, to define the probable causes of the suicide. ...
... There is a high co-morbidity of anxiety disorders in suicidal adults, particularly with major depression and substance abuse. Severe anxiety may be a critical causal factor of acute suicidality [36,82]. Fawcett [35] in his early work showed that anxiety disorders are highly under-recognized and under-treated in suicidal people. ...
Unlabelled:
Suicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year. Suicidal crisis: Acute intervention should start immediately in order to keep the patient alive.
Diagnosis:
An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential.
Treatment:
Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10-14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. TREATMENT with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. TREATMENT with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required. TREATMENT team: Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality. Family: The suicidal person independently of age should always be motivated to involve family in the treatment. Social support: Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks.
Safety:
A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks. Training of personnel: Training of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals.
... There is a high co-morbidity of anxiety disorders in suicidal adults, particularly with major depression and substance abuse. Severe anxiety may be a critical causal factor of acute suicidality [36,82]. Fawcett [35] in his early work showed that anxiety disorders are highly under-recognized and under-treated in suicidal people. ...
Suicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year. SUICIDAL CRISIS: Acute intervention should start immediately in order to keep the patient alive.
An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential.
Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10-14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Treatment with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required. TREATMENT TEAM: Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality. FAMILY: The suicidal person independently of age should always be motivated to involve family in the treatment. SOCIAL SUPPORT: Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks.
A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks. TRAINING OF PERSONNEL: Training of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals.
... According to Litman, physicians have a higher prevalence of psychiatric disorders than does the general population, but their symptoms seem to be milder (Sargent et al. 1977, Litman 1987, Hampton 2005, Schernhammer 2005. As to anesthesiologists, the professional burden comprising elements such as a stressful working atmosphere, heavy professional demands, long working hours, being on call, little vacation time, and confl icts between work and personal life may well lead to social isolation and depression (Kessler et al. 1999, Hem et al. 2000, Spear 2001, Stack 2004, Schernhammer 2005. ...
Anesthesiologists, according to some studies, are highly stressed, die at a significantly earlier age than their colleagues and the general population,and are among the leaders in physicians' suicide records. Data are,however, sparse and contradictory. The aim of this study was to discover details of the work-related well-being of Finnish anesthesiologists. In 2004, a cross-sectional postal survey including all 550 working Finnish anesthesiologists produced a total of 328 responses (60%); 53% were men. The anesthesiologists had the greatest on-call workload among Finnish physicians. Their average in-hospital on-call period lasted 24 hours (range 14 to 38). Over two-thirds felt stressed. The most important causes of stress were work and combining work with family. Their main worries at work were: excessive workload and time constraints, especially being on call, organizational problems, and fear of harming patients. On-call workload correlated with burnout. Being frequently on call was correlated with severe stress symptoms--symptoms associated with sick leaves. Women were more affected by stress than men. High job control and organizational justice seemed to mitigate hospital-on-call stress symptoms. The respondents enjoyed fairly high job and life satisfaction. Job control and organizational justice were the most important correlates of these wellness indicators. Work-related factors were more important in males, whereas family life played a larger role in the well-being of