Blood alcohol concentration of suicide victims by partial hanging

During the investigated period, 2000–2007, 4249 suicides were reported in Slovenia, and 1061 autopsies of suicide deaths from the central, northwestern, and southwestern parts of Slovenia were conducted at the Institute of Forensic Medicine in Ljubljana. To identify a possible role of alcohol use in the selection of suicide method blood samples were collected during medicolegal autopsies of suicide victims in order to establish their blood alcohol concentration (BAC) level at the time of death. The study group consisted of 844 suicide victims that used violent suicide methods and 174 suicide victims that used non-violent suicide methods. Out of the group with violent suicide methods 184 (21.8%) suicide victims by partial hanging and 112 (13.3%) suicide victims by complete hanging were identified. The average age was higher in the group of suicide victims by partial hanging than in the group of suicide victims by complete hanging (p < 0.001; T = 3653; df = 294). The mean BAC was higher (T = 1.604; df = 278; p < 0.05) in the group of suicide victims by partial hanging (0.57 g/kg; SD ± 0.92) than in the group of suicide victims by complete hanging (0.40 g/kg; SD ± 0.82). The proportion of BAC positive suicide victims with blood alcohol concentration above 0.1 g/kg at the time of death was higher in the group of suicide victims who used non-violent suicide methods in comparison to the group of suicide victims who used violent suicide methods (p < 0.001; χ² = 14.988, df = 1). Partial hanging was almost twice as common as complete hanging. Higher BAC in the group of suicide victims by partial hanging and more BAC positive suicide victims in the group who died by non-violent suicide methods could give indications about the role of alcohol in the selection of suicide method.     

Early adolescent suicide: a comparative study

A study was undertaken of suicides in children and adolescents aged 16 years and under in South Australia, (Australia), and in San Diego County (USA) from January 1985 to December 1997. In South Australia there were 48 cases of youth suicide, representing 2% of the total number of 2251 suicides over that time. There were 34 males and 14 females (age range 13 to 16 years; mean = 15.3 years), with 22 hangings (46%), six gunshot wounds (13%), five train deaths (10%), four drug overdoses (8%), four jumping deaths (8%), three self immolations (6%), three carbon-monoxide inhalations (6%) and one electrocution (2%). In San Diego County there were 70 cases, representing 1.6% of the total number of 4492 suicides. There were 48 males and 22 females (age range 11 to 16 years; mean = 14.7 years), with 41 gunshot wounds (59%), 21 hangings (30%), six drug overdoses (9%), and two jumping deaths (3%). Preferred methods of suicide differed between the two areas, with significantly more gunshot suicides in San Diego compared to South Australia. The methods of suicide also differed in South Australia from older age groups, with more hangings, jumping deaths and self immolations, and fewer firearm and carbon monoxide inhalation deaths. Suicides in adolescents under the age of 17 years in both populations were, however, rare, with no demonstrable increase in numbers over the time of the study.     

Changing patterns of female suicide: 1986-2000

A study was undertaken of the rates and methods of female suicide observed at the Forensic Science Centre in South Australia over a 15 year period from 1986 to 2000. A total of 609 cases of female suicide were found (age range= 13-88 yrs; mean= 44 yrs), with 249 drug overdoses, 114 hangings, 100 deaths due to carbon monoxide (CO) toxicity, 40 drownings, 35 firearm deaths and 71 miscellaneous deaths (including deaths due to self-immolation, jumping from heights and incised wounds). The most common age range was 26-50 yrs in all categories except for drowning where victims tended to be older. While overall suicide rates in females remained unchanged, with no changes in the rates at different ages, significant increases in hanging and CO deaths occurred over all age groups (p < 0.05), with significant falls in drug overdose deaths in the 10-25 year age group (p < 0.01), and significant overall falls in suicides due to gunshot wounds (p < 0.05). No changes were observed in female suicides due to drowning. This study has demonstrated, therefore, that although no changes in overall suicide rates for females occurred, there have been alterations in the types of methods being used. Although drug related deaths remained the largest category, hanging deaths, which were once uncommon in females, have increased markedly.     

