Case-control Psychological Autopsy Study Research Articles

Suicide without warning: Results from the Army Study to Assess Risk and Resilience in Servicemembers (STARRS)

ObjectivesThe rate of suicide increased in members of the United States Army since 2011 after the Iraq and Afghanistan wars and continues to be a major concern. In order to reverse this disturbing trend, it is vital to understand the risk and protective factors for suicide death in servicemembers. MethodsData were obtained from a case-control psychological autopsy study, which compared U.S. Army suicide decedent cases (n = 135) to a probability sample of living controls (n = 255) who are also service members weighted to be representative of the Army. Interviews were conducted with next-of-kin (NOK) and supervisor (SUP) informants. Multivariable logistic regressions models were constructed using predictors significant after controlling for multiple comparisons. ResultsThe most parsimonious multivariable model controlling for deployment status, as reported by SUP predicting suicide death consisted of four significant variables: a spouse or partner left him or her in the past month (OR = 28.5 [95% CI = 1.8, 442.7] χ² = 5.72, p = .0168); a smaller social network (OR = 4.2 [95% CI = 1.0, 17.3] χ² = 3.97, p = .0462), less likely to seek help from a mental health counselor (OR = 3.4 [95% CI = 1.2, 9.7] χ² = 5.35, p = .0207) and more likely to be described as incautious (OR = 3.8 [95% CI = 1.2, 11.7] χ² = 5.42, p = .0199). The AUC = .88 [95%CI = 0.82, 0.94] for this regression model suggests strong prediction. ConclusionsOur findings suggest that recent relationship problems, especially in soldiers who are less likely to seek out support from others, may be warning signs for detection and prevention of imminent risk of suicide and according to supervisor informant surveys, had neither evidence of a mental health disorder, nor disclosed suicidal ideation or self-harm. Implications for suicide prevention are discussed.

Impact of Position in Family on Suicide: A Case-Control Psychological Autopsy Study among Chinese Rural Youths

Introduction. Suicide remains an important public health issue in China. Existing literature on the relationship between individual-familial variables and suicide risk mainly focused on family socioeconomic status, and few studies analyzed the effect of position in family on suicide. In this study, we aimed to explore the association between position in family and suicide among Chinese rural youths. Methods. We conducted a case-control psychological autopsy study. The data collection yielded 392 suicide cases aged 15-34 years and 416 community living controls within the same age range. Personal position in family was assessed by the question “How do you evaluate his/her position in the family?” and categorized as high, general, and low to reflect the relative position in family. Logistic regression models were conducted to explore the association between position in family and suicide risk. Results. The results showed that compared with females (males) having a high position in family, females (males) with a low position in family were 7.1 (9.1) times more likely to commit suicide ( p < 0.01 ). Mental disorders, social support, and coping strain were potentially important mediating factors linking position in family to suicide, with certain heterogeneity among males and females. Low coping strain played the most important role in underlying the association between a low position in family and suicide for both females and males, accounting for 55% (28%) of the contribution to the total effect for females (males). Subgroup analysis revealed that low position in family had more significant impacts on suicide risk among married youths and those with low education levels. Conclusion. The effect of position in family on suicide should receive greater consideration when predicting suicide in rural China. Possible mechanisms underlying the effect of position in family on suicide include mental status, social support, and coping strain.

Suicide among young-old and old-old adults in rural China: A case-control psychological autopsy study.

