La autopsia psicológica en Colombia: ¿Concepto o procedimiento para la investigación científica? Una revisión sistemática

Introducción: La literatura científica reporta que la autopsia psicológica desde sus inicios fue utilizada con la finalidad de ayudar a determinar las circunstancias de muerte de una persona, no obstante, en la actualidad se acoge más como concepto que como una herramienta procedimental. Objetivo: Establecer si en Colombia se ha utilizado para reconstruir los aspectos pre mortem de quienes han fallecido en extrañas circunstancias, de acuerdo con la finalidad de esta. Metodología: Se realizó una revisión sistemática de la literatura científica en 10 bases de datos; se emplearon como palabras clave "autopsia psicológica" y "Colombia", bajo una ventana de observación entre 2010 al 2021; por medio del método PRISMA. Resultados: Se evidencia que en Colombia durante los últimos 10 años el número de estudios asciende a 19, publicados en bases de datos, de los cuales 16 no emplearon el procedimiento de autopsia psicológica y solo tres de ellos sí lo hicieron. Discusión: Existe una tendencia a emplear la autopsia psicológica como concepto desde un enfoque clínico para respaldar los análisis retrospectivos, que, como técnica o procedimiento, se distancia de la posibilidad de reconstruir la criminodinámica del delito, así como la reconstrucción de aspectos de la personalidad, el estado mental y el estilo de vida de quién ha fallecido. Conclusiones: Se resalta que en Colombia la autopsia psicológica se ha utilizado exclusivamente en el campo clínico, sin el rigor científico, metodológico y sin la validez del protocolo empleado.

Introduction: The scientific literature reports that psychological autopsy from its beginnings was used with the purpose of helping to determine the circumstances of death of a person, however, it is currently embraced more as a concept than as a procedural tool. Objective: to establish if in Colombia it has been used to reconstruct the pre-mortem aspects of those who have died under strange circumstances, according to its purpose. Methodology: a systematic review of the scientific literature was carried out in 10 databases, using as keywords psychological autopsy and Colombia, under a window of observation between 2010 and 2021; using the PRISMA method. Results: they show that in Colombia during the last 10 years the number of studies published in databases amounts to 19, of which 16 did not use the psychological autopsy procedure and only three of them did. Discussion: There is a tendency to use psychological autopsy as a concept from a clinical approach to support retrospective analyses rather than as a technique or procedure, distancing us from the possibility of reconstructing the criminodynamics of the crime, as well as reconstructing aspects of the personality, mental state and lifestyle of the deceased. Conclusions: it is highlighted that in Colombia the psychological autopsy has been used exclusively in the clinical field, without the scientific and methodological rigor and without the validity of the protocol used.

Métodos, modelos y evaluación en la autopsia psicológica: Una revisión bibliográfica en Iberoamérica / Methods, models and evaluation in the psychological autopsy: a bibliographic revision in Ibero-America / Métodos, modelos e avaliação na autópsia psicológica: uma revisão bibliográfica em Ibero-América

Resumen La Autopsia Psicológica (AP) es una técnica de evaluación retrospectiva útil en el campo clínico-forense que desde sus inicios de aplicación ha sido utilizada para reconstruir el perfil psicológico y el estado mental de personas fallecidas, permitiendo, además, aclarar la causa o circunstancia de una muerte, pero que, a pesar de la diversidad de instrumentos utilizados, hoy en día sigue presentando algunos vacíos metodológicos y no cuenta con una herramienta estandarizada que facilite su utilización. Es por ello que, a través de un estudio de diseño teórico, se realizó una revisión bibliográfica para analizar la literatura existente en Iberoamérica, mediante las siguientes categorías: métodos de aplicación y de estudio, modelos y evaluación. Con ellas se logró identificar 37 artículos seleccionados de siete bases de datos científicas que muestran los resultados de estudios desarrollados durante el periodo 2001-2017. Se evidencian como hallazgos significativos una mayor producción de investigación teórica, orientadas a definir y clarificar el objetivo y proceso de aplicación de la AP y la implementación de entrevistas semiestructuradas como principal medio de recolección de información. Finalmente, se destaca la importancia de generar investigaciones centradas en la validación de instrumentos de AP que permitan consolidar su carácter científico.

