Whether an autopsy is performed will be up to each of the families of the teenagers who have died. Autopsy results will be shared first with families, and later — at families' discretion — with the community at large.
The process involves interviews with family, friends, teachers and others who were in contact with the suicide victim with the goal of learning about what prompted them to die by suicide.
"We're hoping to create a narrative account of as many of these events as possible," Shashank V. Joshi, assistant professor of psychiatry at Stanford University, said.
Initial conversations have been held with several of the families, who indicated they are likely to participate, he said.
Physicians want to "present the aggregate information first to the families affected and then to the community at large. ... Any and all potential information to be shared will first be approved for disclosure by the deceased victims' parents," Joshi said.
Joshi told the Palo Alto City Council July 19 that he hoped the autopsies could lead to improved measures to address teen mental health.
The council was discussing a 68-page report issued by Project Safety Net, a community coalition created in response to five student suicides that occurred at the Caltrain tracks between May 2009 and January 2010.
Three of the teens were students at Gunn High School, one was about to enter Gunn as a freshman and another was a 2008 graduate. After the third suicide last Aug. 21, suicide researchers began to describe the events as a "suicide cluster," a phenomenon that could involve contagion.
Intense parent and community concern led to formation of Project Safety Net, which involves school, police, medical and city officials and a wide array of nonprofit organizations and religious congregations.
The psychological autopsies are one project on a lengthy to-do list suggested by the group. The list includes improved counseling and data-gathering, suicide-prevention training for teachers and city youth workers, guidelines for media coverage, physical supervision of the Caltrain tracks and broad community adoption of a youth-wellness strategy known as the "41 Developmental Assets" of the nonprofit Project Cornerstone.
Autopsy interviews will be conducted by Erica Weitz, a Psychiatry Department research assistant trained by the American Association of Suicidology. The study is subject to clearance by the Institutional Review Board at Stanford, which monitors ethical concerns surrounding behavioral research on human subjects. The clearance was pending as of mid-July.
Suicide researchers Madelyn Gould of Columbia University, David Clark of the Medical College of Wisconsin and Alan Berman of the American Association of Suicidology helped develop a plan for the autopsy study.
Joshi, a Palo Alto resident and parent, is on the executive committee of Project Safety Net and is active in a separate medical coalition that sprang up in response to the suicides, known as HEARD (Health Care Alliance for Response to Adolescent Depression).
HEARD's goal is to foster collaboration among primary-care, mental-health and education workers to address depression among teens.
"We hope to shed light on the risk factors for teen suicide in our community and in other communities, and help us develop better suicide-prevention and wellness approaches," Joshi said.