Psychological Autopsy Studies as Diagnostic Tools: Are They Methodologically Flawed?
Open accessAbstract
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.
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The psychological autopsy approach has limitations including issues relating to the choice (and selective non-response) of control subjects and the reliance on proxy reports, which are prone to recall bias and measurement error.
“In addition, there are several limitations inherent to the psychological autopsy approach,23–25 including issues relating to the choice (and selective non-response) of control subjects and the reliance on proxy reports—the latter being prone to recall bias and measurement error.”
From Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies (2022) · cites this paper as [25]
Risk estimates for diagnostic categories in the current review (especially when limited to studies using living controls) were largely similar in magnitude to those reported in a recent meta-analysis of record linkage studies.
“Although the method of psychological autopsy has been criticised for overestimating the contribution of mental disorders to suicide,25 risk estimates for diagnostic categories in the current review (in particular when limited to studies using living controls) were largely similar in magnitude to those reported in a recent meta-analysis of record linkage studies.22”
From Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies (2022) · cites this paper as [25]
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- Authors
- Hjelmeland, H., Dieserud, G., Dyregrov, K., Knizek, B. L., & Leenaars, A. A.
- Affiliations
- Norwegian Institute of Public Health (NO)
- Norwegian University of Science and Technology (NO)
- Corresponding author
- Hjelmeland, Heidi
- Venue
- Death Studies
- Publisher
- Informa UK Limited
- Published
- 2012-08
- Volume
- 36
- Issue
- 7
- Pages
- 605-626
- ISSN
- 0748-1187 (ISSN-L)
- 1091-7683
- PMC
- PMC3662079
- OpenAlex
- W1978805704
- Cited by
- 232
- References
- 66
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 31 · 2023: 12 · 2022: 13 · 2021: 34 · 2020: 18 · 2019: 12 · 2018: 21 · 2017: 19 · 2016: 19 · 2015: 21 · 2014: 10 · 2013: 7 · 2012: 1
- FWCI
- 14.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Death Studies (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Keywords
- psychological autopsy, suicide, mental illness, psychiatric diagnosis, reliability and validity, qualitative approach, suicide narratives
- MeSH terms
- Mental Disorders, Humans, Psychopathology, Suicide
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