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Tamamlanmış İntiharlarda Psikolojik Otopsi Yöntemi İle İntihar Belirleyici Faktörlerinin Araştırılması

Yıl 2016, Cilt: 30 Sayı: 2, 128 - 134, 31.08.2016
https://izlik.org/JA37GZ65TM

Öz

AMAÇ: İntiharları değerlendirmek için kullanılan psikolojik otopsi yönteminde yarı yapılandırılmış görüşme formu oluşturulmuş, kişilerin adli kayıtları incelenmiş, psikiyatrik ve diğer sağlık bilgileri ile birlikte sorgulayarak bireyleri intihara sürükleyen nedenlerin değerlendirilmesi amaçlanmıştır. Psikolojik otopsi yönteminin daha yaygın kullanılması, kurumlar arası işbirliği sağlanarak sonuçların bir havuzda toplanması, intiharı önlemek için geliştirilecek ulusal strateji ve evrensel veri bankası geliştirilmesi hedeflenmektedir. YÖNTEM: Kasım 2010 - Kasım 2011 tarihleri arasında Adli Tıp Kurumu ATK Morg İhtisas Dairesi’ne intihar şüphesi ile getirilen otopsi incelemesi sonucunda intihar olduğu tespit edilen olguların yakınları ile görüşüldü. Kişiyi en iyi tanıyan yakını çalışma hakkında bilgilendirildikten sonra onamı alınanlar çalışmaya dahil edildi. Görüşmeciler tarafından çalışmaya alınan kişilerin yakınına, tanısal değerlendirme için DSM veya ICD ölçütleri kullanılarak oluşturulan yarı yapılandırılmış formlar aracılığıyla sistematik sorgulama yapıldı. BULGULAR: Olguların %82,5 erkek, %17,5 kadın idi. Hastaların %25’nin intiharı planladığı, %22,5’nun intihar notu olduğu tespit edildi. Olguların %45’inde psikiyatrik bir hastalık bulunduğu ve en sık olarak %55’inde depresif bozukluk olduğu saptandı. Predispozan faktörlerden en sık neden %35 oranında kırsal alandan kentsel alana göç olarak saptanırken ikinci sırada %25 oranlarında maddi kayıplar ve ailesel sorunlar olduğu tespit edildi. Olguların %7,5’inde ailesinde psikiyatrik hastalık bulunduğu %2,5’inde ailesinde intihar girişimi olduğu saptandı. Ölüm nedenleri arasında %60 ası, %15 ateşli silah yaralanması, %10 genel beden travması, %5 suda boğulma, %5 zehirlenme, %2,5 elektrik çarpması, %2,5 kesici delici alet yaralanması olduğu saptandı. SONUÇ: Psikolojik otopsi sonucuna göre tamamlanmış intiharlarda predispozan faktörler; göç, sosyoekonomik durumda kötüleşme , psikiyatrik hastalıklar ve suisidal plan varlığında bireyler daha çok kendine zarar verme davranışı ve ölüm ile karşı karşıya kalmaktadır.

