Transcript The psychological autopsy method of studying

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Qualitative Research & Suicide Seminar
University of Cardiff
2 July 2007
The psychological autopsy method of
studying suicide:
qualitative approaches
Christabel Owens
Hon. Senior Research Fellow
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Outline
 Brief history of the psychological autopsy
 Psychological autopsy study of suicide in people
outside the care of mental health services:
• Analysis using quantitative techniques
• Analysis using qualitative techniques
• What difference does it make?
 Study of social networks – a sociological ‘autopsy’?
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Brief history of the psychological autopsy
 Term coined by Edwin Shneidman in late 1950s
 Original purpose to assist coroner in determining
mode of death (intentional or unintentional)
 Clinical interview with those close to the deceased
 Assessment of behaviour and mental state in the
period leading up to death
 Research potential recognised
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Barraclough et al, 1973 (classic British
psychological autopsy study):
‘Virtually all the suicides studied were
mentally ill…
Mental illness is an essential component of
suicide; our findings… suggest that in
Western society suicide in the healthy
person is a rare event.’
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Rates of mental illness found in previous
psychological autopsy studies:
 Robins et al, 1957 (St Louis): 98%
 Dorpat & Ripley, 1960 (Seattle): 100% ‘Not one case was found
to have been without psychiatric illness.’
 Barraclough et al, 1973 (S. England): 93%
 Runeson, 1989 (Sweden): 97%
 Foster et al, 1997 (N. Ireland): 86%
 Cavanagh et al, 1999 (Scotland): 96%
 Isometsa, 2001: ‘Overall, more than 20 major psychological autopsy
projects have documented that, with rare exceptions, the presence
of a mental disorder is a necessary although not a sufficient
condition for a completed suicide to occur.’
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Psychological autopsy study of suicide in
people outside the care of mental health
services
 Case-controlled study
 100 suicides; 100 age-sex matched living controls
 semi-structured interviews with relatives or others
close to deceased/control
 aimed to identify factors that differentiate those who
took their own lives from the general population
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Analysis using quantitative techniques
 Risk factors, risk factors, risk factors…
 Cases significantly more likely than controls to have:
• been unemployed (OR=9.0; 95%Ci=2.3-35.3)
• been living alone or with strangers (OR=7.4; Ci=2.9-18.8)
• attempted suicide in past (OR=39.0; Ci=5.4-283.9)
• exhibited symptoms in last month warranting diagnosis of
 depression (OR=29.0; Ci=7.2-120.7)
 alcohol or substance abuse (OR=25.0; Ci=3.4-184.5)
 personality disorder (OR=19.0; Ci=2.5-141.9)
• had past mental health service contact (OR=19.3; Ci=6.1-61.7) …
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What’s wrong with risk factors?
 ‘Far too general to be of any practical use’ (Murphy,
1983)
 Designed to aid clinical assessment of risk
 What about the 50% who do not come into contact
with health professions?
 What is the lay equivalent?
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Analysis using qualitative techniques
 Few relatives told ‘illness stories’; accounts of suicide
dominated by moral as opposed to medical categories
 Relatives and friends played a key role in determining
whether suicidal individuals sought medical help
 Many did not consult GP because no-one around them
was aware of seriousness of distress or saw it as
medically significant
 ‘We left her alone. We assumed she’d just get over it
in her own time.’ (Father: female aged 24)
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What difference does it make?
Quantitative:
Qualitative:
 Takes data at face value
 Acknowledges conditions
under which accounts are
constructed
 Aims to penetrate mind of
deceased
 Privileges psychiatric
explanations
 Creates cases of sickness
by imposing diagnostic
overlay – to what end?
 Informs macro-level
prevention strategies
 Aims to understand the
situation from viewpoint of
those close to deceased
 Interested in meanings that
informants attach to events
 Provides better basis for lay
and community-based
approaches to prevention
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Study of social networks – a sociological
‘autopsy’?
 Aims to discover:
• who was in regular contact with the deceased person
• how aware each was of his/her distress
• how each one interpreted what was going on
• whether and in what way they intervened
• what additional information and support might have been
helpful to them in managing the situation
 Design: Qualitative study using in-depth interviews
 Sample: 30 cases; 3-4 informants per case
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Parent 2
GP
Parent 1
Grandparent
Sibling 1
Suicidal
individual
Partner
Colleague
Friend
Sibling 2
Other colleagues
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‘Couples, they break up all the time. You
don’t think, Oh, is he going to commit
suicide? You just don’t.’
(Mother: male aged 24)