Abstract The Psychological Autopsy (PA) is a retrospective evaluation technique useful in the clinical forensic field that since its beginning of application has been used to reconstruct the psychologic profile and the mental status of deceased people, allowing, furthermore, to clarify the cause or circumstance of a death, but that, despite the diversity of instruments used, today it still presents some methodological lacks and does not count on a standardized tool that facilitates its use. That is why, through a study of theoretical design, a bibliographic revision to analyze the existing literature in Ibero-America was performed, by means of the following categories: methods of application and study, models and evaluation. With them one can identify 37 studies selected from seven scientific databases that show the results of studies developed during the 2001-2017 period. As significant findings are evinced a greater production of theoretical investigation, oriented to define and clarify the objective and process of applicationof the PA, and the implementation of semi-structured interviews as main way to collect the information. Finally, one highlights the importance of generate investigations centered in the validation of instruments of PA that allows consolidate its scientific character.

Resumo A Autópsia Psicológica (AP) é uma técnica de avaliação retrospectiva útil no campo clínico-forense que desde os seus inícios de aplicação tem sido utilizada para reconstruir o perfil e o estado mental de pessoas falecidas, permitindo, além disso, aclarar a causa ou circunstância de uma morte, mas que, apesar da diversidade de instrumentos utilizados, hoje em dia segue apresentando alguns vazios metodológicos e não conta com una ferramenta estandardizada que facilite a sua utilização. É por isso que, através de um estudo de projeto teórico, foi realizada uma revisão bibliográfica para analisar a literatura existente em Ibero-América, mediante as seguintes categorias: métodos de aplicação e de estudo, modelos e avaliação. Com elas alcançou-se identificar 37 artigos selecionados de sete bases de dados científicas que mostram os resultados de estudos desenvolvidos durante o período 2001-2017. Evidencia-se como descobertas significativas uma maior produção de investigação teórica, orientada para definir e clarificar o objetivo e proceso de aplicação da AP, e a implementação de entrevistas semiestruturadas como principal meio de recolecção de informação. Finalmente, destaca-se a importância de gerar investigações centradas na validação de instrumentos de AP que permitam consolidar o seu caráter científico.

Development and a Pilot Application Process of the Korean Psychological Autopsy Checklist for Adolescents

OBJECTIVE: The aim of the study was to develop the Korean Psychological Autopsy Checklist for Adolescent (K-PAC-A) and conduct a pilot study. METHODS: A number of steps were undertaken in the development of the K-PAC-A including literature reviews, consultations, and a pilot study. The Korean psychology autopsy checklist 2.0 (K-PAC 2.0) was carefully reviewed to adopt some domains and questions which can be applied to adolescents. RESULTS: In addition to the adoption of some domains and questions from the K-PAC 2.0, some items were developed by considering the risk factors shown in the previous studies and cultural factors including family-based and school-based problems. A pilot study was conducted in collaboration with Eulji hospital, and Suicide and School Mental Health Institute of Hallym University and 5 cases of adolescent suicide victims were recruited. A final version of the K-PAC-A consists of three domains; a bereaved family (informants), a decedent, and psychological assessments. CONCLUSION: An adolescent psychological autopsy study using the K-PAC-A is expected to provide useful evidence for suicide prevention policies and intervention plans for Korean youths in the future.

Characteristics of Patients who Died by Suicide in a Community Mental Health Center / 대한정신분열병학회지

OBJECTIVES: Severe mental illness is a major risk factor for suicide. This study aimed to identify characteristics of patients who died by suicide among subjects who had been received service from a community mental health center. METHODS: We searched individuals who had committed suicide in Gwangju Bukgu Community Mental Health Center since 2006. Sociodemographic and clinical data were gathered from medical records and their case managers and they were compared with those of general members in the center. Characteristics of schizophrenia patients who died by suicide were particularly summarized. RESULTS: Twelve person committed suicide between 2006 and 2016. The characteristics of those who died by suicide were male (67%), diagnosis of schizophrenia (75%), aged below 50 (83%), unemployed (92%), past history of psychiatric hospitalization (100%), recent admission within 3 months (67%), past history of suicidal attempt (78%), family history of schizophrenia (58%), poor adherence to medication (58%), and use of daily rehabilitation program (42%). Ten out of twelve (83%) showed warning sign for suicide. All identified method of suicide in patients with schizophrenia was jumping from high building. Many patients with schizophrenia, who committed suicide, suffered from comorbid depressive symptoms (67%) and auditory hallucination (78%). CONCLUSION: Case managers should pay attention to and carefully manage individuals who showed suicidal warning, particularly with risk factors for suicide, such as unemployment, admission state or recent discharge from psychiatric hospital, poor adherence to medication, family history of schizophrenia, and a history of suicidal attempt.