Kaynakça

  • Kutcher S, Chehil S. Risk Management A Manuel for Health Professionas. in:Semerici B, Ed , Tankaya O Translate , 1st Edition, Istanbul: Sigma Publishing, 2009:1-134.
  • Sertoz OO, Noyan MA, Sertoz N, Elbi H. Can suicide at- tempts be predicted? The results of the six-month prospec- tive follow-up of patients who had attempted suicide and ad- mitted to emergency service of a university hospital. Anatolian Journal of Psychiatry 2010;11 1 :1-8.
  • Sahin NH, Batigun AD. Testing the probability of a model to predict suicide risk in high school and university students. Turkish Journal of Psychiatry 2009;20 1 :28-36.
  • Yasan A, Danıs R, Essizoglu E, Ozkan M. Comparision of so- ciodemographic variables, social support and life events ac- cording to sex in patients who attempted suicide. Psychiatry in Turkey 2008;10 1 :1-8.
  • Atay MI, Gundogar D. Risk Factors in Suicidal Behaviour. KrizDergisi 2010;12 3 :39–52.
  • Kaplan HI, Sadock BJ. Kaplan and Sadock’s Synopsis of Psychiatry. Aydin H, Bozkurt A, Eds. Sayil I, Kesebir S Trans- late Suicide 2nd Edition, Ankara: Oncu Publishing, 2005;389-92.
  • Dilbaz N, Bitlis V, Bayam G, Berksun O, Holat H, Tuzer T, Guney S. Suicidal intent scale: validity and reliability. Psiki- yatri Psikol Psikofarmakol Derg 1995;3 2 :28-31.
  • Dilbaz N, Holat H, Bayam G, Tüzer T, Bitlis V. Suicidal idea scale: validity and reliability, 31.National Psychiatry Congress Report Book Turkish Neuropsychiatry Association 27-30 Sep- tember 1995;40-5, Istanbul, Turkey [in Turkish].
  • Bayam G, Dilbaz N, Bitlis V, Holat H, Tuzer T. The relation between suicidal behaviour and depression, hopelessness, suicidal idea: suicidal behaviour scale validity and reliability study. Kriz Dergisi 1995;3 1-2 :223-5.
  • Seber G, Dilbaz N, Kaptanoglu C, Tekin D. Hopelessness scale : realiability and validity. 1993;1 3 :139-42.
  • Andrew TAC, Tony HHC, Chwen CC, Rachel J. Psycho- social and psychiatric risk factors for suicide. BJ Psych ;177 4 :360-5.
  • Cavanagh JTO, Owens DGC, Johnstone EC. Life events in suicide and undetermined death in south-east Scotland: A case-control study using the method of psychological au- topsy. Soc Psychiatry Psychiatr Epidemiol 1999;34 12 :645-50.
  • Wong P, Chan W, Chen E, Chan S, Yip P. Suicide among adults aged 30–49: A psychological autopsy study in Hong Kong. BMC Public Health 2008;147 8 :147.
  • Waern M, Runeson BS, Allebeck P, Beskow J, Rubenowitz E, Skoog I, Wilhelmsson K. Mental disorder in elderly suicides: A case-control study. Am J Psychiatry 2002;159 3 :450–5.
  • Qin P, Agerbo E, Westergard N, Eriksson T, Mortensen PB. Gender differences in risk factors for suicide in Denmark. B J Psych 2000;177 2 :546-50.
  • Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comor- bidity Survey. Arch Gen Psychiatry 1999;56 7 :617-26.
  • Powell J, Geddes J, Deeks J, Goldacre M, Hawton K. Sui- cide in Psychiatric hospital in-patients. Risk factors and their predictive power. BJ Psych 2000;176 3 :266-72.
  • Qin P, Agerbo E, Mortensen PB. Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial fac- tors: A national register–based study of all suicides in Den- mark, 1981–1997. Am J Psychiatry 2003;160 4 :765-72.
  • Hall RCW, Platt DE. Suicide risk assessment: A review of risk factors for suicide in 100 patients who made severe sui- cide attempts evaluation of suicide risk in a time of managed care. Psychosomatics 1999;40 1 :18-27.
  • Conwell Y, Duberstein PR, Caine ED. Risk factors for sui- cide in later life. Biol Psychiatry 2002;52 1 :193-204.
  • Ak M, Ozmenler KN, Ozsahin A. Psychological autopsy and its practices in Turkey. Anatolian Journal of Psychiatry ;10 4 :332-5.
  • Knoll JL. The psychological autopsy, Part II: Toward a standardized protocol. J Psychiatr Pract 2009;15 1 :52-59.
  • Knoll JL. The psychological autopsy, Part I: Applications and methods. J Psychiatr Pract 2008;14 6 :393-7.
