Article

The Next Generation of Psychological Autopsy Studies--Part One: Interview Content

Authors:
  • University of Rochester School of Medicine & Dentistry
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Abstract

The psychological autopsy (PA) is a systematic method to understand the psychological and contextual circumstances preceding suicide. The method requires interviews with one or more proxy respondents (i.e., informants) of decedents. The methodological challenges that need to be addressed when determining the content of these research interviews for PA studies are described and recommendations are made for meeting these challenges in future PA investigations. Ways to improve the data collected about mental disorders and life events--domains that are assessed in almost all PA studies--are discussed at length. Other understudied content areas considered include the role of personality traits, medical illness and functional limitations, availability of lethal agents, medications, and select distal variables including child maltreatment and family history of mental disorders and suicide. The benefits and challenges to using common protocols across studies are also discussed.

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... Information is gathered from a variety of sources, such as coroners' inquest records, medical records and interviews with next of kin. 22,23 The psychological autopsy method can be used to systematically gather evidence in support of previously unidentified diagnoses (such as autism), personality traits (such as autistic traits), and unique characteristics and risk markers for suicide in different groups (such as those with and without evidence of autism). This approach can therefore identify unique suicide prevention targets in different groups. ...
... This approach can therefore identify unique suicide prevention targets in different groups. 22 The current study is particularly novel as it utilises a large analysis of coroners' inquest records, followed by psychological autopsy interviews with a subsample of next of kin of those who died. Through these two stages, we address the following research questions. ...
... A data spreadsheet was developed, informed by previous research, to capture qualitative data pertaining to a broad range of characteristics of those who died (Table 2). 22,23 Content analysis was conducted on these qualitative data to capture the full range of characteristics of each person who died. This method was used as it is more open to discovering new characteristics in the underexplored area of suicide in autism, rather than relying on a pre-existing theoretical framework. ...
... Information is gathered from a variety of sources, such as coroners' inquest records, medical records and interviews with next of kin. 22,23 The psychological autopsy method can be used to systematically gather evidence in support of previously unidentified diagnoses (such as autism), personality traits (such as autistic traits), and unique characteristics and risk markers for suicide in different groups (such as those with and without evidence of autism). This approach can therefore identify unique suicide prevention targets in different groups. ...
... This approach can therefore identify unique suicide prevention targets in different groups. 22 The current study is particularly novel as it utilises a large analysis of coroners' inquest records, followed by psychological autopsy interviews with a subsample of next of kin of those who died. Through these two stages, we address the following research questions. ...
... A data spreadsheet was developed, informed by previous research, to capture qualitative data pertaining to a broad range of characteristics of those who died (Table 2). 22,23 Content analysis was conducted on these qualitative data to capture the full range of characteristics of each person who died. This method was used as it is more open to discovering new characteristics in the underexplored area of suicide in autism, rather than relying on a pre-existing theoretical framework. ...
Article
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Background Autism and autistic traits are risk factors for suicidal behaviour. Aims To explore the prevalence of autism (diagnosed and undiagnosed) in those who died by suicide, and identify risk factors for suicide in this group. Method Stage 1: 372 coroners’ inquest records, covering the period 1 January 2014 to 31 December 2017 from two regions of England, were analysed for evidence that the person who died had diagnosed autism or undiagnosed possible autism (elevated autistic traits), and identified risk markers. Stage 2: 29 follow-up interviews with the next of kin of those who died gathered further evidence of autism and autistic traits using validated autism screening and diagnostic tools. Results Stage 1: evidence of autism (10.8%) was significantly higher in those who died by suicide than the 1.1% prevalence expected in the UK general alive population (odds ratio (OR) = 11.08, 95% CI 3.92–31.31). Stage 2: 5 (17.2%) of the follow-up sample had evidence of autism identified from the coroners’ records in stage 1. We identified evidence of undiagnosed possible autism in an additional 7 (24.1%) individuals, giving a total of 12 (41.4%); significantly higher than expected in the general alive population (1.1%) (OR = 19.76, 95% CI 2.36–165.84). Characteristics of those who died were largely similar regardless of evidence of autism, with groups experiencing a comparably high number of multiple risk markers before they died. Conclusions Elevated autistic traits are significantly over-represented in those who die by suicide.
... However, these general resources do not provide guidance for navigating the special circumstances of psychological autopsy research studies. This gap has been filled by several published papers and book chapters that offer recommendations for conducting psychological autopsy research studies (Beskow et al., 1990;Brent, 1989;Clark & Horton-Deutsch, 1992;Conner et al., 2011Conner et al., , 2012Ebert, 1987;Hawton et al., 1998;Isometsä, 2001;Kõlves et al., 2021;Pouliot & De Leo, 2006;Schneidman, 1981;Shaffer et al., 1972). Limitations of this literature include that the range of recommendations and critiques can be overwhelming and are at times contradictory; there is not the same level of clarity or consensus as with the more general epidemiological literature on case-control study methodology; and we are aware of no reliable, published method for assessing the methodological quality of psychological autopsy research studies. ...
... Standard elements are described in a validated checklist for studies using case-control designs and related methods developed by Downs and Black (1998) including reporting, external validity, and internal validity, with several items adapted from their report. Additional PAMC items were developed to consider specialized aspects of case-control psychological autopsy research guided by the authors collective experience and two reviews of casecontrol psychological autopsy research methodology (Conner et al., 2011(Conner et al., , 2012. Studies contained in a meta-analysis of case-control psychological autopsy research of mood and substance use disorders (Conner et al., 2017) provided 35 reports that were used to refine the PAMC and establish its inter-rater reliability (Almasi et al., 2009;Appleby et al., 1999;Beautrais, 2001;Brent et al., 1999;Brent et al., 1993;Chan et al., 2009;Chen et al., 2006;Cheng, 1995;Cheng et al., 2000;Chiu et al., 2004;Conner et al., 2003;Conwell et al., 2010;De Leo et al., 2013a;De Leo et al., 2013b;Foster et al., 1999;Freuchen et al., 2012;Harwood et al., 2001;Khan et al., 2008;Kim et al., 2003;Manoranjitham et al., 2010;Page et al., 2014;Palacio et al., 2007;Préville et al., 2005;Renaud et al., 2008;Schneider et al., 2006;Shaffer et al., 1996;Shafii et al., 1988;Tong & Phillips, 2010;Vijayakumar & Rajkumar, 1999;Waern, 2003;Waern et al., 2002;Zhang et al., 2010;Zonda, 2006). ...
... Step 3 (training of raters): The first author trained two research associates who are new to suicide research and did not know any of the other study authors to score the PAMC. This training began with reading and discussion of the aforementioned psychological autopsy methodology reviews (Conner et al., 2011(Conner et al., , 2012 and a review and discussion of each PAMC item. Next, over four rounds, the raters independently scored a series of case-control psychological autopsy research papers selected by the trainer, typically two per round, and came together with the trainer to discuss their ratings, resolve discrepancies, and generate a consensus final rating, with each round leading to minor modification of the instrument to improve reliability. ...
Article
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Objective: Case-control psychological autopsy studies are the research standard for the postmortem, quantitative study of ongoing or recent risk factors for suicide. We aimed to develop a reliable checklist of methodological quality of these studies. Method: We adapted items from a validated checklist to address general methodological elements and created novel items to address the unique aspects of psychological autopsy research to generate a 16-item checklist assessing reporting, external validity, internal validity, and power. We used percent agreement and kappa to evaluate inter-rater reliability of the items and overall checklist based on independent ratings of 26 case-control psychological autopsy studies conducted internationally. We also summed the items to generate overall quality ratings, assessing internal consistency with coefficient alpha (α). Results: Inter-rater reliability for the overall checklist was high (percent agreement, 86.5%) and that based conservatively on kappa was substantial (κ .71) whereas internal consistency was low (α = 0.56). The inter-rater reliability of the individual items showed acceptable to high agreement. Conclusion: A novel checklist provides a reliable means to assess the methodological quality of specific elements of quantitative case-control psychological autopsy studies, providing detailed guidance in planning such studies. Lower internal consistency may limit its utility as a summary measure of study quality.
... Information gathered through PA methods typically involves in-depth interviews with proxies (or "informants") of the deceased, including family members, close friends (Conner et al., 2011), or healthcare professionals (De Leo et al., 2013), supplemented with reviews and analysis of official data, such as medical, police or coroners records (Knoll, 2009). According to Scott (2007), using multiple data sources which all produce overlapping findings presents "warranty through triangulation" (p. ...
... Studies using the PA method have been conducted in multiple research domains and have gathered information on behavioral (e.g., help-seeking behavior, drug and alcohol use), psychological (e.g., personality, psychological distress, attachment style between the victim and perpetrator), social/cultural (e.g., access to social support, relevant cultural norms), and environmental/situational (e.g., significant historical and recent events in the life of the deceased individual) factors. Given its ability to explore multiple factors across different domains of interest, the PA method is considered a valid and useful approach to help identify relevant information linked with an individual's death (Conner et al., 2011;Hawton et al., 1998;Pouliot & De Leo, 2006). This information can then be used as an evidence base upon which prevention programs and recommendations can be built (Knoll, 2009). ...
... First, given the sensitivity of the topic discussed with family and friends of the deceased, researchers have highlighted the importance of adequate clinical experience, knowledge, and training of interviewers (Beskow et al., 1990;Knoll, 2009). To assist researchers and interviewers in performing comprehensive assessments, several standardized and detailed protocols and guides on conducting PA studies have emerged in the past decade (Conner et al., 2011;Knoll, 2009). These emphasize the sensitivity of interviewers to emotional responses of the participants, expressing an appreciation for their participation in the interview given its difficult nature, and ethical conduct of the interview at all times. ...
Article
The most common form of violence experienced by women is that perpetrated by intimate partners, and the gendered nature of intimate partner femicide (IPF) has received particular attention. Few studies to date have delved into the limitations associated with methods used in IPF research, and particularly the methods used to study homicide victims (rather than homicide perpetrators). This article outlines dominant methodologies used to study IPF, and considers a novel method of investigation—the “psychological autopsy”—that may help to improve existing knowledge about IPF.
... To address evidence shortcomings and enhance the knowledge base about IPF and violence against women more broadly, the use of a casecontrol design and psychological autopsy (PA) methods may prove a valuable means of investigating the diverse range of factors surrounding an individual death (Conner et al., 2011;Hawton et al., 1998;Knoll, 2008;Pouliot & De Leo, 2006). Originally designed to gather information about the psychological state of the deceased (Schneideman & Farberow, 1956), PA has evolved to incorporate a wide range of structured and semi-structured tools across multiple research domains including behavioural (e.g., help-seeking efforts), psychological (e.g., psychological distress, relationship attachment style), social/cultural (e.g., access to social support) and environmental/situational (e.g., significant historical and recent events in the life of the deceased individual). ...
... PA combines extensive quantitative and qualitative data gathered from in-depth interviews with proxies of the deceased (typically nextof-kin or close friends; Conner et al., 2011;Hawton et al., 1998) with data from official records. It capturesin a structured and systematic wayunique, detailed, and critical individual information (including, for example, life history, psychosocial factors, and help-seeking behaviours) that is not generally collected in official records. ...
... Collecting adverse life events with an informant is a standard method of psychological autopsies (20). However, only few evidence is available about the reliability of this practice. ...
... Also, the nature of relationship between informants and the deceased persons may have influenced the information that investigators obtained. However, in line with a long tradition of narrative exploration practices, we adopted proven measures to minimize information and/or recall biases and homogenize data collection: systematic semi-structured exploration of pre-specified ALE, minimization of resistances thanks to conversational-style interviews, use of memory anchors, stimulation of the recall efforts with calendars and photos and cross-checking of collected data from various sources (20). Although these precautions may not have fully compensated for the inaccuracies of subjective reporting procedures, it should be noted that possible information biases were likely comparable for the two classes. ...
Article
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Purpose: Adolescence is a key period of transitions in the psychological, cognitive, neurobiological and relational domains, which is associated to high susceptibility to adverse life experiences. However, the way adolescent development alters life paths toward suicide remains unclear. Thereby, we aimed at testing whether and how adolescence interfered with the adversity trajectories of individuals who died by suicide. Methods: In a sample of 303 individuals who died by suicide, longitudinal Burden of Adversity ratings were derived from extensive psychological autopsies and life trajectory narrative interviews conducted with informants. Piecewise Joint Latent Class Models allowed the identification of patterns of adversity trajectories and tested the introduction of breakpoints in life-paths. Classes inferred from the optimal model were compared in terms of socio-demographics, psychopathology, and rate of different adverse life events. Results: The most accurate model derived 2 trajectory patterns with a breakpoint in early adolescence. In the first class (n = 39), the burden of adversity increased steadily from birth to death, which occurred at 23 (SE = 1.29). In the second class (n = 264), where individuals died at 43 years of age (SE = 0.96), the burden of adversity followed a similar trajectory during infancy but stabilized between 10 and 14 years and started to increase again at about 25. Childhood family instability, dependent events, exposure to suicide, intra-family sexual victimization and affective disorders at death were more frequent in class 1. Conclusions: A bifurcation in trajectories between early and late suicides occurs during adolescence. The dynamic pattern of adversity during this period is a key issue to understand the developmental heterogeneity in suicide risk.
