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Psychological autopsy of seventy high school suicides: Combined qualitative/quantitative approach

Published online by Cambridge University Press:  23 March 2020

G. Zalsman ,
Y. Siman Tov ,
D. Tzuriel ,
G. Shoval ,
R. Barzilay ,
N. Tiech Fire ,
M. Sherf  and
J. John Mann
G. Zalsman*
Affiliation:
Geha Mental Health Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
Y. Siman Tov
Affiliation:
Bar Ilan University, Ramat Gan, Israel Ministry of education, Jerusalem, Israel
D. Tzuriel
Affiliation:
Bar Ilan University, Ramat Gan, Israel Feuerstein Institute, Institute Center for Enhancement of Learning Potential (ICELP), Jerusalem, Israel
G. Shoval
Affiliation:
Geha Mental Health Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
R. Barzilay
Affiliation:
Geha Mental Health Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
N. Tiech Fire
Affiliation:
Ministry of education, Jerusalem, Israel
M. Sherf
Affiliation:
Hospital Division, Clalit Health Services and Ben Gurion University, Beer Sheba, Israel
J. John Mann
Affiliation:
Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
*
*Corresponding author. at: Geha Mental Health Center & Psychiatry Department, Tel Aviv University, P.O. Box 102, Petach Tikva 49100, Israel. Tel.: +972 3 9258205; fax: +972 3 9241041. E-mail address:[email protected](G. Zalsman).
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Abstract

Objective

Suicide is the leading cause of death among Israeli youths but data on causes are scarce. This study used psychological autopsies of 70 Israeli school students who committed suicide during 2004–2011, attempting to determine the causes.

Methods

Four narratives of the self were identified (qualitative analysis) and compared (quantitative analysis): (1) regressive: functioning and mood deteriorated continuously (45%); (2) tragic: doing well until rapid decline around suicidal crisis (20%); (3) unstable: peaks and crises throughout life (20%); and (4) stable: long lasting state of adverse living circumstances (15%). Functioning, mental disorders, stressful life events and substance abuse were examined.

Results

A representative profile of the suicide-completer emerged. Suicidality in the tragic narrative involved shorter crisis, fewer risk factors and less psychopathology than the other narratives, also better general functioning and better school performance. Though decrease in functioning was evident in all groups, in the tragic group it tended to be disregarded.

Conclusion

This study presents an in-depth analysis of a unique suicide population of high school students. A combined methodology of qualitative and quantitative analyses reveals a distinct subpopulation of suicidal adolescents with little or no overt psychopathology that poses a challenge to suicide prevention strategies.

Keywords

SuicideAdolescencePostmortemDepressionSchool
Type
Original article
Information
European Psychiatry , Volume 38 , October 2016 , pp. 8 - 14
Copyright
Copyright © Elsevier Masson SAS 2016

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Footnotes

1

Both authors contributed equally to this article.

1

Abbreviations: DSM-IV, Diagnostic and Statistical Manual of Mental Disorders IV; LEC, Life Event Checklist; C-GAS, Children's Global Assessment Scale; CRAFFT test, Car, Relax, Alone, Forget, Friends, Trouble test.

