Psychological Autopsy Study Of Suicides Research Articles

Can a zero-shot learning Large Language Model code complex interview data?

Abstract Background Psychological autopsy is essential to establish theories, explore trends and identify previously unexplored psychosocial risk factors in suicide research. However, qualitative research has been scrutinized for being prone to interpretation bias, problems with accuracy, challenges to reproducibility, and is very time- and cost intensive. The current study aimed to investigate if a Large Language Model can achieve sufficient agreement with a researcher in the deductive coding of interview data obtained in a psychological autopsy study of suicide, to be integrated with qualitative research procedures. Methods Data from 38 interviews was deductively coded by a researcher and a LLAMA 3 based language model. The model performance was evaluated in four increasingly difficult coding tasks, including binary classification and data summarization. Intercoder agreement scores were calculated using Cohen’s Kappa. Results The preliminary results showed that the LLM achieved substantial agreement with the human coders for the binary classification task (.78). The variability in performance was influenced by code definitions. The results of the quality of LLM interpretation and summarization will also be presented. Conclusions State-of-the-art LLM can be easily integrated into the qualitative analyses of psychological autopsy interviews and may improve real time monitoring of suicides. We recommend a human-AI collaborative model, whereby deductive coding by the LLM is complemented by human inductive coding and further interpretation. Key messages • Integrating an LLM with qualitative research procedures is feasible in a collaborative model. • Integrating an LLM with qualitative research procedures allows near real-time monitoring based on qualitative data, which extends to other public health fields.

Psychological autopsy study of suicides in farmers: Study from Kerala

Background: Though agricultural farming is considered a peaceful and healthy industry it has a high rate of mortality especially suicide. In India, 11.2% of suicides are reported in the farming sector. Aim: To identify the role of psychosocial factors leading to farmer’s suicide in a farmer’s dominant district of Kerala. Material and Method: One hundred and sixty-six successive suicides in Wayanad district and age, sex, marital status, and financial status matched normal controls residing in the same locality were evaluated and compared on psycho-social demographic variables, life events, and details of suicide. Results: Significantly a greater number of victims were living separately, living in rented homes, had no own land for cultivation, migrated, had marital discord, and strained relationships with relatives. They had loans from private financial enterprises and single money persons, had past attempts, a family history of alcoholism, and highly stressful life events. The most frequent psychiatric diagnosis was alcohol dependence/abuse followed by depression. The majority committed suicide by hanging followed by insecticide poisoning. Intention to commit suicide was expressed by 38.5% and 30.2% were intoxicated at the time of attempt. The venue for the attempt was the own house in 75.7% of cases. Conclusion: This study suggests the following remedial measures to prevent farmers’ suicides. Expert advice to manage financial constraints like availing loans, crop insurance, etc. Guidance from the agricultural department for cost-effective cultivation. Early identification and treatment of psychiatric disorders.

Pesticides and passion: a qualitative psychological autopsy study of suicide in Guyana

The suicide rate in Guyana has consistently ranked in the top ten globally, yet there is only limited literature related to the context in which these suicides occur. This study aims to better understand the psychosocial circumstances and characteristics of suicides in Guyana. This case series study utilised a qualitative psychological autopsy method. One to three informants per deceased person (N=31) were interviewed regarding the lives of 20 Guyanese who died by suicide (14M, 6F, aged 10-74 years). Interpretative Phenomenological Analysis was utilised for the data. Four superordinate themes were identified: Interpersonal Conflict, Trauma, Health, and Unknown Reasons. Interpersonal conflict included subordinate themes of Domestic Abuse, Marital Separation, and Financial Disputes. Health included subordinate themes of Physical Health and Mental Health. Pesticide poisoning was the method used by Guyanese people whose suicide was triggered primarily by interpersonal conflict. The findings illustrate the complexities of suicide in Guyana and the importance of adopting a biopsychosocial perspective to suicide prevention. Suicide prevention should include mental health and suicide literacy training of medical professionals. It is recommended that the importation of highly toxic pesticides be restricted, and that less toxic substitutes be promoted. Convenience sampling, recall bias, and limited informants are limitations of this study. Future research should focus on suicidal behaviour using larger sample sizes. This research was supported by an Australian Government Research Training Program Scholarship through Griffith University Australia.