Characteristics of Patients who Died by Suicide in a Community Mental Health Center / 대한정신분열병학회지

OBJECTIVES: Severe mental illness is a major risk factor for suicide. This study aimed to identify characteristics of patients who died by suicide among subjects who had been received service from a community mental health center. METHODS: We searched individuals who had committed suicide in Gwangju Bukgu Community Mental Health Center since 2006. Sociodemographic and clinical data were gathered from medical records and their case managers and they were compared with those of general members in the center. Characteristics of schizophrenia patients who died by suicide were particularly summarized. RESULTS: Twelve person committed suicide between 2006 and 2016. The characteristics of those who died by suicide were male (67%), diagnosis of schizophrenia (75%), aged below 50 (83%), unemployed (92%), past history of psychiatric hospitalization (100%), recent admission within 3 months (67%), past history of suicidal attempt (78%), family history of schizophrenia (58%), poor adherence to medication (58%), and use of daily rehabilitation program (42%). Ten out of twelve (83%) showed warning sign for suicide. All identified method of suicide in patients with schizophrenia was jumping from high building. Many patients with schizophrenia, who committed suicide, suffered from comorbid depressive symptoms (67%) and auditory hallucination (78%). CONCLUSION: Case managers should pay attention to and carefully manage individuals who showed suicidal warning, particularly with risk factors for suicide, such as unemployment, admission state or recent discharge from psychiatric hospital, poor adherence to medication, family history of schizophrenia, and a history of suicidal attempt.

Psychological Autopsy: Review and Considerations for Future Directions in Korea / 신경정신의학

Psychological autopsy is a systematic methodology for comprehensive investigation of psychiatric and behavioral factors assumed to be causative or related to death of the deceased. In many countries, psychological autopsy is considered the most direct and valuable tool for determining the relationship between risk factors and suicide. The case of Finland revealed that successful psychological autopsy studies could greatly contribute to the national suicide prevention strategy, which consequently reduced the national suicide rate. Despite the strengths of psychological autopsy for identifying risk factors of suicide and consequently preventing suicide, it has not been successful in Korea. Implementation of psychological autopsy has been inconsistent and sporadic across the provinces. In addition, standardization of psychological autopsy protocol and qualification of interviewers are needed. With all of these methodological issues in mind, conduct of as many psychological autopsies as possible is important in order to build an evidence-based suicide prevention strategy. For successful implementation of psychological autopsy in Korea, it is necessary to improve attitudes toward suicide and psychiatric conditions. Legal, administrative, and institutional support are also important. Finally, multidisciplinary approach based on the financial and legal support should be employed.

A 2-Year Psychological Autopsy Study of Completed Suicides in the Athens Greater Area, Greece

OBJECTIVE: To study the characteristics of a sample of suicide victims from the Athens Greater Area using the psychological autopsy method for the first time in Greece. METHODS: We studied all recorded cases of completed suicide for the 2-year time period November 2007-October 2009 collecting data from the victims' forensic records as well as from the completion of a psychological autopsy questionnaire. RESULTS: 335 persons were recorded as suicide victims. We contacted relatives of 256 victims interviewing those of 248 of them (96.9%). The differences regarding sex, marital and employment status between our sample and the general population were statistically significant (p<0.001). The male/female ratio was 3:1. Comparatively more victims were divorced, separated or single and a greater proportion were pensioners or unemployed. 26.0% of the victims had history of prior attempts (64.4% once, 20.3% twice and 15.3% more times). 42.6% were taking psychiatric medication-significantly more women than men according to blood tests; 14.2% had been hospitalized in a psychiatric clinic the year prior to their death. 84.8% have deceased at the place of suicide and 15.2% died in the hospital; 80.3% died indoors and 19.7% outdoors. Men died primarily by hanging or shooting by a firearm while women preferred jumping from height instead (p<0.001). As many as 48.8% had expressed their intention to die to their relatives; 26.6% left a suicide note. CONCLUSION: Our study has shown that the psychological autopsy method is applicable and widely accepted yielding results comparable to the international literature. Specific parameters associated with suicide have been studied for the first time in Greece.