References

Hawton, KSaunders, KEO’Connor, RCSelf-harm and suicide in adolescents. Lancet. 2012;379:2373–2382CrossRefGoogle ScholarPubMed
Wu, PHoven, CWLiu, XCohen, PFuller, CJShaffer, DSubstance use, suicidal ideation and attempts in children and adolescents. Suicide Life Threat Behav. 2004;34:408–420CrossRefGoogle ScholarPubMed
Huth-Bocks, ACKerr, DCIvey, AZKramer, ACKing, CAAssessment of psychiatrically hospitalized suicidal adolescents: self-report instruments as predictors of suicidal thoughts and behavior. J Am Acad Child Adolesc Psychiatry. 2007;46:387–395CrossRefGoogle ScholarPubMed
Nock, MKGreen, JGHwang, IMcLaughlin, KASampson, NAZaslavsky, AMet al.Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry. 2013;70:300–310CrossRefGoogle ScholarPubMed
Goldston, DBErkanli, ADaniel, SSHeilbron, NWeller, BEDoyle, ODevelopmental trajectories of suicidal thoughts and behaviors from adolescence through adulthood. J Am Acad Child Adolesc Psychiatry. 2016;55:400–407http://dx.doi.org/[e1]CrossRefGoogle ScholarPubMed
McManama O’Brien, KHBecker, SJSpirito, ASimon, VPrinstein, MJDifferentiating adolescent suicide attempters from ideators: examining the interaction between depression severity and alcohol use. Suicide Life Threat Behav. 2014;44:23–33CrossRefGoogle ScholarPubMed
Brent, DABaugher, MBridge, JChen, TChiappetta, LAge- and sex-related risk factors for adolescent suicide. J Am Acad Child Adolesc Psychiatry. 1999;38:1497–1505CrossRefGoogle ScholarPubMed
Brent, DAPerper, JAMoritz, GAllman, CFriend, ARoth, Cet al.Psychiatric risk factors for adolescent suicide: a case-control study. J Am Acad Child Adolesc Psychiatry. 1993;32:521–529CrossRefGoogle ScholarPubMed
Bullis, RKNarrative approaches in psychological autopsies: suggestions for methodologies and training. J Forensic Psychol Pract. 2012;12:124–146CrossRefGoogle Scholar
Hjelmeland, HKnizek, BLWhy we need qualitative research in suicidology. Suicide Life Threat Behav. 2010;40:74–80CrossRefGoogle ScholarPubMed
Samdal, ODur, WYoung people’s health in context.2004 WHOGoogle Scholar
Field, TDiego, MSanders, CAdolescent depression and risk factors. Adolescence. 2001;36:491–498Google ScholarPubMed
Undheim, AMSund, AMSchool factors and the emergence of depressive symptoms among young Norwegian adolescents. Eur Child Adolesc Psychiatry. 2005;14:446–453CrossRefGoogle ScholarPubMed
Roeser, RWEccles, JSSchool as a context of early adolescents’ academic and social emotional development: a summary research findings. Elem Sch J. 2000;100:443–471CrossRefGoogle Scholar
Maris, ROverview of the study of suicide assessment and predictionMaris, RWBerman, ALMaltsberger, JTYufit, RIAssessment and prediction of suicide. New York, NY: Guilford Press; 1992.3–22Google Scholar
Laederach, JFischer, WBowen, PLadame, FCommon risk factors in adolescent suicide attempters revisited. Crisis. 1999;20:15–22CrossRefGoogle ScholarPubMed
Portzky, GAudenaert, Kvan Heeringen, KSuicide among adolescents. A psychological autopsy study of psychiatric, psychosocial and personality-related risk factors. Soc Psychiatry Psychiatr Epidemiol. 2005;40:922–930CrossRefGoogle ScholarPubMed
Brunstein Klomek, ASourander, AGould, MThe association of suicide and bullying in childhood to young adulthood: a review of cross-sectional and longitudinal research findings. Can J Psychiatry. 2010;55:282–288CrossRefGoogle ScholarPubMed
Fergusson, DLynskey, MHorwood, LJTruancy in adolescence. New Zeal J Educ Stud. 1995;30:25–37Google Scholar
Cho, HHallfors, DDIritani, BJEarly initiation of substance use and subsequent risk factors related to suicide among urban high school students. Addict Behav. 2007;32:1628–1639CrossRefGoogle ScholarPubMed
Gould, MSFisher, PParides, MFlory, MShaffer, DPsychosocial risk factors of child and adolescent completed suicide. Arch Gen Psychiatry. 1996;53:1155–1162CrossRefGoogle ScholarPubMed
Gould, MSGreenberg, TVelting, DMShaffer, DYouth suicide risk and preventive interventions: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 2003;42:386–405CrossRefGoogle ScholarPubMed