The impact of patient suicide and sudden death on health care professionals

ObjectiveTo compare the professional and personal impact of patient suicide and sudden death on health care professionals (HCPs) and determine factors associated with these impacts. MethodThe sample was derived from a sudden death-controlled psychological autopsy study of suicide. HCPs were identified by deceased's next of kin, by other HCPs, from coroners' files and from medical records. The HCPs were interviewed about their last contact with the deceased and the impact of the death on their lives. ResultsTwo hundred eleven HCPs were interviewed following suicide; 92 after sudden death. Suicide deaths were significantly more likely to impact upon the HCP's professional practice [suicide n=79 (37.4%); sudden death n=9 (9.9%); χ2=22.06, P<.001] and personal life [suicide deaths n=55 (26.1%); sudden death n=12 (13.0%); χ2=5.58, P=.018] than sudden deaths. Using multinomial logistic regression, being female and suicide within a week of the consultation predicted professional and personal impacts; having less than 5 years experience predicted professional impact and receipt of support/counseling predicted personal impact. ConclusionSuicide deaths have a greater impact than sudden deaths upon the life of HCPs. Clinical inexperience influences impacts on professional practice and availability of support impacts on personal life.

Warning signs of suicide among young men

When young men unexpectedly take their own lives, those close to the deceased will ask themselves whether there were any signs that might have indicated suicide in the near term. Ten young men, aged 18–30, were selected from a psychological autopsy study of suicides among individuals with no prior psychiatric treatment and no previous suicide attempts. In-depth interviews with mothers, fathers, friends, siblings and ex-partners for each suicide, as well as six suicide notes, were analysed. Guided by interpretative phenomenological analysis, we explored possible warning signs of suicide. According to these informants, the young men did not disclose any direct plans of suicide or request for help prior to their death. Rather four indirect signs, related to the psychological condition of the young men in the period prior to ending their life, emerged: (1) repeatedly pointing to the irreversibility of a mistaken decision, (2) the desperation they felt in this respect, (3) using their own death as a threat and (4) referring to death as a place to go. Talk or actions indicating suicidality, as well as worrisome indirect appeals for emotional support, should be investigated directly with the person, as appropriate responses to these signs may have the potential to save lives.

A psychological autopsy study of suicide among Inuit in Nunavut: methodological and ethical considerations, feasibility and acceptability

IntroductionThe increasing global prevalence of suicide has made it a major public health concern. Research designed to retrospectively study suicide cases is now being conducted in populations around the world. This field of research is especially crucial in Aboriginal populations, as they often have higher suicide rates than the rest of the country.ObjectiveThis article presents the methodological aspects of the first psychological autopsy study on suicide among Inuit in Nunavut. Qaujivallianiq Inuusirijauvalauqtunik (Learning from lives that have been lived) is a large case-control study, including all 120 cases of suicide by Inuit that occurred in Nunavut between 1 January 2003 and 31 December 2006. The article describes the research design, ethical considerations and strategies used to adapt the psychological autopsy method to Nunavut Inuit. Specifically, we present local social and cultural issues; data collection procedures; and the acceptability, reliability and validity of the method.MethodA retrospective case-control study using the psychological autopsy approach was carried out in 22 communities in Nunavut. A total of 498 individuals were directly interviewed, and medical and correctional charts were also reviewed.ResultsThe psychological autopsy method was well received by participants as they appreciated the opportunity to discuss the loss of a family member or friend by suicide. During interviews, informants readily identified symptoms of psychiatric disorders, although culture-specific rather than clinical explanations were sometimes provided. Results suggest that the psychological autopsy method can be effectively used in Inuit populations.

