The next generation of psychological autopsy studies. Part I. Interview content

The psychological autopsy (PA) is a systematic method to understand the psychological and contextual circumstances preceding suicide. The method requires interviews with one or more proxy respondents (i.e., informants) of decedents. The methodological challenges that need to be addressed when determining the content of these research interviews for PA studies are described and recommendations are made for meeting these challenges in future PA investigations. Ways to improve the data collected about mental disorders and life events--domains that are assessed in almost all PA studies--are discussed at length. Other understudied content areas considered include the role of personality traits, medical illness and functional limitations, availability of lethal agents, medications, and select distal variables including child maltreatment and family history of mental disorders and suicide. The benefits and challenges to using common protocols across studies are also discussed.     

心理解剖及其在自杀研究中的应用

心理解剖是一种综合性、回顾性的研究方法, 指的是通过访谈死者的知情人或信息代理人, 收集死者生前和死后的相关信息, 重新构建死者的社会、生理、心理状况, 以推定其自杀的危险因素。研究表明, 心理解剖对自杀研究有着重要贡献, 是自杀研究中最有价值的工具之一。本文主要分为两部分：一部分主要论述了心理解剖的研究过程, 为该方法在自杀研究中的应用提供参考; 另一部分论述了通过心理解剖研究得到的自杀的危险因素, 帮助更加详细地了解心理解剖在自杀研究中的研究进展。未来应该进一步加强心理解剖的本土化研究和跨文化研究; 同时有必要应用心理解剖进一步探索自杀的多个危险因素之间的交互作用。     

Adapting the cognitive interview to enhance long-term (35 years) recall of physical activities

The cognitive interview (CI) was modified for use in an epidemiological study in which respondents were asked to recall their daily physical activities from the distant past (35 years ago). In comparison to a traditional epidemiological interview, the CI elicited many more responses and also more precise responses. Several practical costs, however, were incurred by the CI: additional time to train interviewers and to conduct interviews and difficulties in coding the responses. The costs and benefits of conducting the CI are addressed, along with conceptual and methodological challenges. The article ends with an existential question: Is the CI a singular technique if it can be modified so radically for different settings?     

Psychological autopsies: methods and ethics

Essential knowledge on suicide is derived from studies that include interviews with survivors. In this paper, we discuss methodological and ethical issues pertaining to the interview method known as "psychological autopsy"; the discussion is based on our application of the method to three studies of suicides in Sweden and on a review of other investigations. Interviewing a survivor is a delicate matter, and the integrity of the deceased, the integrity and health of the informant, and the psychological strain on the interviewer must all be taken into consideration. The interviewer should have clinical experience in order to be prepared to deal with interviewees in grief. Contact by telephone, followed by an introductory letter, provides an opportunity to meet survivors in an empathic manner and has a low rejection rate. A 2- to 6-month interval between suicide and interview is recommended. The survivor's reactions to the interview should be evaluated in order to expand the empirical base for ethical considerations. Studies on the validity and reliability of the method are necessary.     

A semistructured interview for psychologycal autopsy: an inter-rater reliability study

This study developed and evaluated the inter-rater reliability of a semistructured interview for psychological autopsy (SIPA). The SIPA is composed of 69 items that are distributed into four modules (precipitators and stressors, motivation, lethality, intentionality). The interviews of 42 subjects, related to 21 cases of suicide, were audiotaped and then transcribed and evaluated by the interviewer, and also evaluated by a research assistant and two referees who all acted independently. The SIPA was able to provide information that demonstrated a high degree of concordance (kappa) among the raters. The results of this study demonstrate that the SIPA is a very reliable instrument for psychological autopsy in cases of suicide.     

Performance‐Appraisal Beliefs of Chinese Employees in Hong Kong and the Pearl River Delta

Working adults from Hong Kong (HK; N=102) and the Pearl River Delta (PRD; N=96) participated in a Chinese‐language, 20‐item, structured interview. The interview addressed five topics: performance criteria, implementation of the appraisal, factors attributed to performance, methods of feedback, and concerns about the use of performance appraisal (PA) at work. Results indicated that most respondents believe that PA facilitates communication between superiors and subordinates, that effective performance is a function of each individual's internal attributes (which may include aspects external to the workplace), and that feedback should be direct and frank, communicated by someone with authority and power. These results are consistent with the beliefs of people living in societies characterized as high in Confucian dynamism. We discussed implications of the findings for the use of PA in Chinese enterprises in HK and PRD.     

