If the police take personal possessions, be sure to ask for an inventory so you can keep track of what should be returned to you. You have the right to get all of these possessions back once the investigation is complete. As part of the investigation, the police will want to question you. You should cooperate with them, but you have every right to ask them to conduct their investigation quickly and sensitively. If you are the immediate next of kin but not the person who discovered and identified the body at the scene of the suicide, you will be asked to identify the body either in person or through photographs.
You may choose not to identify the body yourself and ask someone else to do so. Even if the body has already been identified, you have the right to view it, and also to request that the coroner or medical examiner give you time alone with your loved one. Research conducted with people who chose to view the body indicates that most survivors later on feel they made the right decision in doing so.
While they may forever carry that last image in their mind, they also feel that the experience helped them come to terms with the reality of the death. But this comes down to a difficult and obviously stressful decision on your part — take your time, and try, as best you can, to decide what will be best for you in the long run.
Before you view the body, it is a good idea to have a friend or relative view the body or photographs of the body first to determine if the sight might be too traumatic for you. The medical examiner or coroner may discourage you from viewing the body if the suicide method has caused significant damage on the grounds that the sight will unduly upset you.
This is a legitimate concern, but the decision about whether to view the body and how much of the body to view is yours to make. In the event of a suicide, the medical examiner or coroner may be required to perform an autopsy on the body, which is a surgical procedure used to determine the cause of death. The next of kin have a right to request a copy of the autopsy report. You may be hesitant to share with others that your loved one took their own life. While we cannot determine what is right for you, please note that in the long run, most survivors are glad that they decided to be honest about the facts of the death.
One of the most important reasons to be honest about the way your loved one died is that it will give your friends and family the opportunity to support you in an appropriate way. Case Study and Contextualization.
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Since the procedure to acquire the case studies has already been described in other studies 2,3 , the purpose here is to discuss how cases have been and can be organized and prepared for analysis. Presented here below is a strategy to gather and standardize data from the identification form, genogram and interviews. Chart 4 shows the Case Study Organization Guide , which proposes two arrangement systems.
The first one gathers information that will identify the case and describe the suicide, providing details about circumstances associated with the fatal event how it was perpetrated, lethality, location, how the individual was found and others.
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It also includes data about interviewees relationship, sex and age and the individuals who died by suicide sex, age range, social, cultural, economic and religious profile. The second system contextualizes suicide within the individual story that will be retraced. Part of the victim's personal and social profiling involves their biographical information, shows their mental state, motivations and relevant facts; it describes triggering factors or stressors associated with the act and reports the effects of self-inflicted death on the family.
Chart 5 shows a Socioanthropological Data Organization Guide , which includes information about municipalities where suicide cases occurred. The guide arranges the municipality in terms of origin and social, economic and cultural background. Method for Analyzing Psychological and Psychosocial Autopsies. A psychological and psychosocial analysis begins with each case being pre-analyzed by a researcher and reviewed by a pair of researchers, according to guidelines from the instruction manual previously agreed upon.
In the aforementioned study 1 , researchers reorganized cases compactly into four categories: 1 a comprehensive description of each episode history and context, risk and protective factors, relevant facts, motivations or intentions related to suicide ; 2 case development and dynamics flow of events, aggravating factors such as diseases, sicknesses and critical emotional, social or economic circumstances and consequences to personal life ; 3 a description of the suicide act and its impact on the family chosen means, conditions in which the victim was found, information about burial and effects of death on the family ; 4 considerations about the case reasons for suicide, clues extracted from conversations, behavior and hypotheses about the case.
The purpose of this stage is to highlight the most relevant factors and to join them together as circumstantial evidence. Once these individual case studies and data context are organized and the entire logistics system is created, this data is fed into a database that is accessible to researchers responsible for final analysis. The necessary material is then available to perform a qualitative analysis and at the same time, remain unique, local and compared.
It is important that scientific articles about the subject published internationally support considerations for a pure analysis. In each concrete case study which used the above tools, each research center produced their own pre-analysis, emphasizing not only subjective and relationship aspects of those relating to the elderly individuals' compromised physical and mental health, but also contextual aspects.
This diversity built from a common matrix clearly showed researchers' perspectives and interests , emphasizing several risk factors, gender issues, and the impact on families and prevention possibilities and needs. Chart 6 presents the Data Analysis Guide by Region , developed based on analytical treatment given to the material on the fifty-one suicide cases 3. At the end a meta-analysis was performed which consisted of rereading the entire field work material and grouping categories extracted from each case into tables within a subject logic that is described in Chart 6. An initial analysis was performed according to frequency of variables, with the purpose of describing the studied sample.