The socio-demographic profile of hanging suicides in Ireland from 1980 to 2005

This paper provides a comparison of the socio-demographic profile of hanging suicides and suicides by other means in Ireland from January 1st 1980 to December 31st 2005. Data on 9674 suicides occurring in that time frame was provided by the Central Statistics Office of Ireland (CSO). 4031 (42%) of these deaths involved suicide by ‘hanging, suffocation or strangulation’ (HSS), with the remainder being suicides by other means. Binary logistic regressions were used to examine six potential risk factors for suicide across the two groups: Gender, marital status, employment in the agricultural sectors, residential location (urban/rural) and age were entered in Block 1 of the analysis, with year of death (pre 1994 vs. post 1994) added in a second block. Results indicate that those dying through hangings were statistically more likely to be male (OR = 3.1, 95% CI = 2.8–3.5), single (OR = 1.3, 95% CI = 1.2–1.4), rural-dwelling (OR = 1.1, 95% CI = 1.0–1.2), agri-employed (OR = 1.3, 95% CI = 1.1–1.4) and to have died since 1994 (OR = 2.3, 95% CI = 2.1–2.5). The magnitude of the group effect was moderate for all but the gender and time period comparisons. Hanging suicide victims (m = 37.7, sd = 16.7) were also significantly younger than other suicide victims (mean = 42.72, sd = 16.7), although the size of the effect was small (r = .16). Overall the six variables explained 6% of the variance in the criterion variable.     

Fatal ethyl and methyl alcohol-related poisoning in Ankara: A retrospective analysis of 10,720 cases between 2001 and 2011

Methyl and ethyl alcohol poisoning are still responsible for high morbidity and mortality rates. The purpose of this retrospective study was to examine ethyl and methyl alcohol poisoning related deaths in Ankara and surrounding cities between 2001 and 2011 and compare them with previous studied conducted in Turkey and other countries. For this purpose, 10,720 medico-legal autopsy cases performed in Ankara Branch of the Council of Forensic Medicine were reviewed in terms of alcohol poisonings.The deaths due to methanol and ethanol poisoning were 74 (0.69% of all medico-legal autopsies performed) and the distribution among them was 35 (47.3%) for methanol poisoning and 39 (52.7%) for ethanol poisoning. Overwhelming majority of the cases were male (n = 67, 90.5%). The mean age of the victims was 44.9 ± 10.9 years and ranging from 21 to 92 years. The age group of 35–49 years was the mostly affected. Most of the cases were seen in 2004 (n = 12, 16.2%). The levels of postmortem blood alcohol levels were available for all cases and the mean alcohol levels were 322.8 ± 155.5 mg/dL ranging from 74 to 602 mg/dL for methanol and 396.8 ± 87.1 mg/dL and ranging from 136 to 608 mg/dL for ethanol.Early diagnosis is essential for successful treatment in methanol and ethanol poisoning. Besides increased awareness, more sensitive/specific diagnostic tools, and the prompt approach to the poisoned individual should be implemented in the hospitals.     

Deaths attributed to suicide among enlisted U.S. Armed Forces recruits, 1980-2004

OBJECTIVE: The purpose of this study was to describe the epidemiology of suicides among U.S. Air Force, Army, Marine Corps, and Navy recruits from 1980 through 2004. METHODS: Recruit suicides were identified through the Department of Defense Recruit Mortality Registry. We calculated crude, category-specific, and age-adjusted mortality rates as deaths per 100,000 recruit-years. RESULTS: There were 46 onsite suicides by gunshot (39%), hanging (35%), fall/jump (22%), and drug overdose (4%). An additional 20 recruits committed suicide from 1980 through 2004 after leaving the military training site. Methods included gunshot (70%), hanging (20%), fall/jump (5%), and poisoning (5%). Therefore, the overall recruit suicide rate was 6.9 (95% confidence interval = 5.4-8.8) deaths per 100,000 recruit-years. Only three (5%) suicides occurred among females resulting in a 3.5 times higher risk for males compared to females (95% confidence interval = 1.1-11.2). CONCLUSIONS: Suicide rates among military recruits were lower than those of comparably aged U.S. civilians. However, the occurrence of any suicide during basic military training emphasizes the importance of routine evaluation of the effectiveness of each military service's suicide prevention program as it applies to this population.     