  • Ozalp E. The genetics of suicidal behaviour. Turkish Jour- nal of Psychiatry 2009;20 1 :85-93.
  • Bostwick JM, Pankratz VS. Affective disorders and suicide risk: A reexamination. Am J Psychiatry 2000;157 12 :1925-32.
  • Castle K, Duberstein PR, Meldrum S, Conner KR, Conwell Y. Risk factors for suicide in blacks and whites: An analysis of data from the 1993 National Mortality Followback Survey. Am J Psychiatry 2004;161 3 :452-8.
  • Leenaars AA, Sayin A, Candansayar S, Leenaars L, Akar T, Demirel B. Suicide in different cultures: A thematic compari- son of suicide notes from Turkey and the United States. JCCP ;41 2 :253-63.
  • Demirel B, Akar T, Sayin A, Candansayar S, Leenaars AA. Farewell to the World: Suicide notes from Turkey. Suicide and Life-Threatening Behavior 2008;38 1 :123-8.
  • Jason B, Luoma MA, Pearson JL. Suicide and marital status in the United States, 1991–1996: Is widowhood a risk factor? AmJPublic Health 2002;92 9 :1518-22.
  • Kung HC, Pearson JL, Liu X. Risk factors for male and female suicide decedents ages 15–64 in the United States Results from the 1993 National Mortality Followback Survey. Soc Psychiatry Psychiatr Epidemiol 2003;38 8 :419-26.
  • Zubenko G, Mulsant BH, Sweet RA, Pasternak RE, Tu XM. Mortality of elderly patients with psychiatric disorders. Am J Psychiatry 1997;154 10 :1360-8.
  • Oquendo M, Ellis SP, Greenwald S, Malone KM, Weissman MM, Mann JJ. Ethnic and sex differences in suicide rates rela- tive to major depression in the United States. Am J Psychiatry ;158 10 :1652-8.
  • Dumais A, Lesage AD, Alda M, Rouleau G, Dumont M, Chawky RN, Roy M, Mann JJ, Benkelfat C, Turecki G. Risk factors for suicide completion in major depression: A case- control study of impulsive and aggressive behaviors in men. Am J Psychiatry 2005;162 11 :2116-24.
  • Gitlin M. A Psychiatrist’s reaction to a patient’s suicide. Am J Psychiatry 1999;156 10 :1630-4.
  • Hannele H, Erikki TI, Markus MH, Martti EH, Mauri JM, Jouko KL. Suicide and schizophrenia: A nationwide psycho- logical autopsy study on age- and sex-specific clinical char- acteristics of 92 suicide victims with schizophrenia. Am J Psy- chiatry 1997;154 9 :1235-42.
  • Ak M, Ozmenler KN, Ozsahin A. The assessment of re- lationship between suicide and temperament and charac- ter features on the major depressive disorder. J Clin Psy ;11 3 :33-44.
  • Turla A, Aydın B, Gündüz M, Boz H. Suicide of a patient with schizophrenia: a case report. Anatolian Journal of Psy- chiatry 2007;8 1 :74-8.
  • Sareen J, Cox BJ, Afifi TO, Asmundson G, Stein MB. Anxi- ety disorders and risk for suicidal ideation and suicide at- tempts. A population-based longitudinal study of adults. Arch Gen Psychiatry 2005;62 11 :1249-57.
  • Beck AT, Brown G, Berchick RJ, Stewart BL, Ster RA. Re- lationship between hopelessness and ultimate suicide: A rep- lication with psychiatric outpatients. Focus 2006;4 2 :291-6.
  • Malone KM, Waternaux C, Haas GL, Cooper TB, Li S, Mann JJ. Cigarette smoking, suicidal behavior, and sero- tonin function in major psychiatric disorders. Am J Psychiatry ;160 4 :773-9.
  • Yumru M, Savas HA, Herken H, Kokacya MH. Suicide and personality. Anatolian Journal of Psychiatry 2008;9 4 :233-7.
  • Bowasso GB. Cannabis abuse as a risk factor for depres- sive symptoms. Am J Psychiatry 2001;158 12 :2033-7.
  • Robins E, Murphy GE, Wilkinson RH, GassnerS, Kayes J. Some considerations in the prevention of suicide based on study of 134 successful suicides. A.J.H.P 1959;49 7 :888-98.
  • Hirschfeld RM, Russell JM. Assessment and treatment of suicidal patients. N Engl J Med 1997;337 13 :910-5.
  • Ekici G, Savas HA, Citak S. Psychosocial factors increasing suicide risk. Anatolian Journal of Psychiatry 2001;2 4 :204-12.
  • Isometsa ET. Psychological autopsy studies-a review. Eur Psychiatry 2001;16 7 :379-85.
  • Sayıl I, Canat S, Tuğcu H. A study on psychological autopsy: Evaluation of sixteen suicide cases [in Turkish]. Kriz Dergisi ;11 2 :1-6.

