Suicide Research Research Articles

The Top 100 Most Cited Publications on Suicide: A Citation Analysis.

Suicide is one of the leading causes of death globally and a matter of public health concern. Biomedical research on suicide has grown exponentially over the past few decades. Although numerous articles are published on suicide, only some exert significant influence in the evolution of scientific understanding. The number of citations a publication receives are a proxy marker of its impact on the field. Hence we aimed to analyze 100 top-cited articles on suicide till May, 2023, using Google scholar as the search database. These citation classics provide important insights into the historical development and trends in suicide research.

Active involvement of people with lived experience of suicide in suicide research: a Delphi consensus study

BackgroundThe importance and value of involvement of people with lived experience of suicide has been recognized in suicide research and prevention. Nonetheless, clear guidance on research collaboration and co-production is lacking. This study aimed to address this gap by developing a set of guidelines on active involvement of people with lived experience of suicide in suicide studies., i.e., conducting research with or by people with lived experience, rather than to, about or for them.MethodsThe Delphi method was used to determine statements on best practice for the active involvement of people with lived experience of suicide in suicide research. Statements were compiled through a systematic search of the scientific and grey literature, and reviewing qualitative data from a recent related study conducted by the authors. Two expert panels: people with lived experience of suicide (n = 44) and suicide researchers (n = 29) rated statements over three rounds of an online survey. Statements endorsed by at least 80% of panellists of each panel were included in the guidelines.ResultsPanellists endorsed 96 out of 126 statements in 17 sections covering the full research cycle from deciding on the research question and securing funding, to conducting research and disseminating and implementing outcomes. Overall, there was a substantial level of agreement between the two panels regarding support from research institutions, collaboration and co-production, communication and shared decision making, conducting research, self-care, acknowledgment, and dissemination and implementation. However, panels also disagreed on specific statements regarding representativeness and diversity, managing expectations, time and budgeting, training, and self-disclosure.ConclusionsThis study identified consensus recommendations on active involvement of people with lived experience of suicide in suicide research, including co-production. Support from research institutions and funders, and training on co-production for researchers and people with lived experience, are needed for successful implementation and uptake of the guidelines.

Studying Scripts of Women, Men and Suicide: Qualitative-Method Development and Findings from Nepal.

Information about suicidal behavior in Nepal is limited. According to official records, suicide rates were high until the year 2000 and declined thereafter. Official records are considered unreliable and a gross undercounting of suicide cases, particularly female cases. Suicide research in Nepal has been mostly epidemiologic and hospital-based. Little is known about how suicide is understood by Nepali people in general-including dominant suicide attitudes and beliefs in Nepal. Suicide attitudes and beliefs, which are elements of a culture's suicide scripts, predict actual suicidality. Drawing on suicide-script theory, we developed and used a semi-structured survey to explore Nepali beliefs about female and male suicide. The informants were adult (Mage = 28.4) university students (59% male). Female suicide was believed to be a response to the society-sanctioned oppression and abuse that women are subjected to, in their family and community. The prevention of female suicide was viewed as requiring dismantling ideologies, institutions, and customs (e.g., child marriage, dowry) that are oppressive to women, and ensuring that women are protected from violence and have equal social and economic rights and opportunities. Male suicide was believed to be a symptom of societal problems (e.g., unemployment) and of men's psychological problems (e.g., their difficulties in managing emotions). The prevention of male suicide was viewed as requiring both societal (e.g., employment opportunities) and individual remedies (e.g., psychological counseling). This study's findings suggest that a semi-structured survey can be a fruitful method to access the suicide scripts of cultures about which there is limited research.

External Conditions, Internal Rationality: Spinoza on the Rationality of Seneca’s Suicide

I argue alongside some other scholars that there is a plausible reading of Spinoza’s philosophy of suicide which holds both of the following tenets: first, that suicides occur because of external conditions, and second, that there are at least some suicides which are rational. These two tenets require special attention because they seem to be the source of significant tension. For Spinoza, if one’s cognitions are to be the most adequate, they must be “disposed internally” (E2p29s/G II 114), or determined more from one’s own mental nature than from “fortuitous encounters” with other things (E2p29s/G II 114). It may seem there is a conflict, then, in saying both that there are rational suicides in the Spinozist framework, and that suicides must always be a result of external conditions: it seems a suicide simply cannot be rational if it is the result of external conditions. But this tension, it will be shown, can be dissolved. Once this tension is dealt with, I offer some brief closing arguments. I explain how this reading of Spinoza’s philosophy of suicide can satisfy a call for new suicide research which avoids forms of over-individualism and epistemic injustice, and which encourages us to abolish oppressive conditions that lead to rational suicides.

