Do 90% of Suicide Victims Really have Serious Mental Illness? Psychological Autopsy Studies, Psychopathology, and Suicide

For more than fifty years the psychological autopsy has been used in suicide research. The most common application is to determine the incidence of diagnosable psychiatric disorders in suicide victims. These studies have consistently found that about ninety percent of the decedents who were the subjects of such inquiries had signs of mental illness based on interviews of those who knew them in life. This finding is cited to such an extent that it almost seems to be axiomatic. As a result, mental illness appears to overshadow other suicide risk factors. Individuals with mental illness have a high risk of suicide but this may be because of exposure to many other risk factors, some of which are precipitated by mental illness or which interact with it. Psychological autopsy-based studies of suicide victims have received little critical attention. Here they are examined in terms of the reliability of informants, the methodology, feasibility of diagnosis by proxy, other data, and new theories of suicide.

逾五十年，心理尸检在自杀研究中的应用已得到广泛认可。其最常见之用途在于确定自杀受害者中可诊断的心理疾病发病率。此类研究始终一致地发现，约百分之九十的受访者在其生前所知的个体中均表现出精神疾病的迹象。此发现被引用之频繁，以至于几近成为公理。因此，精神疾病似乎掩盖了其他自杀风险因素。患有精神疾病者自杀风险较高，但这可能是因为他们暴露于众多其他风险因素之中，其中一些风险因素由精神疾病引发或与之相互作用。基于心理尸检的自杀受害者研究鲜受批判性审视。在此，我们将从信息提供者的可靠性、方法论、代诊的可行性、其他数据以及自杀的新理论等方面对其进行探讨。