Late-life suicide is a vital public health concern. Though gerontological research suggested the young-old and old-old phases were heterogeneous, age differences in the elderly suicide have not been well studied due to the lack of comparable control groups and small samples. The study aimed to examine the age-specific suicidal characteristics and risk factors among the young-old (60-79) and old-old (over 80) elderly. Two hundred and forty two suicide decedents and 242 living comparisons were enrolled in a 1:1 matched case-control psychological autopsy study in rural China: 173 young-old and 69 old-old in each group. Suicidal characteristics, demographic characteristics, living arrangements, physical health, mental disorder, and psychosocial factors were collected. We used logistic regression models to assess risk factors of suicide and test for interactions between age and each risk factor. Pesticide suicide was more prevalent among young-old suicides than old-old suicides (56.07% vs. 40.58%, p=0.029). Non-currently married, unemployment, mental disorder, higher disability in physical activities of daily living, higher hopelessness and higher depressive symptom were significantly associated with suicide among older adults. The effect of poor function in physical activities of daily living on suicide was significantly greater during younger ages (p for interaction=0.038). Findings indicated that most suicidal characteristics and risk factors for completed suicide were generally similar among young-old and old-old adults. But poor function in physical activities of daily living predicted increase suicide risk only at younger ages. In addition to common risk factors, age-specific factors should also be noted in suicide prevention. According to the ICMJE, purely observational studies (those in which the assignment of the medical intervention is not at the discretion of the investigator) will not require registration. Our study was not registered because this is a case-control study. But all procedures of the study were carried out in accordance with the latest version of the Declaration of Helsinki. The study were approved by the Institutional Review Boards of the Central South University, Shandong University, and Guangxi Medical University.

Psychosocial and psychiatric factors preceding death by suicide: A case-control psychological autopsy study involving multiple data sources.

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. 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. 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. 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 assessment of suicide cases in Punjab Pakistan & medico legal frame work shortcomings in Pakistan related to psychological autopsy -a case control psychological autopsy study

Background: Psychological autopsy in Forensic Medicine context deals with the study of medico legal factors which affected victim to commit suicide. This area of Forensic Medicine is usually rarely addressed in research all over the world and especially in the Pakistan. This study is a case control study to look for the factors and their affiliation to medicolegal frame work shortcomings in Pakistan especially related to psychological autopsy. Aim: To assess different psychological factors which has influenced the victims to commit suicide and compared with the controls who were usually next of kin of these victims. Methods: A case control autopsy study was designed to investigate the factors resultant of psychological autopsy of 100 cases in four districts (Lahore, Faisalabad, Multan & Sargodha) of Punjab , Pakistan occurring during the year 2018 to 2021. We conducted the semi structured interviews with nearly 100 living controls from the next of kin of these victims of suicide. Also a questionnaire circulated to health professional related to medicolegal shortcoming related to psychological autopsy in Punjab. Results: Stresses related to personal and social life, psychiatric illness, domestic issues of marriages and poverty were the main reasons behind all these cases. There is need of implementation of reforms in our medico legal system for arrangements of qualified personals to conduct the psychological autopsy. Conclusions: For proper assessment of risk factors, causes and precipitants of suicidal cases, a proper psychological autopsy is very important in our criminal justice system. For awareness related to mental disorders and psychiatric illness, there is need of mass campaigns to avoid suicidal deaths in community. Keywords: Psychological autopsy, Risk factors, Suicide, Psychological disorders

The Mediating Role of Depressive Symptoms, Hopelessness, and Perceived Burden on the Association Between Pain Intensity and Late-Life Suicide in Rural China: A Case-Control Psychological Autopsy Study.

Background: Few studies have investigated the roles of psychosocial factors such as depressive symptoms and hopelessness on the relationship between pain and suicide with inconsistent results. The study aimed to analyze the impact of pain intensity on suicide death and to estimate the degree to which depressive symptoms, hopelessness, and perceived burden may explain the association in Chinese rural elderly.Methods: Using a 1:1 matched case–control design, we collected data from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including sociodemographic characteristics, pain intensity, depression, hopelessness, perceived burden, physical diseases, and social support. Conditional logistic regression was employed to assess the association between pain intensity and completed suicide. Mediation analysis using the KHB method was applied to explore the mediation effects from depressive symptoms, hopelessness, and perceived burden.Results: The result of multivariable logistic regression showed that unemployment [odds ratio (OR) = 5.06, 95% confidence interval (CI): 1.76–14.49], higher levels of hopelessness (OR = 7.72, 95% CI: 3.49–17.10), depressive symptom (OR = 15.82, 95% CI: 4.53–55.25), and severe pain (OR = 3.46, 95% CI: 1.31–9.13) were significantly associated with elevated suicide risk in older adults in rural China. Depressive symptoms, hopelessness, and perceived burden significantly mediated 43.71% of the pain–suicide association (p = 0.020), with 17.39% due to depressive symptoms, 17.63% due to hopelessness, and 8.69% due to perceived burden.Conclusions: Regular screening of pain, depressive symptoms, hopelessness, and perceived burden using simple but sensitive questions or scales for older adults with pain is vital for the prevention and early detection of suicide risk in Chinese rural areas. Moreover, the importance of pain management and psychological interventions targeted on depressive symptoms and hopelessness should be emphasized.

