The Mask of Suicide.

Although it has been stated that the majority of suicidal people give definite warnings of their suicidal intention, a percentage of suicidal people may dissemble (or mask), possibly 20%. The aim of this psychological autopsy (PA) study was to explore the mask of suicide, examining age and sex of the decedent, and survivors' relationship to the deceased. A PA study in Norway, with 120 survivors/informants, was undertaken. Overall, 80% of informants reported manifest and/or latent content of deception (dissembling); well above the 20% suggested. Three main themes emerged from the interviews of the 95 survivors that were related to the mask. In the opinion of the bereaved, reasons for the mask were due to: 1) Inability to adjust/impairment; 2) Relational problems; and 3) Weakened resilience. Differences in masking or (self) deception were found in the age of the decedent, but not in sex, nor in the survivors' closeness of the relationship. Older deceased people were perceived to exhibit more dissembling, associated to the suicide. Limitations are noted in this beginning study into the mask of suicide, and it is concluded that much greater research is needed to unmask the dangerous dissembling, maybe in some, self-deception.

The Role of Self-Esteem in Suicides Among Young Men.

This study explores self-esteem in suicide among young males with no earlier history of suicide attempt(s) or treatment in mental health services. The data come from an ongoing psychological autopsy study; 10 cases of young men aged 18 to 30, were selected to generate a phenomenologically based understanding of the psychological mechanisms and processes involved in the suicidal process. The analyses are based on in-depth interviews with 61 closely connected individuals, as well as suicide notes. We used Interpretative Phenomenological Analysis. For these young men, the transition to young adulthood, a period of major life challenges, seemed to be associated with personal defeats. According to their significant others, the deceased seemed to have experienced intolerable discrepancies between their actual performances and their ideal self standards. Four themes emerged from the analysis: (a) striving to find a viable path to life as an adult man; (b) experiencing a sense of failure according to own standards; (c) emotional self-restriction in relationships; and (d) strong feelings of loneliness and rejection of self. Improved understanding of suicides outside the mental illness paradigm may have important implications for preventive strategies.

A Multidimensional Theory of Suicide.

BACKGROUND: Theory is the foundation of science; this is true in suicidology. Over decades of studies of suicide notes, Leenaars developed a multidimensional model of suicide, with international (crosscultural) studies and independent verification. AIM: To corroborate Leenaars's theory with a psychological autopsy (PA) study, examining age and sex of the decedent, and survivor's relationship to deceased. METHOD: A PA study in Norway, with 120 survivors/informants was undertaken. Leenaars' theoretical-conceptual (protocol) analysis was undertaken of the survivors' narratives and in-depth interviews combined. RESULTS: Substantial interjudge reliability was noted (κ = .632). Overall, there was considerable confirmatory evidence of Leenaars's intrapsychic and interpersonal factors in suicide survivors' narratives. Differences were found in the age of the decedent, but not in sex, nor in the survivor's closeness of the relationship. Older deceased people were perceived to exhibit more heightened unbearable intrapsychic pain, associated with the suicide. CONCLUSION: Leenaars's theory has corroborative verification, through the decedents' suicide notes and the survivors' narratives. However, the multidimensional model needs further testing to develop a better evidence-based way of understanding suicide.

Suicidio en las cárceles de Chile durante la década 2006-2015 / Suicide in Chilean prisons during the 2006-2015 decade / Suicídio nas cadeias do Chile durante a década de 2006-2015