Fatores de risco relacionados com suicidios em Palmas (TO), Brasil, 2006-2009, investigados por meio de autopsia psicossocial / Risk factors associated with suicides in Palmas in the state of Tocantins, Brazil, between 2006 and 2009 investigated by psycho-social autopsy

Este artigo objetiva analisar e descrever os fatores de risco e seus determinantes, associados a 24 casos de suicídios ocorridos na cidade de Palmas (TO), no período de 2006 a 2009. Utilizou-se o método de autópsia psicológica e psicossocial, a qual, por meio de entrevistas com familiares, busca investigar os suicídios consumados, contextualizando características da vida do sujeito, e compreender os processos familiares e as circunstâncias afetivas, sociais, econômicas e culturais, fundamentando-se na reconstrução da história e da personalidade da pessoa. Os fatores socioeconômicos associados foram: ser do sexo masculino, solteiro, de cor parda, estar na faixa etária de 20 a 40 anos e com ensino fundamental. Os principais fatores de risco identificados foram: transtornos mentais, abuso de álcool e outras drogas, relacionamento familiar conturbado e histórico de tentativas anteriores. Buscamos contextualizar e refletir sobre alguns casos relatados pelos familiares e sobre a resposta das equipes de saúde às demandas das famílias. A necessidade de implantar programas de prevenção e de capacitar os profissionais da atenção básica foi verificada. .

The scope of this article is to analyze and describe the risk factors and determinants linked to 24 suicides in the city of Palmas in the state of Tocantins between 2006 and 2009. The psychological and psycho-social autopsy method was used in order to investigate the consummated suicides by interviewing family members. It contextualized the subjects' life characteristics to understand the family dynamics and the affective, social, economic and cultural background, based on the reconstruction of the history and personality of the individuals. The associated socio-economic factors were: being male, aged between 20 and 40, single, with mixed ethnicity and basic education. The major risk factors identified were: mental disorder, alcohol and other drug abuse, disturbed family relationship and a history of previous suicide attempts. An attempt was made to contextualize and reflect on some cases reported by family members, as well as on the response of the health care teams to the demands of the families. The need to implement prevention programs and to train the primary health care professionals was considered a priority. .

A Methodological Review of Psychological Autopsy for Adolescents

Recently, local governments and suicide prevention centers have been trying to implement psychological autopsy. This effort has focused on adult suicide so far ; however, there are some difficulties in its application to adolescent suicide. Therefore, in this study, psychological autopsy studies of Korea were reviewed, and a methodology for adolescents\' psychological autopsy was suggested. For the effective performance of the psychological autopsy in adolescent suicide, cooperation with each area of the government and implementation of bodies is necessary. In addition, the central system, which disseminates the standardized interview to the community and manages the data nationwide, should be prepared. Also, in order to improve the accuracy of diagnosis and to obtain various types of information, a structured interview should be adopted as the psychological autopsy, as well as considering the use of social media. Investigation of specific risk factors for adolescent suicide through psychological autopsy can enable determination of the intervention point for effective suicide prevention.

Diferentes faces da depressão no suicídio em idosos / Different aspects of depression in suicide among the elderly

O artigo analisa diferentes faces da depressão associadas a suicídio em idosos, a partir de autópsias psicológicas. Utilizou-se um método retrospectivo para o estudo de mortes indeterminadas, a partir de entrevistas e laudos, que analisa circunstâncias psicossociais associadas ao suicídio. O artigo traz uma predominância de gênero, classe social e raça - mulheres, classe média e alta, brancos - e contextualiza de modo inédito a depressão numa população de alto risco de suicídio, pouco estudada no Brasil e no mundo. Buscou-se reconstituir o nível de saúde física e mental, as circunstâncias sociais e os traços biográficos marcantes para compreender a magnitude da depressão no suicídio. A depressão apareceu na quase totalidade dos casos como diagnóstico primário ou secundário, como sintoma associado a outras comorbidades ou como reação a estressores sociais, demandando diferentes condutas e procedimentos terapêuticos. A associação entre depressão e comorbidade múltipla agrava o prognóstico do caso e amplia cumulativamente o risco de suicídio. A depressão acompanhada de ideações suicidas é um fator de risco que justifica medidas preventivas e imediatas. Recomenda-se ampliar as formas de diagnosticar e tratar assertivamente a depressão em idosos.

This article analyzes different aspects of depression association with suicide among the elderly based on psychological autopsies. The retrospective method was used to study indeterminate deaths, based on interviews and reports, which analyze psychosocial circumstances related to suicide. The paper reveals the predominance of gender, social class and race - women, middle and upper class, white - and, in an unprecedented manner, contextualizes depression in a poorly studied population in Brazil and in the world with high risk of suicide. The physical and mental health, social circumstances and predominant biographical characteristics of the suicide victim were reconstructed in order to assess the impact of depression on suicide. Depression was presented in almost all cases, in primary or secondary diagnosis, as the symptom associated with other co-morbidities or as a reaction to social stressors, demanding different therapeutic approaches and procedures. The association between depression and multiple co-morbidity accentuates the case prognosis and cumulatively increases the risk of suicide. Depression followed by suicidal tendencies is a risk factor which justifies immediate preventive measures. Increasing assertive ways to diagnose and treat depression in old age is recommended.