... PA is a tool by which information for deceased persons is reconstructed by interviewing those closest to themknown as the informantsand examining corroborating evidence from sources such as health records. Informants are usually the main information sources for PA, and the information offered by informants is known as proxy data for the target subject [4][5][6][7][8]. ...
... In our previous study, we found that using a second informant did not significant enhance information validity for the target on hopelessness, impulsivity, anxiety and coping, in the form of numeric variables [14]. Life events which are usually measured as categorical variables are important content in psychological autopsy [4]. Conner and his colleagues used one informant for psychological autopsy and found that the validity of proxy data on stressful life events was mixed: specificity was higher than sensitivity across life event categories, and agreement was substantial for public and observable events but lower for more ambiguous events [16]. ...
Article
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Background Life event assessment is an important part in psychological autopsy, and how to integrate its proxy data from two informants is a major methodological issue which needs solving. Methods Totally 416 living subjects and their two informants were interviewed by psychological autopsy, and life events were assessed with Paykel’s Interview for Recent Life Events. Validities of integrated proxy data using six psychological autopsy information reconstruction methods were evaluated, with living subjects’ self-reports used as gold-standard criteria. ResultsFor all the life events, average value of Youden Indexes for proxy data by type C information reconstruction method (choosing positive value from two informants) was larger than other five methods’. For family life related events, proxy data by type 1st information reconstruction method were not significantly different from living subjects’ self-reports (P = 0.828). For all other life events, proxy data by type C information reconstruction method were not significantly different from the gold-standard. Conclusions Choosing positive value is a relatively better method for integrating dichotomous (positive vs. negative) proxy data from two informants in life event assessment in psychological autopsy, except for family life related events. In that case, using information provided by 1st informants (mainly family member) is recommended.
... Two independent reviewers (AH and AZ or MP and AZ) rated the eligibility of each of the abstracts and full texts in Covidence. 22 Disagreements were resolved by consensus, and we measured inter-rater agreement with the κ statistic. ...
... The physician specialty varied across studies: 42 (25%) mixed specialties, 32 (19%) internal medicine, 21 (12%) surgery (ie, trauma, plastic, and neurosurgical), 19 (11%) emergency medicine and intensive care, 11 (6%) general practitioners, eight (5%) interns or residents, eight (5%) paediatrics, seven (4%) oncology (ie, gynaecologist, radiation, or palliative care), six (4%) neurology, three (2%) psychiatry, and 13 (8%) involving other specialties. Physicians had more than seven years of experience in 52 (31%) studies, a mixture of experience was reported in 47 (28%) studies, and 38 (22%) studies involved residents, junior doctors, or interns with fewer than seven years of experience.The most common measure of burnout was the full22-item Maslach Burnout Inventory (81 (48%) of 170 studies). An abbreviated version of the Maslach Burnout Inventory was used in 50 (29%) studies, other types were used in 34 (20%) studies and only five 2.16 (1.81 to 2.58) 1.83 (1.05 to 3.20) 10.07 (7.53 to 13.47) 2.67 (0.87 to 8.16) 1.57 (1.02 to 2.41) seTE fig 3 | association of physician burnout with turnover intention. ...
Article
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Objective To examine the association of physician burnout with the career engagement and the quality of patient care globally. Design Systematic review and meta-analysis. Data sources Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021. Eligibility criteria for selecting studies Observational studies assessing the association of physician burnout (including a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalisation, and a sense of ineffectiveness and little personal accomplishment) with career engagement (job satisfaction, career choice regret, turnover intention, career development, and productivity loss) and the quality of patient care (patient safety incidents, low professionalism, and patient satisfaction). Data were double extracted by independent reviewers and checked through contacting all authors, 84 (49%) of 170 of whom confirmed their data. Random-effect models were used to calculate the pooled odds ratio, prediction intervals expressed the amount of heterogeneity, and meta-regressions assessed for potential moderators with significance set using a conservative level of P<0.10. Results 4732 articles were identified, of which 170 observational studies of 239 246 physicians were included in the meta-analysis. Overall burnout in physicians was associated with an almost four times decrease in job satisfaction compared with increased job satisfaction (odds ratio 3.79, 95% confidence interval 3.24 to 4.43, I2=97%, k=73 studies, n=146 980 physicians). Career choice regret increased by more than threefold compared with being satisfied with their career choice (3.49, 2.43 to 5.00, I2=97%, k=16, n=33 871). Turnover intention also increased by more than threefold compared with retention (3.10, 2.30 to 4.17, I2=97%, k=25, n=32 271). Productivity had a small but significant effect (1.82, 1.08 to 3.07, I2=83%, k=7, n=9581) and burnout also affected career development from a pooled association of two studies (3.77, 2.77 to 5.14, I2=0%, n=3411). Overall physician burnout doubled patient safety incidents compared with no patient safety incidents (2.04, 1.69 to 2.45, I2=87%, k=35, n=41 059). Low professionalism was twice as likely compared with maintained professionalism (2.33, 1.96 to 2.70, I2=96%, k=40, n=32 321), as was patient dissatisfaction compared with patient satisfaction (2.22, 1.38 to 3.57, I2=75%, k=8, n=1002). Burnout and poorer job satisfaction was greatest in hospital settings (1.88, 0.91 to 3.86, P=0.09), physicians aged 31-50 years (2.41, 1.02 to 5.64, P=0.04), and working in emergency medicine and intensive care (2.16, 0.98 to 4.76, P=0.06); burnout was lowest in general practitioners (0.16, 0.03 to 0.88, P=0.04). However, these associations did not remain significant in the multivariable regressions. Burnout and patient safety incidents were greatest in physicians aged 20-30 years (1.88, 1.07 to 3.29, P=0.03), and people working in emergency medicine (2.10, 1.09 to 3.56, P=0.02). The association of burnout with low professionalism was smallest in physicians older than 50 years (0.36, 0.19 to 0.69, P=0.003) and greatest in physicians still in training or residency (2.27, 1.45 to 3.60, P=0.001), in those who worked in a hospital (2.16, 1.46 to 3.19, P<0.001), specifically in emergency medicine specialty (1.48, 1.01 to 2.34, P=0.042), or situated in a low to middle income country (1.68, 0.94 to 2.97, P=0.08). Conclusions This meta-analysis provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care. Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency. Systematic review registration PROSPERO number CRD42021249492.
... At times, they might go through grief or suffer from a mental disorder and help should be offered for the same. [3,45] Proposed semi-structured format for psychological autopsy interview Lack of a standard format for interviewing informants in PA has raised legitimate concerns about the reliability/validity of the process. To our knowledge, only one previous study has outlined a detailed semi-structured interview format for PA. ...
... Previous investigators have recommended approaching informants with a letter explaining the scope and nature of request along with the necessary approvals (ethics approval, if it is a SPA) and obtaining the consent of the kin to obtain their cooperation. [45] Even then, some agencies or systems involved may be reluctant to release information due to concerns about legal liability. Similar concerns may apply to other sources of information in PA interview [ Table 2]. ...
Article
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Background: No review has been attempted, so far, on Indian psychological autopsy (PA) literature. There is also a dearth of interview guides which is at the heart of a PA procedure. Materials and Methods: Electronic searches of MEDLINE through PubMed, PsycINFO, and Google scholar databases were carried out from inception till February 2020 to identify relevant English language peer-reviewed articles from India, as well as global literature that provided information on best practice elements in PA. Abstracts generated were systematically screened for eligibility. Relevant data were extracted using a predesigned structured proforma, and a semi-structured interview guide was developed. Results: A total of 18 original articles, one case report, and three reviews/expert opinion articles which tried to give a description of PA procedure were found from India. Most Indian studies are of suicide PA (SPA), done to assess risk factors associated with suicide. There was a wide variation in reported rates of psychiatric morbidity among suicide decedents, while the other major risk factor for suicide in the Indian setting was stressful life events. An optimal approach to PA involves systematically collecting information from key informants and other sources using a narrative interviewing method, supplemented with psychological measures, and is probably best carried out within 1–6 months after the death. Conclusion: There have been limited attempts to standardize PA. Most Indian studies use SPA. We propose a semi-structured PA interview guide, suitable for both research and investigational purposes.
... Амбрумовой [107], СП психически здоровых (без явных «больших» психических расстройств), но с возможными нарушениями сна. Кстати, к современной психологической аутопсии предъявлены требования сбора более детальной информации для комплексного анализа СП [108]. ...
... According to the school of A.G. Ambrumova tradition [107], special attention is drawn to SB of mentally healthy people (without obvious "serious" mental disorders), but having possible sleep disorders. By the way, the requirements to the modern psychological autopsy are strict now in terms of collecting more detailed information for a comprehensive analysis of SB [108]. ...
... These findings and unanswered questions illustrate that suicide is a multidimensional and multi-causal phenomenon that can be described from different approaches and perspectives. The psychological autopsy is a well-known and established method in suicide research, assessing potential risk factors, that still need to be considered with caution, and analysing the personality, the behaviour, and the motives of the person before committing a suicide (Conner et al., 2011;Knoll & Hatters-Friedman, 2015;Khan et al., 2005;Pouliot & De Leo, 2006). This strategy is widely used in many countries, but it is still minimally used and not analysed methodologically in Lithuania. ...
... Yet, supposedly, a better analysis of socioenvironmental contributors to suicide needs to be prioritized instead of psychiatric diagnoses (Pouliot & De Leo, 2006). The methodological challenges also include timing of the interviews after suicide, designing the structure or standard protocol, defining and reaching proxy respondents, training and supervising interviewers, carrying case-control studies, critically analysing the medical illness, help-seeking behaviour, and other personal information of suicide decedents named by the respondents (Conner et al., 2011;Conner et al., 2012;Pouliot & De Leo, 2006). In general, there is a lack of defined guidelines for performing this type of method (Pouliot & De Leo, 2006). ...
Article
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Conducting a psychosocial autopsy after a suicide is a well-known method in the world for a deeper understanding of suicide, but it still raises a lot of debates over how this method could be applied better to avoid questionable reliability of the research. This study represents methodological insights from a psychosocial autopsy study of adult suicide. 145 people, who lost a close relative or friend due to a suicide, participated in the study. The results revealed that it is particularly important to complete a pilot study and a test of the protocol in a specific sample. Insights to organize face to face meetings due to the sensitivity of the experience, the ability to observe and respond to the risk of suicide of respondents, and to require researchers with practical experience in suicide prevention and psychological assistance is emphasized. This study is an attempt to give methodological insights for future research of suicide and facilitate significant progress in our understanding of suicide.
... Besides, the validity of psychological autopsy studies depends on the validity of the information provided by proxy informants about the deceased [18]. Previous studies have suggested that proxies are good judges of past history of suicide attempts, suicidal intent, psychiatric diagnosis, depression, life events, and social support [4,5,19,20]. As loneliness is a subjective and personal inner experience or feeling, is it amenable to detection by others? ...
... The estimates of the proxy respondents were significantly and slightly higher than subject reports with about a mean difference of 1.23 (SD = 4.72). Symptoms and behaviors that are prominent, noticeable, and recurrent are the most detectable [20]. With increasing age, social networks of older adults will become smaller (e.g., loss of spouse and friends), and social contracts will decrease as well due to worsen physical health and reduced physical activity performance. ...
Article
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Background: There is a lack of evidence for the role of loneliness on suicide using psychological autopsy method, and the validity of proxy informants' reports on loneliness is not well established. This study aimed to investigate the validity of proxy respondent reports on loneliness, and the reliability and validity of the University of California Los Angeles Loneliness Scale-6 (ULS-6) as used in psychological autopsy method with rural elderly people in China. Methods: Two hundred forty-two suicide cases and 242 normal community controls were selected, and the psychological autopsy method was utilized to collect information. Data from proxy respondents of the living controls were compared with data reported by the targets (gold standards). Results: Subject-proxy concordance for ULS-6 was fair (ICC = 0.447) in the living controls. The suicide cases were more likely to have a higher score of ULS-6 than the living controls. Additionally, our data supported that ULS-6 had adequate psychometric properties in both suicide and control groups: factor analyses yielded one-factor component solution; Cronbach's alpha (both > 0.90) demonstrated excellent internal consistency; the Spearman correlation analysis indicated that the ULS-6 score was positively correlated with depression; and negatively correlated with QOL and social support. Conclusions: Results support proxy-based data on loneliness in research of suicide in older adults in rural China, and the ULS-6 is a psychometrically sound instrument for measuring loneliness in psychological autopsy studies.