Chile presenta un alarmante incremento de suicidios, tanto en població n general como intrapenitenciaria, lo que preocupa a las autoridades de justicia y salud. Objetivo: analizar los suicidios consumados por prisioneros en cárceles chilenas durante los años 2006-2015, para obtener el perfil de características sociocriminó genas del acto suicida y de los centros penitenciarios. Metodología: de un total de 162 suicidios, se analizaron los 132 casos examinados por la Policía de Investigaciones de Chile. Resultados: 97,7% de los suicidios ocurrieron en hombres de todas las edades (de 16 a 74 años); dos terceras partes (66,7%) sucedieron en personas con ingresos previos a prisió n, aunque la mayoría no tenían antecedentes penales ni condenas anteriores (97,7%). Una mayoría (65,1%) ocurrieron durante el primer año de ingreso. El 73,5% eran solteros, 47% solo tenían estudios básicos, 84,8% no poseían oficio estable. En 43,2% se reportó estado depresivo como desencadenante del suicidio, y el método más común fue ahorcamiento (97%). Se encontraron diferencias con estadísticas significativas de ciertas correlaciones, como entre nivel de estudios y motivo manifestado para el suicidio, y entre nivel de estudios e ingresos previos a prisió n; asimismo, una correlació n relevante que muestra que a menor edad, más ingresos a prisió n y menor nivel de estudios

Chile exhibits an alarming increase in the number of suicides among both the general population and the prison community, this being a matter of concern for justice and health authorities. Objective: the analysis of suicides committed by prisoners in Chilean jails during years 2006-2015 in order to obtain the profile of both the suicide acts and penitentiary socio-criminogenic features. Methodology: out of a total of 162 suicides, the 132 cases examined by the Criminal Investigation Police of Chile were analyzed. Results: 97.7% of suicides were committed by men of all ages from 16 through 74 years. Two thirds (66.7%) were individuals with previous admissions into prison; but most of them (97.7%) did neither have criminal backgrounds nor former convictions. A majority (65.1%) occurred during the first year in prison. 73.5% prisoners were single, only 47% had basic studies, and 84.8% had no specific jobs. A depressed mood was reported in 43.2% as a trigger factor of suicide, and hanging was the most common method used (97%). Differences were found with significant statistics in certain correlations like, for example, between the study level and the motive for suicide revealed, and between the study level and previous periods of incarceration; and likewise, there is a relevant correlation where the youngest individuals show the highest number of admissions into prison and the lower study level

Chile apresenta um aumento alarmante de suicides, tanto na população geral quanto penitenciária, que preocupa à s autoridades da justiça e a saúde. Objetivo: analisar os suicídios consumados por prisioneiros em cadeias chilenas durante os anos 2006-2015, para obter o perfil de características sociais e criminó genas do ato suicida e dos centros penitenciários. Metodologia: de um total de 162 suicidos, 132 dos casos examinados pela Polícia das Pesquisas do Chile foram analisados. Resultados: 97.7% dos suicidos aconteceram nos homens de todas as idades (de 16 a 74 anos); duas terceiras partes (66.7%) aconteceram em pessoas com renda prévia à prisão, embora a maioria não tivesse os registros criminalis nem as sentenças precedentes (97.7%). Uma maioria (65.1%) aconteceu durante o primeiro ano da entrada. 73.5% eram solteiros, 47% só tinham estudos básicos, 84.8% não possuíam um ofício estável. Em 43.2% o estado depressivo foi relatado como ativador do suicido, e o método o mais comum foi o enforcamento (97%). As diferenças com estatísticas significativas de determinadas correlações foram encontradas, como entre o nível de estudos e a razão para o suicido, e entre o nível de estudos e renda prévia à prisão; também, uma correlação relevante que amostra que à idade menor, mais renda à prisão e menor nível de estudos

A psychological profile of a serial killer: a case report.

Serial killers have always fascinated society. A serial killer is typically defined as a perpetrator who murders three or more people over a period of time. Most reported cases of serial killers come from the United States and Canada. In India, there are few reported cases. We present, to the best of our knowledge, the first Indian case in the literature. The present case is of a 28-year-old man, Surinder Koli. The Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, New Delphi handled the forensic study. We present a most unique psychological investigation into the mind of a serial killer.

Psychological autopsy studies as diagnostic tools: are they methodologically flawed?