Suicide in children and adolescents: a Tunisian perspective from 2009 to 2015

This study presents the characteristics of child and adolescent suicides which occurred in Kairouan, Tunisia. Data were collected from autopsy records of the Forensic Department of the University Hospital Ibn El Jazzar of Kairouan. General characteristics of suicides among children and adolescents (under the age of 18) between 2009 and 2015 were retrospectively reviewed. A total of 49 cases, with a female predominance (61.2%) and a mean age of 15.4 ± 2.1, were registered. Most of the victims were from rural areas (93.1%). In most cases, suicide occurred in the victim’s home or the surrounding area (73.4%). The identified precipitating factors were family problems in 55.1%, and school issues in 12.2%. The most common suicide method was hanging (69.38%) for both genders, followed by self-immolation for males and poisoning for females, the majority using pesticides. This study offers useful information to understand the risk factors in Tunisian child and adolescent suicides and provides a basis for the development of urgently needed preventive strategies.     

Characteristics of methadone-related fatalities in Norway

There are currently over 7000 patients enrolled in opioid maintenance treatment (OMT) programs in Norway. A rise in methadone-related deaths proportional to increasing methadone sales over the period 2000–2006 has been observed, but the causative factors for these fatalities have been elusive. In the present study, individual characteristics, methadone concentrations and additional toxicological findings were analyzed. Methadone intoxication deaths (n = 264) were divided into 3 groups according to toxicological findings in whole blood: group 1 – methadone detected alone, or together with one additional drug at low or therapeutic levels, or a low concentration of ethanol (<1 g/L) (n = 21); group 2 – multiple additional drugs/substances detected below lethal levels (n = 175); group 3 – one or more additional drugs/substances detected at lethal levels, or ethanol >3 g/L (n = 55). Methadone blood concentrations in decedents who had been enrolled in OMT were higher than for decedents not in treatment, in all groups. Blood methadone concentrations around 1 mg/L were present in fatal multi-drug intoxications in OMT patients. Results suggest that some patients may be at risk of dying when combining therapeutic concentrations of methadone with other psychoactive substances. Somatic disease was a common finding among deceased OMT patients. Concentrations in methadone users not enrolled in OMT were predominantly between 0.3 and 0.4 mg/L and were not related to the presence of other drugs. However, methadone concentrations below 0.1 mg/L may be associated with intoxication following methadone use, both alone and in combination with other drugs. Younger male users (mean age 34 years) seemed to have a higher susceptibility to methadone intoxication.     

Toxicological findings in suicides – frequency of antidepressant and antipsychotic substances

The role of psychoactive substances in the treatment of mental disorders and the risk of suicide are major public health issues. This cross-sectional study examined the prevalence of antidepressants and antipsychotics detected in toxicological screenings in suicides. Cases from the Institute of Legal Medicine of the Charité-University Medicine Berlin were reviewed over a 4-year-period. All cases (n = 477) with positive toxicology for antidepressants and antipsychotics in blood or organ tissue were included. Frequencies of the detected substances in non-suicide cases (n = 212; male n = 177, 55.2%; female n = 95, 52.5%) and suicide cases (n = 235; male n = 149, 63.4%; female n = 86, 36.6%) were examined. Tricyclic antidepressants (48.1%) were found most frequently in suicides, followed by atypical neuroleptics (37.0%), selective serotonin reuptake inhibitors (28.1%), typical neuroleptics (17.4%), tetracyclic antidepressants (16.2%) and other substances (8.9%). Alcohol was detected in 37.2% of suicides. The leading cause of death was drug poisoning (35.6%) followed by polytrauma (26.8%) and death by hanging (18.5%). A mental disorder (depression, schizophrenia, bipolar disorder, suicidality) was known in 22.9% of suicides. The most common location of death was the person’s own house (63.8%) followed by public places (28.1%) and hospitals (8.1%) The five most common substances in the suicide group were doxepin (20%) citalopram (15.3%), mirtazapine (14.9%), quetiapine (13.6%) and amitriptyline (12.3%). Toxicological findings from cross-sectional studies provide insight into how often certain types of antidepressants and antipsychotics are associated with suicide. A complementary approach is valuable for assessing the risk of suicide during medical treatment because the various available approaches (analysis of suicidal behavior/ideation, toxicity of drugs) each have strengths and limitations.     