... This approach is based on the "meticulous collection of data that are likely to help reconstitute the psychosocial environment of individuals who have committed suicide and thus understand better the circumstances of their death" [10]. The approach is useful in assessing psychological characteristics, psychosocial circumstances, health service use and proximal risk or contributing factors associated with suicide, provided that standardised definitions and systematic procedures are used [11,12]. ...
... Psychological autopsy studies have become more widely used in recent years [11,12], but the potential of this approach has yet to be exploited fully. Some psychological autopsy studies fail to include a control group, and where controls are used, methodological shortcomings include an imbalance of available information between cases and controls and absence of a matched comparison between cases and controls [13,14]. ...
Article
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Background: Suicide has profound effects on families and communities, but is a statistically rare event. Psychological autopsies using a case-control design allow researchers to examine risk factors for suicide, using a variety of sources to detail the psychological and social characteristics of decedents and to compare them to controls. The Suicide Support and Information System Case Control study (SSIS-ACE) aimed to compare psychosocial, psychiatric and work-related risk factors across three groups of subjects: suicide decedents, patients presenting to hospital with a high-risk self-harm episode, and general practice controls. Methods: The study design includes two inter-related studies; one main case-control study: comparing suicide cases to general practice (GP) controls, and one comparative study: comparing suicide cases to patients presenting with high-risk self-harm. Consecutive cases of suicide and probable suicide are identified through coroners' registration of deaths in the defined region (Cork City and County, Ireland) and are frequency-matched for age group and gender with GP patient controls recruited from the same GP practice as the deceased. Data sources for suicide cases include coroners' records, interviews with health care professionals and proxy informants; data sources for GP controls and for high-risk self-harm controls include interviews with control, with proxy informants and with health care professionals. Interviews are semi-structured and consist of quantitative and qualitative parts. The quantitative parts include a range of validated questionnaires addressing psychiatric, psychosocial and occupational factors. The study adopts several methodological innovations, including accessing multiple data sources for suicide cases and controls simultaneously, recruiting proxy informants to examine consistency across sources. Conclusions: The study allows for the investigation of consistency across different data sources and contributes to the methodological advancement of psychological autopsy research. The study will also inform clinical and public health practice. The comparison between suicide cases and controls will allow investigation of risk and protective factors for suicide more generally, while the comparison with high-risk self-harm patients will help to identify the factors associated specifically with a fatal outcome to a self-harm episode. A further enhancement is the particular focus on specific work-related risk factors for suicide.
... It is an individual-level, exploratory study to more fully explore these relationships between exposure to violence, access to firearms, and suicide. We do so by conducting interviews with next of kin of recent suicide decedents (36,37). We conducted our study in New Orleans, Louisiana: in 2015, there were 722 suicides in Louisiana of which 65% were caused by a firearm; three-quarters of all firearm-caused deaths in the state were suicides (38). ...
... We began to send outreach letters in November 2015 and data collection ended in September 2016 (11 months). Our original plan was to conduct interviews 6 weeks after the date of death, based on recommendations for conducting these kinds of studies (36,37). However, after 3 months of data collection without receiving any acceptances to our interview requests, we extended our time frame to include anyone who had died by suicide since January 2015 with interview requests sent in batches to ease interviewer burden. ...
Article
Many Americans own guns to protect themselves against other people, but there is evidence that both victimization and gun access increase suicide risk. We conducted qualitative interviews with informants of 17 suicide cases in New Orleans of the 60 who died between January 2015 and April 2016 to understand the relationship between past trauma, gun access and storage, and suicide. Nine cases had experienced a past trauma, including three who had recently had a family member killed by homicide. Eight died via firearm; of those, seven owned the guns they used to take their lives and stored them locked (but loaded) at home or in their cars. Preventing community violence and addressing its sequelae may be important for reducing suicides. A multi-pronged strategy consisting of policies, education, and marketing will likely be needed to address the risk of suicide conferred by gun access.
... As a postvention protocol [59], respecting emotions and potentially heightened risk of suicide by loss survivors [60], both before and at the close of the interviews, an offer should be made to each person of literature and referral information for service providers in their home area that may help them if needed engage more with their thoughts and feeling regarding the event. The work of Conner et al. (2011) provides an example helpful in establishing a viable interview process [61]. ...
... As a postvention protocol [59], respecting emotions and potentially heightened risk of suicide by loss survivors [60], both before and at the close of the interviews, an offer should be made to each person of literature and referral information for service providers in their home area that may help them if needed engage more with their thoughts and feeling regarding the event. The work of Conner et al. (2011) provides an example helpful in establishing a viable interview process [61]. ...
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This topic review paper provides a brief overview of factors considered in the determination of so-called ‘suicide by cop’ (SbC), including potential contextual signs of such an event. The summarization and analysis of the suicide by cop extant literature indicates a gap, and subsequent need, in commentary on content and viability of police training in this area. Within the United States, this phenomenon is often either unrecognized, or unremarkable in official reports subsequent to an officer involved shooting. It is important for law enforcement officers to be trained to recognize, when possible, the signs of an individual seeking self-harm by attempting to elicit the action from officers. While it is important to note that such potential recognition of self-harm-seeking behavior may inform responding personnel in fashioning an approach to the individual, this does not obviate the need to consider the safety of officers and bystanders first, as such incidents may rapidly unfold. Agency training, driven by written policy and prevailing law, should be based on empirical evidence, where available, and when utilization of such research does not seek to supersede other safety considerations. While law enforcement recruit academy curriculums in the United States have increased significantly in hours of classroom study, there is a limit to the practicality of training blocks on sundry topics. Additionally, within the U.S. context, laws and court decisions impose expectations regarding training requirements and limits of liability. The use of psychological autopsy investigation holds the potential to fill knowledge gaps about an event and provide a more complete contextual picture to many fatal force usage situation involving police. Future research is needed to examine behavior motivations, potentially using the psychological autopsy investigation method, and how results can enhance police training.
... Psychological autopsy methodologies may enhance population-wide analyses because they integrate autopsy reports, police death scene investigations, medical and psychiatric record review, and interviews with decedents' family members. While psychological autopsy studies cannot account for decedents' subjective experience, validated postmortem methodologies can be used to characterize decedents' functioning prior to death and evaluate manner of death (Conner et al., 2011;Connor et al., 2012). ...
Article
Background: Opiate misuse has reached epidemic levels. Prevention efforts depend on distinguishing opiate users from abusers. The current study compared opioid users who died by natural cases, accidents, and suicide using psychological autopsy methods. Groups were compared on substance use characteristics, treatment history, experiences of negative life events, and circumstances at the time of death. Methods: Substance use and suicide risk were evaluated using psychological autopsy methods in 63 decedents with positive toxicology for opiates at death divided into three groups: adults dying by suicide (n = 19), accident (n = 19), and natural causes (n = 25). Groups were compared on several dependent measures, using chi-square analyses to examine categorical variables and one-way analyses of variance (ANOVA) to examine continuous variables. Results: Individuals who died by suicide were similar in many ways to adults who died by an accidental overdose. However, suicide completers were more likely to have struggled with severe depression, and previously attempted suicide, whereas the accidental overdose sample was more likely to display a chronic pattern of severe drug abuse. Conclusions: The current study helps to distinguish between opiate users who are at risk for death by an accidental or intentional overdose. In the ongoing opiate crisis, clinicians must understand the risk of overdose and the nuances of accidental behaviors compared to purposeful ones. Signs of suicidal planning, relevant psychopathology, and ongoing life stress may be useful points of intervention for stopping the increasing number of deaths among opiate users.
... were unavailable; such data would have enabled our findings to be put into context. However, the approach taken (reviewing risk factors among those who have died by suicide) has been used in many previous studies to explore heightened risk of suicide in different occupational groups (Conner, 2011;Hawton et al., 2002;Hawton, Malmberg, & Simkin, 2004;Malmberg, Simkin, & Hawton, 1999). ...
Article
Background: There is growing evidence to suggest that ambulance service staff may be at increased risk for suicide; however, few studies have explored risk factors within this occupational group. Aim: To investigate factors commonly associated with ambulance staff suicides. Method: Eleven ambulance service trusts across the United Kingdom were asked to return details of staff suicides occurring between January 2014 and December 2015. Coroners were then contacted to request permission to review the records of the deceased. Results: Fifteen suicides were identified (73% male, mean age 42 years). Inquest data were available on 12 deaths. The most common method used was hanging. Possible risk factors identified included recent return to work following a period of sickness absence, poor mental health, relationship and debt problems, history of self-harm and the loss of a driving licence/change in job role. Conclusion: Identifying characteristics of suicide among this high-risk group is important to inform the development of suicide prevention initiatives. Additional research is needed with an adequate control group to further explore the risk factors identified in this study.
... We used a novel mixed methods psychological autopsy case-series method (Kral, Links, and Bergmans 2012;Arieli, Gilat, and Aycheh 1996;Conner et al. 2005;Chavan et al. 2008;Zhang et al. 2009;Apter et al. 1993) tailored for cross-cultural research, henceforth referred to as MPAC. This allows the informants (typically relatives) to share detailed accounts and interpretations of suicide circumstances including perceived warning signs, contributing factors, helpseeking phenomena, and the various impacts on the family and surrounding community (Shneidman 2004;Conner et al. 2011). The analyses presented here focus on events and circumstances that preceded the suicide death. ...
Article
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South Asia accounts for the majority of the world’s suicide deaths, but typical psychiatric or surveillance-based research approaches are limited due to incomplete vital surveillance. Despite rich anthropological scholarship in the region, such work has not been used to address public health gaps in surveillance and nor inform prevention programs designed based on surveillance data. Our goal was to leverage useful strategies from both public health and anthropological approaches to provide rich narrative reconstructions of suicide events, told by family members or loved ones of the deceased, to further contextualize the circumstances of suicide. Specifically, we sought to untangle socio-cultural and structural patterns in suicide cases to better inform systems-level surveillance strategies and salient community-level suicide prevention opportunities. Using a mixed-methods psychological autopsy approach for cross-cultural research (MPAC) in both urban and rural Nepal, 39 suicide deaths were examined. MPAC was used to document antecedent events, characteristics of persons completing suicide, and perceived drivers of each suicide. Patterns across suicide cases include (1) lack of education (72% of cases); (2) life stressors such as poverty (54%), violence (61.1%), migrant labor (33% of men), and family disputes often resulting in isolation or shame (56.4%); (3) family histories of suicidal behavior (62%), with the majority involving an immediate family member; (4) gender differences: female suicides were attributed to hopeless situations, such as spousal abuse, with high degrees of social stigma. In contrast, male suicides were most commonly associated with drinking and resulted from internalized stigma, such as financial failure or an inability to provide for their family; (5) justifications for suicide were attributions to ‘fate’ and personality characteristics such as ‘stubbornness’ and ‘egoism’; (5) power dynamics and available agency precluded some families from disputing the death as a suicide and also had implications for the condemnation or justification of particular suicides. Importantly, only 1 out of 3 men and 1 out of 6 women had any communication to family members about suicidal ideation prior to completion. Findings illustrate the importance of MPAC methods for capturing cultural narratives evoked after completed suicides, recognizing culturally salient warning signs, and identifying potential barriers to disclosure and justice seeking by families. These findings elucidate how suicide narratives are structured by family members and reveal public health opportunities for creating or supplementing mortality surveillance, intervening in higher risk populations such as survivors of suicide, and encouraging disclosure.
... Our response rates were relatively low compared with surveys conducted in the general population, but they were high for multi-informant interviews conducted within a military population. 34,35 Future research should focus on study design efforts to facilitate larger sample sizes. ...
Article
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Importance: Since 2004, the suicide rate among US Army soldiers has exceeded the rate of death from combat injury. It is critical to establish factors that increase the risk of acting on suicidal thoughts to guide early intervention and suicide prevention. Objective: To assess whether firearm ownership, use, storage practices, and accessibility are associated with increased risk of suicide. Design, setting, and participants: In this case-control study, suicide cases (n = 135) were defined as US Army soldiers who died by suicide while on active duty between August 1, 2011, and November 1, 2013. Next-of-kin and Army supervisors of soldiers who died by suicide (n = 168) were compared with propensity-matched controls (n = 137); those soldiers with a suicidal ideation in the past year (n = 118) provided structured interview data. Data were analyzed from April 5, 2018, to April 2, 2019. Main outcomes and measures: Firearm ownership, storage, and accessibility were assessed by using items from the World Health Organization Composite International Diagnostic Interview screening scales along with items created for the purpose of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) study. Results: Among the 135 suicide decedents, next-of-kin reported that they had greater accessibility to firearms compared with propensity-matched controls. Specifically, suicide decedents were more likely to own 1 or more handguns compared with propensity-matched controls (odds ratio [OR], 1.9; 95% CI, 1.0-3.7; χ21 = 4.2; false discovery rate [FDR] P = .08), store a loaded gun at home (OR, 4.1; 95% CI, 1.9-9.1; χ21 = 12.2; FDR P = .003), and publicly carry a gun when not required for military duty (OR, 3.2; 95% CI, 1.4-7.3; χ21 = 7.4; FDR P = .02). The combination of these 3 items was associated with a 3-fold increase in the odds of suicide death (OR, 3.4; 95% CI, 1.2-9.4; χ21 = 5.4; FDR P = .05). Storing a loaded gun with ammunition at home or publicly carrying a gun when not on duty was associated with a 4-fold increase in the odds of suicide death (OR, 3.9; 95% CI, 1.9-7.9; χ21 = 14.1; FDR P = .002). Conclusions and relevance: In this study, in addition to gun ownership, ease and immediacy of firearm access were associated with increased suicide risk. Discussion with family members and supervisors about limiting firearm accessibility should be evaluated for potential intervention.