One of the most established "truths" in suicidology is that almost all (90% or more) of those who kill themselves suffer from one or more mental disorders, and a causal link between the two is implied. Psychological autopsy (PA) studies constitute one main evidence base for this conclusion. However, there has been little reflection on the reliability and validity of this method. For example, psychiatric diagnoses are assigned to people who have died by suicide by interviewing a few of the relatives and/or friends, often many years after the suicide. In this article, we scrutinize PA studies with particular focus on the diagnostic process and demonstrate that they cannot constitute a valid evidence base for a strong relationship between mental disorders and suicide. We show that most questions asked to assign a diagnosis are impossible to answer reliably by proxies, and thus, one cannot validly make conclusions. Thus, as a diagnostic tool psychological autopsies should now be abandoned. Instead, we recommend qualitative approaches focusing on the understanding of suicide beyond mental disorders, where narratives from a relatively high number of informants around each suicide are systematically analyzed in terms of the informants' relationships with the deceased.

Lives and deaths: Biographical notes on selections from the works of Edwin S. Shneidman.

Edwin S. Shneidman (DOB: 1918-05-13; DOD: 2009-05-15) is a father of contemporary suicidology. His work reflects the intensive study of lives lived and deaths, especially suicides, and is the mirror to his mind. His contributions can be represented by five categories: psychological assessment, logic, Melville and Murray, suicide, and death. His works on suicide can be further divided into five parts: definitional and theoretical, suicide notes, administrative and programmatic, clinical and community, and psychological autopsy and postvention. In this article, not only are the selected works explicated, but also Dr. Shneidman's rather personal biographical notes are shared to allow the reader to understand one more unique individual's life lived, and his death: Edwin S. Shneidman.

Edwin S Shneidman y la suicidología moderna / Edwin S Shneidman and modern suicidology

Edwin S. Shneidman (13-05-1918 - 15-05-2009) is known as the father of contemporary suicidology. His work reflects the intensive study of lives and deaths, especially suicides, and is the mirror to his mind. Few people, like doctor Edwin S. Shneidman, are vouchsafed the rare opportunity to create a new discipline, to name it, to shape it, to contribute to it, and most importantly, to catalyze other competent investigators to invest in it: suicidology. In his reflections, Shneidman does not know whether suicide was looking for him or he was looking for suicide. Part of his motivation on that day in 1949, when he discovered 100's of <

En el año 2003 el suicidio se declaró como un problema de salud pública por la World Health Organization (WHO), y por tanto la Organización de las Naciones Unidas (ONU), junto con la Asociación Internacional de Prevención de Suicidio (IASP), declararon al 10 de septiembre como el <

Martyrs' last letters: are they the same as suicide notes?

Of the 800,000 suicides worldwide every year, a small number fall under Emile Durkheim's term of altruistic suicides. Study on martyrdom has been limited. There has to date, for example, been no systematic empirical study of martyr letters. We examined 33 letters of Korean self-immolators, compared with 33 suicide notes of a matched sample of more common suicides. An analysis of intrapsychic factors (suicide as unbearable pain, psychopathology) and interpersonal factors (suicide as murderous impulses and need to escape) revealed that, although one can use the same psychological characteristics or dynamics to understand the deaths, the state of mind of martyrs is more extreme, such that the pain is reported to be even more unbearable. Yet, there are differences, such as there was no ambivalence in the altruistic notes. It is concluded that intrapsychic and interpersonal characteristics are central in understanding martyrs, probably equal to community or societal factors. More forensic study is, however, warranted.

Suicide notes from India and the United States: a thematic comparison.