Relationship between community environments and suicide behaviors / 中华行为医学与脑科学杂志

Objective To explore the relationship between the neighborhood environment and the residents' suicidal risk and provide evidence for suicide prevention.Methods The study sample consisted of 392young suicides (aged 15-34 years) and 416 community living controls from the same areas of China (randomly selected from 16 rural counties in three provinces).Social factors in the village neighborhoods were measured by the WHO SUPRE-MISS scale of Community Stress and Problems.Psychological autopsy methods and multivariable Logistic regression were employed.Two informants were interviewed to collect the information of each subject.Results It was found that there was positive correlation between the community surrounding score and suicide.The community stress and problems was the main risk factor for suicide(Wald x2 =10.036,P＜0.05,OR=1.323).Family disputes,inconvenience transportation,lack of health care and job security,alcohol abuse,and superstition can increase the suicidal risks among rural young Chinese.It was still indicated that relative poverty,suffering from a mental illness(OR=32.346) were the risk factors; but good education,married and good health were the protective factors for suicide.Conclusion Further improving the social assistance system,solving the existing community stress and problems,building better community environment are needed to reduce the stress of community residents.Psychological screening and the community mental health intervention for high-risk groups should be strengthened to improve residents' response capacity to stress.Those measures can reduce the suicide rate of China rural community residents effectively.

Autópsias psicológicas e psicossociais de idosos que morreram por suicídio no Brasil / Psychological and psychosocial autopsies of the elderly who committed suicide in Brazil

Analisam-se 51 casos de suicídio de idosos em dez municípios brasileiros, visando a conhecer a interação de variáveis associadas ao fenômeno. Uma revisão sobre o tema dá suporte teórico ao estudo. Tendo como base o método da autópsia psicológica, o estudo parte de um roteiro de entrevista semiestruturada, aplicada e analisada por pares de pesquisadores, mediante um mesmo procedimento de coleta, organização e análise dos dados. O conjunto foi reexaminado através de uma meta-análise de enfoque psicossocial e qualitativo sobre dados dos familiares entrevistados, interpretações dos pesquisadores, contextualização socioantropológica e categorias de relevância. Foram estudadas formas de perpetração e letalidade por sexo, faixa etária, perfil socioeconômico; fatores associados; e motivos atribuídos. Analisou-se a interação de fatores precipitantes relevantes. As conclusões apontam convergências entre estudos epidemiológicos e qualitativos. Doenças graves, deficiências e transtornos mentais juntos formam as principais causas, seguidas de depressão, conflitos familiares e conjugais. Recomenda-se atenção à qualidade de vida dos idosos, especialmente dos homens, que constituem o grupo de maior risco para suicídio.

The authors analyze 51 cases of suicide among the elderly from ten Brazilian municipalities. The objective is to understand the interaction of variables associated with suicide among the elderly. A bibliographic review gives theoretical support to this study. Based on psychological autopsy, the study begins with a semi-structured interview format, which was applied and analyzed by peer researchers, using the same procedure for gathering, organizing and analyzing the data. This material was reviewed using a psychosocial and qualitative meta-analysis approach based on family interview data, researchers' interpretations, socio-anthropological contextualization and relevance categories. Ways of committing suicide, reasons for suicide, associated factors, attributed motives and lethality were studied by sex, age and socioeconomic characteristics. The interaction of major precipitant factors was analyzed. The conclusions showed that there are convergences among epidemiological and qualitative studies. Severe illness, disabilities and mental disorders are the major causes, followed by depression and family and marital conflicts. Close attention to the quality of life of the elderly is recommended, especially of men who constitute the main suicide risk group.