Orbach, IBar-Joseph, HThe impact of a suicide prevention program for adolescents on suicidal tendencies, hopelessness, ego identity, and coping. Suicide Life Threat Behav. 1993;23:120–129Google ScholarPubMed
Shamseddeen, WClarke, GWagner, KDRyan, NDBirmaher, BEmslie, Get al.Treatment-resistant depressed youth show a higher response rate if treatment ends during summer school break. J Am Acad Child Adolesc Psychiatry. 2011;50:1140–1148CrossRefGoogle ScholarPubMed
WHO MC, Suicide huge but preventable public health problem, says WHO. Geneva: WHO; 2004Google Scholar
Scott, MAWilcox, HCSchonfeld, ISDavies, MHicks, RCTurner, JBet al.School-based screening to identify at-risk students not already known to school professionals: the Columbia suicide screen. Am J Public Health. 2009;99:334–339CrossRefGoogle Scholar
Brent, DAPerper, JAKolko, DJZelenak, JPThe psychological autopsy: methodological considerations for the study of adolescent suicide. J Am Acad Child Adolesc Psychiatry. 1988;27:362–366CrossRefGoogle Scholar
Cavanagh, JTCarson, AJSharpe, MLawrie, SMPsychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33:395–405CrossRefGoogle ScholarPubMed
Chachamovich, EDing, YTurecki, GLevels of aggressiveness are higher among alcohol-related suicides: results from a psychological autopsy study. Alcohol. 2012;46:529–536CrossRefGoogle ScholarPubMed
Jacobs, DKlein-Benheim, MThe psychological autopsy: a useful tool for determining proximate causation in suicide cases. Bull Am Acad Psychiatry Law. 1995;23:165–182Google ScholarPubMed
Shneidman, ESSample investigation of equivocal suicide deathsFaberow, NLShneidman, ESThe cry for help.New York, NY: McGraw-Hill; 1961Google Scholar
Hawton, KHouston, KMalmbergand, ASimkin, SPsychological autopsy interviews in suicide research: the reactions of informants. Arch Suicide Res. 2003;7:73–82CrossRefGoogle Scholar
Conner, KRBeautrais, ALBrent, DAConwell, YPhillips, MRSchneider, BThe next generation of psychological autopsy studies. Part I. Interview content. Suicide Life Threat Behav. 2011;41:594–613CrossRefGoogle ScholarPubMed
Kral, MJLinks, PSBergmans, YSuicide studies and the need for mixed methods research. J Mix Methods Res. 2012;6:236–249CrossRefGoogle Scholar
Gavin, MRogers, ANarratives of suicide in psychological autopsy: bringing lay knowledge back in. J Ment Health. 2006;15:135–144CrossRefGoogle Scholar
Chase, SENarrative inquiry: multiple lenses, approaches, voicesDenzin, NKLincoln, YSThe Sage handbook of qualitative research.3rd ed.Thousand Oaks, CA: Sage Publications Ltd;2005. 651–679Google Scholar
Bruner, JActual minds, possible worlds. Cambridge, MA: Harvard University Press; 1986Google Scholar
Lieblich, ATuval-Mashiach, RZilber, TNarrative research: reading, analysis and interpretation. Thousand Oaks, CA: Sage Publications; 1998CrossRefGoogle Scholar
Clandinin, DJConnelly, FMNarrative inquiry: experience and story in qualitative research. San Francisco: Jossey Bass; 2000Google Scholar
McAdams, DPThe psychology of life stories. Rev Gen Psychol. 2001;5:100–122CrossRefGoogle Scholar
Gergen, KJGergen, MMNarrative of the selfSarbin, TRScheibe, KEStudies in social identity. New York, NY: Praeger: 1983. 254–273Google Scholar
Cottle, TJMind shadows: a suicide in the family. J Contemp Ethnography. 2000;29:222–255CrossRefGoogle Scholar
Lester, DUnderstanding suicide through studies of diaries: the case of Cesare Pavese. Arch Suicide Res. 2006;10:295–302CrossRefGoogle ScholarPubMed
Sandage, SJThe tragic-ironic self: a qualitative case study of suicide. Psychoanal Psychol. 2012;29:17–33CrossRefGoogle Scholar
Orbach, IGilboa-Schechtman, EOfek, HLubin, GMark, MBodner, Eet al.A chronological perspective on suicide – the last days of life. Death Stud. 2007;31:909–932CrossRefGoogle ScholarPubMed
Jacob, JAdolescent suicide. New York, NY: John Wiley; 1971Google Scholar
Tuval-Mashiach, RLieblich, AZilber, THolistic analysis of formLieblich, ATuval-Mashiach, RZilber, TNarrative research: reading, analysis and interpretation. Tousand Oaks, CA:Sage Publications; 1998.88–111Google Scholar