We compared frequency of suicide according to age range and occurrence of studied cases in all five regions in the country.
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- Psychological and psychosocial autopsy on suicide among the elderly: a methodological approach.
The study took into account data by age range within the elderly segment and sex, perpetration method, place where the suicide occurred, the victims' socioeconomic profile, risk factors and protective factors. Whenever necessary we resorted to individual datum in order to situate a unique phenomenon within the local and regional context.
Therefore it was possible to move from individual features to group trends and from these to local or regional trends, crossing information with contextualization. Afterwards, an analysis was built according to hierarchy of variables, in two distinct ways: 1 by saturation , when one or more motives associated with suicide case by case were grouped. Therefore, 79 motives were grouped that expanded the stress range or motivational factors associated with suicide in the elderly.
They also allowed producing explanatory hypothesis for the 51 cases; 2 and an analysis by hierarchy of interactions , which grouped the main factors that triggered the fatal act, aiming to understand the role of interacting variables and identify what was predominant. We developed 51 multi-cause hypotheses in order to develop a type of "autopsy report", quantifying a pattern of interactive answers with greater weight to justify the victim's option for self-inflicted death. At that point, psychological features coordinate with biographical, socioeconomic and cultural ones.
This analytical procedure provides a holistic vision of the theme, contrary to the one-dimensional trend of many studies that treat suicide motives as isolated topics and not as multiple, interacting factors that compete among themselves, making people progressively more vulnerable. Since the tools were presented in their final format, we will discuss points that guided their improvement and use, considering it necessary to address not only their logic and the research's internal coherence, but also to make recommendations for its use.
It was taken into account experience gathered by the research group and suggestions from literature. Care was taken to ensure that researchers who were part of this investigation team were people with extensive clinical practice and experience in mental and public health.
This decision was based on the sensibility that is required to work with a topic so delicate and complex and that demands a high level of maturity when approaching family members and compiling data. Search for quality work - The following were important to guarantee the quality of this study and the use of the tools: 1 training workshops were held gathering the group of senior researchers and local teams before research work began.
All workshops were based on the manual that consensually standardized procedures; 2 all personnel had access to the literature that grounded research assumptions and hypotheses; 3 workshops were held after fieldwork was finished and after the pre-analysis process had been developed. Narratives from each autopsy were shared and their overall aspects, similarities and differences were discussed. Team training - There were a few differences between local teams as to how they trained their members: some of them conducted a systematic process, reproducing the first workshop for senior researchers; others worked with tools by role-playing imaginary stories and applied the genogram with group members.
Others conducted a pilot test in a real situation, in order both to check the tool and their skills as interviewers. Later they discussed each item in the procedures, aiming to minimize possible errors, although they were aware that each case would be different from the next. It is recommended that these participatory strategies be used for training field researchers enabling them to try different possibilities and to see for themselves interactions between interviewers and interviewees, developing feelings of empathy and warmth and avoiding judgment.
Changes occurred while using tools - Teams used the identification form without any problems; however they included information about ethnicity and interviewee's affinity with the victim. Although the genogram, in theory, is considered an excellent tool to gather data about families, it was little used throughout this research, because some researchers did not feel prepared to use it or because interviewees were not familiar with important information about their family group.
Therefore, most investigators settled for the informal narrative provided by family members of the story of the elderly individual who had died by suicide, since in two hours, on average, it would not be easy to methodically build a family history The purpose of those preliminary moments is to obtain a temporary general picture of the family which will help understand the elderly individual's suicide within a context.
About the psychological and psychosocial autopsy guide - The in-depth interview guide was extensively discussed with respect to appropriateness of language and overall comprehension. The interview guide with its improvements allowed data to be prepared, collected and organized. This helped create a thematic common thread and also a connection between participating researchers. About the process of conducting interviews with relatives or other interlocutors Interview guides to perform autopsies were used in different ways, depending on the relationships between interlocutor and interviewer.
In some cases, as soon as a few questions had been asked the interviewee would fluently detail the elderly individual's story, the suicide episode, and would cover several topics in the interview guide. Conversely, there were cases in which even when researchers made an effort and all questions were gradually asked keeping up with the interviewee's narrative, answers were evasive or unclear and some did not answer the questions.
In those cases, we observed that when a person did not delve deeper into a topic it was because it was emotionally difficult for them, or because they did not want to speak their mind, or also because they had trouble understanding and reflecting on what had happened.
