Psychological Autopsy and Forensic Considerations in Completed Suicide of the SARS-CoV-2 Infected Patients. A Case Series and Literature Review

Abstract

Our paper aims to present three cases of committed suicide in SARS-CoV-2 infection during the quarantine period. We investigated if there is a role for the infection itself in triggering the suicidal act or if it is augmented by other risk factors such as fear, psychosocial stress, lifestyle changes, and social isolation. To this goal, we analyzed the clinical, paraclinical, histopathological, toxicological records, mental health conditions, psychological, social, cultural, and economic aspects in detail. One patient committed suicide at home, by hanging, while the other two during hospitalization in the red zone, within the Sibiu County Emergency Clinical Hospital, hanging and falling from a height, respectively. The autopsy was carried out within the restricted area for COVID-19 in Sibiu County Forensic Medicine Service. Patients’ medical histories were analyzed based on the available medical reports. Additionally, we interviewed a family member, applying the so-called psychological autopsy method, based on open-ended questions and standardized instruments (questionnaire) to point out the motives and behavioral changes that might explain the committed suicide. With this data, we could fulfill a design to elucidate and outline the reasons for the suicidal act. Our findings showed that the mental state deteriorated progressively, both in preexisting depressive and non-depressive backgrounds. Furthermore, we highlight the COVID-19 psychological impact in the suicidal acts. Further on, we reviewed the risk factors presented in the literature that are associated with mental health problems and behavioral changes such as stress, anxiety, depressions, sleep disorders, impulsivity, loneliness.