female anesthesiologists. Women had less job control, fewer permanent job contracts, and a higher domestic workload. Of the respondents, 31% were willing to consider changing to another physician's specialty and 43% to a profession other than medicine. The most important correlates for these job turnover attitudes were conflicts at the workplace, low job control, organizational injustice, stress, and job dissatisfaction. One in four had at some time considered suicide. Respondents with poor health, low social support, and family problems were at the highest risk for suicidality. The highest risks at work were conflicts with co-workers and superiors, on-call-related stress symptoms, and low organizational justice. If a respondent had several risk factors, the risk for suicidality doubled with each additional factor. On-call work-burden, job control, fairness of decision-making procedures,and workplace relationships should be the focus in attempts to increase the work-related well-being of anesthesiologists. Anestesialääkärit ovat eräiden tutkimusten mukaan stressaantuneita, kuolevat muita lääkäreitä ja muuta väestöä nuorempina ja ovat lääkärien itsemurhatilastojen kärkipäässä. Aiempien tutkimusten tulokset ovat kuitenkin osittain ristiriitaisia. Väitöskirjatyössäni pyrin selvittämään anestesialääkäreiden työhön liittyvää subjektiivista vointia ja siihen vaikuttavia tekijöitä. Poikkileikkaustutkimuksen aineisto koottiin postikyselyllä v. 2004. Tutkimukseen otettiin kaikki Suomessa työskentelevät anestesiaerikoislääkärit (N = 550). 60 % heistä (328) vastasi. Vastaajista 53 % oli miehiä. Anestesialääkäreillä on suomalaisista lääkäreistä suurin päivystystaakka. Sairaalapäivystysrupeama saattoi kestää jopa 38 tuntia. Yli kaksi kolmasosaa vastanneista koki olevansa stressaantunut. Suurimmat stressin syyt olivat työ ja työn ja perheen yhteen sovittaminen. Työssä eniten huolestuttivat kiire ja työn määrä etenkin päivystäessä, organisaatioon liittyvät ongelmat sekä pelko potilaan vahingoittamisesta. Runsas päivystäminen oli yhteydessä jopa vakavaan stressioireiluun, joka puolestaan liittyi sairauslomalla oloon. Hyvä työn hallinta ja organisaation oikeudenmukaisuus näytti vähentävän raskaisiin sairaalapäivystyksiin liittyvää päivystysstressioireilua. Naiset kärsivät stressioireilusta miehiä enemmän. Huolimatta stressaantuneisuudestaan anestesialääkärit olivat melko tyytyväisiä työhönsä ja elämäänsä. Oman työn hallinta ja organisaation oikeudenmukaisuus olivat tärkeimmät tekijät työhyvinvoinnissa. Työhön liittyvät tekijät olivat tärkeämpiä miehillä, kun taas perhe-elämä oli tärkeämpää naisten hyvinvoinnille. Naisilla oli miehiä vähemmän työnhallintamahdollisuuksia sekä pysyviä työsuhteita, mutta enemmän kotitöitä. Lähes kolmannes vastaajista oli halukkaita harkitsemaan ammattinsa vaihtamista toiseen lääkärin ammattiin ja 43 % muuhun kuin lääkärin ammattiin. Tärkeimmät tällaiseen suhtautumiseen vaikuttavista tekijöistä olivat konfliktit työyhteisössä, huono työn hallinta, organisaation epäoikeudenmukaisuus, stressi ja tyytymättömyys työhön. Neljäsosa vastaajista raportoi harkinneensa itsemurhaa. Suurimmat riskit itsemurha-ajattelulle olivat huono terveys, vähäinen sosiaalinen tuki ja perhe-ongelmat. Työhön liittyvistä riskeistä suurimmat olivat konfliktit työyhteisössä, päivystysstressi ja organisaation epäoikeudenmukaisuus. Riskitekijöiden kumuloituessa riski kaksinkertaistui jokaisen uuden tekijän myötä. Päivystysrasitetta tulisi vähentää, ammatillista itsemääräämisoikeutta lisätä sekä parantaa organisaation oikeudenmukaisuutta ja työpaikan ihmissuhteita haluttaessa kohentaa anestesialääkärien työhyvinvointia.
... Some 30 to 70 percent of all persons who attempt suicide apparently have an affective disorder (generally depression), a substance-use-related disorder, or schizo-phrenia. 3 Evidence further suggests that drug abuse and alcoholism, possibly under circumstances of heightened stress or depression, are often associated with the suicides of physicians. Female physicians, in particular, have been shown to have a higher frequency of alcoholism than women in the general population. ...
... Acknowledging that affective and anxiety disorders may be caused by similar underlying disturbances of the regulation of neurotransmitters in the brain (van Praag, 2000), Fawcett reiterated that depressed patients are inhibited whereas anxious patients are agitated, and that anxiety is a neglected aspect in the study of suicidality. Litman (1987) similarly regarded suicidal acting out as a symptom of acute anxiety. ...
