Personality factors associated with manner of death: A psychological autopsy study

Psychological autopsies are a well-established tool for understanding contributing factors in suicide completion. These tools have been used less often to understand personality characteristics of people with other manners of death (e.g. overdose). This study examined personality characteristics related to the manner of death in 83 autopsy cases using the UTHealth Psychological Autopsy Interview Schedule (UTH-PAIS), a psychological autopsy which assesses the presence of mental illness or substance use disorder but also includes items to capture transdiagnostic personality factors. Exploratory factor analysis of the items assessing personality factors was used to examine patterns in personality, and these factors were confirmed via k-means clustering. This analysis uncovered four distinct personality factors: (1) perseverance and self-regulation, (2) aggression, (3) sensitivity to rejection, and (4) extraversion. Of these personality factors, only perseverance and self-regulation differed by the manner of death. Individuals who died of natural causes or by completed suicide had a higher perseverance and self-regulation factor score than those who died by substance overdose, and these patterns were further supported by cluster analysis. The findings suggest that, in this autopsy sample, suicide was a planned, rather than an impulsive, act, though this interpretation is made cautiously given the sample size which also prohibited analysis of overdose death between those with vs. without a prior suicide attempt. Additionally, the results support prior work suggesting substance use disorders are associated with poor self-regulation, which may contribute to overdose deaths in these individuals. The study demonstrates the utility of psychological autopsy for studying personality factors related to the manner of death in cases where ante mortem data is unavailable.