Fatal poisoning in Estonia 2000–2009. Trends in illegal drug-related deaths

The aim of this study is to provide an overview of deaths caused by poisoning (especially illicit drugs) in Estonia from 2000 to 2009. The data on poisoning deaths (N = 4132) were collected from the autopsy reports of the Estonian Forensic Science Institute. Ethanol poisoning was the most frequent cause of death (N = 1449, 35.1%), followed by carbon monoxide (N = 1151, 27.9%) and poisoning from illicit drugs (N = 888, 21.5%). The study included 3267 male (79.1%) and 865 female fatalities, with the prevalent age group being 35–64 years. Since 2002, deaths from fentanyles have increased sharply and remained at a high level – from 63 cases in 2002 to 138 cases in 2009. This high number indicates that in spite of the state's drug policies, illegal drugs remain easily available and that this area requires more attention. Alcohol abuse prevention policies – restrictions on alcohol advertisements in the media, limitations on sale times and anti-alcohol campaigns concerning traffic – have not brought about a significant decrease in ethanol poisoning.     

Suicidal and homicidal deaths: a comparative and circumstantial approach

The incidence of suicide and homicide is on the increase worldwide, including India. One million people die annually due to suicides and homicides alone. A comparison of the results between suicides and homicides was performed. From a total of 5773 medicolegal deaths reported at an Apex medical centre of Nagpur University over a period of three years 1998-2000, only 241 cases (4.2%) were homicidal deaths in comparison to 1127 cases (19.5%) of suicidal deaths with suicide rate of 23.1/100,000 per year and homicide rate of 4.9/100,000 per year. Poisoning, burning, hanging and drowning forms the major methods of suicide in contrast to blunt trauma, sharp trauma, burning, and strangulation in homicide. Combined methods were more common in homicide as compared to suicide. Predominance of male was present in all methods of suicide and homicide, except burning. In general, male predominance was seen in both suicidal and homicidal deaths with peak age 21-30 years in suicides in contrast to 31-40 years in homicides. At younger age 11-20 years, the victims of suicide outnumbered the victims of homicide; but at extremes of ages below 10 years and above 60 years, homicides were relatively more common than suicides. Married victims were predominant in both types of deaths. Quarrel and revenge were the common precipitating cause/motive for homicide in comparison to chronic illness and mental illness for suicide. Majority of the accused were having close family relationship with the victims of suicide in contrast to homicides in which most of the assailant were having no family relationship with the victims. 'Acquaintance' were the accused in majority of the victims of homicides in contrast to 'self' in suicides. Most of the victims of homicide were killed outdoor in contrast to victim's own domicile in suicides. In both suicidal and homicidal deaths, most of the victims were found in summer season, but the peaks were noticed in the months of April and May in suicidal deaths and October in homicidal deaths.     

Fatal dextropropoxyphene poisonings in Jutland (Denmark)

Summary For many years dextropropoxyphene (dxp) has been the medicament most frequently occurring in drug poisoning cases examined at the Institute of Forensic Medicine, University of Aarhus.This study includes 85 cases of acute fatal poisoning examined in the period 1985–1987 in which dxp alone (40 cases) or in combination with alcohol (29 cases) and/or other drugs (16 cases) contributed significantly to death. Two-thirds of the deceased were men and one-third women. The average age was 37 years for both sexes. More than half of the deceased were drug and/or alcohol misusers. Eighteen were drug addicts. Half of the deaths resulted from accidents, while 40% were suicides. Accidental deaths prevailed among younger men. In a majority of the cases the drug had been taken orally. In these cases the median total blood concentration of dxp and the metabolite nordextropropoxyphene (ndxp) was 17 mg/kg in the suicide cases and 7.1 mg/kg in the accident cases. The corresponding figures for dxp without metabolite were 9.4 mg/kg and 2.2 mg/kg, respectively. The median value of the quotient dxp/ndxp was 1.9 in the suicide cases and 0.5 in the accident cases. The quotient, together with the concentrations of the drug, may therefore indicate the manner of death in many cases.     

