Psychological Autopsy of Suicidal Deaths Brought for Medicolegal Autopsy: A Cross-Sectional Study from a Tertiary Care Centre in Western India.

Abstract

Background: Suicide accounts for a large share of the unnatural deaths subjected to medicolegal autopsy in India. The conventional autopsy establishes the cause and manner of death but reveals little about the mental state and life circumstances that preceded it. Psychological autopsy reconstructs this context through structured informant interviews and record review. Data from tertiary medicolegal centres in Western India remain limited. Aim: To describe the sociodemographic profile, place of occurrence, psychosocial stressors and psychiatric antecedents of suicidal deaths, and to assess the feasibility of psychological autopsy within routine medicolegal practice at a tertiary care centre in Western India. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Forensic Medicine and Toxicology over 12 months July 2025 to July 2026. Consecutive deaths in which suicide was established on the basis of police history, scene information and post-mortem findings were included. A structured psychological-autopsy proforma, adapted from published instruments, was administered to adult relatives or close associates, and police inquest papers and available medical records were reviewed. Results are presented as frequencies and percentages with Wilson 95% confidence intervals (CI); the chi-square test was used for associations (p < 0.05). Results: Of 110 cases (age range 12–78 years), 84 (76.4%; 95% CI 67.6–83.3) were aged 15–44 years, the largest group being 25–34 years (29.1%). Males comprised 61.8% (male-to-female ratio 1.62:1); the age distribution did not differ significantly by sex (χ² = 0.59, df = 2, p = 0.75). Most decedents (91.8%) had studied up to the 12th standard or less, and 92.7% of acts occurred at home. The leading antecedents were family/marital discord (34.5%; 95% CI 26.3–43.8), financial problems or unemployment (20.0%), known psychiatric illness (16.4%), interpersonal/romantic problems (13.6%) and alcohol- or substance-related problems (12.7%); 6.4% had prior self-harm. Interviews were completed in all cases and frequently yielded information absent from the police papers. Conclusion: Suicidal deaths at this centre predominantly involved young adults of modest educational attainment, occurred at home, and were preceded by interpersonal and financial stressors. Psychological autopsy was feasible within the mortuary workflow and added forensic and public-health information. Structured psychosocial enquiry should be integrated into medicolegal practice and linked with family-oriented and community mental-health interventions.