Suicide is a global concern, hence, cross-cultural research ought to be important; yet, there is a paucity of cross-cultural study in suicidology. This study sought to investigate suicide notes drawn from India and the United States, as these countries have similar suicide rates but markedly different cultures. A thematic or theoretical-conceptual analysis of 72 suicide notes drawn from these countries, matched for age and gender, was undertaken, based on Leenaars' (1996) multidimensional model of suicide. The results suggested that there were more commonalities than differences; yet, not consistent with previous cross-cultural studies of suicide notes, Indian notes expressed more indirect expression including veiled aggression, or aggression turned inward, and unconscious dynamics. It was concluded that the model may be applicable to suicide in both countries, but also much greater study in India is warranted on collectivism and dissembling as a suicide risk factor.

Motivation for research participation among people bereaved by suicide.

Few studies directly address vulnerable populations' motivation for participating in research. Often motives are expressed spontaneously and typically given post-interview. This article investigates motivation for research participation among informants who have been bereaved by suicide. Informants were specifically asked for their motivation either prior to, or directly after the interview. Four categories of motivations were identified: (1) Helping Others, (2) Venting, (3) Insight, and (4) Just Because. Sixty percent of informants gave more than one motivation. The majority was altruistically motivated; they hoped that by taking part they could play a role in helping to prevent suicide, improving services for the bereaved or moving research forward. Close family members were more likely to be motivated by a desire to help others than more distant family members. Findings are discussed in the context of suicide-related bereavements. Information about research participation as beneficial to others should be given parallel to that of possible strain.

Identity of victims from fragmented and decomposed remnants by DNA profiling in a case of serial killings.

A 28-year-old man, Surinder Koli, from a Nithari village adjoining Delhi, India committed serial murder. This case was of paramount importance in medico-legal investigations, as it was a landmark case of a serial killer reported from India. The skeletal remains (627 pieces) including skull/skull portions (19) were recovered from the nearby sewer drain, sump and the backyard of the house in which this man was residing. In addition, soft tissues (51) were also recovered from the same sewer drain. The victims were killed over a two-year period. The establishment of identity of the victims was crucial to prove the case in the court of law as well as for the claimants. Nineteen sets were prepared by radiology/anatomical examination from the exhibits recovered. DNA profiling confirmed the correctness of these sets and also short tandem repeat typing of nuclear DNA successfully identified eight individuals. Both DNA profiling and radiography/anatomical examination played an important role in solving this complicated case.

Menstruation and suicide: a histopathological study.

BACKGROUND: Previous research, albeit limited, has reported mixed findings on the impact of menstruation cycle on suicidal behavior. The contribution of menstruation to completed suicide is also controversial; the studies are, in fact, very limited and are not carefully designed. AIMS: To examine whether the menstruation cycle impacts on suicide. METHODS: In order to explore this relationship, 56 autopsies on completed suicides in females were performed and matched to a control group of 44 females who had died from other causes, at the All India Institute of Medical Sciences in New Delhi. Histopathological examination, a method of collecting tissue from the uterus through biopsy, was used to determine the stage of the menstrual cycle. RESULTS: The results show that 25% of women who had died by suicide were menstruating at the time, compared to 4.5% of the control group; this is statistically (chi2) significant at the p < .002 level. CONCLUSIONS: Menstruation in the women who completed suicide, compared to a control group, appeared to have an association, though more research is warranted. Not only there are serious methodological problems in the study of menstruation and suicide (largely because of problematic tissue storage and examination), but also because of the need to understand the impact within a larger psychological, social, and cultural frame.

Suicide notes from Mexico and the United States: a thematic analysis.

OBJECTIVE: This study sought to investigate suicide notes drawn from Mexico and the United States (US) as these countries share geographical proximity, but markedly different cultures and suicide rates. MATERIAL AND METHODS: A theoretical conceptual analysis of 102 suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars,1,2 across countries. RESULTS: The inter-judge reliability was adequate (.86 coefficient of concordance). CONCLUSIONS: The results suggested that there are more psychological commonalities than differences. Yet, as this study marks the first one using suicide notes, between Mexico and the USA, much greater study is warranted.

