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Suicide Trends in At-Risk Territories (START)

Component Three

The third component of START is comprised of two parts. The first seeks to investigate the circumstances preceding fatal suicidal behaviours through the ‘Psychological Autopsy’ interview method. This technique gathers information about the events and circumstances occurring prior to suicide deaths by interviewing proxies of the deceased. The interview includes an adapted version of the Structured Clinical Interview for DSM–IV TR (non-patient version) - SCID (Spitzer, Williams & Gibbon, 1987) and also seeks to gather information on family history, physical health and significant life events.

The START Study offers an immense opportunity for refinement of the Psychological Autopsy technique. With regard to inter-rater reliability between interviewers, the co-rating of at least 10% of interviews is necessary, with audio/video recording of interviews and re-rating of items. Eligible interviewees must have had a history of regular contact with the deceased in the six months leading up to the death, and a minimum of two informants are required per case. For consent purposes, one of the informants needs to be a next of kin (local definition) and, when possible, the health care professional that regularly treated the deceased. All informants will be interviewed within 12 months of the occurrence of a suicide. The interview schedule is based on a bereavement counselling model (similar to Structured Clinical Interview for DSM IV-TR).

The second part of component three is the Community Description. This aims to illustrate the basic sociocultural characteristics of each participating site. This will permit an appropriate contextualization of the study and complement the multidisciplinary dimension of the START study. This survey instrument should be given to an expert or researcher who has extensive knowledge of the cultural, social, political, religious and economic environment in the country. Candidates most suitable for this would be a cultural psychologist, anthropologist or sociologist.

The START Community Description Form contains socio-cultural indices on:

• The external socio-cultural context (including the population and gender structure);
• The socio-cultural and linguistic structure;
• Social and economic context;
• Religious systems;
• Communications, media and entertainment;
• Health and medical dynamics;
• Social deviancy patterns according to demographic markers;
• Mental health and wellbeing;
• General socio-cultural context; and
• The socio-cultural context of suicide (the cultural attitudes toward suicide).