0630 For Whom the Bell Tolls: Empirical Clustering of Insomnia and Suicidal Ideation

Abstract Introduction Insomnia is associated with risk for suicidal thoughts and behaviors. It is unclear if insomnia drives risk equivalently across all individuals, or whether there are subgroups of high-risk individuals for whom insomnia is more relevant. This exploratory archival analysis examined the relationship between insomnia and current suicidal ideation among subgroups of individuals with lifetime suicidal ideation. Methods Data were acquired from the Military Suicide Research Consortium on 2,617 individuals without missingness on measures of suicidal thoughts and behaviors, anxiety, insomnia, thwarted belongingness, traumatic brain injury, risky alcohol use, and symptoms of post-traumatic stress. Medoid (k-means) clustering algorithms identified subgroups. Robust Poisson models tested interactions between insomnia and cluster identity in association with current suicidal ideation. Models were unadjusted, adjusted for demographic factors, and adjusted for clinical characteristics. Results Clustering identified two subgroups: Cluster 1 (N=1,141) and Cluster 2 (N=1,494). Cluster 1 had fewer individuals with current suicidal ideation (29.2% vs. 66.6%) and in general had less severe symptoms of anxiety, PTSD, insomnia, traumatic brain injury, and suicidal thoughts and behaviors. Across clusters, insomnia severity was associated with risk for current suicidal ideation (PRR: 1.09 [1.03-1.14]). Although individuals in Cluster 1 were less likely to have current suicidal ideation (PRR 0.51 [0.44-0.58]), greater severity of insomnia was associated with greater risk (PRR: 1.11 [1.04-1.18]). By contrast, individuals in Cluster 2 had a greater risk of current suicidal ideation (PRR: 1.68 [1.51-1.88]) and greater severity of insomnia was associated with a diminished risk of current ideation (PRR 0.92 [0.88-0.97]). Conclusion In this exploratory study, individuals with less severe psychopathology were more likely to report current suicidal ideation with worsening insomnia, while those with severe psychopathology were less likely to report suicidal ideation with worsening insomnia. Insomnia may disproportionately increase suicide risk among lower risk individuals. Support (if any) This work was in part supported by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award No. (W81XWH-16-2-0003). Opinions, interpretations, conclusions, and recommendations are those of the author and are not endorsed by the MSRC or the Department of Defense.

Suicide risk assessment and suicide risk management protocol for the Texas Youth Depression and Suicide Research Network

IntroductionSuicide prevention research is a national priority, and national guidance includes the development of suicide risk management protocols (SRMPs) for the assessment and management of suicidal ideation and behavior in research trials. Few published studies describe how researchers develop and implement SRMPs or articulate what constitutes an acceptable and effective SRMP. MethodsThe Texas Youth Depression and Suicide Research Network (TX-YDSRN) was developed with the goal of evaluating screening and measurement-based care in Texas youth with depression or suicidality (i.e., suicidal ideation and/or suicidal behavior). The SRMP was developed for TX-YDSRN through a collaborative, iterative process, consistent with a Learning Healthcare System model. ResultsThe final SMRP included training, educational resources for research staff, educational resources for research participants, risk assessment and management strategies, and clinical and research oversight. ConclusionThe TX-YDSRN SRMP is one methodology for addressing youth participant suicide risk. The development and testing of standard methodologies with a focus on participant safety is an important next step to further the field of suicide prevention research.

Announcements.

