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。     

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.     

Utah youth suicide study: psychological autopsy

We conducted a psychological autopsy study to further understand youth suicide in Utah. While traditional psychological autopsy studies primarily focus on the administration of psychometric measures to identify any underlying diagnosis of mental illness for the suicide decedent, we focused our interviews to identify which contacts in the decedent's life recognized risk factors for suicidal behavior, symptoms of mental illness, as well as barriers to mental health treatment for the decedent. Parents and friends recognized most symptoms universally, although friends better recognized symptoms of substance abuse than any other contact. The study results suggest that parents and friends are the most appropriate individuals for gatekeeper training and, in conjunction with other innovative screening programs, may be an effective strategy in reducing adolescent suicide.     

PTSD symptoms among tsunami exposed mothers in Sri Lanka: the role of disaster exposure,culturally specific coping strategies,and recovery efforts

Background and objectives: Women in Sri Lanka have been uniquely exposed to a complex and protracted set of stressors stemming from a civil war conflict spanning over 25 years and the tsunami which struck Southeast Asia in 2004. This study investigates coping strategies and their association with trauma-related symptoms of tsunami-exposed mothers in Sri Lanka at two time points.

Design: Data for this study come from surveys administered in two waves of data collection to investigate both mothers’ and adolescent children’s post-tsunami mental health in early 2005, three months after the tsunami struck, and again in 2008, three years later.

Methods: Latent-variable structural equation modeling was used to test the study hypotheses among 160 tsunami-affected mothers in the Polhena village, Matara district, Sri Lanka.

Results: Among the various coping strategies examined, the use of cultural rituals as well as inner psychological strength was associated with lower levels of posttraumatic stress symptoms. In contrast, passive religious beliefs were associated with greater posttraumatic stress levels.

Conclusions: The results of this study reveal the differential associations of various coping strategies including rituals used by mothers exposed to the tsunami in Sri Lanka and their posttraumatic stress symptom levels.     

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.     

Geographical Frame of Reference and Dangerous Intergroup Attitudes: A Double-Minority Study in Sri Lanka

An ethnic group can comprise a local majority, but be a minority within a broader geographic region or vice-versa. This situation has interesting psychological implications that may contribute to intergroup conflict. To test some of these implications, an experiment was conducted in Sri Lanka, during a ceasefire in the conflict between the government and Tamil rebellion forces. Participants were 100 Sinhalese students. An experimental manipulation was introduced to make one of two geographical regions salient: either just Sri Lanka (within which Sinhalese outnumber Tamils) or a broader region of south Asia (within which Sinhalese are outnumbered by Tamils). Following the manipulation, stereotypes and conflict-relevant attitudes were assessed. Results revealed that when Sinhalese participants were inclined to think of their group as the outnumbered minority, stereotypic perceptions of Tamils were more demonizing (i.e., depicting Tamils as more malevolent and also more competent), and their conflict-relevant attitudes were less conciliatory. These results have conceptual implications as well as implications for understanding conflict and conflict resolution.     

A Psychological Autopsy of an Indian Adolescent Suicide with Implications for Community Services

This psychological autopsy of the suicidal death of an adolescent Indian boy includes a brief family background, a history of his difficulties, and a report of his psychological evaluation. There is an attempt to understand the societal and familial factors that seem to have predisposed him to commit suicide. The report includes an analysis of the resources currently available in Indian communities and a recommendation for the kinds of resources that might prevent suicide in this setting.     

Suicide in peacekeepers: risk factors for suicide versus accidental death

To investigate risk factors for suicide in veterans of peacekeeping, 43 suicides and 41 fatal accidents in Norwegian peacekeepers (1978 to 1995) were compared in a psychological autopsy study. Mental health problems were the most important risk factor for suicide. Both living alone and the break-up of a love relationship contributed uniquely to suicide risk, even when controlling for mental health problems. No peacekeeping-related factor was associated with suicide. Preventive measures should focus on firearms control, improved detection systems for mental health problems in the military, and peer support through veterans' associations.     

Suicide Terrorists: Are They Suicidal?

Are suicide terrorists suicidal? A review of the worldwide literature on suicide terrorism uncovered five published empirical studies describing data collected from potential suicide terrorists or the surviving friends and families of deceased terrorists. The many discrepancies uncovered between suicide terrorists and other suicides on key factors known to underpin suicidality, suggest that such terrorists are not truly suicidal and should not be viewed as a subgroup of the general suicide population. Nonetheless, methods developed by suicidologists, such as the psychological autopsy, will help increase our understanding of the individual and group factors that underpin suicide terrorism.     

A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 1. Quantitative outcome and process studies

Scope of review: The paper reports a meta‐review of 15 previous systematic reviews and meta‐analyses of the literature concerning the outcome of counselling and psychotherapy with people at risk of suicide; a meta‐analysis of 67 outcome studies in this area; and a narrative review of 17 studies of the therapeutic process. Publication time span: The literature reviewed was published between 1981 and 2008. Publication origin: The majority of the literature reviewed was by authors from the USA or the UK, but there were also authors from other European countries, Australia, Canada, India, and Sri Lanka. Findings: There is evidence of the effectiveness of dialectical behaviour therapy, cognitive‐behavioural therapy, and problem solving therapy, but also for other forms of therapy. Therapist and client variables, as well as the therapeutic relationship, appear to be related to treatment outcome. Conclusions: People at risk of suicide should have access to psychological interventions, including, but not necessarily limited to, those within the cognitive‐behavioural spectrum. Therapies for which there have been promising findings, but which are under‐researched, should be a research priority.     