Men in despair: A qualitative psychological autopsy study of suicide in Northern Uganda

The psychosocial circumstances surrounding men's suicide in postconflict Central Northern Uganda were investigated using qualitative psychological autopsy interviews. Records of 17 men who died by suicide were identified through police and local leaders in Internally Displaced Peoples' camps of Amuru and Gulu Districts. Two to five significant others were interviewed around each case. Data were analyzed by interpretative phenomenological analysis (IPA). Lost dignity and social value, lack of hope for the family's future, overwhelming family responsibility, and mental illness were circumstances found to have preceded the suicides. The protracted war in the Northern region of Uganda left men in rural communities feeling disempowered and disenfranchised. This may have contributed to suicidal behavior in some of them. Suicide prevention in this area needs to be multidisciplinary with an emphasis on helping both men and women understand and deal with the many social changes that have evolved over time and affected their traditional roles and responsibilities.

Suicide or accident? A psychological autopsy study of suicide in youths under the age of 16 compared to deaths labeled as accidents

ObjectiveIn the present paper, we describe suicide in youths under 16 years of age and compare their risk factors for suicide to those of older adolescents as described in the literature. Furthermore, we evaluate the possible mislabeling of suicides as accidents, and vice versa.MethodWe used the data from a nationwide psychological autopsy of youths 15 years and younger who had committed suicide or died in accidents in Norway from 1993 to 2004 (n = 84). We additionally constructed a suicide index to distinguish between the two causes of death.ResultsThe young suicide victims presented, with little gender difference, fewer obvious risk factors and less suicide intent than commonly described for older adolescents. The suicide index distinguished quite well between suicides and accidents, with few cases indicating a possible mislabeling, although some suicide cases could have been labeled as uncertain.ConclusionIn line with previous research, suicides in 11-15-year-olds have many similarities to suicides in older adolescents in terms of external circumstances, but they present less apparent warning signs. In our total sample of 84 deaths, there were few indications of incorrect labeling.

P03-469 - Socio-demographic correlates of suicide in the regions affected by chernobyl nuclear disaster

BackgroundThe Chernobyl nuclear reactor accident that occurred on 26 April 1986 was the greatest technological disaster in history. There is evidence that the accident has had a significant long-term impact on psychological well-being of the affected population. In particular, the rate of suicide has increased dramatically among the exposed population.AimsThis study was design to examine same of the socio-demographic characteristics which might explain this rise.MethodsA psychological autopsy study of suicides occurring in the regions affected by Chernobyl nuclear disaster between 2003 and 2007 was conducted.ResultsThe suicide rate among the affected population is 3–4 times higher (95–130 per 100.000 of the population) than among general population (33 per 100.000 of the population). The risk factors for suicide among the affected population are the same as for general population. These include unemployment, low income, low education level, acute and chronic alcohol intoxication. Alcohol dependence was diagnosed in 70% of male suicides and 71.4% of female suicides. Alcohol dependence was diagnosed more frequently among men age 30–39 (81.1%) and 50–59 (80%). In the present study 72.3% of males and 62% of females were BAC-positive at the time of death. Positive BAC cases were found more frequently in men age 30–39 (86.5%); 50–59 (86.7%) and women age 30–39 (85.7%).ConclusionsThese results are consistent with previous studies suggesting that acute and chronic alcohol intoxication may function as proximal and distal risk factors of suicide.

Psychological autopsy study of suicide in three rural and semi-rural districts of Sri Lanka

Knowledge concerning the epidemiology of suicide in Sri Lanka is limited despite its suicide rates being amongst the highest in the world. To examine the characteristics of a large sample of Sri Lankan suicides to inform approaches to prevention. Psychological autopsy study of suicides occurring in three rural districts of Sri Lanka during August-October 1997. Interviews were conducted with contacts of 372 (74%) of the 499 suicides that occurred over the study period. Males accounted for 79% of the deaths. Twenty-one percent of male and 57% of female suicides were aged <25 years of age. Pesticide self-poisoning accounted for 259 (70%) of the deaths. Almost two-thirds (62%) of the deaths occurred in hospital and 95 (26%) had made previous suicidal gestures. 138 (37%) were moderately or severely depressed and 144 (49%) of male suicides, but only 2 (2.5%) of the females, were alcohol dependent. Illegally brewed alcohol (kasippu) was the main product used by two thirds (62%) of problem drinkers. There was a family history of suicide in 20% of cases. Pesticide self-poisoning accounts for over two thirds of suicides in rural Sri Lanka. Suicide prevention efforts in Sri Lanka should focus on restricting access to pesticides, improving the medical management of pesticide poisoning, reducing alcohol misuse-particularly targeting the supply of illegal alcohol-and improving the identification and aftercare of people who self-harm.