Free AccessAnnouncementsPublished Online:June 02, 2023https://doi.org/10.1027/0227-5910/a000913PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreThe Annual Meeting 2023 of the International Society for the Study of Self-Injury (ISSS) is taking place in Vienna, Austria, June 21--23, 2023. For more information go to https://www.meduniwien.ac.at/web/ueber-uns/events/2023/isss-2023-annual-conference/The 32nd World Congress of the International Association for Suicide Prevention (IASP) is taking place September 19–22, 2023, in Piran, Slovenia. For more information go to https://www.iasp.info/piran2023/ Abstract submissions are now open: https://www.iasp.info/piran2023/abstract-submission/The 2023 IASR/AFSP International Summit on Suicide Research is taking place in Barcelona, Spain, October 15–18, 2023. For more information go to https://suicideresearchsummit.org/The 20th European Symposium on Suicide and Suicidal Behaviour will take place in Rome, Italy, August 27–30, 2024. Further information will be provided 2023.The IASP Pan-American Conference will take place in Orlando, FL, USA, November 9–11, 2024. For more information go to https://www.iasp.info/panamericaconference2024/TO BE AT THE FOREFRONT OF GLOBAL SUICIDE PREVENTION EFFORTSJoin as an individualJoin as an organizationBenefits include: Special Interest Groups, Membership Network, IASP Early Career Group, Congresses, Conferences, Symposiums & Workshops, the Crisis journal, and the IASP AwardsIASP is a nonprofit organization for those interested and working in suicide prevention. The membership consists of individuals (clinicians, researchers, crisis workers, volunteers and people who have lost a family member or friend to suicide) and community, national and international organizations. The membership currently extends over 80 countries and is affiliated with the World Health Organization as the key organization concerned with suicide prevention.IASP membership is open to all individuals and organisations interested in suicide prevention: from academics, clinicians, volunteers, and survivors to community, national, and international organizations.Sign up now at www.iasp.info/become-a-member-or-renewIASP Executive Committee 2023–2026PresidentProf. Rory O'Connor (UK) 2021–2024Vice President 1Prof. Thomas Niederkrotenthaler (Austria) 2021–2024Vice President 2Prof. Jo Robinson (Australia) 2023–2026Vice President 3Prof. Lai Fong Chan (Malaysia) 2023–2026General SecretaryProf. Annette Erlangsen (Denmark) 2021–2024TreasurerProf. Maurizio Pompili (Italy) 2023–2026IASP Council of National Representatives 2023–2026Co-ChairsProf. Charity Akotia (Ghana) 2021–2024 & Associate Professor Vita Postuvan (Slovenia) 2023–2026For a current listing of the IASP Council of National Representatives please refer to www.iasp.info/iasp-national-regional-representatives/FiguresReferencesRelatedDetails Volume 44Issue 3May 2023ISSN: 0227-5910eISSN: 2151-2396 InformationCrisis (2023), 44, pp. 255-256 https://doi.org/10.1027/0227-5910/a000913.© 2023Hogrefe PublishingPDF download

A Suicide-Specific Diagnosis – The Case Against

A Suicide-Specific Diagnosis – The Case Against

Lifetime and Jail-Specific Suicidal Ideation: Prevalence and Correlates in a Sample of People in Jail in the United States.

Despite high suicide mortality in U.S. jails, there is limited research into precursors for suicide in this population, such as suicidal ideation. The current study examined the prevalence and correlates of lifetime and jail-specific suicidal ideation among a sample of 196 individuals (137 men) in custody in a U.S. jail. Nearly half the sample had reported lifetime suicidal ideation (45%), whereas 30% had reported jail-specific suicidal ideation. Adjusted correlates of lifetime suicidal ideation included a history of mental illness (OR = 2.79) and drug use (OR = 2.70). Adjusted correlates of jail-specific suicidal ideation included a history of mental illness (OR = 2.74), drug use (OR = 3.16), and a dehumanizing custodial environment (OR = 3.74). Some theoretically and empirically relevant factors were not significantly associated with suicidal ideation. Both expected and unexpected findings are discussed within the context of suicide theory and research, and practical implications are explored.

The use of advanced technology and statistical methods to predict and prevent suicide.

In the past decade, two themes have emerged across suicide research. First, according to meta-analyses, the ability to predict and prevent suicidal thoughts and behaviours is weaker than would be expected for the size of the field. Second, review and commentary papers propose that technological and statistical methods (such as smartphones, wearables, digital phenotyping and machine learning) might become solutions to this problem. In this Review, we aim to strike a balance between the pessimistic picture presented by these meta-analyses and the optimistic picture presented by review and commentary papers about the promise of advanced technological and statistical methods to improve the ability to understand, predict and prevent suicide. We divide our discussion into two broad categories. First, we discuss the research aimed at assessment, with the goal of better understanding or more accurately predicting suicidal thoughts and behaviours. Second, we discuss the literature that focuses on prevention of suicidal thoughts and behaviours. Ecological momentary assessment, wearables and other technological and statistical advances hold great promise for predicting and preventing suicide, but there is much yet to do.

