Recording the Echoes of Suicide: Informant-based psychosocial autopsy to understand and prevent suicide in the Netherlands

The overall aim of this thesis is to report on the development and implementation a standardized psychosocial autopsy to understand and prevent suicides in the Netherlands.

Chapter 2 sets off with an exploration of stakeholder perceptions and needs concerning the implementation of a standardized psychosocial autopsy in the Netherlands. Standardized herein refers to a specific, predetermined set of guiding principles and conditions relating to processes involved with the psychosocial autopsy, ranging from the interview instrument to data collection and the translation into recommendations for prevention.

In the second part of this dissertation, we present findings from psychosocial autopsy studies into adolescent suicides, and railway suicides. In chapter 3 we investigated the differences in suicide-related communication between young male and female (aged under 20 years old) suicide decedents.

We used a qualitative analysis technique called the ‘Constant Comparative Method’101 to investigate 798 suicide-related communication events reported in interviews concerning 35 young male and female decedents.

In chapter 4 we explored the meaning of social media in the lives of the adolescents who died by suicide. Interpretative Phenomenological Analysis was performed to assess the role social media had in the lives and to the deaths of these adolescents, with particular attention to the ways in which social media use affected their wellbeing and distress.

Chapter 5 reports a mixed-methods psychosocial autopsy of railway suicides. In this study, we combined data detailing the sociodemographic characteristics of all railway suicide decedents in the Netherlands from 2017 and 2021, with data from in-depth psychosocial autopsy interviews concerning 39 railway suicide decedents.

We started working towards a retrospective, dynamic, cross-sectional cohort that facilitates real-time monitoring of psychosocial characteristics of suicides and allows for an analysis of time-trends and clusters in the future. Chapter 6 describes findings from the pilot study with the new, mixed-methods psychosocial autopsy of suicide in young and middle-aged people.

In chapter 7, the use of Large Language Models for automated deductive coding of interview data is explored and evaluated.In chapter 8, we discuss the findings from our research that have yet received little attention in scientific literature, reflect on lessons learned, and discuss the future of the psychosocial autopsy.