Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands.
Faculty of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands.
PLoS One. 2020 Aug 27;15(8):e0238031. doi: 10.1371/journal.pone.0238031. eCollection 2020.
In the Netherlands, there was a sharp increase in the number of suicides among 10- to 19-year-olds in 2017. A multi-method psychological autopsy study (PA) was conducted to assess feasibility, identify related factors, and study the interplay of these factors to inform suicide prevention strategies.
Coroners identified youth suicides in 2017 in their records and then general practitioners (GPs) contacted the parents of these youths. Over a period of 7 months, 66 qualitative interviews were held with the parents, peers, and teachers, providing information on precipitating factors and five topics involving 35 cases (17 boys and 18 girls, mean age 17 years). Furthermore, 43 parents and care professionals filled in questionnaires to examine risk and care-related factors. Qualitative and quantitative analyses were performed.
Although registration problems faced by coroners and resistance to contacting bereaved families by GPs hampered the recruitment, most parents highly appreciated being interviewed. Several adverse childhood experiences played a role at an individual level, such as (cyber) bullying, parental divorce, sexual abuse, as well as complex mental disorders, and previous suicide attempts. Two specific patterns stood out: (1) girls characterized by insecurity and a perfectionist attitude, who developed psychopathology and dropped out of school, and (2) boys with a developmental disorder, such as autism, who were transferred to special needs education and therefore felt rejected. In addition, adolescents with complex problems had difficulty finding appropriate formal care. Regarding potential new trends, contagion effects of social media use in a clinical setting and internet use for searching lethal methods were found.
This first national PA study showed that, as expected, a variety of mostly complex clusters of problems played a role in youth suicides. An infrastructure is needed to continuously monitor, evaluate, and support families after each youth suicide and thereby improve prevention strategies.
2017 年，荷兰 10 至 19 岁青少年自杀人数急剧增加。本多方法心理尸检研究（PA）旨在评估可行性、确定相关因素，并研究这些因素的相互作用，以为自杀预防策略提供信息。
验尸官在记录中确定 2017 年的青少年自杀事件，然后全科医生（GP）联系这些青少年的父母。在 7 个月的时间里，对 66 名父母、同龄人及教师进行了 66 次定性访谈，提供了促成因素的信息以及涉及 35 个案例（17 名男孩和 18 名女孩，平均年龄 17 岁）的 5 个主题。此外，43 名父母和护理专业人员填写了问卷，以检查风险和护理相关因素。进行了定性和定量分析。
尽管验尸官面临登记问题以及全科医生不愿联系丧亲家庭的问题，阻碍了招募工作，但大多数父母都非常感谢接受采访。一些不良的童年经历在个体层面上发挥了作用，例如（网络）欺凌、父母离异、性虐待以及复杂的精神障碍和先前的自杀企图。有两种特定的模式比较突出：（1）女孩表现出不安全感和完美主义态度，出现精神病理学并辍学；（2）患有发育障碍的男孩，例如自闭症，被转至特殊需要教育，因此感到被排斥。此外，有复杂问题的青少年很难找到适当的正规护理。关于潜在的新趋势，发现了临床环境中社交媒体使用的传染效应以及互联网搜索致命方法的使用。
这是第一项全国性的 PA 研究，结果表明，正如预期的那样，大多数复杂的问题集群在青少年自杀中发挥了作用。需要建立一个基础设施，以在每次青少年自杀后持续监测、评估和支持家庭，从而改善预防策略。