Population attributable fractions of clinical and social risk factors for suicide in Bangladesh: Finding from a case-control psychological autopsy study.

BackgroundOur knowledge of suicide in low‐income countries is limited. Understanding the importance of factors that contribute to suicide risk will allow for the appropriate allocation of limited resources. In order to prioritize suicide prevention activities in Bangladesh, we estimate the fractions of suicides attributable to key risk factors.MethodsUsing data from matched cases (100) and controls (100) as part of a psychological autopsy study in Dhaka, we estimate the population attributable fraction for key clinical (psychiatric disorders and physical disability), and social (life events, psychical and/or sexual abuse, unemployment, and social isolation) risk factors for suicide in Bangladesh.ResultsAssuming a causal relationship, life events were responsible for the largest proportion of suicide deaths (85.9%; confidence interval [CI], 79.6–90.2), followed by mental disorder (49.5%; CI, 45.3–53.4). The population attributable fraction for the risk factors was 42.9% (CI, 40.6–45) for depression, 11% (CI, 8.9–13) for sexual abuse, and 34.9% (CI, 10.1–52.9) for social isolation.ConclusionsThe study determined the population attributable fraction of risk factors for suicide in Bangladesh. Prevention strategies should be prioritized on the management of the aftermaths of adverse life events, treatment of psychiatric disorders, sexual abuse, and social isolation in the country.

Studying suicide using proxy-based data: reliability and validity of a short version scale for measuring quality of life in rural China

BackgroundTo evaluate the reliability and validity of the short version six-item Quality of Life Scale (QOLS-6) and the consistency of subject-proxy data in a case-control psychological autopsy study on elderly suicide in rural China.MethodsA two-stage stratified cluster sampling method was used to select research sites. We used self-administered questionnaires to collect proxy-based information from informants and subject-based information from living comparisons.ResultsA total of 242 pairs of suicide cases and living comparisons were selected in our research. Subject-proxy consistency for QOLS-6 was good (Intraclass correlation coefficient (ICC) was 0.688) in living controls. Good internal consistency of QOLS-6 was validated by Cronbach’s α being greater than 0.6 among suicide cases and living comparisons. The mean scores of quality of life were lower among suicide cases than living controls. Quality of life was negatively correlated with depression, loneliness, hopelessness, impulsiveness and stressful life events, while it was positively correlated with activities of daily living and family function.ConclusionsQOLS-6 has good reliability and validity, which can be used for assessing quality of life among Chinese rural older adults. It is shorter and easier than any other scale for measuring quality of life and can be used as a screening tool in future studies.

Relationship between impulsivity and suicide among the rural elderly in China: a case-control psychological autopsy study.

BackgroundThe relationship between impulsivity and suicide is inconsistent in different populations. Hence, the relationship between impulsivity and suicide still needs to be studied among the elderly population. The present study intends to explore the relationship between impulsivity and suicide among the rural Chinese elderly.MethodsA case-control psychological autopsy study was conducted from February 1, 2014 to December 18, 2015 among rural residents over the age of 60 who died by suicide. The sample consisted of 242 suicides as the case group and 242 living individuals as the control group. Data on demographic characteristics, impulsivity, previous history of suicide attempts, social support, negative life events, and suicidal behavior were collected.ResultsOur study found that impulsivity increased the risk of suicide. The case group showed a higher Barratt Impulsiveness Scale score compared with the control group (p < 0.001), which indicates that impulsivity was higher among the elderly suicides. In addition, regression analyses show that impulsivity (odds ratio: 1.03, 95% confidence interval: 1.01–1.06) is an independent risk factor of suicide, after controlling for the effects of marital status, education, family annual income, being left behind, social support, and negative life events. Finally, compared with elderly who do not have a history of attempted suicide, elderly with a history of attempted suicide showed higher impulsivity (p = 0.001).

