Psychological autopsy of seventy high school suicides: Combined qualitative/quantitative approach.
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.



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.



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.



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.
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. Electronic address: zalsman@post.tau.ac.il.
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G
Zalsman
Bar Ilan University, Ramat Gan, Israel; Ministry of education, Jerusalem, Israel.
Y
Y
Siman Tov
Bar Ilan University, Ramat Gan, Israel; Feuerstein Institute, Institute Center for Enhancement of Learning Potential (ICELP), Jerusalem, Israel.
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D
Tzuriel
Geha Mental Health Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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G
Shoval
Geha Mental Health Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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R
Barzilay
Ministry of education, Jerusalem, Israel.
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N
Tiech Fire
Hospital Division, Clalit Health Services and Ben Gurion University, Beer Sheba, Israel.
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M
Sherf
Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA.
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John Mann
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D001344:Autopsy; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D036301:Qualitative Research; D012307:Risk Factors; D012574:Schools; D013334:Students / Q000523:psychology; D019966:Substance-Related Disorders; D013405:Suicide / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology
Adolescence; Depression; Postmortem; School; Suicide