... Psychological autopsy (PA) is a widely used method to explore the risk factors of completed suicide and has been validated previously in China (Zhang et al., 2003;Conner et al., 2012). Using a 1 : 1 matched case-control design, this PA study aims to shed light on this research gap. ...
Article
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Aims Loneliness is increasingly recognised as a serious public health issue worldwide. However, there is scarce research addressing the association between loneliness and suicide in older adults in rural China. We set out to examine loneliness and other psychosocial factors in elderly suicide cases and explore their interaction effects. Methods Using a 1 : 1 matched case–control design, data were collected from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including demographic characteristics, loneliness, depression, hopelessness and social support. The chi-square automatic interaction detection (CHAID) tree model and multivariable logistic regression analysis were used to explore the relationships of these factors and suicide. Results The CHAID tree model showed that loneliness, hopelessness and depressive symptoms were closely associated with completed suicide and that loneliness and hopelessness interacted with each other. The result of multivariable logistic regression showed that individuals who were unemployed [odds ratio (OR) = 2.344; 95% confidence interval (CI): 1.233–4.457], living alone (OR = 2.176; 95% CI: 1.113–4.254), had lower levels of subjective social support (OR = 2.185; 95% CI: 1.243–3.843), experienced depressive symptoms (OR = 6.700; 95% CI: 3.405–13.182), showed higher levels of hopelessness (OR = 7.253; 95% CI: 3.764–13.974) and felt higher levels of hopelessness × higher levels of loneliness (OR = 2.446; 95% CI: 1.089–5.492) were significantly associated with an elevated suicide risk in older people in rural China. Conclusions Regular evaluation of loneliness, hopelessness and depression can help detect older adults who are at risk of committing suicide. Interventions should target social support systems, particularly among people living alone, to alleviate feelings of loneliness and hopelessness. Treating depression is also key to preventing suicide among elderly people in rural China.
... What stipulates a person to take own life is still unanswered in specific fashion, which acts as prime obstacle in suicide research (Cavanagh et al., 2003). However, psychological autopsy studies (PAS) have been considered as the most valuable, systematic as well as straight research tool to determine the relation of any specific risk factor and suicide by tracing psychological and contextual issues before death from the proxy respondents (Cavanagh et al., 2003;Conner et al., 2011;Isometsä, 2001). In suicidology, it has been postulated that at least 90% of those who kill themselves by suicide suffer from at least 1 psychiatric disorder which has been revealed by repeated PAS (Hjelmeland et al., 2012;Milner et al., 2012;Cavanagh et al., 2003). ...
... Data were gathered using a structured psychological autopsy interview developed for use in the current study. This interview was created using a multistep measure-development procedure that involved (a) comprehensive literature reviews of prior autopsy studies; (b) review of measures used in these prior studies; (c) following recommendations regarding best practice procedures for autopsy studies (i.e., Conner et al., 2011Conner et al., , 2012); (d) as possible, paralleling the assessment of constructs in other Army STARRS studies to more easily allow for comparison across study components; and (e) as possible, paralleling the questions asked of next of kin and supervisors to allow for comparisons across informants. The interview included 26 sections assessing a wide range of potential risk and protective factors for suicide (e.g., mental disorders, prior suicidal behavior). ...
Article
Objective: To examine suicide decedents' use of mental health treatment and perceived barriers to initiating and maintaining treatment. Method: We used a psychological autopsy study conducted as part of the Army Study to Assess Risk and Resilience Among Servicemembers (Army STARRS) that compared suicide decedents (n = 135) to soldiers in two control conditions: those propensity-score-matched on known sociodemographic and Army history variables (n = 137) and those with a history of suicidal thoughts in the past 12 months (n = 118). Informants were next of kin and Army supervisors. Results: Results revealed that suicide decedents were significantly more likely to be referred to services and to use more intensive treatments (e.g., medication, overnight stay in hospital) than propensity-matched controls. However, decedents also were more likely to perceive significant barriers to treatment-seeking. All differences observed in the current study were between propensity-matched controls and decedents, with no observed differences between suicide ideators and decedents. Conclusions: Many suicide decedents used some form of mental health care at some point in their lives; however, they also were more likely than propensity-matched controls to perceive barriers that may have prevented service use. The lack of differences between suicide ideators and decedents suggests that more information is needed, beyond knowledge of treatment utilization or perceived barriers, to identify and intervene on those at highest risk for suicide. These findings underscore the importance of reducing attitudinal barriers that may deter suicidal soldiers from seeking treatment, and also improving risk detection among those who are attending treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... La autopsia psicológica es el método de investigación idó-neo en suicidio; a través de informantes se trata de explicar retrospectivamente qué llevó a una persona a fallecer por suicidio. Mediante este sistema de entrevistas a familiares o personas cercanas se evalúan factores precipitantes, eventos vitales estresantes, rasgos psicopatológicos, diagnósticos psiquiátricos, entre muchas otras variables 22 . Los inicios de la autopsia psicológica fueron en los años 20 cuando los primeros investigadores comenzaron a recolectar datos de suicidio 23 . ...
Preprint
El suicidio constituye un importante problema de salud pública. La mortalidad por suicidio, la calidad de las estadísticas y su validez son un elemento crucial en su monitorización y prevención. En este artículo pretendemos realizar una actualización de las aportaciones de la medicina forense a la conducta suicida, destacando la importancia de las fuentes forenses en el conocimiento de los factores de riesgo así como la participación de Institutos de Medicina Legal y Ciencias Forenses en programas de prevención del suicidio. Hemos querido señalar las distintas colaboraciones del Instituto de Medicina Legal y Ciencias Forenses con especialistas del ámbito de la psiquiatría y también de la salud pública que han permitido desarrollar un modelo integrativo de investigación de la conducta suicida dirigidas a conocer con precisión los datos relativos a las muertes por suicidio, estandarizar la investigación en suicidio y elaborar estrategias de prevención suicida efectivas frente a una causa de mortalidad prevenible. Suicide is an important public health problem. Suicide mortality, and the quality and reliability of suicide statistics are key points in monitoring and preventing suicidal behaviours. The objective of this paper is to review the contribution of forensic medicine to suicidal behaviour, to underline the importance of forensic sources to investigate risk factors, and to highlight the role of Institutes of Legal Medicine and Forensic Sciences in suicide prevention programmes. We describe the collaboration between Institute of Legal Medicine and Forensic Sciences and specialists in the fields of psychiatry and public health. This collaborative work has facilitated the development of an integrative model in the investigation of suicidal behaviour allowing more precise suicide mortality data, the standardisation of research on suicide, and the development of suicide prevention strategies to reduce a preventable cause of death.
... In de studie van Seguin et al. (2011) werd een percentage van 14.9 % gevonden voor jongeren die overleden door suïcides. Dit effect kan onderschat worden door het internaliserend karakter van deze aandoening (Conner, 2011). In een longitudinale bevolkingsstudie onder jongeren in Nieuw Zeeland vonden Boden, Woorward en Fergusson (2007) auteurs bewijs dat er ook ten aanzien van suïcidepogingen onder jongeren er een belangrijk risico uitgaat van een angststoornissen. ...
Article
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Suicide and attempted suicide by young people in Amsterdam. What do we know about the background and factors associated with suicide and suicidal behaviors? At the end of 2016, suicide among adolescents has been on the rise among Dutch youth. This finding highlights the importance of collecting relevant information concerning adolescent suicide. In this study, we will take a first step in collecting knowledge prior to this rise regarding the background, characteristics and precipitating factors of suicidality in Dutch youth in Amsterdam in the period between 1996 and 2010. Two types of files were collected; for suicides in Amsterdam, coroners’ files were collected (1996-2010). For suicide attempts, we collected medical files from the emergency room of a hospital in Amsterdam (2003-2006). Regarding suicides of young people, we mainly see young men between the ages of 18-23 who mainly died through hanging, jumping from height or in front of a train. Few other factors were recorded in the coroners’ files. Regarding suicide attempts, five themes were visible: 1) demographic and social factors; older adolescents and girls were strongly overrepresented, and a third of all attempters had a non-Dutch origin; 2) Stressful life events, particularly sexual abuse and parental divorce; 3) psychological issues and psychiatric disorders, especially depression and borderline personality; 4) trigger factors consisting of conflicts and disputes with parents or a partner and lastly, 5) previous self-harm or attempts were frequently noted. This study provides a very first indication of relevant factors that could assist in future research about the recent rise in Dutch adolescent suicide and guide prevention efforts. To generate more specific epidemiological knowledge, and in order to formulate prevention strategies more optimal data-gathering systems are needed that systematically take a wide range of known risk factors into account.
... Psychological autopsy is considered a superior method than the examination of the absolute documents approach to determining the psychological/psychiatric antecedents and risk factors (32). Cases can be enlightened using various psychological/psychiatric methods for defining the perpetrator's relationship with the victims, and the motivations for the homicide-suicide action such as jealousy, altruism, revenge (20). ...
Article
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The term ¨Homicide-Suicide¨ is described with an interpersonal violence where a perpetrator commits suicide after murders at least one victim. Mostly it has been thought that it is an act which is posterior to decision of suicide of the dominant family member. In various cases this situation is considered as a concern of the dominant member about leaving no-one behind. It has been considered that in those cases where an individual has suicided or has been killed perpetrators persuade the victims even if they aren’t willling to do it. By homicide-suicide’s very nature perpetrator and victim are deceased thus several sorts of information do not include sufficent nuance about the causes and dynamics of the event. In this paper, it is aimed that to examine fundamentals, prevalence and differences of homicide suicide and to provide a perspective about spesific traits of sub-types of the cases with the help of literature. The method of psychological autopsy, which is conducted in order to determine the psychological/psychiatric antecedents and risk factors of the cases, includes all kind of data collection and examination. Due to these reasons it is very important to profiling the individuals and to enlighten the causes of homicide-suicide with examinations and evaluations. Consequently, it has been thought that it would be very contributing to prepare a protocol for psychological autopsy and to support proffessions. Also it would be beneficial for risk prevention studies both indivudually and socially.
... Given the significant differences between these behavioral categories, suicidologists are aware that the generalizability of research findings is dramatically affected by the population selected for study (4,6). To date, one of the most prevalent methods for studying suicide is the psychological autopsy (7,8). This strategy allows for very detailed information about the patient, including psychiatric records, police investigations, military records, etc. (9). ...
Article
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Background: One of the main obstacles in studying suicide risk factors is the difference between cases in which the individual died by suicide and those in which the individual engaged in suicidal behavior. A promising strategy that overcomes this obstacle is the study of survivors of serious suicide attempt (SSA), i.e. an attempt that would have been fatal had it not been for the provision of rapid and effective emergency treatment. Serious suicide attempters are epidemiologically very similar to those who died by suicide, and thus may serve as valid proxies for studying suicides. This paper aims to define the specific risk factors of SSAs by conducting a qualitative data synthesis of existing studies. Methods: In accordance with PRISMA guidelines, we conducted a systematic search of the literature in PubMed, ProQuest and Psychlit electronic research-literature databases. Search terms were “serious” “OR” “near lethal,” combined with the Boolean “AND” operator with “suicide*.” In addition, a manual search of the literature on Google Scholar was performed, for further studies not yet identified. Results: Initial search identified 683 citations. A total of 39 research reports met the predefined criteria and were analyzed. Mental pain, communication difficulties, decision-making impulsivity, and aggression, as well as several demographic variables, were found to be major risk factors for SSAs. Limitations: We found a variability of definitions for SSA that hamper the ability to draw a model for the risk factors and processes that facilitate it. Moreover, the role of suicide intent and planning in SSA is still unclear. Further studies should aim to clarify and refine the concepts and measures of SSA, thereby enabling more specific and concrete modelling of the psychological element in its formation. Conclusions: SSA is a distinguishable phenomenon that needs to be addressed specifically within the scope of suicidal behavior. Interpersonal problems, as well as impulsivity and aggression, seem to facilitate SSA when mental pain serves as a secondary factor. Healthcare professionals should to be aware of SSA, and familiar with its specific risk factors. Moreover, psychological and suicidal risk assessment should include a designated evaluation of these risk factors as part of intervention and prevention models for SSA.