Suicide notes from Mexico and the United States: a thematic analysis / Notas suicidas de México y Estados Unidos: un análisis temático

OBJECTIVE: This study sought to investigate suicide notes drawn from Mexico and the United States (US) as these countries share geographical proximity, but markedly different cultures and suicide rates. MATERIAL AND METHODS: A theoretical conceptual analysis of 102 suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars,1,2 across countries. RESULTS: The inter-judge reliability was adequate (.86 coefficient of concordance). CONCLUSIONS: The results suggested that there are more psychological commonalities than differences. Yet, as this study marks the first one using suicide notes, between Mexico and the USA, much greater study is warranted.

OBJETIVO: Este estudio tuvo por objetivo la comparación de notas suicidas (póstumas) de México y de Estados Unidos, países que aunque vecinos geográficos, presentan marcadas diferencias culturales y porcentajes de suicidio. MATERIAL Y MÉTODOS: Se realizó un análisis conceptual de 102 notas (51 mexicanas, 51 estadunidenses), pareadas por edad y sexo. Se utilizó el Modelo temático de suicidio desarrollado por Leenaars1,2 y que ha sido la base de varios estudios en diversos países. RESULTADOS: La técnica de Análisis de contenido obtuvo un adecuado nivel de concordancia (86%) con el Método de interjueces. CONCLUSIONES: Los resultados informan que existen más semejanzas que diferencias psicológicas entre ambas muestras. El presente es el primer estudio que utiliza notas suicidas entre ambos países.

Psychache and suicide: a preliminary investigation.

Shneidman's Psychological Pain Assessment Scale (PPAS; 1999) was administered to 88 psychiatric patients. Both current and worst-ever psychache were significantly higher in those patients judged by a psychiatrist, on the basis of a structured clinical interview, to be at risk of suicide. However, current and worstever psychache were not associated with having attempted suicide in the past. Thus, for the present sample of psychiatric patients, the PPAS appears to be more sensitive to current suicidality than to past suicidality. Further, there are validity issues with the PPAS, with the need for multi-item measures and probably a multifactor measure.

Farewell to the world: suicide notes from Turkey.

There has been limited study of suicide in Islamic countries. This paper marks the first study of suicide notes in Turkey, an Islamic country. Using a classification scheme, 49 suicide notes (a rate of 34.5%) were studied. The results show that note writers do not differ greatly from other suicides. Further analysis of younger (<40) and older (>40) suicide note writers reveal few significant differences. Our results, together with the results of classification studies in different countries, suggest that caution is in order in transposing findings from one country to other countries. Future study of suicide notes should, in fact, focus on cross-cultural investigation.

Gun-Control Legislation and the Impact on Suicide.

Gun control is the prototypical example of controlling the environment for the means of suicide, an effective public health approach to suicide prevention. Canada's Criminal Law Amendment Act of 1977 (Bill C-51) provides an excellent opportunity to illustrate the effects of legislative gun-control laws and the impact on suicide. The research in Canada supports the significant effect of C-51 in reducing suicides and firearm suicides, even if one controls for socioeconomic factors, although not equally for all ages. The young, a high-risk group, show the most significant decrease, without significant substitution of other methods (displacement). Studies on gun-control laws from New Zealand, the United States, and Australia support the Canadian findings. It is concluded that, although not equally applicable in all countries, gun control may well have significant applications in reducing suicide worldwide.

Menstruation and suicide: an exploratory study.

Previous research has reported mixed findings on the effect of the menstrual cycle on suicidal behavior. The contribution of menstruation to completed suicide is also controversial, though the studies are very limited and have not been carefully designed. To explore the relationship, 217 autopsies on completed suicides were performed, matched to a control group at the All India Institute of Medical Sciences in New Delhi. The results show that 54.46% of people who died by suicide were menstruating (results excluded pregnancies), compared to 6.75% of the control group. Menstruation in those who completed suicide, compared to a control group, appeared to have an association with suicide. More research is warranted.