The Psychological Autopsy in Suicide

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Presentation Transcript

Slide 1: 

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The Psychological Autopsy in Suicide : 

2 The Psychological Autopsy in Suicide Walid Sarhan F.R.C.Psych. Consultant Psychiatrist www.walidsarhan.net

Slide 3: 

3 “Autopsy- A surgical procedure, postmortem, which involves the examination of body tissues, often to determine cause of death.” There are three major differences from this definition that are very important: surgical procedure, examination of body tissues and cause of death.

“Psychological Autopsy’’ : 

4 “Psychological Autopsy’’ A psychological procedure, which involves the examination of the psychological history, often to determine the mode of death.”

“Psychological Autopsy: : 

5 “Psychological Autopsy: A retrospective reconstruction of the life history of the decedent, which involves the examination of physical, psychological and environmental details of the decedent’s life in order to more accurately determine the mode of death and get a better knowledge of the death process and the victim’s role in hastening or affecting his own death.

The psychological autopsy method: : 

6 The psychological autopsy method: 1. The victim personal information –construction of the victim’s profile.2. Details of death – date and time of death, cause and or method, place of death. 3. Victim’s history – siblings, marriage, medical illnesses and treatments, prescriptions, suicide attempts. 4. Stress coping – emotional upsets, disequilibrium, coping style to stressful situations. 5. Death history of the victim’s family – suicide, cancer, fatal illnesses, ages at death.

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7 6. Personality.7. precipitant factors – short and long term history of upsets, pressures, tensions and other stressful facts of the victim’s life. 8. Addictions – alcohol and or drug abuse. 9. Interpersonal relationships – within the family, with physicians, friends, coworkers etc. 10. Fantasies, dreams, thoughts, fears relating to death, accident or suicide.

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8 11. Changes before death – eating ,life routines, habits, hobbies, isolation. 12. Life events – victim’s future plans, successes, swings. 13. Intention – assessment of the victim’s intentionality. 14. Lethality – assessment and evaluation of the method and process in which the death has occurred. 15. informants – their reaction to the victim’s death, coping, relationship with the victim.

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Features Associated With Suicide Risk : 

10 Features Associated With Suicide Risk

SEX : 

11 SEX Men commit suicide more than 3 times as often as females. This rate is stable over all age groups. Women, however, are more likely to attempt suicide than are men.

METHODS : 

12 METHODS Men’s higher rates of successful suicide is due primarily to the methods they employ: firearms, hanging, or jumping from high places. Women more commonly take overdoses of psychoactive substances or a poison, but they are now employing firearms more then ever before.

AGE : 

13 AGE Suicide rates increase with age and underscore the significance of the midlife crisis. Among men, suicides peak past the age of 45. Among women, the greatest number of completed suicide occurs after age 55. Older people attempt suicide less often than do younger people, but they are often more successful. However, the suicide rate is rising most rapidly among young people, particularly among males 15-24 years of age. In this age group, the rate for women is increasing at a lower rate.

RACE : 

14 RACE Two of every three completed suicides are white males. The risk of suicide among whites is nearly twice that of all other groups. However, this general rule is changing, as the suicide rate among blacks (especially black males) is rising. Among young people who live in inner cities, and certain Native American, suicide rates have greatly exceeded the national rate. Suicide among immigrants are higher than the native-born population.

RELIGION : 

15 RELIGION Historically the suicide rates among Roman Catholics has been lower than among Jews and Protestants. A person’s degree of orthodoxy and integration may be a more accurate measure of risk than is simple religious affiliation. Moslems have lower rates of suicide.

MARITAL STATUS : 

16 MARITAL STATUS Marriage reinforced by children significantly lessens the risk of suicide. Single, never-married individuals have rates twice as high as for those who are married and have children.

OCCUPATION : 

17 OCCUPATION The higher a person’s social status, the greater the risk of suicide, but a fall in status also increases the risk. Work, in general, tends to protect against suicide. Special at-risk populations include: psychiatrists, Psychologists, ophthalmologists, anesthesiologists, physicians, musicians, dentists, law enforcement officers, lawyers, and life insurance agents. Suicide rates are higher among the employed than the unemployed. The suicide rate increases during recessions and times of high unemployment and during wars.

PHYSICAL HEALTH : 

18 PHYSICAL HEALTH The relationship between physical health and suicide is significant. Previous medical care seems to be a positively correlated risk indicator of suicide. Postmortem studies have found that physical illness is present in some 25 to 75 percent of all suicide victims. It is estimated that a physical illness is a significant factor in some 11 to 51 percent of all suicides. Cancer is found in many suicide victims (as high as 70 percent for some cancer forms). Sever disease of the central nervous system increase the risk of suicide. Some endocrine diseases are associated with increased suicide risk.

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19 Gastrointestinal disorders associated with increased risk include: peptic ulcer and cirrhosis of the liver . Urogenital problems associated with increased risk are benign prostatic hypertrophy (BPH) treated with prostatectomy (surgical resection), and renal disease treated with hemodialysis. Factors associated with illness and contributing to increased risk are: loss of mobility, disfigurement (particularly among women), and chronic intractable pain.

MENTAL HEALTH : 

20 MENTAL HEALTH Highly significant psychological factors in suicide include: substance abuse, depressive disorders, schizophrenia, and other mental disorders. Close to 95 % of all people who attempt or complete suicide have a diagnosed mental disorder. Depressive disorder account for some 80% of this figure, schizophrenia (10%), and dementia or delirium account for 5 %.

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21 Among all people with mental disorders, 25 % are alcohol dependent and have dual diagnoses. The suicide risk in people with depressive disorders is about 15%. 25% of all people with a history of impulsive or violent acts are also at high risk of suicide.