Children, adolescents and young adults suicide data from Epirus, northwestern Greece

The aim of this study was to evaluate suicide trends among individuals ≤ 24 years of age in the region of Epirus, northwestern Greece, from January 1998 to December 2008. Twenty-one cases were classified as suicides out of 242 total deaths (8.7%). The male to female suicide ratio was 4.25 (17 males and 4 females). The preferred suicide method for those aged ≥ 19 years involved firearms, and for those aged < 19 years was hanging. Alcohol was implicated in more than 50% of the suicides and was consumed exclusively by those aged > 16 years. Suicides by self-shooting were more often related to drinking than suicides by other methods. Children and adolescents (aged up to 15 years), older adolescents (15–18 years) and young adults (19–24 years) had suicide rates of 0.05/100,000, 0.10/100,000 and 0.39/100,000 inhabitants per year, respectively. These suicide rates are the lowest reported so far in Europe. The main reason for this may be the traditional lifestyle of the local population and the strong family ties that protect against suicide, especially for the young.     

An analysis and report of custodial deaths in Nebraska,USA: Part II

All medico-legal cases investigated by the Nebraska Institute of Forensic Sciences, Inc. in Lincoln, Nebraska, USA, between 2003 and 2009, were reviewed for deaths which occurred in custody (n = 38). The causes of death, in ranked order, were natural causes 37% (14/38), followed by homicide 21% (8/38), accident 21% (8/38), and suicide 21% (8/38). Each cause of death was then subdivided by age, race, and sex. The findings of this investigation are a continuation of a previous study of the same population from 1991 to 1996 (n = 51). This article also provided five case studies: two natural deaths, two suicides, and one homicide.     

Forensic aspects of carbon monoxide poisoning by charcoal burning in Denmark, 2008–2012: an autopsy based study

Carbon monoxide (CO) inhalation is a well-known method of committing suicide. There has been a drastic increase in suicide by inhalation of CO, produced from burning charcoal, in some parts of Asia, and a few studies have reported an increased number of these deaths in Europe. CO-related deaths caused by charcoal burning have, to our knowledge, not been recorded in the Danish population before. In this retrospective study we present all autopsied cases of CO poisoning caused by charcoal burning in the period 2008–2012. 19 autopsied cases were identified, comprising 11 suicides, 4 accidents, and 2 cases of maternal/paternal filicide-suicide. The mean age of decedents was 38.2 years and the majority of the decedents were men. In 16 cases carboxyhemoglobin levels were above 50 % and in 14 cases we found distinctive cherry red livor mortis. Various concentrations of ethanol and drugs were found in 9 cases. Data suggest that this method of death has increased significantly in Denmark. Therefore, it is highly relevant to draw attention to the subject, to increase awareness as well as prevent future escalation.     

Poisoning deaths in married women

Unnatural deaths of married women amongst the total female deaths have been an increasing trend in Indian society during the recent past years. These unnatural deaths may be suicide, homicide or even accidents. But these suicides and homicides are currently more commonly associated with the dowry disputes. In India, dowries are a continuing series of gifts endowed before and after the marriage. When dowry expectations are not met, the young bride may be killed or compelled to commit suicide, either by burning, poisoning or by some other means. Here, in the study, the main objective is to present the different epidemiological and medicolegal aspects of poisoning deaths in the married women. In a cohort of 200 married female deaths, 35 (18%) were poisoning deaths and these were analyzed from both epidemiological and medicolegal aspects. In this series, most of the women consumed organophosphorus compound and died within 10 days. The majority of the affected wives due to dowry problems were below 35 years of age. Most incidents occurred either during morning hour or during daytime.     

Suicides in Trakya region, Turkey, from 1984 to 2004

The aim of this study is to investigate some features of suicide cases in Trakya region, Turkey. During the 21-year period from January 1984 to September 2004, there were 137 suicide cases autopsied by the Department of Forensic Medicine, Trakya University. Suicides comprised 16.1% of all forensic autopsies. Twenty-seven per cent of the cases were aged between 21 and 30 years and the mean age was 39.7 years. Males constituted 78.1% of the cases. The most frequent method of suicide was hanging (40.1%), followed by firearms, and poisoning. Overall, suicide rates in males showed an increase in the last five years. Most of the suicides occurred in the winter months. In conclusion, since suicides present a major public health problem, detection and prevention methods must be developed for high-risk groups.