Research of determinative factors in completed suicide by psychological autopsy

Objective: Suicide is defined as an action through which a person deliberately punishes him/herself. In other words, suicide is a pathologic behavior which if the actor succeeds results in death. Suicide is a common problem in the world. In many countries, it is hard to determine the prevalence of suicide, because the act is often concealed. Psychological autopsy is a retrospective approach to evaluating completed suicides, based on information received from the dead person’s relatives through structured interview forms. These forms are investigating the deceased’s demographics, recent symptoms and behavior, precipitants, psychiatric history, substance abuse, family history, medical and legal records. With this interview, clinicians are seeking to evaluate determinative factors for the suicidal action. The aim of this study is to research the determinative factors prompting someone to commit suicide and to prevent suicidal deaths.

Methods: Suicide cases have been selected after postmortem examination and autopsy in the Council of Forensic Medicine Morgue Department in 2010-2011 November. Relatives of the deceased who accepted to join the study have been interviewed. Systematic inquiry was made through semi-structured forms using DSM or ICD criteria for diagnostic evaluation administered to the relatives by interviewers. The form were given to the relatives by a forensic medicine specialist under the control of a psychiatrist.

Results: There were 40 suicide cases; 82.5% of them were male and 17.5% female. The average age of females was 25, of males 39. Among the methods of suicide, 60% were hanging, 15% gunshot wounds, 10% general body traumas, 5% drowning, 5% poisoning, 2.5% electrocution, 2.5% stab wounds. 25% of person had been planning suicidal action, 25% of person left suicide notes. 30% of cases had previously attempted suicide. The most important predisposing factor is migration from a rural area to an urban center and the next causes are financial losses and familiar conflicts. 45% of cases have psychiatric disorders, the most common one being depressive disorder (55%) and the second one bipolar disorder (17.5%);other conditions were anxiety disorder (7.5%), personality disorder (7.5%), substance abuse (7.5%), obsessive compulsive disorder (2.5%), and schizophrenia (2.5%).

Conclusion: Suicide is a complex behavior in which clinicians need to take into account biological, psychological, and sociological factors. Suicide causes include many factors; therefore, holistic research must be done to understand this phenomenon. To assess the risk of suicidal behavior it is important to evaluate age, sex, psychiatric diseases, psycho-social support, and the accessibility of lethal weapons. Understanding the act of suicide and motives behind suicidal behavior are important for preventing suicidal deaths. There is no standardized protocol for semi-structured psychological autopsy. This study is pioneering multicenter psychological autopsy research. In the future psychological autopsy can be used more frequently and in cooperation between institutions that are pooling information about the determinative factors of suicide.