Abstract
Rates, demographics and diagnostics, which are the focus of many studies of suicide, may provide an insufficient account without adequate consideration of psychological, social and cultural contexts and motives. Furthermore, reported explanations of suicide are shaped not only by events but also the relationship of survivor respondents explaining the suicide. An explanatory model interview for sociocultural autopsy has been used to assess underlying problems and perceived causes. This study in a low-income community of Mumbai in 2003–2004 compared accounts of the closest family survivors and more distant relationships. Our study design distinguished series-level agreement (i.e., consistency of accounts within a group) and case-level agreement for particular cases. Serious mental illness was the perceived cause reported by a respondent in either group for 22.0% of index suicides, but case-level agreement was only 6.0%. Regarding financial stressors, more closely related family respondents focused on acute stressors instead of enduring effects of poverty. Case-level agreement was high for marital problems, but low for other sources of family conflict. Tension was a feature of suicide reported in both groups, but case-level agreement on tension as a perceived cause was low (kappa = 0.14). The role of alcohol as a perceived cause of suicide had high series level agreement (46.0% in both groups) and case-level agreement (kappa = 0.60), suggesting comparable community and professional views of its significance. The study shows that it is relevant and feasible to consider general community patterns and particular survivor interests. Findings from this study recommend an approach to sociocultural autopsy to assess reasons for suicide in community studies. Findings clarify diverse views of underlying problems motivating suicide that should be considered to make mental health care more effective in assessing risk and preventing suicide.
Highlights
It is important to understand the reasons for suicide, so that efforts to prevent it are well-grounded and guided by locally relevant motivations, and so that an appreciation of community-reported reasons for suicide may contribute to the broader interests of mental health in services and community action
Mental health professionals concerned with suicide prevention typically focus on the role of high-risk psychiatric disorders (Goldsmith, Pellmar, Kleinman & Bunney, 2002; Harris & Barraclough, 1997), because their training and professional priorities suggest effectiveness relies on identification and treatment of mental illness that puts people at risk for suicide
Reasons for suicide reported by family, friends, and the popular press typically focus on the triggers and underlying problems, which may be regarded as perceived causes of suicidal behaviour
Summary
It is important to understand the reasons for suicide, so that efforts to prevent it are well-grounded and guided by locally relevant motivations, and so that an appreciation of community-reported reasons for suicide may contribute to the broader interests of mental health in services and community action. Mental health professionals concerned with suicide prevention typically focus on the role of high-risk psychiatric disorders (Goldsmith, Pellmar, Kleinman & Bunney, 2002; Harris & Barraclough, 1997), because their training and professional priorities suggest effectiveness relies on identification and treatment of mental illness that puts people at risk for suicide. This orientation guides strategies for universal and selective prevention targeting high-risk groups (Bertolote, Fleischmann, De Leo & Wasserman, 2004). Community studies of suicide in Kaniyambadi Block, Vellore District, in Tamil Nadu, highlight the underappreciated role of ongoing stress and chronic pain as reasons for suicide, in contrast with overestimation of the role of psychiatric disorders based on uncritical use of symptom check lists that are too easy to apply (Manoranjitham, Rajkumar, Thangadurai, Prasad, Jayakaran & Jacob, 2010)
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