Depressive affect, anxiety, and psychological defenses were studied in the presented research with PORT, a projective test that exploits subliminal perception of object-relation images. Protocols of 20 hospitalized suicide attempters were compared to those of 20 matched controls, 34 previously studied nonsuicidal depressed patients, 18 patients with panic attack, and 32 patients with borderline and psychotic disorders. The suicide attempters were anxious; their defenses resembled those seen in borderline pathology; depressive reactions were limited in symbolic content; reality testing was poor. The closeness between depression and anxiety in suicidality is further discussed throughout this article. A constellation of signs using the PORT test was hypothesized to be a marker for suicidality. The test is deemed useful for future research on suicide.
Suicide is the second leading cause of death for adolescents aged 15-to-24. The rate of completed and attempted suicides could be reduced by training teachers, counselors, and students to recognize those who are high risk and immediately responding by implementing both prevention and postvention strategies. Prevention strategies include identifying warning signs of suicidal behavior, referring to trained personnel, and teaching alternative coping techniques. Postvention strategies are directed toward sharing information, expressing feelings, and identifying those who are most vulnerable for suicidal actions.
Attitudes toward suicide, as assessed by the Suicide Opinion Questionnaire (SOQ), were evaluated in samples of New Zealand (N = 236) and United States (N = 248) college students. Substantial differences were found, with New Zealand students attitudinally perceiving to a greater degree a relationship between suicide and mental illness, perceiving suicide as less serious, agreeing with the right to take one's life, and seeing suicide in a more religious context and as a less impulsive, less “normal,” and more moral action.
Two groups of college students (n = 58 each) were identified through a combination of teacher nominations and creativity test scores, were labeled as creative or control, and matched on gender, age, college major, and vocabulary level. Their attitudes towards suicide were assessed using the Suicide Opinion Questionnaire (SOQ). Seven of the eight SOQ scales statistically differentiated the two groups, with creative subjects showing greater agreement of endorsement on the Mental Illness, Right to Die, Normality, and Aggression scales, and greater disagreement on the Cry for Help, Religion, and Moral Evil scales. The results suggest considerable attitudinal differences towards suicide between highly creative subjects and their control peers, with creative students perceiving suicide in more liberal and less judgmental terms.
Suicide is strongly correlated to mental disorders. In several studies up to more than 90% of the deceased could be given psychiatric diagnoses. The aim of this study is to account for psychiatric and somatic disorders in suicide and to discuss their relation to the suicide and the implications for preventive work. One hundred consecutive cases of suicide in Va¨sterbotten County, 25 women and 75 men, were investigated by means of telephone interviews with close relatives, police reports, psychiatric and other medical records, and data from the forensic investigation. In 96% at least one axis-I diagnosis according to DSM-III-R was found. The most common psychiatric disorders were mood disorders (63%), psychoactive substance use disorders (37%), and personality disorders (22%). Two-thirds of the subjects had one or more somatic disorder of significance for the case. In 50% of the cases two or more psychiatric diagnoses could be given. Schizophrenic subjects died on average 14 years after their first psychiatric contact, at a mean age of 36 years, whereas subjects with major depression died on average 4 years after their first contact, at 55 years. The finding that 96% of the deceased had at least one mental disorder and a high occurrence of somatic disorders is interpreted as a severe increase in the burden of the person, which restricts his/her ability to satisfy vital dependency needs. The issue of specific personality characteristics in suicide should be further investigated.
Suicide rates among physicians have constantly been reported to be higher than in the general population and anaesthesiologists appear to lead the suicide statistics among physicians.
A cross-sectional questionnaire study was sent to all working Finnish anaesthesiologists (n=550) investigating their suicidality (ideation and/or planning and/or attempt). The response rate was 60%.