Clark, DCHorton-Deutsch, SAssessment in absentia: the value of the psychological autopsy method for studying antecedents of suicide and predicting future suicidesMaris, RWBerman, ALMaltsberger, JTYufit, RIAssessment and prediction of suicide. New York, NY:The Guilford Press; 1992.144–182Google Scholar
Bertolote, JMFleischmann, ADe Leo, DWasserman, DPsychiatric diagnoses and suicide: revisiting the evidence. Crisis. 2004;25:147–155CrossRefGoogle ScholarPubMed
Milner, ASveticic, JDe Leo, DSuicide in the absence of mental disorder? A review of psychological autopsy studies across countries. Int J Soc Psychiatry. 2013;59:545–554CrossRefGoogle ScholarPubMed
Siegel, JMJohnson, JHSarason, IGMood states and the reporting of life changes. J Psychosom Res. 1979;23:103–108CrossRefGoogle ScholarPubMed
Horesh, NSever, JApter, AA comparison of life events between suicidal adolescents with major depression and borderline personality disorder. Compr Psychiatry. 2003;44:277–283CrossRefGoogle ScholarPubMed
Shaffer, DGould, MSBrasic, JAmbrosini, PFisher, PBird, Het al.A Children’s Global Assessment Scale (C-GAS). Arch Gen Psychiatry. 1983;40:1228–1231CrossRefGoogle Scholar
Knight, JRSherritt, LShrier, LAHarris, SKChang, GValidity of the CRAFFT substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med. 2002;156:607–614CrossRefGoogle ScholarPubMed
Lester, DQualitative research in suicidology: thoughts on Hjelmeland and Knizek’s “Why we need qualitative research in suicidology”. Suicidol Online. 2010;1:76–78Google Scholar
Hjelmeland, HDieserud, GDyregrov, KKnizek, BLLeenaars, AAPsychological autopsy studies as diagnostic tools: are they methodologically flawed?. Death Stud. 2012;36:605–626CrossRefGoogle ScholarPubMed
Goldney, RDQualitative and quantitative approaches in suicidology: commentary. Arch Suicide Res. 2002;6:69–73CrossRefGoogle Scholar
Leenaars, AADe Wilde, EJWenckstern, SKral, MSuicide notes of adolescents: a life-span comparison. Can J Behav Sci/Rev Can Sci Comport. 2001;33:47–57CrossRefGoogle Scholar
Apter, ABleich, AKing, RAKron, SFluch, AKotler, Met al.Death without warning? A clinical postmortem study of suicide in 43 Israeli adolescent males. Arch Gen Psychiatry. 1993;50:138–142CrossRefGoogle Scholar
Marttunen, MJHenriksson, MMIsometsa, ETHeikkinen, MEAro, HMLonnqvist, JKCompleted suicide among adolescents with no diagnosable psychiatric disorder. Adolescence. 1998;33:669–681Google ScholarPubMed
Jensen, PSBloedau, LDeGroot, JUssery, TDavis, HChildren at risk: I. Risk factors and child symptomatology. J Am Acad Child Adolesc Psychiatry. 1990;29:51–59CrossRefGoogle ScholarPubMed
Music, GNurturing natures: attachment and children’s emotional, sociocultural and brain development. East Sussex: Psychology Press; 2010CrossRefGoogle Scholar
Taylor, SEWay, BMSeeman, TEEarly adversity and adult health outcomes. Dev Psychopathol. 2011;23:939–954CrossRefGoogle ScholarPubMed
King, RASchwab-Stone, MFlisher, AJGreenwald, SKramer, RAGoodman, SHet al.Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation. J Am Acad Child Adolesc Psychiatry. 2001;40:837–846CrossRefGoogle ScholarPubMed
McEwen, BSAllostasis and allostatic load: implications for neuropsychopharmacology. Neuropsychopharmacology. 2000;22:108–124CrossRefGoogle ScholarPubMed
McEwen, BSMood disorders and allostatic load. Biol Psychiatry. 2003;54:200–207CrossRefGoogle ScholarPubMed
Adams, DMOverholser, JCSpirito, AStressful life events associated with adolescent suicide attempts. Can J Psychiatry. 1994;39:43–48CrossRefGoogle ScholarPubMed
Cohen-Sandler, RBerman, ALKing, RALife stress and symptomatology: determinants of suicidal behavior in children. J Am Acad Child Psychiatry. 1982;21:178–186CrossRefGoogle ScholarPubMed
Apter, AKing, RABleich, AFluck, AKotler, MKron, SFatal and non-fatal suicidal behavior in Israeli adolescent males. Arch Suicide Res. 2008;12:20–29CrossRefGoogle ScholarPubMed
Hawton, KAppleby, LPlatt, SFoster, TCooper, JMalmberg, Aet al.The psychological autopsy approach to studying suicide: a review of methodological issues. J Affect Disord. 1998;50:269–276Google ScholarPubMed
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