key: cord-0252529-wiq0pyy9
authors: Foster, Tom
title: REVISITING PSYCHOLOGICAL AUTOPSY RESEARCH OF SUICIDE IN NORTHERN IRELAND
date: 2021-11-11
journal: Ulster Med J
DOI: nan
sha: 2233bc413f5c818d0f37729df894c9fa3f7d1628
doc_id: 252529
cord_uid: wiq0pyy9

nan

A contemporary, scientific understanding of suicide is required to devise a meaningful prevention strategy in Northern Ireland. Psychological autopsy (PA) suicide studies comprise sensitive interviews with bereaved informants and clinicians (GPs, psychiatrists, etc), combined with meticulous scrutiny of records (coronial, healthcare, social care, etc). 1 For more than six decades these studies have contributed immensely to appreciation of the biopsychosocial complexity of suicide. The low incidence of suicide means that a case-control PA is the most pragmatic research design to identify risk/protective factors.

In the sole case-control PA study in Northern Ireland (suicides 1992-1993) 2 there was an estimated 38-fold increased risk of suicide linked to the presence of at least one current DSM-III-R 3 Axis I nemtal disorder (depressive disorders, primary non-affective psychoses, psychoactive substance use disorders). Other risk factors were: presence of at least one Axis II (personality) disorder; previous self-harm; mental health service contact ever, particularly current; current unemployment; manual social class; GP contact within 26 weeks; occurrence of at least one adverse life event during the previous 52, 26, 12 and 4 weeks, notably a "serious problem with close friend, neighbour or relative" (also "broke off a steady relationship", "problems with police or court appearance" and a "serious illness, injury or assault"). 4 Axis I-Axis II comorbidity conferred a much higher risk compared with Axis I disorder(s) only. Exposure to civil disorder ("the Troubles") did not increase suicide risk. Higher religious commitment was protective against suicide.

Apart from the contributions of prevention, early diagnosis and effective treatment of mental disorders to suicide risk reduction, the Northern Ireland Suicide Study findings indicated that suicide prevention necessitated 1) high quality self-harm services; 2) minimisation/mitigation of unemployment; 3) public education/intervention regarding interpersonal problems; 4) recurrent suicide risk assessment/ mitigation training for multidisciplinary practitioners within healthcare especially primary care, mental health services and general hospitals; and 5) recurrent suicide awareness/ intervention training within the police service, the court service and the third sector. All of these remain relevant now.

The authors of a recent review of suicide in Northern Ireland recommended that suicide research/prevention should "focus on the transgenerational effect of the conflict ("the Troubles"), youth suicide, suicide prevention in minority groups, and the criminal justice context". 5 Northern Ireland needs another case-control PA suicide study soon. Study objectives may include: 1) updating the prevalence of mental disorders including comorbidity (noting temporal relationships) and disorder-specific suicide risk; 2) a more nuanced understanding of the suicidogenic impact of adversity including timing (distal/proximal, chronic, acuteon-chronic, anticipated) and dependence/independence of individual behaviour; 3) analysis of interactions between mental disorders and adversity; 4) scrutiny of the likely suicidogenic effect of physical illnesses (number, type, severity, chronicity, pain, disability, delay in diagnosis/ treatment); 5) defining risk factors for different age groups; 6) measurement of suicide risk linked to social deprivation; 7) consideration of any suicide risk linked to the transgenerational legacy of "the Troubles"; 8) evidencing any suicidogenic impact of COVID-19; and 9) hypotheses regarding possible protective factors e.g. social connectedness, social support, educational attainment, religion/spirituality, engagement in sport, competent social problem-solving and willingness to seek help.

The psychological autopsy approach to studying suicide: A review of methodological issues

Risk factors for suicide independent of DSM-III-R Axis I disorder. Case-control psychological autopsy study in Northern Ireland

American Psychiatric Association. DSM-III-R: Diagnostic and Statistical Manual of Mental Disorders

Adverse life events proximal to adult suicide: A synthesis of findings from psychological autopsy studies

Suicide in Northern Ireland: epidemiology, risk factors and prevention

 1 MPICs can occur anywhere along the peritoneal surface, arising from the peritoneal mesothelium, but are most frequently found in the pelvis as multiple, thin-walled, multi-locular cysts, that can form large intra-abdominal masses. 2,3 A 41-year old man presented as an emergency with a short history of pelvic pain and discomfort. He complained of bladder and rectal symptoms