Research of Suicide Determinative Factors by Psychological Autopsy in Completed Suicides

Yıl 2016, Cilt: 30 Sayı: 2, 128 - 134, 31.08.2016
https://izlik.org/JA37GZ65TM

Öz

OBJECTIVE: In psychological autopsy method, which was used in order to evaluate suicides, a semi-structured interview form was created, criminal records of individuals are examined and evaluating the causes that lead individuals to suicide is aimed by investigating with psychiatric and other medical information of individuals. The aim is to use psychological autopsy more frequently, gather the results in a pool through cooperation between institutions, form a national strategy to prevent suicide and develop a universal data bank. METHOD: Between November 2010 and November 2011, the relatives of cases, which were brought to The Council of Forensic Medicine ATK Morgue Specialization Department and detected to have completed suicide after the autopsy examination, were interviewed. After the immediate relative was informed of the study, the approved cases were included in the study. The relatives included in the study by interviewer were systematically interrogated for diagnostic evaluation, by using semi-structured forms using the DSM or ICD criteria. RESULTS: 82.5% of the cases were male, and 17.5% were women. It was determined that 25% of the patients plotted suicide, and 22.5% had suicide notes. 45% of the cases had a psychiatric condition, and the most common one was depressive disorder, being 55%. The most common cause in predisposing factors was determined to be migration from rural areas to urban areas with the rate of 35%. Financial loss and family issues take the second place with the rate of 25%. It has been detected that 7.5% of the cases had a psychiatric disease history, and 2.5% had suicide attempt history in the family. It has been seen that 60% of the causes of death was hanging, 15% was gunshot injury, 10% was general physical trauma, 5% was drowning, 5% was intoxication, 2.5% was electrocution, and 2.5% was sharp object injuries. CONCLUSION: According to the results of psychological autopsy on completed suicides, individuals’ predisposing factors of such as deterioration of socio-economic condition and migration, psychiatric diseases and presence of suicidal plans cause individuals to face more self-harm situations and death.