Physical diseases and elderly suicide in rural China: A case–control psychological autopsy study

Physical diseases are well-established risk factor for suicide, particularly among older adults. However, little is known about the underlying mechanism of the association. This study aimed to describe the prevalence of physical diseases and their influences on the elderly in rural China and to examine the underlying mechanisms of the relationship between physical diseases and suicide. This matched case-control psychological autopsy study was conducted from June 2014 to September 2015. Consecutive suicide cases (242) among people aged 60 years or above were identified in three Chinese provinces. The suicide cases were 1:1 matched with living comparisons based on age, gender and residential area. Two informants for each participant were interviewed to collect data on their demographic characteristics, the severity index of physical diseases, depressive symptoms, feelings of hopelessness, mental disorders and social support. A significant difference was found between suicide cases and living comparisons regarding the prevalence of physical diseases (83.5% vs 66.5%, p < 0.001) and their severity (11.3 ± 6.2 vs 6.7 ± 5.3, p < 0.001). Independent risks of suicide included the following: not currently married (OR = 2.81, 95% CI = [1.04, 7.62]), mental disorders (OR = 7.18, 95% CI = [1.83, 28.13]), depressive symptoms (OR = 1.15, 95% CI = [1.05, 1.26]) and feelings of hopelessness (OR = 1.51, 95% CI = [1.20, 1.90]). The structural equation model indicated that the relationship between the severity index of physical diseases and suicide was mediated by depressive symptoms, feelings of hopelessness and mental disorders. The severity and number of physical diseases were found to be correlated with suicide among the elderly in rural China, after controlling for demographic characteristics. Physical diseases elevate one's suicide risk by increasing depressive symptoms, feelings of hopelessness and mental disorders. Efforts for suicide prevention should be integrated with strategies to treat physical diseases along with psychological interventions.

Risk factors for suicide in Bangladesh: case-control psychological autopsy study.

Suicide is an important, understudied public health problem in Bangladesh, where risk factors for suicide have not been investigated by case-control psychological autopsy study. To identify the major risk factors for suicide in Dhaka, Bangladesh. We designed a matched case-control psychological autopsy study. We conducted a semi-structured interview with the next-of-kin of 100 individuals who died by suicide and 100 living controls, matched for age, gender and area of residence. The study was conducted from July 2019 to July 2020. The odds ratios for the risk factors were 15.33 (95% CI, 4.76-49.30) for the presence of a psychiatric disorder, 17.75 (95% CI, 6.48-48.59) for life events, 65.28 (95% CI, 0.75-5644.48) for previous attempts and 12 (95% CI, 1.56-92.29) for sexual abuse. The presence of a psychiatric disorder, immediate life events, previous suicidal attempts and sexual abuse were found as significant risk factors for suicide in Dhaka, Bangladesh.

The pattern of stressful life events prior to suicide among the older adults in rural China: a national case-control psychological autopsy study

BackgroundThere is a lack of evidence concerning the stressful life events experienced prior to suicide which may be associated with an increased suicide risk among Chinese rural older adults. The aim of this study was to identify the pattern of stressful life events prior to suicide among the older adults in China.MethodsTwelve counties were randomly selected using two-stage stratified cluster sampling method. Suicide cases aged 60 years and older (n = 242) were collected from those counties from June 2014 to September 2015. Matched living controls were selected 1:1 with suicide cases by age, gender, and location. Data were collected using face-to-face interviews by a psychological autopsy method. The Life Event Scale for the Elderly was used to measure the stressful life events prior to suicide/interviews.ResultsApproximately 99.6% of suicide cases and 88.4% of controls experienced at least one stressful life event. The suicide group experienced more long-term stressful life events than recent stressful life events. The top three most frequent stressful life events for the suicide group were being diagnosed with chronic disease, hospitalization, and being diagnosed with terminal illness. More female suicide cases experienced the death of a spouse, while more males experienced hospitalization, diagnosis with terminal illness and family poverty. Experiencing at least one stressful life event, an unstable marital status, physical diseases and mental disorders were shown to increase the risk of suicide.ConclusionsStressful life events were common for the rural older adults, especially long-term stressful life events. The experience of at least one stressful life event can increase suicide risk among this population. More attention should be paid to the rural older adults who experienced more long-term stressful life events and health related life events.