How do personality disorders modify suicide risk?

There is a lack of psychological autopsy studies assessing the influence of axis II disorders on other risk factors for suicide. Therefore, we investigated if the estimated suicide risk for axis I disorders and socio-demographic factors was modified by personality disorders. Psychiatric disorders were evaluated by a semi-structured interview including the Structured Clinical Interview for DSM-IV Axis I (SCID-I) and Personality Disorders (SCID-II) by psychological autopsy method in 163 completed suicides and by personal interview in 396 population-based control persons. Personality disorders modify suicide risk, differently for affective disorders, substance use disorders, smoking, life events during the last three months, and socio-demographic factors such as being single. Estimated suicide risk for socio-demographic factors and life events is not substantially altered following adjustment for affective disorders or substance use disorders. These findings suggest that treatment of personality disorders is essential for suicide prevention.     

Does Information That a Suicide Victim Was Psychiatrically Disturbed Reduce the Likelihood of Contagion?1

For example, psychological disturbance is stigmatizing, so knowledge that the suicide victim was psychiatrically disturbed may decrease the possibility that others will imitate the act. To assess this possibility, 306 undergraduate volunteers read a fictitious newspaper article about a 16-year-old high school sophomore, Pat, who committed suicide. There were 7 variations of the article, 4 containing negative circumstances (psychiatric disturbance, romantic relationship breakup, parents’ divorce, alcohol problems), and 2 containing positive circumstances (being a varsity athlete, being an honors student). A control group received no information about circumstances. Knowledge of Pat's life circumstances had no effect on respondents’ estimates of the possibility of the suicide being imitated, but did affect attitudes about the suicidal act itself and attitudes toward Pat's family. Apparently the circumstances surrounding the suicide have no affect on respondents’ estimates of themselves following suit, but do affect how they see the victim and bereaved family.     

Attempted suicide among young rural women in the People's Republic of China: possibilities for prevention

This article reports on a sample of 147 women under age 35 living in rural areas in China who had attempted suicide and were treated in the emergency room of hospitals in four different locations. The interview instrument took 2 to 3 hours to complete and included audiotaped in-depth interviews with the patient and family members (separately); detailed evaluation of the circumstances surrounding the attempt, life events, and the family environment; and a formal psychiatric evaluation by an attending-level psychiatrist. Overwhelmingly, the method used by the attempters was poisoning with highly lethal pesticides and organic fertilizers. The women's suicidal behavior was characterized by high levels of impulsivity; little effort to seclude themselves before and after ingesting poison; and low rates of mental illness, including depression. Detailed suggestions are made about ways to implement suicide prevention strategies within the particular social and economic context of China.     

Palestinian suicide bombers

The factors underlying the development of Palestinian suicide bombers are explored through a review of published studies and drawing on interviews with five bombers caught before they detonated the bombs they were carrying. The concomitants of becoming a suicide bomber are explored through political, social and psychological processes, including religious and ideological belief systems and personal characteristics. It is argued that there is no single cause or explanation for taking on this role, but that it comes out of a mixture of circumstances, which varies from individual to individual. The current review challenges the common assumption that all suicide bombers are teenage religious fanatics and shows that less extreme personality characteristics can lead to a person deciding to kill him/herself for a cause, given other circumstances. The implications of these findings as well as the weaknesses in the current study are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

Recounting the K-12 school experiences of adults who stutter: a qualitative analysis

This study qualitatively explored the primary and secondary (K-12) school experiences of adults who stutter. The primary investigator conducted semi-structured interviews with 11 participants, a first focus group interview with 6 participants, and a second focus group interview with 4 participants. Participants discussed the various ways in which stuttering affected their personality; emotional and psychological experiences in the context of school; academic and learning experiences; classroom participation; teacher and peer relationships; speech therapy experiences; school activity involvement; and post-educational experiences. Results suggest that school is a complex cultural environment in which students must engage on academic and social levels. People who stutter may experience observable and unobservable challenges as they navigate the complexity of school. EDUCATIONAL OBJECTIVES: After reading this article, the reader will be able to: (1) provide a rationale for the need to explore the school experiences of people who stutter; (2) describe the major themes associated with the school experiences of participants in the study; and (3) discuss how knowledge of school experiences can be useful to classroom teachers and speech-language pathologists.     