Observar, ouvir, compartilhar: trabalho de campo para autópsias psicossociais / Watching, listening and sharing: field work for psychosocial autopsies

O artigo descreve as etapas de realização do trabalho de campo da pesquisa. É possível prevenir a antecipação do fim? Suicídio de Idosos no Brasil e possibilidades de Atuação do Setor de Saúde, realizada em 10 municípios das cinco regiões do país. A amostra composta por 51 autópsias psicossociais abrangeu cinco idosos que faleceram por suicídio em nove municípios e seis em um deles. Oitenta e quatro familiares foram entrevistados. Trabalhou-se com um roteiro denominado autópsia psicossocial e com observação do contexto. Cada entrevista durou 60 minutos em média, e na maioria dos casos, houve mais de um encontro com os familiares. O estudo foi construído por meio de um processo coletivo que abrangeu compartilhamento da revisão bibliográfica, discussão do universo, das amostras, das estratégias de abordagem, dos resultados de campo e das análises empíricas. Este artigo destaca a preparação teórica, conceitual e prática dos pesquisadores; o processo de elaboração dos instrumentos para o trabalho de campo; informações sobre as fontes de dados existentes e sobre as efetivamente acessadas; apresentação de credencial institucional; entrada no contexto das famílias, dificuldades e estratégias para realização do estudo empírico; entrada e saída do campo; e impacto da pesquisa sobre os investigadores.

The article describes the research realization phases of field work in ten municipalities in five regions entitled "Is it possible to prevent the anticipation of the end? Suicide among the elderly in Brazil and the possibilities for action by the Health Sector." The sample comprises 51 psychosocial autopsies of 5 elderly people who committed suicide in 9 locations and 6 in another. 84 family members were interviewed. Semi-structured psychosocial autopsies and contextual observations were used. Each interview lasted 60 minutes on average and in the majority of the cases there was more than one encounter with family members. The study consisted of a collective process that involved bibliographic review, discussion of the samples, approach strategies, field results and empirical analysis. This article highlights the theoretical, conceptual and practical preparation of researchers and production and standardization of instruments; information about existing data sources and those that are actually used; introduction of institutional credentials; assessment of the family context, difficulties and strategies for empirical study; entrance to and exit from the field; and the impact of the research on the investigators.

Autópsia psicológica e psicossocial sobre suicídio de idosos: abordagem metodológica / Psychological and psychosocial autopsy on suicide among the elderly: a methodological approach

O artigo analisa a qualidade e a consistência de um roteiro de entrevista semiestruturada, adaptado para o estudo do suicídio de pessoas idosas e apresenta o método das autópsias psicossociais que resultou da aplicação desse instrumento. O objetivo é demonstrar como o uso da entrevista em profundidade e sua forma de organização e análise de dados foram testados e aperfeiçoados por uma rede de pesquisadores de vários centros de pesquisa do Brasil. O método envolveu a aplicação do instrumento em que se socializou um manual de instruções sobre a coleta, sistematização e análise de dados. A metodologia foi aplicada no estudo de 51 casos de idosos que faleceram por suicídio em dez municípios brasileiros, e permitiu a verificação da consistência do instrumento usado e a aplicabilidade do seu método, durante o processo e ao final, por meio de uma avaliação em rede. O roteiro aperfeiçoado e as instruções para replicá-lo e analisá-lo são aqui apresentados. Os resultados apontam o rigor e a credibilidade dessa abordagem metodológica testada e qualificada de um modo interdisciplinar e interinstitucional.

The article analyzes the quality and consistency of a semi-structured interview script, adapted for the study on suicide among elderly people, and presents the psychological and psychosocial autopsy method, which is the result of application of this instrument. The objective is to demonstrate how the in-depth interview and subsequent data organization and analyses were tested and improved by a network of researchers from eight regions in Brazil. Evaluation of the method was conducted before and after the application of the instruments to collect, systematize and analyze the data. This methodology was applied in 51 cases of elderly people who committed suicide in ten Brazilian municipalities. The study did more than just collect data with scientific rigor, since it also verified the consistency of the instrument used and the applicability of the method. The improved script and the instructions of how to apply and analyze it are thus presented here. The results reveal the rigor and credibility of this methodological approach tested and qualified by a multidisciplinary and inter-institutional procedure.

Suicidal characteristic-clusters for rural young victims aged 15-34 in three provinces, China:a case controlstudy / 中华流行病学杂志

Objective To explore the categories on suicide and their characteristic-clusters among rural young people of Chinese aged 15-34 in three provinces to provide evidence for suicide prevention.Methods A total number of 392 suicidal deaths and 416 live controls sampled from 16 counties of Shandong,Liaoning,Hunan provinces in China,were included in this study.Psychological Autopsy and Classification Tree methods were employed.Two informants were interviewed to collect the information of each subject.Results Expectation on future,mental disease,seeking guidance and support were important factors for the classification of suicide among rural young population,and their scores of standardized importance were 100,97,91 and 76,respectively.Desperation ( including feeling about the future and expectation) seemed to be more important than mental disease,with 6-8 more scores on standardized importance.Five categories of rural young suicides were determined.Desperate people or patients with mental disease but with less desperation were the main two categories,accounting for 64.8％ and 11.8％ respectively.Sensitivity and specificity of this classification tree were 84.34％ and 92.08％,respectively.Conclusion For programs on suicide screening and prevention,evaluation on desperation seems more significant than screening on mental disease.