Do Cerebrovascular Risk Factors Confer Risk for Suicide in Later Life? A Case-Control Study

Cerebrovascular pathologies have been implicated as a cause of depressive disorders. This study aims to examine the role of cerebrovascular risk factors in late-life suicide. The authors calculated cerebrovascular risk factor (CVRF) score, based on the American Heart Association Criteria, for each case and comparison subject from a psychological autopsy study of suicide among community-dwelling adults over age 50 years. CVRF scores were significantly higher in suicide cases than community-dwelling comparison subjects after accounting for age, sex, depression diagnosis, and functional status. Cerebrovascular disease may predispose to suicide in older adults by a variety of psychopathological means.

Suicide in Bipolar I Disorder in Finland: Psychological Autopsy Findings from the National Suicide Prevention Project in Finland

ABSTRACT Suicide mortality in bipolar disorders is high, but little is known about the conditions preceding these fatal acts. The Research phase of the National Suicide Prevention Project in Finland comprised a nationwide psychological autopsy study of suicides (N = 1397) in Finland in 1987–88. In a series of studies, all of the 31 suicides with bipolar I disorder were comprehensively investigated. These suicides usually occurred during a depressive phase, but many male victims also suffered from comorbid alcohol use disorders. Despite contact with psychiatric care, most subjects had not received adequate treatment nor adhered to it. In most cases, suicide occurred after a recent adverse life change. More than half had communicated their intent to next of kin or attending personnel before death.

Psychological autopsy study of suicides by people aged under 35.

In the past two decades the suicide rate in young people has risen in the UK and other countries. To identify the characteristics of people aged under 35 who commit suicide. Psychological autopsy study with case-control design. Cases were 84 suicides and probable suicides (open verdicts). Controls were 64 age- and gender-matched non-suicides obtained through the general practices of the matched cases. social, including employment status, marital status and living circumstances; life events and interpersonal difficulties; clinical, including current psychiatric disorder, alcohol and drug misuse, previous self-harm and personality disorder. A large number of highly significant social, interpersonal and clinical differences between suicides and controls was found. Factor analysis identified two groups of variables within each of the social, interpersonal and clinical domains which were independently linked to suicide, corresponding to: acute, severe mental disorder and chronic disorder of behaviour; rootlessness and social withdrawal; chronic and recent interpersonal problems. A broad prevention strategy is needed to reverse the recent rise in the suicide rate in young people.

Ethical issues and their practical application in a psychological autopsy study of suicide.

The psychological autopsy research method provides detailed information about a suicide using various sources including, coroners' reports, medical records and information gathered from interviews with key informants. The purpose of this article is to discuss the ethical issues that arose when undertaking a psychological autopsy study in Manchester, UK. The sensitive nature of the research is discussed, in particular in relation to the participation of the close relatives and friends of the deceased. These issues, identified from the experiences of other researchers in this field and by conducting a study in Manchester, had implications for the research design and its application. The reactions of the informants who took part in the Manchester study are reported, and their comments should be used to refine future studies on sensitive topics. Their suggestions on their needs and the needs of the suicidal have implications for future health service provision.

A study of suicide in farmers in England and Wales

The proportional mortality ratio for suicide is higher in farmers than in the general population. The reasons for this are likely to be complex, but may include easy availability of firearms, stress related to work, financial difficulties, and family problems. A psychological autopsy study of suicide in 84 farmers who died between 1991–1994 is presented and some preliminary findings are discussed.

