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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:zalsman@post.tau.ac.il(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.

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