Mental disorder and suicide among youths in rural China: a case control study based on consecutive samples from Hunan, Liaoning and Shandong provinces / 中华流行病学杂志

Objective To study the prevalence of mental disorders among the Chinese youths aged 15-34 years,in rural areas and to identify risk factors related to suicide.Methods A consecutive sampling strategy was used for suicidal cases in 16 randomly selected counties in Hunan,Liaoning,and Shandong provinces.Between 2005 and 2008,a total of 392 suicide cases were recruited with 416 community controls at the same age range,selected from the same areas one family member together with one close friend of each suicidal case were interviewed,using the psychological autopsy (PA) method.The same method with structured instruments was performed on the two informants for each control in the same community.SCID was used for the diagnosis of mental disease.Results 48.0％ of the suicides were diagnosed as having at least one mental disorder episode,in comparison with only 3.8％ among the controls.It was found that mental disorder was the most important risk factor for the Chinese young suicide cases in the rural areas.Conclusion As seen in the Western countries,mental disorder had also been the number one correlate on suicidal cases in China,with the difference as other social and psychological factors might have played relatively more important roles in China.

La autopsia psicológica: una técnica forense para el esclarecimiento del suicidio / The psychological autopsy: a forensic technique for the clarification of suicide

El presente documento contiene una serie de consideraciones en torno una de las técnicas más importantes y utilizadas en la comprensión de los comportamientos a través del peritazgo psicológico. En el cual el psicólogo despliega todos sus conocimientos en el ámbito legal y psicológico. Entre estos peritajes se encuentra la denominada Autopsia Psicológica. La autopsia psicológica es considerada un proceso de recolección de datos del occiso que permite reconstruir el perfil psicológico y el estado mental antes del deceso (Acevedo, Núñez y Pinzón, 1999). Esta técnica pericial surge en los EE.UU. como una necesidad administrativa de definir la etiología médico legal en los casos de muertes dudosas donde no se contaba con los elementos suficientes para afirmar si se trataba de un suicidio o un accidente.

This document contains a series of considerations around one of the most important and used techniques in the understanding of behaviors through psychological expertise. In which the psychologist displays all his knowledge in the legal and psychological field. Among these expert opinions is the so-called Psychological Autopsy. The psychological autopsy is considered a data collection process of the deceased that allows reconstructing the psychological profile and mental state before the death (Acevedo, Núñez and Pinzón, 1999). This expert technique arises in the United States as an administrative need to define the medico-legal etiology in cases of doubtful deaths where there were not enough elements to confirm whether it was a suicide or an accident.