Psychological autopsy study of suicide in high risk occupational groups

Psychological autopsy study of suicide in high risk occupational groups

Psychosocial Stressors More Common in Adolescent Suicides with Alcohol Abuse Compared with Depressive Adolescent Suicides

Relationships between stressors and psychiatric diagnoses were studied among 13- to 19-year-old adolescent suicide victims with alcohol abuse/dependence (N = 14), depressive disorders (N = 18), and the remainder (N = 21). The study included all adolescent suicides (N = 53) during a nationwide psychological autopsy study of suicides in Finland during a 12-month period (N = 1397). The data were collected through interviews with the victims' parents and health care personnel and from official records. Interpersonal separations and difficulties regarding discipline or the law were common recent stressors among the alcohol abuse victims, and interpersonal conflicts and somatic illness among those with depressive disorders. Compared with the depressive victims, an unstable earlier family history was more common among the alcohol abusers. The accumulation of stressors and weakened parental support during the previous year were also more frequently found in the alcohol abuse victims. The results indicate that specific psychosocial stressors may be critical for suicidal adolescents with different diagnoses. In the evaluation of suicidal adolescent substance abusers, particularly recent interpersonal separations and family support need to be carefully weighed. Disruptions in the adolescent's interpersonal relationships, excess accumulation of stress, and lacking support from the family may be warning signs of suicide potential and indications for additional social support, for more intensive treatment, or for a change in the treatment setting.

Antisocial behaviour in adolescent suicide

Antisocial behaviour among adolescent suicide victims (44 males, 9 females) was investigated in a nationwide psychological autopsy study of suicides in Finland. The data were collected through interviews of the victims' relatives and attending health care personnel, and from official records. Antisocial behaviour was reported among 43% of the victims. Separation from parents, parental alcohol abuse and parental violence were common among male victims with antisocial behaviour. Their psychosocial adjustment was poor, and they had experienced severe stressors. Depressive disorders were common among all suicides, but male victims with antisocial behaviour had more often alcohol abuse and comorbid mental disorders compared with victims without antisocial behaviour. The results indicate a strong relatedness between adolescent suicide and antisocial behaviour. Recognition and treatment of manifest mental symptoms and evaluation of suicide risk among adolescents with antisocial behaviour and substance abuse is emphasized. Antisocial symptoms with relatively short duration and not severe enough to meet the criteria for actual antisocial disorders also need to be taken into account.

Suicide and Cancer in Late Life

In a controlled psychological autopsy study of suicide in late life, eight cases in which the victim's belief that he had cancer played a major role in the decision to end his life were examined. All victims were men. The majority had diagnosable major affective disorders, but none had been seen in mental health care settings. Other common characteristics were an active relationship with a primary physician, numerous losses, prior experience with cancer or debilitating disease, and a rigid, self-sufficient personality style. The cases illustrate the complex determinants of suicidal behavior in the elderly and suggest preventive strategies for the primary care setting.

Availability of Knowledgeable Informants for a Psychological Autopsy Study of Suicides Committed by Elderly People

Psychological autopsy methodology has not been applied in studies of elderly suicides, despite the fact that the elderly are associated with a higher rate of suicide than any other age group. One school of thought argues that older adults who die by suicide are socially isolated and/or estranged for a long period of time before death, so that knowledgeable informants are difficult or impossible to obtain. In the present retrospective study we examine the number and availability of knowledgeable informants for 145 older people who committed suicide. We believe that the ability to access several motivated informants per case is essential to any psychological autopsy study by modern standards. The stereotype of the "average expectable" elderly suicide victim as socially isolated and living alone or in an institutional setting was not supported by our findings; an unexpectedly high percentage of subjects were married at the time of their death. There was at least one knowledgeable informant in 90% of cases and two or more in almost 50%. In 46%, the subject had expressed despondency over illness. In a prospective study involving interviews with informants for eight subjects, all eight had at least two knowledgeable and willing informants. Two cases of the eight are presented to illustrate the role of delirium and an ominous diagnosis (cancer) as causes of suicide. We conclude that it is feasible to do a psychological autopsy study of elderly suicides.