Kaynakça

  • Kutcher S, Chehil S. Risk Management A Manuel for Health Professionas. in:Semerici B, Ed , Tankaya O Translate , 1st Edition, Istanbul: Sigma Publishing, 2009:1-134.
  • Sertoz OO, Noyan MA, Sertoz N, Elbi H. Can suicide at- tempts be predicted? The results of the six-month prospec- tive follow-up of patients who had attempted suicide and ad- mitted to emergency service of a university hospital. Anatolian Journal of Psychiatry 2010;11 1 :1-8.
  • Sahin NH, Batigun AD. Testing the probability of a model to predict suicide risk in high school and university students. Turkish Journal of Psychiatry 2009;20 1 :28-36.
  • Yasan A, Danıs R, Essizoglu E, Ozkan M. Comparision of so- ciodemographic variables, social support and life events ac- cording to sex in patients who attempted suicide. Psychiatry in Turkey 2008;10 1 :1-8.
  • Atay MI, Gundogar D. Risk Factors in Suicidal Behaviour. KrizDergisi 2010;12 3 :39–52.
  • Kaplan HI, Sadock BJ. Kaplan and Sadock’s Synopsis of Psychiatry. Aydin H, Bozkurt A, Eds. Sayil I, Kesebir S Trans- late Suicide 2nd Edition, Ankara: Oncu Publishing, 2005;389-92.
  • Dilbaz N, Bitlis V, Bayam G, Berksun O, Holat H, Tuzer T, Guney S. Suicidal intent scale: validity and reliability. Psiki- yatri Psikol Psikofarmakol Derg 1995;3 2 :28-31.
  • Dilbaz N, Holat H, Bayam G, Tüzer T, Bitlis V. Suicidal idea scale: validity and reliability, 31.National Psychiatry Congress Report Book Turkish Neuropsychiatry Association 27-30 Sep- tember 1995;40-5, Istanbul, Turkey [in Turkish].
  • Bayam G, Dilbaz N, Bitlis V, Holat H, Tuzer T. The relation between suicidal behaviour and depression, hopelessness, suicidal idea: suicidal behaviour scale validity and reliability study. Kriz Dergisi 1995;3 1-2 :223-5.
  • Seber G, Dilbaz N, Kaptanoglu C, Tekin D. Hopelessness scale : realiability and validity. 1993;1 3 :139-42.
  • Andrew TAC, Tony HHC, Chwen CC, Rachel J. Psycho- social and psychiatric risk factors for suicide. BJ Psych ;177 4 :360-5.
  • Cavanagh JTO, Owens DGC, Johnstone EC. Life events in suicide and undetermined death in south-east Scotland: A case-control study using the method of psychological au- topsy. Soc Psychiatry Psychiatr Epidemiol 1999;34 12 :645-50.
  • Wong P, Chan W, Chen E, Chan S, Yip P. Suicide among adults aged 30–49: A psychological autopsy study in Hong Kong. BMC Public Health 2008;147 8 :147.
  • Waern M, Runeson BS, Allebeck P, Beskow J, Rubenowitz E, Skoog I, Wilhelmsson K. Mental disorder in elderly suicides: A case-control study. Am J Psychiatry 2002;159 3 :450–5.
  • Qin P, Agerbo E, Westergard N, Eriksson T, Mortensen PB. Gender differences in risk factors for suicide in Denmark. B J Psych 2000;177 2 :546-50.
  • Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comor- bidity Survey. Arch Gen Psychiatry 1999;56 7 :617-26.
  • Powell J, Geddes J, Deeks J, Goldacre M, Hawton K. Sui- cide in Psychiatric hospital in-patients. Risk factors and their predictive power. BJ Psych 2000;176 3 :266-72.
  • Qin P, Agerbo E, Mortensen PB. Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial fac- tors: A national register–based study of all suicides in Den- mark, 1981–1997. Am J Psychiatry 2003;160 4 :765-72.
  • Hall RCW, Platt DE. Suicide risk assessment: A review of risk factors for suicide in 100 patients who made severe sui- cide attempts evaluation of suicide risk in a time of managed care. Psychosomatics 1999;40 1 :18-27.
  • Conwell Y, Duberstein PR, Caine ED. Risk factors for sui- cide in later life. Biol Psychiatry 2002;52 1 :193-204.
  • Ak M, Ozmenler KN, Ozsahin A. Psychological autopsy and its practices in Turkey. Anatolian Journal of Psychiatry ;10 4 :332-5.
  • Knoll JL. The psychological autopsy, Part II: Toward a standardized protocol. J Psychiatr Pract 2009;15 1 :52-59.
  • Knoll JL. The psychological autopsy, Part I: Applications and methods. J Psychiatr Pract 2008;14 6 :393-7.
  • Ozalp E. The genetics of suicidal behaviour. Turkish Jour- nal of Psychiatry 2009;20 1 :85-93.
  • Bostwick JM, Pankratz VS. Affective disorders and suicide risk: A reexamination. Am J Psychiatry 2000;157 12 :1925-32.
  • Castle K, Duberstein PR, Meldrum S, Conner KR, Conwell Y. Risk factors for suicide in blacks and whites: An analysis of data from the 1993 National Mortality Followback Survey. Am J Psychiatry 2004;161 3 :452-8.