An example of this situation is the answer often given: Why he did that, only he could tell you. Whether the reports were fluent or inhibited, the interview guide proved to be an appropriate tool to support interviewers, as long as the latter were able to be flexible when asking questions, aware of associations between ideas and allowed spontaneous and emotionally-charged information to flow freely. In all circumstances, it is also worth remembering that researchers should never let themselves become tied to questions or interrupt the interlocutor's narrative flow.
Those were some of the statements made by interviewees. The importance of portraying a comfortable atmosphere and friendly attitude is highlighted here so that the interview, if well conducted, may consist of repeating an experience and reflecting on it. This is because the interview is often the first type of support, attention and coping tool to the family members which tell the story of the suicide and talk about the elderly individual who died, in an environment that is not judgmental and that provides understanding and empathy. For instance, a woman wanted to know about the possibility of suicide being genetically transmitted because she was afraid of repeating her father's act.
A son of German descent who preserves the same paternal values, but who allows himself some enjoyment, taking a vacation and going to the beach, unlike old family habits, asked whether his destiny could be different from his father's. Those questions required researchers to give positive affirmation and to explain how certain choices offered different possibilities, which could be resolved in a short amount of time. Another young man who took care of his father until he died, cried very much during the interview and asked himself whether he had actually done everything he could while caring for him.
That was a moment where feelings were expressed and where guilt and emotions triggered reflections attempting to make sense of the event. This interaction helped them address the issue better both internally and socially. Such topics require careful handling and it is important that researchers are prepared to address them, always avoiding being judgmental or taking sides. When faced with another human being who had suffered so much, investigators reported getting in touch with their own limits and often they experienced feelings marked by suffering, pain and death experiences. Mutual help provided by pairs of researchers and group discussions provided them with emotional support: we were so involved with our research that it became our daily and favorite subject.
Being playful and making jokes also helped process feelings triggered by the study. And being open to hearing further than what was required in the interview guide was crucial for building solidarity with family members, so that people could be referred to support services and so that people could comfort each other.
We recommend that the tool never suppresses the need for being friendly and that researchers attempt to support each other, since no one is safe from becoming emotionally unstable when hearing such sad and touching stories. Coordination with services and referrals - Finally, we recommend following the same preparation procedures as our research center incorporated to provide training.
We recommend that whenever possible local Basic Healthcare or Mental Health teams should be available aiming to prevent suicide, above all, among the elderly. It is also important to interact with professionals so they familiarize and follow up on family members. This interaction is even more necessary as one realizes that the issue of suicide is also taboo among most professionals in local healthcare networks.
Therefore, providing them with support means giving them an opportunity to get to know cases and how to take action.
In-depth interview guides, techniques and related strategies were all improved especially at the end of the field work, when the research team was already able to look at procedures with a much more critical and refined eye. Different forms of training, training materials, the collection of articles shared with all team members and the permanent exchange of information should be highlighted.
Face-to-face meetings, available databases and the operation of a communication network were all means that allowed sharing ideas and interests, a common thread that joined both the research process and products.
At the end, a written debate recorded critical and reflective thinking of the entire group, reviewing the research process step by step. As one researcher said:. The process was extremely rich and participatory; it brought us an enormous amount of learning and reflections and enabled us to see the process as a whole.
Tools and techniques presented here proved to be reliable and consistent, whenever proper care was taken when applying them. However, it is always worth remembering that methods and techniques are always tools for researchers to work. Without them, understanding and empathy make all the difference. This was what our study showed when, through interviews carried out with a methodological level of depth, we were able to not only collect important data for healthcare but also address the taboo topic of suicide, breaking the silence and providing room for listening to situations where guilt, secrets, shame and fear become intertwined.
That is, in addition to their technical role in research, interviewers were able to make a contribution to mitigate the suffering endured by families, showing them new ways to deal with self-harm. Finally, we conclude that the main advantage of psychological and psychosocial autopsies is collecting and analyzing contextualized information that will be useful to take preventive action targeting elderly individuals. When caring for elderly people potentially at risk it is crucial to understand the interaction between variables - psychiatric or clinical symptoms, risk and protective factors, personality traits, circumstantial events, family continence and support capabilities of the healthcare area.
Each interaction pattern reveals that suicide has many reasons while being unique, for each person reacts to and interprets suffering that affects them in a unique way. Since old age brings together men and women who are increasingly vulnerable for many reasons, it is crucial that healthcare becomes prepared and acquires the means to identify, propose and ensure global care to be provided to elderly individuals - through research, care and public policies. Rio de Janeiro: Claves, Fiocruz; Cien Saude Colet ; 17 8 Conwell Y, Thompson C.
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