A systems science approach to identifying data gaps in national data sources on adolescent suicidal ideation and suicide attempt in the United States

BackgroundSuicide is currently the second leading cause of death among adolescents ages 10–14, and third leading cause of death among adolescents ages 15–19 in the United States (U.S). Although we have numerous U.S. based surveillance systems and survey data sources, the coverage offered by these data with regard to the complexity of youth suicide had yet to be examined. The recent release of a comprehensive systems map for adolescent suicide provides an opportunity to contrast the content of surveillance systems and surveys with the mechanisms listed in the map.ObjectiveTo inform existing data collection efforts and advance future research on the risk and protective factors relevant to adolescent suicide.MethodsWe examined data from U.S. based surveillance systems and nationally-representative surveys that included (1) observations for an adolescent population and (2) questions or indicators in the data that identified suicidal ideation or suicide attempt. Using thematic analysis, we evaluated the codebooks and data dictionaries for each source to match questions or indicators to suicide-related risk and protective factors identified through a recently published suicide systems map. We used descriptive analysis to summarize where data were available or missing and categorized data gaps by social-ecological level.ResultsApproximately 1-of-5 of the suicide-related risk and protective factors identified in the systems map had no supporting data, in any of the considered data sources. All sources cover less than half the factors, except the Adolescent Brain Cognitive Development Study (ABCD), which covers nearly 70% of factors.ConclusionsExamining gaps in suicide research can help focus future data collection efforts in suicide prevention. Our analysis precisely identified where data is missing and also revealed that missing data affects some aspects of suicide research (e.g., distal factors at the community and societal level) more than others (e.g., proximal factors about individual characteristics). In sum, our analysis highlights limitations in current suicide-related data availability and provides new opportunities to identify and expand current data collection efforts.

Psychometric properties of Concise Associated Symptom Tracking (CAST) scale in youths and young adults: Findings from the Texas youth depression and suicide research network (TX-YDSRN)

Symptoms of irritability, anxiety, panic, and insomnia are common in patients with depression, and their worsening after antidepressant treatment initiation is associated with poorer long-term outcomes. The Concise Associated Symptom Tracking (CAST) scale was developed to measure these symptoms in adults with major depressive disorder (MDD). Here, we evaluate the psychometric properties of CAST in an ongoing community-based observational study involving children, adolescents, and young adults. Individuals from the ongoing Texas Youth Depression and Suicide Research Network (TX-YDSRN; N = 952) with CAST data available were included. Fit statistics [Goodness of Fit Index (GFI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA)] from confirmatory factor analyses were used to evaluate the five- and four-domain structure of CAST. Item response theory (IRT) analyses were also used. Individuals were grouped based on age (in years) as youths (8–17) and young adults (18–20). Correlations with other clinical measures were used to inform construct validity. Four-domain (irritability, anxiety, panic, and insomnia) 12-item structure of CAST (CAST-12) was optimal for youths (N = 709, GFI = 0.906, CFI = 0.919, RMSEA = 0.095) and young adults (N = 243, GFI = 0.921, CFI = 0.938, RMSEA = 0.0797) with Cronbach's alpha of 0.87 and 0.88, respectively. Slope of each item exceeded 1.0 on IRT analyses suggesting adequate discrimination for each item. Scores on irritability, anxiety, panic, and insomnia were significantly correlated with similar items on other scales. Together these findings suggest that CAST-12 is a valid self-report measure of irritability, anxiety, insomnia, and panic in youths and young adults.

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

Concurrent validity and reliability of suicide risk assessment instruments: A meta-analysis of 20 instruments across 27 international cohorts.

A major limitation of current suicide research is the lack of power to identify robust correlates of suicidal thoughts or behavior. Variation in suicide risk assessment instruments used across cohorts may represent a limitation to pooling data in international consortia. Here, we examine this issue through two approaches: (a) an extensive literature search on the reliability and concurrent validity of the most commonly used instruments and (b) by pooling data (N ∼ 6,000 participants) from cohorts from the Enhancing NeuroImaging Genetics Through Meta-Analysis (ENIGMA) Major Depressive Disorder and ENIGMA-Suicidal Thoughts and Behaviour working groups, to assess the concurrent validity of instruments currently used for assessing suicidal thoughts or behavior. We observed moderate-to-high correlations between measures, consistent with the wide range (κ range: 0.15-0.97; r range: 0.21-0.94) reported in the literature. Two common multi-item instruments, the Columbia Suicide Severity Rating Scale and the Beck Scale for Suicidal Ideation were highly correlated with each other (r = 0.83). Sensitivity analyses identified sources of heterogeneity such as the time frame of the instrument and whether it relies on self-report or a clinical interview. Finally, construct-specific analyses suggest that suicide ideation items from common psychiatric questionnaires are most concordant with the suicide ideation construct of multi-item instruments. Our findings suggest that multi-item instruments provide valuable information on different aspects of suicidal thoughts or behavior but share a modest core factor with single suicidal ideation items. Retrospective, multisite collaborations including distinct instruments should be feasible provided they harmonize across instruments or focus on specific constructs of suicidality. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Predictors of suicide ideation among South Korean adolescents: A machine learning approach