Conducting a Multi Family Member Interview Study

Family researchers have long recognized the utility of incorporating interview data from multiple family members. Yet, relatively few contemporary scholars utilize such an approach due to methodological underdevelopment. This article contributes to family scholarship by providing a roadmap for developing and executing in‐depth interview studies that include more than one family member. Specifically, it outlines the epistemological frames that most commonly underlie this approach, illustrates thematic research questions that it best addresses, and critically reviews the best methodological practices of conducting research with this approach. The three most common approaches are addressed in depth: separate interviews with each family member, dyadic or group interviews with multiple family members, and a combined approach that uses separate and dyadic or group interviews. This article speaks to family scholars who are at the beginning stages of their research project but are unsure of the best qualitative approach to answer a given research question.     

Studying suicide with psychological autopsy: social and cultural feasibilities of the methodology in China

As China opens its door to the world, suicide research is making rapid progress using methods and instruments developed in the West. This is a feasibility study of the psychological autopsy methodology applied in China, with its emphasis on the social and cultural environments. With samples of 66 completed suicides and 66 community normal living controls, the authors found that it is feasible to interview at least two informants for each suicide case and each control, between 2 and 6 months after the suicide. With the Chinese-cultivated contacting method of recruiting cases, the refusal rate is nearly zero. The Western-developed methodology per se proved to be valid in the Chinese culture. Ethical considerations in the context of Chinese culture are as important as in the West. Psychological autopsy technique is shown to be an equally applicable method for the study of completed suicides in Chinese culture as it is in the West. Future epidemiological research on Chinese suicide should use the psychological autopsy method to collect data from larger samples in order to increase our understanding of the risk factors for Chinese suicides.     

Sex differences in reporting sensitive behavior: A comparison of interview methods

While telephone surveys generally are considered to be comparable to in-person interviews for the collection of survey data, their utility for the acquisition of sensitive information from respondents remains in question. This paper examines the effect of interview method upon self-reports of a threatening topic—substance use—for male and female college students. It is hypothesized that males may be less likely to admit sensitive behaviors in telephone interviews, compared to face-to-face encounters, due to an interaction of a characteristic of the telephone medium (i.e., the lack of balanced exchange of identifying information between the interviewer and respondent) and aspects of the male sex role, which discourages self-revelation. Findings indicate that differences in reported use of both legal and illegal substances by interview method were greater among males than females. These gender differences in reporting behavior by survey method remained after statistical controls were applied.     

Timelines for difficult times: use of visual timelines in interviewing suicide attempters

The stories of people who attempt suicide are insufficiently reflected in suicide research in psychology. This article outlines a method using a visual timeline during the interviews to explore the narratives of suicide attempts. The method was successfully employed in two studies to collect data on the suicidal process from people with prior experience of suicide attempts. The advantages of the method in collecting comprehensive data, building rapport, and fostering participants’ insight are outlined. Strategies that were used to ensure safety of participants are described in addition to the requirements for interviewers seeking to apply this method.     

