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2.2.1. Construction of suicide by fire coronial database

The Suicide by Fire Coronial Database (“the Database”) was developed by the researcher to record information about self-immolation with the aim of identifying personal/event

characteristics and to compare this data with research findings from key studies where other methods of suicide have been used. The information for the database was obtained from coronial files that were compiled to explain the circumstances surrounding the death.

The process for recording information for each suicide death started with the coroners’ files of 'all deaths by fire' being carefully read to ascertain those cases where death resulted through suicide by self-immolation, using the above criteria. Once these cases were identified, the data from each of these files was then systematically coded.

The development of the codes used in the Database was a threefold process:

1. A number of coroners’ reports were carefully viewed to determine the type/quality/consistency of standardised information within and between state coroner files.

2. An extensive literature review was conducted to identify relevant variables and coding systems used in suicide literature.

3. The researcher consulted the Victoria University Coronial Fire Database manual (developed to record information about fatal fires) and adopted relevant codes (especially regarding

categorising personal characteristics, environmental factors, and capturing human behaviour). Approximately 20% of the files were comprehensively discussed on a one-to-one basis with a group of mental health professionals (MHP). In each case the MHP read the relevant sections of the file and discussed both whether the case met the above criteria for a suicide and reviewed the completed coding sheet with the researcher. In practice there was rarely any ambiguity on the issue of whether the case met the criteria for suicide or not. While this was a

comprehensive process and resulted in the resolution of key ambiguities, especially around coding, it was not a blind process.

2.2.2 Structure of suicide by Fire Coronial Database

In general terms the Database was constructed in three sections. The first group of

variables (n=10) outlined in detail the socio-demographic information available from the coroners’ file about the particular characteristics of each individual who chose to use self-immolation as their method of suicide.

The second section of the Database recorded information about mental health and other contributing factors known about the individual. Included in this group of variables was

psychiatric condition and history (n=7); contributing factors (n=6) and any evidence of previous self-harm, suicide attempts using fire or other methods (n=5).

In the third section of the Database variables about the suicide event were recorded (n=22). This included details such as location where the self-immolation took place; accelerant use,

presence of suicide note and survival interval if relevant. In this section selected additional background information from witness statements of family members, close friends and medical professionals associated with the person prior to their death were included (see Appendix A for a listing of all variables).

The Database was developed to allow multiple entries to be made for some of the more complex variables. It was often the case that more than one important or contributing factor, either surrounding the event or the individual, needed to be recorded. For example, up to fifteen pre- existing diagnosable psychiatric disorders could be accommodated for each person who suicided. Likewise up to ten contributing factors could be nominated for any one suicide.

2.2.3 Suicide by Fire Coronial Database coding manual

A coding manual was developed to provide precise definitions of all codes in the order they appear in the Database (Appendix B). Codes were grouped into three distinct code types:

standard codes; confidence codes; and specific codes (see below). It should be noted that the development of this coding manual was, to a certain extent, an ongoing process, where new codes were developed as informed by new information in files.

Standardised codes

A number of standard codes applied in a standardised way to all variables, for example 99 was used for all missing data (see coding manual pg 2, Appendix B).

Confidence codes

Confidence codes appear throughout the Database and were included to indicate the degree of certainty the researcher had regarding the coding of some variables. They were linked to

findings regarding psychiatric history and diagnosis, contributing factors, and events leading up to the suicide.

They systematised the degree of certainty surrounding the accuracy of information that may, for example have come from multiple sources, or where there was the absence of solid evidence. Confidence codes captured the degree of certainty used by experts such as the coroner and fire investigators in describing underlying causes. They were also used to describe the degree of certainty regarding subjective judgments made by the researcher, for example the mental health status of the deceased prior to the suicide.

Two confidence codes were listed in the manual, definite or probable. The confidence code of "definite' was given when one of the following occurred:

 the self-immolator was still alive at some point following the incident and was able to give their account of events;

 a suicide was directly witnessed;  a suicide note was written;

The confidence code of 'probable' was given when the information in the coroners' report was detailed enough to suggest a strong likelihood that the variable under question was more likely than not to have been a factor. For example, a case file may have provided supporting evidence (e.g. family observations of the deceased person’s deterioration of mental health and change of behaviour) of symptomology that the researcher judged met the criteria for clinical depression according to the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM IV, TR, 2000). The deceased person may not have had any contact with mental health services leading up to their death and therefore there had been no mental health assessment. In this case the researcher may record 'probable' next to the variable of depression.

Specific codes

Specific codes were used to describe the variables being investigated in the study. They were organised into the three general sections reflecting the structure of the Database. The first cluster of specific codes contained codes pertaining to the socio-demographic information of each individual who chose self-immolation. The second cluster related to mental health and other contributing factors. Lastly, the third cluster described information about the suicide event itself (see Appendix B).

2.2.4 Coronial Case Summary Record

Standardisation of information retrieval from coroners’ files was obtained through the aid of a semi-structured instrument called the Coronial Case Summary Record (see Appendix C) which was designed by the researcher to record information from coronial files. The Coronial Case Summary Record was structured to reflect the database and included all variables under investigation in the study.

The first section of the Coronial Case Summary Record identified relevant social- demographic information for each case. For example, ranking of occupation type for those

employed was categorised using Victorian Department of Education and Training Groupings (State Government Victoria: Department of Education & Training, 2004).

The second section of the Coronial Case Summary Record recorded mental health history and other contributing factors (see Appendix C). In cases where there was recorded evidence of significant mental health deterioration but no known psychiatric history or no diagnosis, the researcher made a ‘probable’ judgement. The classifications of mental illness was derived from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV- TR) (DSM-IV-TR, 2000) and included mood disorders (depressive disorders, bipolar disorder), anxiety disorders, substance related disorders (alcohol, drugs), delirium, dementia and amnestic cognitive disorders, schizophrenia and other psychotic disorders (DSM-IV-TR, 2000). A ‘definite’ diagnosis of mental illness was recorded if a clinical diagnosis was available from a health professional, such as a General Practitioner, Psychiatrist or Psychologist that the victim was suffering a mental illness. It was also recorded if there was an explicit statement from the Coroner that the deceased was suffering from a mental illness prior to their death, which the coroner had determined based on data obtained through various parties (e.g. statement from family member) informing the coronial process. A ‘probable’ diagnosis will only be permitted where there is significant evidence to indicate a person was most likely suffering from a mental illness; such evidence can often be found in statements from police, family and friends, and autopsy reports or toxicology reports (often this is where medications are detected and recorded). To aid the

researcher in classifying the presence and type of mental illness symptomology described in the coroners’ files a previously developed classification tool was used (see Appendix D).

The third section of the Coronial Case Summary Record focused on the circumstances surrounding the death, including: precipitants, witnesses, involvement of alcohol and other drugs, location of the suicide, accelerant use, notes left, and survival interval where relevant. Witness statements were categorised into three distinct categories, according to which parts of the

sequence of the self-immolation each witness observed: those that witnessed the ignition, those that witnessed the burning and immediate aftermath, and those that witnessed both the ignition and burning. This enabled the researcher to have more information as to whether the presence of a witness was in itself a possible factor of importance.

Completed Coronial Case Summary Record forms provided a hard copy of information that was later manually transposed into a computerised Database. Clerical errors transposing data from hard copy to data base were checked by an independent research assistant.