... Despite the evidence that most people in Western countries who die by suicide have a diagnosed mental illness (Cavanagh et al., 2003), there are cultural variations (Phillips, 2010) and some argue that the association between mental illness and suicide is not as marked as is commonly reported (Hjelmeland and Knizek, 2017). As the relationship between mental illness and suicide is often ascertained via a psychological autopsy, researchers should implement the recommendations on the next generation of psychological autopsy studies that aim to increase the accuracy of data collected (Conner et al., 2011). These latter three challenges highlight the more general point that we still often treat people at risk of suicide as an homogeneous group but we need to move beyond such characterization and identify distinct profiles of people at risk: the precision medicine approach. ...
Article
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Suicide and attempted suicide are major public health concerns. In recent decades, there have been many welcome developments in understanding and preventing suicide, as well as good progress in intervening with those who have attempted suicide. Despite these developments, though, considerable challenges remain. In this article, we explore both the recent developments and the challenges ahead for the field of suicide research and prevention. To do so, we consulted 32 experts from 12 countries spanning four continents who had contributed to the International Handbook of Suicide Prevention (2nd edition). All contributors nominated, in their view, (i) the top 3 most exciting new developments in suicide research and prevention in recent years, and (ii) the top 3 challenges. We have synthesized their suggestions into new developments and challenges in research and practice, giving due attention to implications for psychosocial interventions. This Perspective article is not a review of the literature, although we did draw from the suicide research literature to obtain evidence to elucidate the responses from the contributors. Key new developments and challenges include: employing novel techniques to improve the prediction of suicidal behavior; testing and applying theoretical models of suicidal behavior; harnessing new technologies to monitor and intervene in suicide risk; expanding suicide prevention activities to low and middle-income countries; moving toward a more refined understanding of sub-groups of people at risk and developing tailored interventions. We also discuss the importance of multidisciplinary working and the challenges of implementing interventions in practice.
... To date, one of the most prevalent methods for studying suicide is the psychological autopsy (Conner et al., 2012;Cavanagh et al., 2003). This strategy facilitates gathering detailed information about the deceased, such as psychiatric records, police investigations, and military records (Wong et al., 2001). ...
Article
Full-text available
The study of survivors of a serious suicide attempt (SSA)-an attempt that would have been fatal had it not been for the provision of rapid and effective emergency treatment can help researchers understand the suicidal mind. Serious suicide attemp-ters are epidemiologically very similar to those who died by suicide, and thus can serve as valid proxies for studying suicides. In this paper, our objective was to briefly review the main risk factors that may facilitate more dangerous suicide behavior with high levels of intent. Our review highlights several dimensions of risk factors for SSAs, including psychopathology, mental pain, communication difficulties, decision-making impulsivity, and aggression. Several studies have indicated that the interaction between some of these dimensions, especially between mental pain and interper-sonal difficulties, may serve as major catalysts for SSAs. Suicidal risk assessment should incorporate a designated evaluation of these risk factors as part of suicide prevention models.
... Psychological autopsy (PA) is a widely used method to explore the risk factors of completed suicide and has been validated previously in China (Zhang et al., 2003;Conner et al., 2012). Using a 1 : 1 matched case-control design, this PA study aims to shed light on this research gap. ...
... Although there are controversies psychological autopsy study (PAS) has been still considered as the gold standard for the identification of the risk factors of suicide (Hjelmeland et al., 2012;Conner et al., 2011;Cavanagh et al., 2003). PAS was an unmet need in Bangladesh as there was no such study in the country and risk factors for suicide were poorly studied (Arafat, 2019). ...
... Thirdly, using a follow-back and life calendar method to assess the presence of mental health symptoms and life events by third parties entails recall biases or imprecise information and underreporting (84). Recall biases when collecting data through proxy-based, retrospective explorations of suicide trajectories have been frequently discussed in the literature (85). Informants may remember more easily mental health symptoms or events that are observable, e.g., externalized behaviors vs. internalized behaviors. ...
Article
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Purpose: This study sets out to compare the presence of life events across different domains throughout the life course which may contribute to the burden of adversity experienced differently among men and women who died by suicide. Method: In a sample of 303 individuals (213 men and 90 women), data was derived from extensive clinical interviews conducted with informants. Models allowed the identification of patterns of life trajectories. Results: Overall, the burden of adversity was similar across the life course except for the 5–9, 25–29, and 30–34 age ranges, where a significant difference appeared between genders [ t -test = 2.13 ( p < 0.05), 2.16 ( p < 0.05) and 3.08 ( p < 0.005), respectively] that seems to disadvantage women. The early adversities of violence and neglect, between 0 and 19 years old, are important for both groups. During the life course, women were more exposed to interpersonal adverse events such as being victims of negligence and violence, relational difficulties or abuse from their spouse, as well as tension with their own children. Men encountered more academic difficulties, legal entanglements and financial difficulties, and were more than three times more likely to develop an alcohol/drug abuse problem than women. Conclusions: The data suggests some gender differences in exposure to longstanding and severe life problems contributing to suicide vulnerability. For women, the continuing burden emerges from chronic interpersonal adversities, whereas, for men, the adverse events are to a larger degree socially exposed, compounded with alcohol misuse. The adversities, especially those of a public or social nature, may be witnessed by others, which should favor the detection of vulnerability over the life course, and psychosocial or mental health services should be offered and provided earlier during the life course. Yet more men die by suicide than women. Resiliency and protective factors may benefit women to a greater degree. Future research should tackle the challenge of investigating these important elements. Meanwhile, from a public health perspective, access to psychosocial and mental health services and social acceptability of seeking services should be part of an ongoing effort in all institutional structures as a way of decreasing downstream mental health problems and vulnerability to suicide.
... Consequently, it seems unlikely that, in this situation, the close ones-not so close as it appears-are qualified to produce a relevant narrative about the individual who ended its life. However, no work seems to have deepened this critic and the popularity of the method, illustrated for example by the production of the 'next generation' psychological autopsy (Conner et al. 2011) might represent that this theoretical limitation is empirically irrelevant. The psychological autopsy's popularity for studying suicide begins in the middle of the 1980s (Shafii et al. 1985), grows in the 1990s (Duberstein et al. 1994;Hawton et al. 1998;Appleby et al. 1999) and explodes worldwide in the 2000s and after (Cheng et al. 2000;Isometsä 2001;Phillips et al. 2002;Cavanagh et al. 2003;Hawton et al. 2004;Zonda 2006;Bastia and Kar 2009;Yook et al. 2020;Affleck et al. 2020;Leenaars et al. 2020;Zhu et al. 2021;최et al. 2021;Choi et al. 2021;Zhou et al. 2021). ...
Article
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Being responsible for a death every 40s, suicide is a major public health concern (Brunier et al. 2019). Even if many of its risk factors are social (Van Orden et al. 2010), there are surprisingly few qualitative sociological studies about the phenomenon. This study aim is to provide a life-story sociological analysis of suicidal trajectories. Two challenges are identified: gathering suicidal narrative and maintaining a quantitative foreground in order to deepen and rationalize the interpretation of data. They are both faced using a self-made, free to use, open access, algorithm: Highway_star (https://github.com/matheo-daly/highway_star). Two corpora of Wikipedia biographies of people who died by suicide in the 1920s (N = 82) and 2020s (N = 49) are gathered. Following an application of Fritze Schütze’s methodology (Schütze, 2014), classical textual visualizations are produced. A Hierarchical Descending Classification, a Factorial Correspondence Analysis and a Similarity Analysis reveal five narration categories centered around different topics: cinema, death, family, poetry and politics. As none of those visualizations focuses on the developmental aspect of the biography, they offer limited interest for a life-story investigation. The second functionality of the Highway_star tool, which represents a narrative’s unfolding with a Sankey Diagram, allows completing the analysis. It shows interesting differences between decades or gender. An example of the last being that men narratives tend to be more complex and achievement focused, while the women ones are more linear and family centered. The study’s range has limitations. A major one is related to the corpus and the inability to identify clearly which parts of the narratives are associated to fame and which to suicide. Another one is linked to the Highway_star tool that sometimes lack of flexibility.
... 33 The study took into account elements of the psychological autopsy approach according to Conner and colleagues. 34 Thirty-four family members agreed to take part but one interview was not fully completed and was excluded from analyses. Therefore, full interviews were completed with 33 family members (44%). ...
Article
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Objectives Research focussing on the impact of suicide bereavement on family members’ physical and psychological health is scarce. The aim of this study was to examine how family members have been physically and psychologically affected following suicide bereavement. A secondary objective of the study was to describe the needs of family members bereaved by suicide. Design A mixed-methods study was conducted, using qualitative semistructured interviews and additional quantitative self-report measures of depression, anxiety and stress (DASS-21). Setting Consecutive suicide cases and next-of-kin were identified by examining coroner’s records in Cork City and County, Ireland from October 2014 to May 2016. Participants Eighteen family members bereaved by suicide took part in a qualitative interview. They were recruited from the Suicide Support and Information System: A Case-Control Study (SSIS-ACE), where family members bereaved by suicide (n=33) completed structured measures of their well-being. Results Qualitative findings indicated three superordinate themes in relation to experiences following suicide bereavement: (1) co-occurrence of grief and health reactions; (2) disparity in supports after suicide and (3) reconstructing life after deceased’s suicide. Initial feelings of guilt, blame, shame and anger often manifested in enduring physical, psychological and psychosomatic difficulties. Support needs were diverse and were often related to the availability or absence of informal support by family or friends. Quantitative results indicated that the proportion of respondents above the DASS-21 cut-offs respectively were 24% for depression, 18% for anxiety and 27% for stress. Conclusions Healthcare professionals’ awareness of the adverse physical and psychosomatic health difficulties experienced by family members bereaved by suicide is essential. Proactively facilitating support for this group could help to reduce the negative health sequelae. The effects of suicide bereavement are wide-ranging, including high levels of stress, depression, anxiety and physical health difficulties.
... Two independent reviewers (AH and AZ or MP and AZ) rated the eligibility of each of the abstracts and full texts in Covidence. 22 Disagreements were resolved by consensus, and we measured inter-rater agreement with the κ statistic. ...
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Objective To examine the association of physician burnout with the career engagement and the quality of patient care globally. Design Systematic review and meta-analysis. Data sources Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021. Eligibility criteria for selecting studies Observational studies assessing the association of physician burnout (including a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalisation, and a sense of ineffectiveness and little personal accomplishment) with career engagement (job satisfaction, career choice regret, turnover intention, career development, and productivity loss) and the quality of patient care (patient safety incidents, low professionalism, and patient satisfaction). Data were double extracted by independent reviewers and checked through contacting all authors, 84 (49%) of 170 of whom confirmed their data. Random-effect models were used to calculate the pooled odds ratio, prediction intervals expressed the amount of heterogeneity, and meta-regressions assessed for potential moderators with significance set using a conservative level of P<0.10. Results 4732 articles were identified, of which 170 observational studies of 239 246 physicians were included in the meta-analysis. Overall burnout in physicians was associated with an almost four times decrease in job satisfaction compared with increased job satisfaction (odds ratio 3.79, 95% confidence interval 3.24 to 4.43, I ² =97%, k=73 studies, n=146 980 physicians). Career choice regret increased by more than threefold compared with being satisfied with their career choice (3.49, 2.43 to 5.00, I ² =97%, k=16, n=33 871). Turnover intention also increased by more than threefold compared with retention (3.10, 2.30 to 4.17, I ² =97%, k=25, n=32 271). Productivity had a small but significant effect (1.82, 1.08 to 3.07, I ² =83%, k=7, n=9581) and burnout also affected career development from a pooled association of two studies (3.77, 2.77 to 5.14, I ² =0%, n=3411). Overall physician burnout doubled patient safety incidents compared with no patient safety incidents (2.04, 1.69 to 2.45, I ² =87%, k=35, n=41 059). Low professionalism was twice as likely compared with maintained professionalism (2.33, 1.96 to 2.70, I ² =96%, k=40, n=32 321), as was patient dissatisfaction compared with patient satisfaction (2.22, 1.38 to 3.57, I ² =75%, k=8, n=1002). Burnout and poorer job satisfaction was greatest in hospital settings (1.88, 0.91 to 3.86, P=0.09), physicians aged 31-50 years (2.41, 1.02 to 5.64, P=0.04), and working in emergency medicine and intensive care (2.16, 0.98 to 4.76, P=0.06); burnout was lowest in general practitioners (0.16, 0.03 to 0.88, P=0.04). However, these associations did not remain significant in the multivariable regressions. Burnout and patient safety incidents were greatest in physicians aged 20-30 years (1.88, 1.07 to 3.29, P=0.03), and people working in emergency medicine (2.10, 1.09 to 3.56, P=0.02). The association of burnout with low professionalism was smallest in physicians older than 50 years (0.36, 0.19 to 0.69, P=0.003) and greatest in physicians still in training or residency (2.27, 1.45 to 3.60, P=0.001), in those who worked in a hospital (2.16, 1.46 to 3.19, P<0.001), specifically in emergency medicine specialty (1.48, 1.01 to 2.34, P=0.042), or situated in a low to middle income country (1.68, 0.94 to 2.97, P=0.08). Conclusions This meta-analysis provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care. Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency. Systematic review registration PROSPERO number CRD42021249492.