Frequency of stuttering during challenging and supportive virtual reality job interviews

This paper seeks to demonstrate the possibility of manipulating the frequency of stuttering using virtual reality environments (VREs). If stuttering manifests itself in VREs similarly to the way it manifests itself in real world interactions, then VREs can provide a controlled, safe, and confidential method for treatment practice and generalization. Though many researchers and clinicians recognize the need for generalization activities in the treatment of stuttering, achieving generalization in a clinical setting poses challenges to client confidentiality, safety, and the efficient use of a professionals’ time. Virtual reality (VR) technology may allow professionals the opportunity to enhance and assess treatment generalization while protecting the safety and confidentiality of their clients. In this study, we developed a VR job interview environment which allowed experimental control over communication style and gender of interviewers. In this first trial, persons who stutter (PWS) experienced both challenging and supportive VR job interview conditions. The percentage of stuttered syllables was calculated for both interviews for each participant. Self-reported ratings of communication apprehension and confidence were also obtained, and were not significantly correlated with stuttering severity. Results indicated that interviewer communication style affected the amount of stuttering produced by participants, with more stuttering observed during challenging virtual interviews. Additionally, the amount of stuttering observed during the VR job interviews was significantly, positively correlated with the amount of stuttering observed during an interview with the investigator prior to VR exposure. Participants’ subjective reports of the VR experience indicate reactions similar to those they report experiencing in the real world. Possible implications for the use of VR in the assessment and treatment of stuttering are discussed.

Educational objectives: After reading this article, the reader will be able to—(1) list some of the challenges to treatment generalization; (2) describe how virtual reality technology can assist in alleviating some of these challenges; (3) describe how the frequency of stuttering varies across two different virtual environments.     

Age variation in the prevalence of DSM-IV disorders in cases of suicide of middle-aged and older persons in Sydney

Data concerning 127 persons aged 35 years or above who died by suicide (as determined in consecutive cases by a Sydney coroner) were analyzed. Psychological autopsy (PA) interviews were conducted in 52 cases, and details were compared with the 75 cases where data were available only from coroner's files (CF). Most characteristics of the two groups were similar, although more CF suicide victims were of Asian background and unable to speak English fluently. Consensus diagnoses were reached following detailed discussion about PA and CF cases. Logistic regression showed no significant difference between age-groups in the proportion diagnosed with major depression, which contrasts with the results of an earlier U.S. study.     

Support groups: A psychological or social device for suicide bereavement?

This paper examines the psychological studies of bereavement support groups as well as exploring the ways in which people talk about their participation in such groups after their family member's suicide. Rather than reflecting any universal human condition, talk about experiences is considered as a local and contextual social construction, which in this case takes place in qualitative interviews in the modernWest (Finland). The paper draws on a study of 16 interviews with bereaved parents and (adult) children, half of whom had attended a bereavement support group after their family member's suicide. The study makes a contribution to the research field of family suicide bereavement from which sociological analysis has been so far largely missing.     

Community Reactions to Attempted and Completed Child Suicide1

In order to assess community reactions to attempted and completed child suicide, 180 shoppers were asked to read a short newspaper article about a 10-year-old who either (a) attempted suicide, (b) completed suicide, (c) completed suicide after having previously attempted, (d) was psychiatrically hospitalized, (e) died of a viral illness, or (f) died of an accident. Subjects then completed a 9-item Likert scale designed to assess their reactions. A2 × 6 (Gender of Victim × Type of Incident) multivariate analysis of variance indicated a significant effect only for type of incident. Families of psychiatrically hospitalized adolescents received milder reactions than families of suicide attempters, in terms of (a) other's assessment of their psychological health, (b) how long they were expected to be sad and depressed after the incident, and (c) how tense respondents expected to feel while visiting them. Apparently, families of suicide attempters must face many of the same negative community reactions as families whose loved ones actually die by suicide, whereas families who have a loved one psychiatrically hospitalized face less problematic reactions from others in the community.     

The psychological autopsy: methodological considerations for the study of adolescent suicide

The psychological autopsy has been employed to study risk factors for completed suicide for more than three decades. Despite a wide range in methods of approach to families and interview techniques, the studies show high compliance and remarkable consistency of results across a wide age range and diverse geographic samples. The convergent evidence is that the diagnostic information obtained is both reliable and valid, although it is likely that such an approach will be more specific than sensitive. Integration of data obtained through psychological autopsies with data obtained through biochemical, toxicological, and epidemiological approaches is likely to deepen our understanding of suicide. Successful completion of careful psychological autopsy studies should enable investigators to examine intensively patients who resemble suicide completers, thereby transcending the inherent limitations of this important first step in the investigation of suicide.