Relationship and Effects of Community Problems on Anxiety and Suicide: A Case-Control Psychological Autopsy Study.

This study aimed to explore the relationship and the effects of community problems on anxiety and suicide. Data were from a case-control psychological autopsy study (392 suicides and 416 community living controls) carried out in 16 rural counties from three provinces in China. The World Health Organization Suicide Prevention-Multisite Intervention Study on Suicidal behaviors scale of community stress and problems and Spielberger State-Trait Anxiety Inventory were used to measure the community problems and trait anxiety. Spearman's correlation and multivariable regression methods were used to probe the effect of community problems on anxiety and suicide. There were 12 and 6 community problems correlated with anxiety (rs = 0.169, p < 0.001) and suicide (rs = 0.081, p = 0.022), respectively. Medical care, alcohol abuse, superstition, and job security were important community problems for anxiety and suicide. Community problems had stronger correlation with anxiety than suicide. It might be an effective method to reduce anxiety and suicide risk by solving different community problems.

Gender-specific risk for late-life suicide in rural China: a case-control psychological autopsy study.

despite unique gender patterns of suicide among older people in rural China, research addressing this issue is scarce. This study aims to clarify the gender-specific risk factors of late-life suicide in rural China. the study included 242 persons (51% male) aged 60 and above who had committed suicide between June 2014 and September 2015 in the rural areas of three provinces of China. Using 1:1 matched case-control design, 242 living controls matched in age, gender and neighbourhood were randomly selected. Psychological autopsy interviews and psychological assessments were conducted with two informants for each suicide and living control, respectively. men used alcohol before suicide more than women (12.6 versus 4.7%, P < 0.05). There was no gender difference in suicide method, suicide intent and previous attempts. Univariate analysis showed that married status, mental disorder, depressive symptoms, hopelessness, impulsivity, loneliness, social support, family function and quality of life were associated with suicide in both genders. For men, other risk factors were chronic physical illness and functions of daily living. Variables remaining in the multivariable model for both men and women were depressive symptoms and hopelessness. depression and hopelessness are the two major risk factors for suicide among both older men and woman in rural China. Suicide prevention programmes focusing on depression and hopelessness in this population are indicated. Also needed are continued efforts to develop and refined gender-specialised strategies to identify high-risk individuals or groups and to enhance targeted support in the rural community.

Loneliness, hopelessness and suicide in later life: a case-control psychological autopsy study in rural China.

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. 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. 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. 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.

Family Functioning and Suicide Among the Elderly in Rural China: A Case-Control Psychological Autopsy Study.

This study aimed to examine the association between family functioning and suicide among the elderly in rural China. This 1:1 paired case-control psychological autopsy study included 242 suicides at age 60 or more and an equal number of controls matched on age (±3 years), gender, and residency. Family functioning was assessed by the Family Adaptation Partnership Growth Affection Resolve Index. Family dysfunction was reported more frequently in suicides than in paired controls. Severe family dysfunction denoted a significant risk factor for suicide only in women after adjusting for potential confounding factors. Suicides with family dysfunction were prone to have unstable marital status, physical illness, mental disorders, family suicide history, and more stressful life events than those with good family functioning. The findings suggest that the intervention enhancing family functioning may be effective in decreasing suicide among the elderly in rural China.

Disability in Daily Living Activities, Family Dysfunction, and Late-Life Suicide in Rural China: A Case-Control Psychological Autopsy Study.