... Psychological autopsy studies deploy a systematic methodology to enhance understanding of the psychological and contextual circumstances preceding suicide (Conner et al., 2011). They are designed to provide more detailed information about risk and protective factors for suicide than only comparing the medical records of those who have died by suicide with the records of controls. ...
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Background: A range of factors including mental disorders and adverse life events can increase the risk of suicide. The objectives of this study were to examine psychosocial and psychiatric factors and service engagement among suicide decedents compared with living controls. Methods: A case-control study using multiple sources was conducted. Information on 132 consecutive cases of suicide was drawn from coronial files, and interviews were carried out with 35 family informants and 53 living controls. GPs completed questionnaires for 60 suicide cases and 27 controls. Results: The majority (83.3%) of suicide decedents had contacted a GP in the year prior to death, while 23.3% had 10 or more consultations during the year prior to death. Half of suicide decedents had a history of self-harm. Suicide cases were significantly more likely than controls to have a psychiatric diagnosis (60% vs. 18.5%) and a depressive illness (36.7% vs. 14.8%). Over one-quarter of suicide decedents had been treated as a psychiatric inpatient. Discussion: Primary care providers should be supported to deliver multidisciplinary interventions to engage, assess, and treat patients at risk of suicide, targeting those who present very frequently, those with a history of self-harm or substance misuse, and those with psychological presentations.
... Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies Suicide is a global public health concern, accounting for over 700 000 deaths annually. 1 Identifying factors associated with suicide can improve risk stratification and help target interventions for high-risk groups. 2 One widely used approach to investigating suicide risk factors at the individual level is the psychological autopsy method, 3 which involves collecting information about the person who has died by suicide through standardised interviews with proxy informants (such as family members) and, when available, examination of medical and coronial records. This retrospective approach aims to construct a comprehensive picture of the clinical and psychosocial circumstances that contributed to the suicide. ...
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Question Effective prevention of suicide requires a comprehensive understanding of risk factors. Study selection and analysis Five databases were systematically searched to identify psychological autopsy studies (published up to February 2022) that reported on risk factors for suicide mortality among adults in the general population. Effect sizes were pooled as odds ratios (ORs) using random-effects models for each risk factor examined in at least three independent samples. Findings A total of 37 case–control studies from 23 countries were included, providing data on 40 risk factors in 5633 cases and 7101 controls. The magnitude of effect sizes varied substantially both between and within risk factor domains. Clinical factors had the strongest associations with suicide, including any mental disorder (OR=13.1, 95% CI 9.9 to 17.4) and a history of self-harm (OR=10.1, 95% CI 6.6 to 15.6). By comparison, effect sizes were smaller for other domains relating to sociodemographic status, family history, and adverse life events (OR range 2–5). Conclusions A wide range of predisposing and precipitating factors are associated with suicide among adults in the general population, but with clear differences in their relative strength. PROSPERO registration number CRD42021232878.
... The PA method requires one or more information sources: judicial records, psychiatric records, other medical information about the suicide victim, and interviews (recommended face-to-face) with relatives of the victim (4,5). ...
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Objective: Aim of this study was an evaluation of the completed suicide rate as well as exploring what associated psychological and social factors might have increased the risk of death from suicide. Method: The study examines all adult suicide cases in the Province of Denizli that occurred between January 2009 and December 2010. In addition to examining the judicial files, interviews were conducted with the suicide victims' relatives to elaborate the cases and evaluate the risk factors for suicide. For 19 of 53 suicide victims (35.9%), no interviews were conducted; telephone interviews were carried out with relatives of 27 of the victims (50.9%), and face-to-face interviews were held with relatives of 7 of the subjects (13.2%). Healthy controls were randomly chosen from the registers of 14 Denizli primary healthcare centers. The 31 control individuals were from a similar geographic area and social backgrounds as the case group. Results: Of the cases, 13.2% (n=7) were female, while 86.8% (n=46) were male. The mean age was 41.57±15.33 years. The total mean age of the control group was 42.84±16.98 years (p=0.725). The results of this study showed that a history of psychiatric disorder, prior suicide attempts, a history of alcohol abuse, stressful life events, and lack of social support/interaction were associated with suicide. Conclusion: Clinical and psychosocial factors such as a history of psychiatric disorder, unemployment, and financial or relationship problems increase the risk of suicide.
Article
Homicide committed by a person who subsequently commits suicide within one week of the homicide is a relatively rare event. The current study used an explanatory sequential design, including psychological autopsies, to identify psychiatric and other contributing factors in 35 homicide-suicide cases in northern Gauteng Province, South Africa. This research highlighted the complex multifactorial nature of these events. Identification of high-risk individuals and delineation of contributing factors is important. Early recognition and effective treatment of psychiatric illness, particularly depression and substance use problems, in people experiencing relationship issues (with pending/recent separations) and financial stressors, is an essential component in the prevention of homicide-suicide incidents. Evaluations should always include direct questioning about suicidal and homicidal ideations. Mental health practitioners have a definite role to play in offering comfort, support, and treatment to all those who remain behind after these devastating events. Urgent attention needs to be given to the availability of support and treatment for investigating police officers and surviving family and friends.
Article
Background: The Geriatric Depression Scale (GDS) has been widely used for late-life depression, but it lacks validation in psychological autopsy research. This study aimed to assess the validity and establish the optimal cut-off values of the GDS-30 and the GDS-15 with proxy-based data in rural China. Methods: We applied psychological autopsy to collect data from 242 consecutive suicide cases and 242 paired living community controls. Results: Subject-proxy concordance for the GDS-30 (ICC = 0.590) and the GDS-15 (ICC = 0.539) were fair in the living controls. Based on proxy-data, we found that the suicide cases had higher scores of depression than the living controls did; the values of Cronbach's alpha demonstrated good internal consistency of the GDS-30 and the GDS-15; the Spearman correlation analysis indicated that the GDS scores were correlated with hopelessness, loneliness, and quality of life. For suicide cases, the GDS-30 showed the highest Youden's index as 34.86% with a cut-off value at 22, when its sensitivity and specificity was 0.78 and 0.56, respectively; the score of 12 on the GDS-15 showed the highest Youden's index of 31.39%, and its sensitivity and specificity was 0.74 and 0.58, respectively. Limitations: This study is limited to its generalizability to Chinese urban elderly with psychological autopsy method. Conclusions: The GDS-30 and the GDS-15 were both valid tools for measuring the severity of depressive symptoms rather than screening for major depression in psychological autopsy research in rural China. The GDS-15 can be considered as a good substitute for the GDS-30.
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This represents one of several sections of "A Bibliography Related to Crime Scene Interpretation with Emphases in Geotaphonomic and Forensic Archaeological Field Techniques, Nineteenth Edition" (The complete bibliography is also included at ResearchGate.net.). This is the most recent edition of a bibliography containing resources for multiple areas of crime scene, and particularly outdoor crime scene, investigations. It replaces the prior edition and contains approximately 10,000 additional citations. As an ongoing project, additional references, as encountered, will be added to future editions. The impact of one’s culture on daily activities is inescapable. That impact, whether conscious or not, must in some ways extend to the commission of crimes as well as victim reactions. The compiler witnessed this in the investigation of the abduction and murder of a young Bosnian girl who had resettled in the United States with more than 8,000 other refugees from the Balkan Wars of the early 1990s. The ease with which her neo-Nazi murderer was able to enter the homes of the Bosnian refugees, and ultimately kidnap this victim, was partly the result of the cultural experiences of the victimized families who feared law enforcement in their home country and so were reluctant to report the preadtor who introduced himself into their community as a health inspector. This category includes citations beyond those about death rituals and includes references about criminal psychology, cultural studies, and forensic psychiatry. A greater understanding of the psychological and cultural motivation subjects might have in committing crimes will impact approaches to searching for, and processing, evidence. One need not be a behavioral scientist or criminal profiler to realize that a subject diagnosed with paranoia might dispose of a victim in a manner different than a sociopath. An example of cultural influence in the selection of a victim’s disposal site is the case of Jeremiah James Bringsplenty. Accounts of this 1992 case included that of the abuse and murder of Jeremiah by family acquaintances who were babysitting the infant in his Clarksville, Tennessee home. Both the victim and the subjects were of Native American ancestry. The subjects left Tennessee for the Rosebud Reservation in South Dakota with plans to bury Jeremiah near relatives. Because of decomposition, however, they were forced to stop outside Lincoln, Nebraska to bury the remains. This section also contains references valuable for investigators interviewing subjects and witnesses. This category and “General and Cultural Anthropology of Death” overlap to some degree. The examples or accounts examined in the resources within this section involve a spectrum of physical traumas which might befall victims of homicide or suicide. For that reason, the reader/research should also look in Taphonomy-Trauma for related citations. (3305 citations)
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The combined presence of depression with alcohol abuse can increase suicide risk. We used psychological autopsy to evaluate 101 individuals who died by suicide, to understand relationships between stressful life events, alcohol abuse, and depression. As compared to suicidal adults with depression only, individuals meeting criteria for both a depressive disorder and alcohol use disorder tended to be younger and experienced higher rates of stressful life events during the six months prior to death. Alcohol abuse likely influences interpersonal conflict, financial distress, and legal problems. Interventions focusing on managing life problems may help to reduce suicide risk.
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Background Suicide in armed forces is a matter of concern despite adequate prophylactic measures that have been adopted to reduce it. Military psychiatrists routinely conduct psychological autopsies. It may reveal various biopsychosocial factors leading to suicide and may be helpful in suicide prevention too. A few studies have been done in Indian Armed Forces but all of them involve cases of attempted suicide. Our study is different as it uses the methodology of psychological autopsy to find out various psychosocial factors of suicide in armed forces. Methods The present study was carried out in a large service hospital and included all suicide cases occurring in a particular strategic location from February 2014 to July 2017. A total of 16 suicide cases were investigated, and information was collected through visiting the scene, detailed semistructured interviews, the perusal of mobile call records, social website activities, notes in a social diary, bank statements, service record, and health records. Results The majority (nine of sixteen) of suicide victims were less than 30 years of age. The most common method of suicide (ten of sixteen) was use of firearms. Family history of mental illness/suicide was seen in three of them. Three had a past history of mental illness. Two were abusing substance in the recent past. Behavioral change was noticed in three, and suicide notes were available in three cases. Five had expressed their intent to die. Conclusions Strain of serving in frontiers is not a common stressor associated with suicide as commonly perceived.
Article
Background Opioids and cocaine are the leading drugs for fatal drug intoxication (FDI). Manner of death may be accidental (i.e., unintentional); suicide (i.e., intentional), or undetermined. Difficulties of the medical examiner (ME) in confirming the manner of death by a standard investigation may result in underreporting of intentional FDI thus limiting efforts to identify, reduce, and prevent it. Objective Examine the rate of youth intentional and undetermined FDI and address the need for closing the gap in the determination of intentional FDI among youths by the addition of a psychological autopsy. Method Two hundred ninety-three (293) consecutive FDI case files from the State of Connecticut Office of the Chief Medical Examiner were reviewed. The case files were those of youths, 10 to 25 years of age, who died between January 1, 2016, and December 31, 2018. Results The annual intentional FDI rates among this group were between 3% and 5%. Undetermined manner of death rates were between 0% and 5% percent, while the remaining cases was reported as accidental. A majority of the FDI cases involved youths 20 to 25.11 years old, while a small percentage were among those ages 15 to 19.11 and none for 10 to 14.11. Male-to-female ratio was approximately 2:1 in all categories of FDI. Conclusion These low rates of intentional FDI among youths support the arguments regarding limitations in the procedures employed by a ME to determine intent. There is a need for an individual-level study of a multipronged approach to identify modifiable acute high-risk circumstances for intentional FDI, including a psychological autopsy.