One in four had at some time seriously been thinking about suicide. Respondents with poor health (crude odds ratios 11.2 and 95% confidence interval 3.8-33.0), low social support (10.5, 4.0-27.9), and family problems (6.5, 3.4-12.5) had the highest risk of suicidality. The highest risks at work were conflicts with co-workers (4.1, 2.3-7.1) and superiors (2.1, 1.2-3.6), on-call-related stress symptoms (3.9, 1.9-8.3) and low organizational justice (1.9, 1.1-3.2). If a respondent had several risk factors, the risk of suicidality doubled with each cumulating factor.
The reported level of suicidal ideation among Finnish anaesthesiologists is worth concern. It should be of utmost importance to screen the risk factors and recognize suicidal physicians in order to help them. Interpersonal relationships, decision-making procedures, and on-call-burden should be focused on when aiming to prevent suicidality among physicians.
Suicide as a premature exit from life is confusing not only for family and friends of the individual who shows suicidal behavior but also for many professionals. This article defines the concept of suicide, clarifies terms associated with suicide, reviews current clinical and research literature on suicide, and proposes a conceptual model that describes suicide as both an event and a process.
Five hundred psychological autopsies on equivocal (suicide versus accident) deaths were reviewed to ascertain which factors are significant in making the determination between suicidal and accidental deaths. Factors varied in relative importance according to the method used to cause death. Significant factors included life-style, recent stress, suicidal communications, previous self-destructive behaviors, history of depression, and obvious factors from the physical evidence such as large amounts of drugs in the blood. Although the court-provided decision guideline is "a preponderance of the evidence", in practice, the assembled evidence is often used to construct a "most credible" scenario to explain the death.
The purpose of this study was to determine whether distinctive features of language could be discerned in the poems of poets who committed suicide and to test two suicide models by use of a text-analysis program.
Approximately 300 poems from the early, middle, and late periods of nine suicidal poets and nine nonsuicidal poets were compared by use of the computer text analysis program, Linguistic Inquiry and Word Count (LIWC). Language use within the poems was analyzed within the context of two suicide models.
In line with a model of social integration, writings of suicidal poets contained more words pertaining to the individual self and fewer words pertaining to the collective than did those of nonsuicidal poets. In addition, the direction of effects for words pertaining to communication was consistent with the social integration model of suicide.
The study found support for a model that suggests that suicidal individuals are detached from others and are preoccupied with self. Furthermore, the findings suggest that linguistic predictors of suicide can be discerned through text analysis.
This study developed and evaluated the inter-rater reliability of a semistructured interview for psychological autopsy (SIPA). The SIPA is composed of 69 items that are distributed into four modules (precipitators and stressors, motivation, lethality, intentionality). The interviews of 42 subjects, related to 21 cases of suicide, were audiotaped and then transcribed and evaluated by the interviewer, and also evaluated by a research assistant and two referees who all acted independently. The SIPA was able to provide information that demonstrated a high degree of concordance (kappa) among the raters. The results of this study demonstrate that the SIPA is a very reliable instrument for psychological autopsy in cases of suicide.
The authors studied 30 patients treated at an urban trauma center for self-inflicted gunshot wounds, most or all of which would have been fatal without emergency treatment. About half the patients had used alcohol or drugs immediately before wounding themselves, and slightly more than half had experienced interpersonal conflict just before the incident. Thirteen of the 30 were women. Only nine were given diagnoses of major depressive episode or dysthymia; none of the patients had written suicide notes. These data indicate that the reported demographic and clinical characteristics of impulsive, violent self-injury must be reexamined.
The crucial concept for defining suicide is intention. A major purpose of the psychological autopsy is to clarify the pre‐mortem intentions of the victim, now deceased. This article reports cases in which the issue of suicide vs. accident came to trial because insurance benefits were at issue. Currently, the courts, in considering to what extent mental disorders impair the capacity for intentional self destruction, evaluate each case independently according to its own unique set of facts. 1984 The American Association for Suicidology
The psychological autopsy
- Shneidman