BackgroundThe current study developed a predictive model for suicide ideation among South Korean (Korean) adolescents using a comprehensive set of factors across demographic, physical and mental health, academic, social, and behavioral domains. The aim of this study was to address the pressing public health concerns of adolescent suicide in Korea and the methodological limitations of suicidal research. MethodsThis study used machine learning methods (decision tree, logistic regression, naive Bayes classifier) to improve the accuracy of predicting suicidal ideation and related factors among a nationally representative sample of Korean middle school students (N = 6666). ResultsFactors within all domains, including demographic characteristics, physical and mental health, and academic, social, and behavioral, were important in predicting suicidal thoughts among Korean adolescents, with mental health being the most important factor. LimitationsThe predictive model of the current research does not infer causality, and there may have been some loss of information due to measurement issues. ConclusionsStudy results provide insights for taking a multidimensional approach when identifying adolescents at risk of suicide, which may be used to further address their needs through intervention programs within the school setting. Considering the cultural stigma attached to disclosing suicidal ideation and behavior, the current study proposes the need for a preventive screening process based on the observation and assessment of adolescents' general characteristics and experiences in everyday life.

Psychometric evaluation of the 9-item Concise Health Risk Tracking - Self-Report (CHRT-SR9) (a measure of suicidal risk) in adolescent psychiatric outpatients in the Texas Youth Depression and Suicide Research Network (TX-YDSRN)

BackgroundThis study evaluated the psychometric properties of the 9-item Concise Health Risk Tracking Self-Report (CHRT-SR9), a measure of suicidality, in adolescent psychiatric outpatients. MethodsAltogether, 933 depressed or suicidal adolescents (12–20 years of age), receiving treatment at psychiatric outpatient clinics in Texas, completed the 16-item CHRT-SR at baseline and one month later. CHRT-SR9 was extracted from CHRT-SR16 using multigroup confirmatory factor analysis. Sex and age measurement invariance, classical test theory, item response theory (IRT), and concurrent validity analyses (against the suicidal ideation Item 9 of Patient Health Questionnaire-Adolescent (PHQ-A)) were conducted. ResultsThe CHRT-SR9 demonstrated excellent model fit with four factors (pessimism, helplessness, despair, and suicidal thoughts). Measurement invariance was upheld. Acceptable item-total correlations (0.56–0.80) and internal consistency (Spearman-Brown 0.78–0.89) were revealed. IRT analyses showed a unidimensional instrument with excellent item performance. Using the CHRT-SR9 total score as a measure of overall suicidality and comparing it against levels of PHQ-A Item 9, the mean (standard deviation) of CHRT-SR9 total score was 8.64 (SD = 5.97) for no-risk (0 on Item 9), 17.05 (SD = 5.00) for mild, 23.16 (SD = 5.05) for moderate, and 26.96 (SD = 5.24) for severe-risk (3 on Item 9). Significant differences (p-value<0.0001) indicated that CHRT-SR9 total score distinguished between levels of suicidal risk. Furthermore, CHRT-SR9 was sensitive to change over a one-month period. LimitationsWhether CHRT-SR9 predicts actual suicidal attempts in adolescents is not well defined. ConclusionThe CHRT-SR9 is an easy-to-administer, user-friendly self-report with good psychometric qualities which makes it an excellent screening measure of suicidal risk in adolescent psychiatric outpatients.

Suicide among lawyers: Role of job problems.