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Secrecy kills. What can we learn about the most dangerous aspect of the suicidal mind? A psychological autopsy was undertaken. We interviewed 120 survivors of people who died by suicide. Like in suicide notes, we found the mask, (self)deception, dissembling, camouflaging, whatever you may call it, in almost 80%! That is risk! We learn from the survivors' stories (narratives) and the suicide notes. Kurt Cobain, for example, said in his note, "faking it and pretending if I'm having a 100% fun". We must reach through the MASK!
Thesis
This thesis focuses on misdiagnoses and diagnostic processes and methods in clinical psychology research and practice.
Article
We reply to the thoughtful commentary by Joiner and Robison (this issue) about the documentary Robin’s Wish. Joiner and Robison suggest that a major depressive episode may have been a proximal cause of Robin Williams’ suicide, but that stigma surrounding mental illness led the documentary to eschew a role for depression. We find this perspective compelling and important. Mental illness can be an important cause of suicide, and stigma can harm our ability to understand and treat mental illness and suicide risk. As a complementary perspective, we discuss research and theory suggesting that mental illness does not explain all deaths by suicide. We present research and theory suggesting that suicide is motivated by pain and hopelessness, and that pain and hopelessness can be caused not only by mental illness but by other factors such as overwhelming interpersonal struggles or loss, seemingly insurmountable financial problems, chronic medical conditions, and systematic discrimination and persecution. Finally, we reaffirm Joiner and Robison’s belief that understanding and preventing suicide requires the pursuit of accurate knowledge, unburdened by stigma that can harm progress and people.
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Resumen El suicidio es un fenómeno que se ha estudiado en adolescentes en diferentes países del mundo desde el punto de vista de los cambios sociales, culturales, económicos y tecnológicos recien-tes. El incremento del suicidio en los adolescentes se ha convertido en un problema de Salud Pública en México. En este documento se revisan de manera general, la historia del suicidio, epidemiología del suicidio a nivel mundial y algunas investigaciones epidemiológicas en adolescentes mexicanos en las que se consideran aspectos neurobiológicos (predisposición ge-nética), la desesperanza, los trastornos psiquiátricos, el embarazo, el bullying escolar (maltrato escolar), el ciberbullying (maltrato cibernético), el desempleo y el consumo indiscriminado de la tecnología a través de la música y los videos como factores de riesgo. También se considera a la autopsia psicológica como una técnica de investigación del suicidio; así como el repor-te de los Servicios de Salud Mental en México acerca de este fenómeno, el duelo en los padres del adolescente suicida y el abordaje terapéutico. El adolescente mexicano actual, muestra un incremento de riesgo de la conducta suicida. Abstract Suicide is a phenomena studied in adolescents worldwide; it has been studied from the social, cultural, economic and technological recent changes. The increase in number of suicide in adolescents has become a Public Health in México. This document, revise in a brief way the history of suicide, the epidemiology of suicide, both internationally and in Mexican epidemiological studies in adolescents, neurobiologic aspects (genetic predisposition), helplessness , psychiatric disorders, impulsivity, pregnancy, bullying, cyber-bullying and unemployment. The
Article
Evidence for proximal risk factors for suicide is based on case–control psychological autopsy studies, with these reports showing that mood and substance use disorders are the most prevalent mental disorders among suicide decedents worldwide and are associated with marked risk. However, moderators of risk and the degree of risk associated with (nonalcohol) drug use disorder are unknown. A comprehensive search was used to identify 35 case–control psychological autopsy studies published worldwide over a 30-year period that were metaanalyzed using random effects models. Major depression, odds ratio (95% confidence interval) = 9.14 (5.53, 15.09), and drug use disorder, OR (95% CI) = 7.18 (3.22, 16.01), had large effect sizes, among other results. Risk estimates associated with major depression were greater in studies with a larger proportion of women and those conducted in Asia compared with other regions. There was no evidence of publication bias or that any one study had a disproportionate impact on findings. Risk for suicide associated with major depression appears to be moderated by sex and/or world region. Drug use disorder is a potent risk factor, illustrating the importance of assessing drug use in clinical risk assessment.
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Reviews the support for the hypothesis that the personality disorders of the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) represent variants of normal personality traits. The focus is, in particular, on the efforts to identify the dimensions of personality that may underlie the personality disorders. The relationship of personality to personality disorders is illustrated using the 5-factor model, conceptual issues in relating normal and abnormal personality traits are discussed, and methodological issues that should be addressed in future research are considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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There has recently been increased interest in the relationship between physical illness, mental illness, and suicide. The present study utilizes a large community-based sample to investigate the association between certain physical conditions and suicidal behavior, among those with a history of a mood disorder. Data came from the nationally representative German Health Survey (N=4181, age 18-65). Physical conditions were assessed by a general practice physician. DSM-IV mental disorders were assessed using a modified version of the Composite International Diagnostic Interview. Among those with a lifetime mood disorders, suicidal ideation, plans, and attempts were assessed by self-report. Multiple logistic regression analyses were used to examine the association between physical conditions and suicidal behavior among those with a history of mood disorder. Anxiety and substance use disorders were significantly positively associated with suicidal behavior [OR 1.61, 95% CI 1.13-2.31 and 2.01, 95% 1.34-3.00, respectively]. After adjusting for anxiety and substance use disorders as well as sociodemographic variables, respiratory illness, hypertension, and number of physical disorders were significantly associated with suicidal behavior [AORs 1.72, 1.68, and 1.16, respectively]. The findings of this study are limited to adults with a history of a mood disorder. Personality disorders were not assessed. The present study suggests that among people with mood disorder, respiratory illnesses, hypertension, and number of physical conditions are associated with suicidal behavior independent of the effects of comorbid mental illness. Clinicians should recognize the contributing risk of physical health problems to suicidal behavior.
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There is substantial evidence suggesting that suicide aggregates in families. However, the extent of overlap between the liability to suicide and psychiatric disorders, particularly major depressive disorder, remains an important issue. Similarly, factors that account for the familial transmission of suicidal behavior remain unclear. Thus, through direct and blind assessment of first-degree relatives, the authors conducted a family study of suicide by examining three proband groups: probands who committed suicide in the context of major depressive disorder, living depressed probands with no history of suicidal behavior, and psychiatrically normal community comparison probands. Participants were 718 first-degree relatives from 120 families: 296 relatives of 51 depressed probands who committed suicide, 185 relatives of 34 nonsuicidal depressed probands, and 237 relatives of 35 community comparison subjects. Psychopathology, suicidal behavior, and behavioral measures were assessed via interviews. The relatives of probands who committed suicide had higher levels of suicidal behavior (10.8%) than the relatives of nonsuicidal depressed probands (6.5%) and community comparison probands (3.4%). Testing cluster B traits as intermediate phenotypes of suicide showed that the relatives of depressed probands who committed suicide had elevated levels of cluster B traits; familial predisposition to suicide was associated with increased levels of cluster B traits; cluster B traits demonstrated familial aggregation and were associated with suicide attempts among relatives; and cluster B traits mediated, at least in part, the relationship between familial predisposition and suicide attempts among relatives. Analyses were repeated for severity of attempts, where cluster B traits also met criteria for endophenotypes of suicide. Familial transmission of suicide and major depression, while partially overlapping, are distinct. Cluster B traits and impulsive-aggressive behavior represent intermediate phenotypes of suicide.
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The suicide rate in Bali has significantly increased in recent years. However, to date, there have been no case-control studies investigating risk factors for suicide. A psychological autopsy study was conducted comparing 60 suicide cases and 120 living controls matched in age, sex, and area of residence. Multiple logistic regression analysis identified the following risk factors for suicide: at least one diagnosis of axis-I mental disorder (OR: 14.84 CI: 6.12 - 35.94); low level of religious involvement (OR: 7.24 CI: 2.28 - 22.95); and severe interpersonal problems (OR: 3.86 CI: 1.36 - 11.01). Forty-eight (80.0%) of the suicide cases were diagnosed with mental disorders; however, only 16.7% visited a primary care health professional and none received psychiatric treatment during the 1 month prior to death. Clinical, religious, and psychosocial factors were associated with suicide. These results highlight the significance of early recognition and treatment of mental disorders, religious activities, and interpersonal problem-solving strategies for suicide prevention in Bali.
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Suicide is a leading cause of death worldwide. Mental disorders are among the strongest predictors of suicide; however, little is known about which disorders are uniquely predictive of suicidal behavior, the extent to which disorders predict suicide attempts beyond their association with suicidal thoughts, and whether these associations are similar across developed and developing countries. This study was designed to test each of these questions with a focus on nonfatal suicide attempts. Data on the lifetime presence and age-of-onset of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) mental disorders and nonfatal suicidal behaviors were collected via structured face-to-face interviews with 108,664 respondents from 21 countries participating in the WHO World Mental Health Surveys. The results show that each lifetime disorder examined significantly predicts the subsequent first onset of suicide attempt (odds ratios [ORs] = 2.9-8.9). After controlling for comorbidity, these associations decreased substantially (ORs = 1.5-5.6) but remained significant in most cases. Overall, mental disorders were equally predictive in developed and developing countries, with a key difference being that the strongest predictors of suicide attempts in developed countries were mood disorders, whereas in developing countries impulse-control, substance use, and post-traumatic stress disorders were most predictive. Disaggregation of the associations between mental disorders and nonfatal suicide attempts showed that these associations are largely due to disorders predicting the onset of suicidal thoughts rather than predicting progression from thoughts to attempts. In the few instances where mental disorders predicted the transition from suicidal thoughts to attempts, the significant disorders are characterized by anxiety and poor impulse-control. The limitations of this study include the use of retrospective self-reports of lifetime occurrence and age-of-onset of mental disorders and suicidal behaviors, as well as the narrow focus on mental disorders as predictors of nonfatal suicidal behaviors, each of which must be addressed in future studies. This study found that a wide range of mental disorders increased the odds of experiencing suicide ideation. However, after controlling for psychiatric comorbidity, only disorders characterized by anxiety and poor impulse-control predict which people with suicide ideation act on such thoughts. These findings provide a more fine-grained understanding of the associations between mental disorders and subsequent suicidal behavior than previously available and indicate that mental disorders predict suicidal behaviors similarly in both developed and developing countries. Future research is needed to delineate the mechanisms through which people come to think about suicide and subsequently progress from ideation to attempts.
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This study was conducted to determine the population-attributable risk (PAR) of completed suicide among Hong Kong Chinese with axis I psychiatric diagnoses. With a case-control psychological autopsy method, 150 suicide decedents aged 15-59 were compared for axis I psychiatric diagnoses and psychosocial variables with 150 randomly selected age- and gender-matched persons living in the community. In the presence of other, non-disease-related social risk factors (unemployment and unmanageable debt), past suicide attempt independently accounted for 44% of the PAR of suicide, followed by current major depressive disorder (27%), schizophrenia spectrum disorders (22%), and substance use disorder or pathological gambling (16%). Other diagnoses (such as anxiety and phobic disorders, dysthymia, adjustment disorders, and past major depressive episode) accounted for 24% of PAR. Psychiatric morbidity remains the major risk factor for suicide in Hong Kong despite well-developed psychiatric services. Mental health policy should be refined to target clinical groups at high risk of suicide.
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Hungary previously had one of the highest suicide rates in the world, but experienced major social and economic changes from 1990 onwards. We aimed to investigate the antecedents of suicide in Hungary. We hypothesised that suicide in Hungary would be associated with both risk factors for suicide as identified in Western studies, and experiences related to social and economic restructuring. We carried out a controlled psychological autopsy study. Informants for 194 cases (suicide deaths in Budapest and Pest County 2002-2004) and 194 controls were interviewed by clinicians using a detailed schedule. Many of the demographic and clinical risk factors associated with suicide in other settings were also associated with suicide in Hungary; for example, being unmarried or having no current relationship, lack of other social contacts, low educational attainment, history of self-harm, current diagnosis of affective disorder (including bipolar disorder) or personality disorder, and experiencing a recent major adverse life event. A number of variables reflecting experiences since economic restructuring were also associated with suicide; for example, unemployment, concern over work prospects, changes in living standards, practising religion. Just 20% of cases with evidence of depression at the time of death had received antidepressants. Suicide rates in Hungary are falling. Our study identified a number of risk factors related to individual-level demographic and clinical characteristics, and possibly recent societal change. Improved management of psychiatric disorder and self-harm may result in further reductions in suicide rates.
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To examine the associations of suicide in the second half of life with medical and psychiatric illness, functional limitations, and reported use of inpatient, ambulatory, and home health care services. A retrospective case-control design was used to compare 86 people over age 50 years who died by suicide with a comparison group of 86 living community participants that were individually matched on age, gender, race, and county of residence. Suicide decedents had more Axis I diagnoses, including current mood and anxiety disorders, worse physical health status, and greater impairment in functional capacity. They were more likely to have required psychiatric treatment, medical, or surgical hospitalization in the last year, and visiting nurse or home health aide services. In a multivariate model, the presence of any active Axis I disorder and any impairment in instrumental activities of daily living (IADL) made independent contributions to suicide risk. Mental illness, physical illness, and associated functional impairments represent domains of risk for suicide in this age group. In addition to individuals with psychiatric illness, those with severe or comorbid physical illness and functional disability who require inpatient and home care services should be targeted for screening and preventive interventions.
