Psychological Autopsy Semi-Structured Interview Format
The interviewer will NOT be asking these questions verbatim. Interviewers will be trained to
conduct the interview in a manner that is sensitive and professional. Interviewees who do not
speak English will be interviewed with the help of a translator.
Case Initials: Interview Date:
Date of Birth: Interviewer:
Date of Death: Interview venue:
Age at time of death:
Method used for
suicide:
Relationship of Any comments on respondent’s
respondent to cooperation/questions/reactions
decedent regarding the validity of
Spouse
Friend responses:
Father/Mother
Work
Brother/Sister Colleague/Employer
Aunt/Uncle Classmate
Child Teacher
Other Other
Relative Specify:_________
Comments: Time Interview Started:
Time Interview Ended:
Demographic Information of decedent
1. Place of birth (city, state,
country)
2. Tribal nation
3 Was the decedent a US Yes
citizen No. Specify status in t he US
Don’t know
4. Primary language:
5. Gender:
6. Race/Ethnicity White Asian
Black Pacific Islander
Hispanic Other – Please
American Indian Specify _______
Alaskan Native Don’t know