Risk Factors for Adolescent Suicide and Suicidal Behavior: Mental and Substance Abuse Disorders,Family Environmental Factors,and Life Stress

This review focuses on psychopathologic risk factors for adolescent suicide and suicidal behavior, namely, affective, disruptive, substance abuse, psychotic, and personality disorders. The interaction of psychopathology with age and gender is discussed. The role of family environmental risk factors and stress events in suicide and suicidal behavior, both alone, and in interaction with psychopathology are reviewed. Research reviewed will include psychological; autopsy studies, longitudinal studies examining predictors of suicide, and epidemiologic studies of suicide attempts.     

Abiding by Sri Lanka Qadri Ismail's way

Qadri Ismail's book, Abiding by Sri Lanka: On Peace, Place, and Postcoloniality (2005) suggests that literary theory might help Sri Lankans re-imagine the colonial social categories and histories that underwrite their long-running conflict. Ismail also argues that the social sciences (particularly anthropology) and history fail Sri Lanka. They fail either because, like anthropology, their colonial origins render them epistemologically unable to ‘abide by’ Sri Lanka (or to see its politics as political); or because, like history, their embrace of an empiricist belief in an objectively real history betrays them into reconfirming nationalism. My article will argue that while the first part of Ismail's thesis is fascinating and useful (if a bit lacking in practical details), his claim that anthropology and history writing as such must be ‘de-authorized’ is too broad. It concludes by arguing for a cease-fire in Sri Lanka.     

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.     

The relationship between impulsivity and suicide among rural youths aged 15–35 years: a case–control psychological autopsy study

In China, the gender ratio of suicide rates did not match the Western patterns, which was higher for females than males. However, the rural men were at relatively high risk of suicide in Liaoning province. Impulsivity was an important factor of suicide behaviors, but there was a lack of studies in China. This research aimed to study the relationship between impulsive personality traits and suicidal behavior among Chinese rural youths. Suicides were consecutively sampled from six randomly selected counties in Liaoning Province in China. Between 2005 and 2007, a total of 162 suicide victims were enrolled in the study along with 162 community controls matched for age, gender, and location. The psychological autopsy method was used to collect data from informants knowledgeable about the selected suicide victims and controls. The results showed the suicide victims in the study were more likely to demonstrate dysfunctional impulsivity and less likely to demonstrate functional impulsivity compared with the controls. Mental disorders, acute negative life events, and dysfunctional impulsivity contributed to the risk of suicide; educational and functional impulsivity were protective factors. Suicide prevention efforts in rural China may address impulsivity.     

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.     

Metaanalysis of Mood and Substance Use Disorders in Proximal Risk for Suicide Deaths

Evidence for proximal risk factors for suicide is based on case–control psychological autopsy studies, with these reports showing that mood and substance use disorders are the most prevalent mental disorders among suicide decedents worldwide and are associated with marked risk. However, moderators of risk and the degree of risk associated with (nonalcohol) drug use disorder are unknown. A comprehensive search was used to identify 35 case–control psychological autopsy studies published worldwide over a 30‐year period that were metaanalyzed using random effects models. Major depression, odds ratio (95% confidence interval) = 9.14 (5.53, 15.09), and drug use disorder, OR (95% CI) = 7.18 (3.22, 16.01), had large effect sizes, among other results. Risk estimates associated with major depression were greater in studies with a larger proportion of women and those conducted in Asia compared with other regions. There was no evidence of publication bias or that any one study had a disproportionate impact on findings. Risk for suicide associated with major depression appears to be moderated by sex and/or world region. Drug use disorder is a potent risk factor, illustrating the importance of assessing drug use in clinical risk assessment.     

Method choice, intent, and gender in completed suicide

Women who commit suicide use less violent methods, such as drugs and carbon monoxide poisoning, than do men, who more often use violent methods such as guns and hanging. Theories that attempt to explain this finding focus on gender differences in suicidal intent, socialization, emotions, interpersonal relationships, orientation and access to methods, and neurobiological factors. Data from a psychological autopsy study were used to test the theory that women who commit suicide use less violent means because they are less intent on dying. Although women were significantly less likely to use a violent method than men, there was no difference in the lethality of their suicidal intent.     

Suicidology: A Look Backward and Ahead

Using the metaphor of “a long run’ to describe our progress in suicidology, the author looks back to discuss important concepts that have become well established, such as clues to suicide, ambivalence, crisis services, suicide consultations, and psychological autopsies. An example is the psychological autopsy of Marilyn Monroe. Follow-up studies of crisis center clients have indicated that chronically suicidal clients are at the greatest risk of suicide. Recommendations for the long-term treatment of such patients are provided. Research on youth suicide is reported. Finally, the author looks ahead toward new developments in training and treatment.     

Psychological autopsies in court

The crucial concept for defining suicide is intention. A major purpose of the psychological autopsy is to clarify the pre-mortem intentions of the victim, now deceased. This article reports cases in which the issue of suicide vs. accident came to trial because insurance benefits were at issue. Currently, the courts, in considering to what extent mental disorders impair the capacity for intentional self destruction, evaluate each case independently according to its own unique set of facts.