Article
Background: There is considerable debate as to whether suicide is more likely to occur early in the course of major depressive disorder or by cumulative risk, with an increasing risk with each subsequent major depressive episode (MDE). By considering the number of MDEs among representative suicides, we aimed to further investigate the relationship between suicide outcome and the course of major depressive disorder. Method: A psychological autopsy method with best informants was used to investigate 154 consecutive suicides who died in the context of a DSM-IV MDE. Proxy-based interviews were conducted by using the Structured Clinical Interview for DSM-III-R; the Structured Clinical Interview for DSM-IV Axis II; and a series of behavioral and personality-trait assessments. Second, 143 living depressed outpatients of comparable age to the suicide group were assessed for their history of MDEs. The study was conducted between 2000 and 2005. Results: The distribution of MDEs among depressed suicide completers was as follows: first MDE, 74.7%; second MDE, 18.8%; more than 2 MDEs, 6.5%. This distribution is compared to 32.9% of depressed living outpatients with a single MDE. Increased levels of hostility were associated with single MDE suicide completers. The anxious trait of harm avoidance increased among multiple MDE suicide completers. Alcohol abuse increased among first MDE suicide completers. Conclusions: Suicide in major depressive disorder is most likely to occur during the first MDE, and this appears to be related to increased levels of the impulsive-aggressive diathesis.
Article
Background: General population survey data are presented on the lifetime prevalence of suicide attempts as well as transition probabilities to onset of ideation, plans among ideators, and attempts among ideators either with or without a plan. Risk factors for these transitions are also studied. Methods: Data are from part II of the National Comorbidity Survey, a nationally representative survey carried out from 1990 to 1992 in a sample of 5877 respondents aged 15 to 54 years to study prevalences and correlates of DSM-III-R disorders. Transitions are estimated using life-table analysis. Risk factors are examined using survival analysis. Results: Of the respondents, 13.5% reported lifetime ideation, 3.9% a plan, and 4.6% an attempt. Cumulative probabilities were 34% for the transition from ideation to a plan, 72% from a plan to an attempt, and 26% from ideation to an unplanned attempt. About 90% of unplanned and 60% of planned first attempts occurred within 1 year of the onset of ideation. All significant risk factors (female, previously married, age less than 25 years, in a recent cohort, poorly educated, and having 1 or more of the DSM-III-R disorders assessed in the survey) were more strongly related to ideation than to progression from ideation to a plan or an attempt. Conclusions: Prevention efforts should focus on planned attempts because of the rapid onset and unpredictability of unplanned attempts. More research is needed on the determinants of unplanned attempts.
Article
To test the reliability of children's reporting as compared with that of their mothers, a highly structured psychiatric diagnostic interview was used with 307 subjects, ages 6 through 16. Another interviewer gave each mother a similar interview about the child. Responses of each mother-child pair to 168 questions were compared using the kappa statistic. Highest agreement was found on questions concerning symptoms that are concrete, observable, severe, and unambiguous. Mothers tended to report significantly more behavioral symptoms, and children more subjective symptoms. Reasons for low kappas and asymmetrical reporting of symptoms are discussed.
Article
Objective: Suicide rates in young people have increased during the past three decades, particularly among young males, and there is increasing public and policy concern about the issue of youth suicide in Australia and New Zealand. This paper summarises current knowledge about risk factors for suicide and suicide attempts in young people. Method: Evidence about risk factors for suicidal behaviour in young people was gathered by review of relevant English language articles and other papers, published since the mid-1980s. Results: The international literature yields a generally consistent account of the risk factors and life processes that lead to youth suicide and suicide attempts. Risk factor domains which may contribute to suicidal behaviour include: social and educational disadvantage; childhood and family adversity; psychopathology; individual and personal vulnerabilities; exposure to stressful life events and circumstances; and social, cultural and contextual factors. Frequently, suicidal behaviours in young people appear to be a consequence of adverse life sequences in which multiple risk factors from these domains combine to increase risk of suicidal behaviour. Conclusions: Current research evidence suggests that the strongest risk factors for youth suicide are mental disorders (in particular, affective disorders, substance use disorders and antisocial behaviours) and a history of psychopathology, indicating that priorities for intervening to reduce youth suicidal behaviours lie with interventions focused upon the improved recognition, treatment and management of young people with mental disorders.
Article
Background: As part of the Taiwan Aboriginal Study Project, a case-control study of suicide among two aboriginal groups and the Han Chinese was carried out in East Taiwan.Methods: Biographical reconstructive interviews were conducted for consecutive suicides from each of the three ethnic groups (a total of 116 suicides), 113 of whom were matched with two controls for age, sex, and area of residence.Results: In all three groups, a high proportion of suicides suffered from mental illness before committing suicide (97% to 100%). The two most prevalent psychiatric disorders were depression and alcoholism, and the most common comorbid pattern was depression with substance use disorders. The risk for suicide was significantly associated with all of these psychiatric conditions, previous suicide attempts, and a family history of suicide and depression. Fifty-one percent of all suicides had consulted medical professionals in the previous month.Conclusion: Despite the widely different rates of depressive illness and alcoholism in different cultures previously reported, the psychiatric antecedents of suicide are the same in the West and the East.
Article
• We earlier reported that nearly one third of a consecutive series of 31 alcoholics who committed suicide had experienced loss of a close interpersonal relationship within six weeks or less of their death. In a replication study of 50 additional unselected alcoholic suicides, we found that 26% had experienced such loss within six weeks. As before, the distribution of such events was strikingly and significantly skewed toward the final weeks of the subject's life. This powerful confirmation gives added significance to such loss as a predictor of suicide among alcoholics.
Article
Medicines (CSM) in the UK advised that the majority of the selective serotonin re- the majority of the selective serotonin re- uptake inhibitors (SSRIs) and another uptake inhibitors (SSRIs) and another new-generation antidepressant, venlafax- new-generation antidepressant, venlafax- ine, were not suitable to be used as anti- ine, were not suitable to be used as anti- depressants by those aged under 18 years depressants by those aged under 18 years (see the safety information messages issued (see the safety information messages issued in 2003 by the Medicines and Healthcare in 2003 by the Medicines and Healthcare Products Regulatory Agency; http://www. Products Regulatory Agency; http://www. mhra.gov.uk). This warning was based on mhra.gov.uk). This warning was based on a review of reports from controlled trials a review of reports from controlled trials that had been submitted by pharmaceutical that had been submitted by pharmaceutical companies, published in journals, or both. companies, published in journals, or both. The review found that for many of these The review found that for many of these drugs efficacy was not clearly demon- drugs efficacy was not clearly demon- strated. It also found that for several of strated. It also found that for several of them there was an increased rate of self- them there was an increased rate of self- harm and suicidal thoughts in participants harm and suicidal thoughts in participants
Article
Suicide implies a direct connection between the deceased's intention, his self-destructive action, and his subsequent death. Uncertainty about the correct certification results when the victim's intention is ambivalent, with coexisting wishes both to live and to die, or when the self-destructive action is in itself inconclusive, or when death follows the action after a considerable delay. Investigations of 100 such cases are reported with illustrative examples. The present classification of deaths into natural, accident, homicide, and suicide obscures the fact that individuals may make a considerable contribution toward their own deaths under circumstances not ordinarily considered suicide.
Article
the phrase "psychological autopsy" refers to a procedure for reconstructing an individual's psychological life after the fact, particularly the person's lifestyle and those thoughts, feelings, and behaviors manifested during the weeks preceding death, in order to achieve a better understanding of the psychological circumstances contributing to a death / highlight some of the findings generated by psychological autopsy research, relying on studies published in English and based for the most part on work done in the United States, Canada, the United Kingdom, Australia, and Sweden / pay particular attention to significant findings, methodological innovations, alternate definitions of the psychological autopsy method, and implications for predicting or averting suicides / conclude . . . with a brief discussion of five clinical case vignettes from the perspective of psychological autopsy research application of the psychological autopsy method to youth suicides / application of the psychological autopsy method to suicides by elderly persons / equivocal death consultations to the Los Angeles medical examiner / the accuracy of reported suicide statistics / Shneidman's broader view of the psychological autopsy / retrospective studies of psychiatric inpatient and jail suicides / the suicide postmortem conference and the clinical audit / psychological autopsy studies for forensic purposes / methodological considerations / research assessment instruments / the experience of being interviewed for a psychological autopsy study / standards for future psychological autopsy studies (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Discusses a project introduced by the Finnish National Board of Health aimed at reducing suicide mortality in Finland by 20% by 1995. The project will be implemented in 3 phases: (1) In 1987–1988, information will be collected on suicide rates; (2) on the basis of the data, national, regional, and local conclusions and recommendations will be drawn in 1989 and 1990; and (3) between 1990 and 1995, development programs will be carried out and their effects assessed. The study design is discussed with regard to data processing and analysis and areas of research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Describes a phenomenological approach to the study of personality factors in drug abuse, emphasizing the problem of compulsion, symptom equivalence, and their effects on life-style. The question of whether certain personality traits are indicative of a predisposition to drug addiction (e.g., object dependency or affect defense), the long-range effects of drugs on personality, and implications for treatment are also examined. (67 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Much of the writing on the psychological autopsy is reviewed. Several writers' opinions about what should be included in a comprehensive behavioral analysis conducted after an individual's death are compiled in an Appendix. Several additional and new areas to be covered in a psychological autopsy are included. The primary emphasis is on the provision of a practical guide for the working professional. Twenty-four separate factors, ranging from reconstruction of events that occurred before the death to the deceased's family death history, are presented. Some legal considerations are examined briefly in order to acquaint the professional with the significant impact that the results can have on family benefits and criminal prosecution. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Chapter
IntroductionHistorical PerspectiveSources of InformationEvidence from Randomized Controlled TrialsOther Research Methods DiscussionConclusion References
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IntroductionSuicidal Behaviour in Depressive PatientsClinically Detectable Suicide Risk Factors in Depressive DisordersSuicide Protective Factors in Depressive DisordersPrevention of Suicide in Patients with Depressive DisordersConclusions References
Article
As China opens its door to the world, suicide research is making rapid progress using methods and instruments developed in the West. This is a feasibility study of the psychological autopsy methodology applied in China, with its emphasis on the social and cultural environments. With samples of 66 completed suicides and 66 community normal living controls, the authors found that it is feasible to interview at least two informants for each suicide case and each control, between 2 and 6 months after the suicide. With the Chinese-cultivated contacting method of recruiting cases, the refusal rate is nearly zero. The Western-developed methodology per se proved to be valid in the Chinese culture. Ethical considerations in the context of Chinese culture are as important as in the West. Psychological autopsy technique is shown to be an equally applicable method for the study of completed suicides in Chinese culture as it is in the West. Future epidemiological research on Chinese suicide should use the psychological autopsy method to collect data from larger samples in order to increase our understanding of the risk factors for Chinese suicides.
Article
Despite the widespread influence of the alcohol dependence syndrome concept on the major nosological classification systems, little work has been done to test the validity of the alcohol dependence syndrome in community samples. In addition, numerous questions have been asked about the validity of current definitions of alcohol abuse. We examined the cross-sectional validity of DSM-IV alcohol dependence and abuse in 936 household residents randomly selected and screened for elevated drinking. We investigated validity by testing the association of a set of seven “criterion” variables, external to the alcohol diagnostic criteria, with dependence and abuse diagnoses. Results indicated that dependence diagnoses were significantly associated with all criterion variables when compared to those with no diagnosis, even though all subjects had elevated drinking and the cases of alcohol dependence were mild. In contrast, abuse diagnoses did not show a pattern of association with the criterion variables when compared to no diagnosis. When associations were tested comparing dependence cases to those with abuse only, results were mixed. This study is one in a series of investigations in this sample of household residents screened for elevated drinking levels.
Article
Aggression confers risk for suicide. However, “aggression” is a heterogeneous construct, and it is likely that subgroups of individuals with particular types of aggression are at higher risk. We postulate that a subtype of aggression, reactive aggression, underlies the link with suicide with implications for suicide risk-recognition and prevention. The theoretical rationale and empirical evidence for the role of reactive aggression in suicide is presented from the perspectives of neurobiology, psychopathology, and overt violent behavior. It is hypothesized that partner–relationship disruptions amplify risk for suicide in the near term among reactive aggressive individuals, particularly those with psychiatric disorders, and preliminary evidence in support of this hypothesis is reviewed. We also discuss being jailed as a potential precipitant of suicide in reactive aggressive individuals. Recommendations are made to advance the study of reactive aggression and suicide, including methodological innovations and a greate