Psychological Autopsy: Definition, Steps & Ethics
What is a Psychological Autopsy?
For clinicians working in the field of mental healthcare, it is not uncommon to regularly discuss feelings of profound depression and thoughts about suicide. What is far less common, however, is when a client or patient who has expressed suicidal feelings actually follows through successfully in taking their life. In cases where this does happen, clinicians, friends, and family are often left wondering why the death happened and whether something could have been done to prevent it.
In these situations, a psychological autopsy is often the most effective tool for providing information and answers in the wake of a suicide. Like a physical autopsy, the psychological autopsy attempts to explain why a person has taken their life by analyzing medical records, interviewing friends and family, and conducting research into a person's state of mind prior to their death.
The reasons why a psychological autopsy might be conducted are many. Frequently, the primary objective is often to determine definitively that the person did die as the result of a suicide. In other cases, the psychological autopsy can be a useful tool in gathering data for the purposes of suicide prevention or to better understand suicidal behavior.
In less common situations, the autopsy might be conducted in order to determine whether or not clinicians or practitioners are in any way at fault. For example, if I was working in a community mental health care facility and one of my patients had committed suicide, there would be some question as to whether or not there was any negligence on my part. In this case, the autopsy would be, at least in part, focused on the level and quality of treatment provided in a period of time leading up to the death.
Ethical Review
Psychological autopsies are very much an inexact science and researchers are strongly encouraged to have their methodologies and protocols reviewed prior to beginning an investigation. In this case, a institutional review board (IRB) can be contracted to review the research materials to ensure the investigation is conducted ethically and does not violate anyone's rights or personal privacy.
Among the things investigators will want to keep in mind is the strong potential for structural bias, which is a type of bias that influences how a person interprets events in light of their beliefs. In this case, investigators are looking for accurate information which is being gathered from a third party. Because of this, the reporter may potentially give biased information about the person's behavior based on what they think or feel about the individual.
Investigating the Suicide
In the aftermath of a person's death, coroners will often begin immediately collecting information to complete the autopsy as quickly as possible while the evidence is still fresh. In the wake of a suicide, on the other hand, the process is much slower and far less exact. This is often because, from a research ethics perspective, it is considered unethical to impose upon surviving family and friends during the earliest part of the grieving process.
Given the ethical considerations at play, the first place to start would likely be with medical and treatment records of the deceased. By reviewing medical records and case notes on the individual, investigators will begin establishing a timeline and a picture of the individual's state of mind will begin to emerge. By analyzing case notes and treatment records, investigators can effectively determine whether or not the individual had been experiencing suicidal ideation, which is strong recurrent thoughts suicide.
From that point, the next step will be a series of qualitative interviews with the individual's doctors or other treatment providers. Qualitative interviews are in-depth interviews that collect data based on the interviewee's experience and individual perspective. These interviews can provide valuable information on the person's long-term care and help researchers understand what treatments were effective and which were ineffective. In the psychological autopsy, qualitative interviews are the best possible means of collecting data, which is why there is often an emphasis on doing these as quickly as possible, before facts or events begin to fade from memory.
The final step in gathering data will often be interviews with the individual's friends and family members. Typically, these interviews occur between 2 and 6 months after the suicide has occurred. Within the research community, it is widely held that this amount of time allows for individuals to be past the initial phase of grief without having sacrificed any valuable information to the passage of time.
Through these interviews, researches can gain information about possible behaviors, such as giving away personal items or large sums of money, or statements made outside of a clinical environment. When all the information is viewed collectively, investigators should be able to piece together the events that preceded the suicide, including the levels of treatment, any contributing health factors, and the behaviors witnessed by friends and family. When the autopsy is complete, this information should be able to provide survivors and researchers with a general understanding of why the death occurred.
Lesson Summary
In psychology, a psychological autopsy is conducted when a person has successfully ended their life with suicide. The goal of the autopsy is to gather information that will help determine that it was indeed suicide and to assess what, if any, steps could have been taken to prevent the death. Before beginning the psychological autopsy, it is often expected that the proposal will be reviewed by an institutional review board to ensure that research is conducted ethically and that structural bias is limited.
Generally, the autopsy relies heavily on a review of medical or treatment records and qualitative interviewing with providers, family, and friends. These interviews can provide valuable insight into the whether or not the person was experiencing suicidal ideation in the period leading up to the death. As a general rule, it is expected that investigators wait between 2 to 6 months before interviewing family.
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Prompts About Psychological Autopsy:
Study Prompt:
Make a set of flashcards that provides the definitions of all of the bolded terms from the lesson—psychological autopsy, institutional review board, structural bias, suicidal ideation, qualitative interviews, 2 and 6 months. Note: For ''2 and 6 months,'' simply note that that is the timeline after a suicide in which interviews are conducted with the deceased person's friends and family.
Example: Suicidal ideation means persistent and strong thoughts of suicide.
Graphic Organizer Prompt 1:
Create a poster, chart, or some other type of graphic organizer that lists and briefly describes the reasons for conducting a psychological autopsy.
Example: The insights gained from a psychological autopsy can help provide more effective means of suicide prevention.
Graphic Organizer Prompt 2:
Make a poster, chart, or some other type of graphic organizer that presents the measures of ethical review.
Example: Investigators performing a psychological autopsy must always be on the lookout for structural bias.
Essay Prompt 1:
Write an essay of approximately one to two pages that describes the psychological autopsy process. Be sure to explain why it is a much slower process than that of a physical autopsy.
Example: The first step is analysis of case notes and treatment records.
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Psychological Autopsy: Definition, Steps & Ethics
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