  • Leenaars AA, Sayin A, Candansayar S, Leenaars L, Akar T, Demirel B. Suicide in different cultures: A thematic compari- son of suicide notes from Turkey and the United States. JCCP ;41 2 :253-63.
  • Demirel B, Akar T, Sayin A, Candansayar S, Leenaars AA. Farewell to the World: Suicide notes from Turkey. Suicide and Life-Threatening Behavior 2008;38 1 :123-8.
  • Jason B, Luoma MA, Pearson JL. Suicide and marital status in the United States, 1991–1996: Is widowhood a risk factor? AmJPublic Health 2002;92 9 :1518-22.
  • Kung HC, Pearson JL, Liu X. Risk factors for male and female suicide decedents ages 15–64 in the United States Results from the 1993 National Mortality Followback Survey. Soc Psychiatry Psychiatr Epidemiol 2003;38 8 :419-26.
  • Zubenko G, Mulsant BH, Sweet RA, Pasternak RE, Tu XM. Mortality of elderly patients with psychiatric disorders. Am J Psychiatry 1997;154 10 :1360-8.
  • Oquendo M, Ellis SP, Greenwald S, Malone KM, Weissman MM, Mann JJ. Ethnic and sex differences in suicide rates rela- tive to major depression in the United States. Am J Psychiatry ;158 10 :1652-8.
  • Dumais A, Lesage AD, Alda M, Rouleau G, Dumont M, Chawky RN, Roy M, Mann JJ, Benkelfat C, Turecki G. Risk factors for suicide completion in major depression: A case- control study of impulsive and aggressive behaviors in men. Am J Psychiatry 2005;162 11 :2116-24.
  • Gitlin M. A Psychiatrist’s reaction to a patient’s suicide. Am J Psychiatry 1999;156 10 :1630-4.
  • Hannele H, Erikki TI, Markus MH, Martti EH, Mauri JM, Jouko KL. Suicide and schizophrenia: A nationwide psycho- logical autopsy study on age- and sex-specific clinical char- acteristics of 92 suicide victims with schizophrenia. Am J Psy- chiatry 1997;154 9 :1235-42.
  • Ak M, Ozmenler KN, Ozsahin A. The assessment of re- lationship between suicide and temperament and charac- ter features on the major depressive disorder. J Clin Psy ;11 3 :33-44.
  • Turla A, Aydın B, Gündüz M, Boz H. Suicide of a patient with schizophrenia: a case report. Anatolian Journal of Psy- chiatry 2007;8 1 :74-8.
  • Sareen J, Cox BJ, Afifi TO, Asmundson G, Stein MB. Anxi- ety disorders and risk for suicidal ideation and suicide at- tempts. A population-based longitudinal study of adults. Arch Gen Psychiatry 2005;62 11 :1249-57.
  • Beck AT, Brown G, Berchick RJ, Stewart BL, Ster RA. Re- lationship between hopelessness and ultimate suicide: A rep- lication with psychiatric outpatients. Focus 2006;4 2 :291-6.
  • Malone KM, Waternaux C, Haas GL, Cooper TB, Li S, Mann JJ. Cigarette smoking, suicidal behavior, and sero- tonin function in major psychiatric disorders. Am J Psychiatry ;160 4 :773-9.
  • Yumru M, Savas HA, Herken H, Kokacya MH. Suicide and personality. Anatolian Journal of Psychiatry 2008;9 4 :233-7.
  • Bowasso GB. Cannabis abuse as a risk factor for depres- sive symptoms. Am J Psychiatry 2001;158 12 :2033-7.
  • Robins E, Murphy GE, Wilkinson RH, GassnerS, Kayes J. Some considerations in the prevention of suicide based on study of 134 successful suicides. A.J.H.P 1959;49 7 :888-98.
  • Hirschfeld RM, Russell JM. Assessment and treatment of suicidal patients. N Engl J Med 1997;337 13 :910-5.
  • Ekici G, Savas HA, Citak S. Psychosocial factors increasing suicide risk. Anatolian Journal of Psychiatry 2001;2 4 :204-12.
  • Isometsa ET. Psychological autopsy studies-a review. Eur Psychiatry 2001;16 7 :379-85.
  • Sayıl I, Canat S, Tuğcu H. A study on psychological autopsy: Evaluation of sixteen suicide cases [in Turkish]. Kriz Dergisi ;11 2 :1-6.
Toplam 47 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Adli Biyoloji
Bölüm Araştırma Makalesi
Yazarlar

Kader Semra Karataş Bu kişi benim

M Feyzi Şahin Bu kişi benim

Sinan Sevinç Bu kişi benim

Gönderilme Tarihi 1 Ocak 2016
Yayımlanma Tarihi 31 Ağustos 2016
IZ https://izlik.org/JA37GZ65TM
Yayımlandığı Sayı Yıl 2016 Cilt: 30 Sayı: 2

Kaynak Göster

Vancouver 1.Kader Semra Karataş, M Feyzi Şahin, Sinan Sevinç. Tamamlanmış İntiharlarda Psikolojik Otopsi Yöntemi İle İntihar Belirleyici Faktörlerinin Araştırılması. ATD [Internet]. 01 Ağustos 2016;30(2):128-34. Erişim adresi: https://izlik.org/JA37GZ65TM

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