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PSYCHIATRIC PATIENTS : 

23 PSYCHIATRIC PATIENTS The suicide risk for psychiatric patients is three to twelve times that of nonpsychiatric patients. The degree of risk varies according to the age, sex, diagnosis, and inpatient or outpatient status.

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24 Psychiatric patients who commit suicide tend to be relatively young. The relatively youthfulness in these cases was partly accounted for by the fact that two early-onset disorders – schizophrenia and recurrent major depressive disorder- account for just over half of all these suicides. Patients with panic disorder who frequently uses emergency services, have an increased suicide risk.

PREVIOUS SUICIDAL BEHAVIOR : 

25 PREVIOUS SUICIDAL BEHAVIOR A past suicide attempt is possibly the best indicator that a patient is at greater risk for suicide. Some 40 percent of depressed patients who attempt suicide have made a previous attempt. The risk of a second attempt is highest within three months of the first attempt.

Truth or Myth: What Do You Know About Suicide? : 

26 Truth or Myth: What Do You Know About Suicide? Most suicidal people have made up their minds that they really want to die. Myth: Most suicidal people desperately want to live. Many will seek help immediately after attempting to harm themselves

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27 . Mental health professionals are the only ones that can really help a suicidal person Myth: Intervention by mental health professionals are very important, but many suicidal individuals never see a therapist. It is important that all people who interact with a suicidal person know how to help

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Slide 29: 

29 People who want attention talk about suicide; those who are set on killing themselves say nothing. Myth: All suicide threats must be taken seriously. This behavior may be a sign of deep depression, and professional help is needed . While it may, in fact , be a manipulative act, it is one that can end in death

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30 There is no correlation between drug and alcohol abuse and suicide. Myth: Alcohol, drug , use and suicide often go hand. Addicts are at increased risk for suicidal behavior.Even people who don’t usually drink or use drugs will often use shortly before killing themselves

Slide 31: 

31 Experts believe that for every one completed teen suicide, their are as many as two attempts. Myth: The problem is even more common, for every completed youth suicide, there is an estimated 20 or more attempts by other youth.

Slide 32: 

32 6 . The number one factor associate with adolescent suicide is depression and feelings of helplessness and hopelessness. Myth: Most suicidal people suffer some degree of depression. In young people , depression often goes undiagnosed until a crisis occurs. Depression may leave a person feeling drained , “too tired” to carry out a suicide plan. When depression begins to lift and there is a sudden improvement ,be aware that this could be a very dangerous time. The three months following a period of depression is thought to be a critical time of suicide risk. The person has the energy to act, and may even appear cheerful and at peace with the world

Slide 33: 

33 In Florida, more people are murdered than commit suicide each year. Myth: In Florida, suicide is the 9th leading cause of death, while homicide was 19th .In 2000 more than twice as many died by suicide (2.086) than by homicide (956).It is the 3rd leading cause of death in 15-34 year olds.

Slide 34: 

34 The rate of adolescent suicide began increasing in the mid-1950s, while the rate for other age groups remained relatively constant. Myth: Youth suicide rates increased by 300% from the 1950s to the late 1970s. Since the late 1970s, the rates for youth suicides have remained stable.

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35 Adolescent girls are more likely to attempt suicide than boys, but boys are more likely to complete a suicide Myth: Four times as many young men kill themselves as compared to young women.Yet, three to four times as many young women attempt suicide.

Slide 36: 

36 People who are suicidal tend to hide it very well. Suicidal people usually send strong warning signs. Myth: Suicidal people usually send strong warning signs. Warning are changes in a person’s behavior that are considered to be out of character. Research shows that all individuals who attempt suicide gave clues that they intended to kill themselves.

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37 People who talk about killing themselves, make suicide threats and attempts, should always be treated seriously. Myth: All suicide threats should be taken seriously. Intervention should happen immediately

Slide 38: 

38 Most suicidal people are in long-term crisis situations. Myth: The average crisis period lasts for about two weeks. The earlier the intervention the better. Anyone can start the process to get help

Slide 39: 

39 If you ask a suicidal person about his suicidal intentions, you’ll encourage the person to kill himself. Myth: Talking about suicide does not cause someone to become suicidal. Encouraging someone to talk about pent-up emotions through a frank discussion shows that you care and are willing to help

Slide 40: 

40 Most suicidal people develop a plan for suicide, the more specific the plan, the greater the danger Myth: Once the idea suicide has been considered, they have to plan the time, place, and means to complete the act. With intervention , there is less time to plan.

Slide 41: 

41 A promise to keep a note unopened and unread should always be honored. Myth: Promises and confidences cannot be maintained when the potential for harm exists .A sealed note can be a serious warning sign of suicidal intent.

Facts and Fables About Suicide : 

42 Facts and Fables About Suicide Fable: People who Talk about suicide don’t complete suicide. Fact: Many people who die by suicide have given definite warning of their intentions. Always take any comment about suicide seriously

Slide 43: 

43 Fact: Suicide happens without warning Fact: Most suicidal people give many clues and warning signs regarding their suicidal intention Fable: Suicidal people are fully intent on dying

Slide 44: 

44 Fact: Most suicidal people are undecided about living or dying –which is called suicidal ambivalence. A part of them wants to live, however , death seems like the only way out of their pain or situation, They may allow themselves to “gamble with death’’ leaving it up to others to save them.

Slide 45: 

45 Fables: Males are more likely to be suicidal.

Slide 46: 

46 Fact :Males complete suicide more often than females . Perhaps the reason fewer females complete is that they tend to choose less lethal methods than males.

47 Fables: Improvement following a suicide crisis means that the risk is over.

Slide 48: 

48 Fact: Most suicides occur within three months of ‘’Improvement’’ when individual has the energy and motivation to actually follow through with his/her suicidal thoughts .

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