Mixed-methods psychosocial autopsy study of suicide in young and middle-aged individuals in the Netherlands.

Introduction: Sociodemographic characteristics of suicide decedents are recorded in the Netherlands, through which we know who died by suicide, but not why. In this mixed-methods, informant-based psychosocial autopsy, we aimed to identify psychosocial characteristics and precipitating factors of suicide in young (aged 10-30) and middle-aged (40-70 years old) women and men and investigate differences on a group level. Methods: Data were collected through a structured questionnaire and semistructured interviews with bereaved proxy informants. The questionnaire detailed sociodemographic and psychosocial characteristics of the suicide decedent. We conducted bivariate analyses to explore differences between women and men. Additionally, we employed the constant comparative method to investigate the perceptions of respondents about key contributing factors and proximal stressors in the months preceding the suicide, as expressed in the interviews. The findings from questionnaires detailing 428 suicide cases were integrated with themes reported in 64 interviews using statistics-by-theme. Results: We identified differences in psychosocial characteristics, proximal stressors and experiences with healthcare of young and middle-aged women and men, including a high prevalence of out-of-the-blue suicide in young men and sexual abuse in young women. Notably, middle-aged men showed no significantly higher rates for any of the considered risk factors in our comparisons. Furthermore, respondents reported the lowest number of perceived contributing factors in young men. Thematic patterns in the interviews concerning young decedents included disconnectedness, a silent struggle and a loss of hope and perspective. In middle-aged decedents, two patterns described a long-term struggle with episodic depression, and conversely a brief suicidal process following an event of loss. In middle-aged women, physical problems and pain were salient topics. Conclusions: Mixed-methods psychosocial autopsy produces a unique empirical perspective on the diverse needs of individuals who died by suicide. We discuss practice implications and possible avenues for future research.