Maltrato y suicidio infantil en el Estado de Guanajuato

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SUMMARY The understanding of child suicide has achieved more and more specific notions since it started to be studied from the theory of adult suicide. Now, the implication of certain factors such as the evolution of death conceptualization, the desire of joining an absent significant person, the premeditation of the suicidal act, the involvement of family environment as a contributing or protective factor, or a previous mistreatment experience, has become clearly recognized. Suicides which occur during the childhood period have been associated to previous sexual-nature abuse experiences. In adult suicides, the presence of some kind of mistreatment during their childhood period has also been found. Both phenomena, mistreatment and child suicide, are usually under-registered because of the variability of their defining approaches or because of some cultural influences such as violence occurring naturally or negation of child suicide or premeditation. It is postulated that the mechanics of child mistreatment traps the abuser into a dynamics based on the inequality of physical, intellectual and/or moral conditions; this reality plus the defenseless nature of children, impedes the termination of that situation unless it finishes by means of another violent act such, as a suicide. Furthermore, the consequences suffered by a child victim of mistreatment can become contributing factors for a suicidal behavior consummation. Consequently, dysfunctions or disturbances on cognitive, psychological, identity, belonging or hopelessness state of the victim, as well as the emotional pain caused by the mistreatment may favor a suicide behavior. Therefore, the purpose of this study is to determine the presence of any given type of child mistreatment in children (since eight to 14 years old) that incurred in a suicide in the State of Guanajuato between 1995 and 2001. The methodology used for this descriptive, observational, retrospective and transversal study, was ex-post-facto (after the event), since the technique for data gathering was carried out by psychological autopsy. This technique facilitates an access into the families and to the understanding of their dynamics, and also to recognizing the circumstances prior to the decease. This technique included one or several interviews with people close to deceased child, besides a detailed analysis of the suicidal event and of all the deceased child's residual belongings (suicide notes in this case). This study searched some direct and indirect indicators of a possible child mistreatment suffered by suicidal children. The psychological autopsy was conformed by a Questionnaire of Psychosocial data, a Suicidal Act Evaluation Questionnaire and by an Informant's Reliability Scale. Because of the lack of specific backgrounds for the cases of child suicide, the Psychological Questionnaire was specifically developed for this study. Studied cases were those belonging to child suicides, up to 14-year-old children, who consummated their death in the State of Guanajuato in the 1995 to 2001 period. The files were obtained by the General Attorney Department. With the information extracted from such files, we proceeded to establish phone and mail contact with relatives of the deceased children. Later on, some interviews were carried out with one or more people close to each child; these interviews were held by psychologists qualified in Psychological Autopsy and Emotional Contention Techniques. The examined data came basically from the Psycho-Social Questionnaire and from the Content Analysis of suicide notes. The analysis method for first data, of quantitative nature, was by frequency distribution and correlation, computed by SPSS statistical software. Qualitative data resulting from the analysis of suicide notes content were verified by a technical jury integrated by three participating clinical psychologists. Results: Twenty nine suicide cases were analyzed, representing 69% of child suicides up to 14-year-old children in the State of Guanajuato within the aforementioned period. The rest of the files were not included in this research because the impossibility for locating the victim's relatives due to changes of residence, and in a lower percentage because they refused to participate in the study due to the emotional pain of talking about the suicide event, or because they ignored the minor child's data regarding the circumstances and causes of his death. Of all the examined cases, 19 (65.5%) were men and 10 (34.5%) were women. The range of child suicides' age was from eight to 14 years old, with a 12.55 year-old average and a 1.62 year-old standard deviation. Five suicide notes were analyzed, which belonged to 4 children: 3 girls (one of them left two notes) and one boy. With respect to 72.4% of the cases, the interviewed persons were first-degree relatives and regarding the remaining percentage, they were cousins, uncles or grandparents who reported having had a close relationship with the deceased child. The average age of the interviewees was 43 years, with a standard deviation age of 17.19 years. In almost half of the suicides (51.7%) some kind of violence was suffered. According to the interviewees' statements, 31% of the children who committed suicide had suffered some kind of psychological mistreatment, 41.1% of them had received some of kind of physical mistreatment, 3.4% were victims of sexual abuse and 10.34% were neglected. Almost a quarter of all the children had suffered two or three kinds of mistreatment. Additionally, 41.4% of suicidal children had seen physical violence at home. Four of the suicide notes included explicit declarations of mistreatment experiences. Other variables that were found were the presence of previous suicide attempts in 20.7% of the cases; and a 26.3% of cases where a relative also had a previous suicide attempt. Family alcohol consumption was detected in 65.5% and drug consumption in 24% of the cases. Further analysis show a correlation between child previous suicide attempts and psychological mistreatment (p= 0.004) or any other kind of violence exposure (p= 0.015). It is concluded that an important percentage of children who incurred in a suicide were indeed victims of some kind of child mistreatment, of which physical one was particularly evident. However, neither physical nor sexual abuse can be separated from their implicit component: the emotional mistreatment. Studies of pure qualitative nature could contribute with more information about the dynamics that associates both phenomena. It is deemed that child mistreatment prevention would directly impact both suicide occurrence for the same group of age, and probably also within adult populations thus reducing its prevalence.

Suicide - the magnitude of the problem.

Suicide is the second commonest manner of unnatural death flanked by accident and homicide. Suicide is by no means a simple issue, for it hinges on a spectrum of ethical, legal, sociological and psychological problems and it is yet to be offered an unequivocal and satisfactory answer to all the questions raised by this perplexing phenomenon. In an attempt to analyse the magnitude of the problem of suicide, this paper provides a comprehensive data encompassing the prevailing scenario of suicide, investigation of suicide as viewed by different workers and the importance of differentiation between accident, homicide and suicide The presentation is concluded by emphasizing the advantages of psychological autopsy in suicide investigation.

The Applicability of Psychological Autopsy for Suicide Research in China / 中国心理卫生杂志

0.6). And there was high internal consistency in major instruments. The validity was examined by comparing the responses of informants and responses (good standards) of the target person in normal control group. There was also a high validity(r=0.21~0.61).Conclusion: The information reconstructed from the informants has good reliability and validity. It is possible to study suicide with psychological autopsy in China.