Background: Although late-life suicide in rural China is a matter of concern, research is scarce addressing the association between capability of daily living activities, family function, and late-life suicide. We conducted this psychological autopsy study to explore associations between disability in daily living activities, family dysfunction, and late-life suicide in rural China.Methods: Using a 1:1 matched case–control design, we collected data from 242 elderly suicide cases and 242 living community controls in rural China using the psychological autopsy method. We used Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID), Activities of Daily Living Scale (ADL), and Family Adaptive, Partnership, Growth, Affection and Resolve scale (APGAR) to assess the presence of mental disorders, capability of daily living activities, and family function, respectively.Results: Compared with the living controls, suicide cases presented more severe impairment in capability of daily living activities and poorer family function. After controlling for all other factors, capability of daily living activities and family function remained in the final model. The results of the multivariate analysis also show that the presence of a mental disorder, lower levels of social support, and increased number of life events in the last year were significantly associated with elevated suicide risk.Conclusions: Disability in daily living activities and family dysfunction are associated with elevated risk of late-life suicide in rural China. It is warranted to design programs, including family interventions, peer-support groups, and community programs, to help the rural elderly improve activities of daily living and obtain the social support they need to prevent suicidal behaviors.

Reliability and validity of short Beck Hopelessness Scale in psychological autopsy study among Chinese rural elderly.

Older adults represent the segment of population most exposed to the risk of suicide nearly everywhere in the world. Previous studies showed that hopelessness was an important risk factor for suicide. This study aimed to evaluate the reliability and validity of the four-item Beck Hopelessness Scale (BHS-4) in psychological autopsy study among Chinese rural elderly. Two-stage stratified cluster sampling method was used to select research sites. Using case-control psychological autopsy study, face-to-face interviews were conducted to collected information. A total of 242 elderly suicide deaths and 242 matched living comparisons were investigated, including 135 males and 107 females for each group. Intraclass Correlation Coefficients (ICC) of the controls were 0.682-0.713. The median score of BHS-4 among suicides was significantly higher than that among controls. The corrected correlation coefficient between items and total score were 0.184-0.723. Cronbach's Alphas coefficient was 0.834. Only one common factor was precipitated by exploratory factor analysis and the cumulative variance contribution rates were 59.558% for suicides and 52.722% for living controls. The correlation coefficient between hopelessness and depression were 0.481 among suicide death and 0.617 among living controls. The information provided by the informants through psychological autopsy method had high reliability to reflect the actual situation of suicides and controls. BHS-4 has good reliability and validity among Chinese rural elderly suicides. It is suitable for psychological autopsy study among Chinese rural elderly.

Psychosocial, psychiatric and work-related risk factors associated with suicide in Ireland: optimised methodological approach of a case-control psychological autopsy study

BackgroundSuicide 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.MethodsThe 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.ConclusionsThe 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.

Validating the Life Events Scale for the Elderly with proxy-based data: A case-control psychological autopsy study in rural China.

The present study aimed to evaluate the validity of proxy informants' reports on Life Event Scale for the Elderly (LESE) by using psychological autopsy method among rural older adults in China. A multistage stratified cluster sampling method was used to select research sites. Using a case-control psychological autopsy study, face-to-face interviews were carried out to collect information from 242 suicide cases and 242 living controls. We compared the intensity and number of life events to assess the validity and reliability of LESE with proxy data reported by different informants. Data from proxy respondents of the living controls were compared with data reported by the targets (gold standards). Intraclass correlation coefficients were computed to evaluate the consistency of informants. Spearman's correlation analysis was used to analyze the convergent validity and discriminate validity of the LESE. The number of life events between different informants showed higher intraclass correlation coefficients values than the intensity of life events, but the results of correlation analysis was similar. The LESE was positively correlated with depression, loneliness and hopelessness, and negatively correlated with quality of life, family function and social support both in suicide cases and living controls. The LESE has good convergent validity and discriminant validity. LESE is a valid instrument for measuring life events in psychological autopsy studies. We suggest using the number of life events to assess the validity and reliability with proxy data in a psychological autopsy study, which is more reliable than using the intensity of life events. Geriatr Gerontol Int 2019; 19: 547-551.