Suicide research has neglected the legal profession. The present investigation determines what risk factors distinguish lawyers' suicides from those of the general population. Given the substantial investment in their careers, client dependency, and ongoing stress of work, job problems are seen as key potential drivers of lawyers' suicides. Data are from the National Violent Death Reporting System (NVDRS). They refer to 30,570 suicides. Fifteen predictors, including social strains, psychiatric morbidity, and demographics, are assessed as possible drivers of lawyers' suicides. The dependent variable is a dichotomy where lawyers' suicides=1 and other suicides=0. The results of a multivariate logistic regression analysis showed that after adjusting for the other 14 risk factors, lawyers' suicides were 91% more apt (Odds ratio=1.91, CI: 1.17, 3.14) than other suicides to have job problems that contributed to their suicide. Other constructs differentiating lawyers' suicides from other suicides included presence of a known mental health problem, age, presence of a known substance abuse problem, and marital status. The full model correctly classified 99.57% of the suicides. Job problems can serve as a key warning sign for lawyers' suicides. This is the first investigation of the drivers of lawyers' suicides.

Male suicide cases in Bangladesh: Lensing through Durkheim’s sociological typology

ABSTRACT Durkheim’s classic Le Suicide provides the most astounding perspective in the sociological analysis of suicide. Using macro-level statistical data, he analyzed the suicide patterns of different populations and groups with reference to socio-cultural factors and social structures. His model comes with a four-fold typology of suicide: anomic, egoistic, altruistic, and fatalistic. This classification of suicide provides a means for analyzing the structural conditions in society with regard to the causes of suicide and the pathways for meaningful empirical research in sociology Moreover, suicide as a topic gradually waned from the mainstream sociological focus. Nonetheless, we attempted to understand the individual cases of suicide by explicating the essence form Durkheim’s four-fold schema. In doing so, we contextualized 20 male suicide cases from Bangladesh through qualitative semi-structured research interviews with persons close to deceased males and characterized their relevance to Durkheim’s typology. We conclude that explicating Durkheim’s model at the individual level has potential for rejuvenating the sociology of suicide in the field of suicide research.

A qualitative study of multiple voices to inform aftercare services for older persons following self-harm.

Self-harm and suicide are closely related in older adults, highlighting the opportunity for Aftercare interventions in targeted suicide prevention. The study aims were to explore strengths and shortfalls of current Aftercare services for older adults from the perspective of key stakeholders and researchers; and inform a set of guiding principles for older persons' Aftercare. Semi-structured interviews were undertaken with a convenience sampleof older people with lived experience of self-harm, clinicians and suicide researchers (n=22). Interviews were focussed on current practice (strengths and limitations), potential improvements, and identifying the core components of an acceptable Aftercare model. Interviews were audio-recorded, transcribed and subjected to a reflexive thematic analysis grounded in interpretive description. Current practice strengths included validation, a person-centred approach and optimising aftercare delivery. Limitations included ageism, practical limitations (lack of service awareness, fragmented service provision, barriers to access, and traumatising approaches), and limited services, funding and training. Overarching themes included anti-ageism; anti-stigma; empowerment and agency; conveying hope; patience and pace; accessible; and finding purpose: connections and meaningful activity. Older people who have self-harmed have complex, individualised needs. They sit within intersecting systems traversing healthcare, support services, family, and the social environment. Systemic, coordinated Aftercare founded upon core principles of anti-ageism, anti-stigma, partnership, empowerment, accessibility and provision of connections and meaning are needed.

Psychological Autopsy Structured on Individual Cases: Methodological Considerations for A New Protocol

Psychological autopsy is an investigative procedure used in cases of "equivocal death" (a situation in which the cause of death is uncertain); it originated in the early 1960s and has since spread to the United States, Europe, and especially Cuba. The initial MAP (Modelo de Autopsia Psicologica) protocol, developed specifically in Cuba, has since evolved into the more current MAPI (Modelo de Autopsia Psicologica Integrado). It is characterized by the use of a retrospective analysis of the deceased's life, with emphasis on risk factors, mental health history and interpersonal relationships. The Psychological Autopsy is considered one of the most valuable suicide research tools. Information is collected and included in 16 categories (Shneidman) from multiple sources through structured interviews. Despite its widespread use, the original PA model has several methodological problems that can be overcome through a revision of the protocol from a specialized perspective tailored to each case. The innovative PASIC (Psychological Autopsy Structured on Individual Cases) protocol aims to adapt the psychological autopsy protocol to each case, making it unique and personalized. PASIC, therefore, is based on principles of individuality and its management by a single specialized professional figure. This makes it more effective in identifying which subjects to interview and what type of interview to use. The professional will be able to select the appropriate measures to obtain reliable and effective sources of information. Through a review of the origin and development of the psychological autopsy, this article aims to describe the structural and operational features of the new PASIC method and its advantages over the previous protocols.