Adolescent death: a 15-year retrospective review

Adolescents comprise an eclectic mix of people vitally important to society yet long-term comprehensive studies on the circumstances of their deaths are lacking in the pediatric forensic literature. The authors reviewed all forensic cases referred to the Medical University of South Carolina Forensic Pathology section over the fifteen years between January 1989 and December 2003. In accordance with the World Health Organization (WHO) definition of adolescents, only decedents 10-19 years of age were included. The authors examined the cause and manner of death, age, gender, and race of the victims in all cases. The toxicology results, perpetrator, death scenario and location, and victim traits were analyzed when available. For all adolescents, the most common manner of death was accident followed by homicide, suicide, natural, and undetermined. Within the adolescent population two distinct groups, 10-14 years old and 15-19 years old, were identified. Though both groups were similar in that they experienced a high number of accidental deaths, decedents of older age group suffered a higher percentage of violent deaths while decedents of the younger group were more likely to die of natural causes. Many of the accidental deaths in this review were preventable, including deaths due to motor vehicle collisions and drowning. In deaths due to homicide, the perpetrator was often known to the victim, whether as an acquaintance or family member. Toxicology testing was often positive in decedents of the older age group, while only rarely positive in decedents of the younger age group. With a solid understanding of the circumstances, it may be possible to predict, and hopefully prevent, future cases of adolescent death. The authors present their findings in this 15-year retrospective study to better aid forensic pathologists, death investigators, law enforcement, and epidemiologists.     

Clinicopathologic features of fatal self-inflicted incised and stab wounds: a 20-year study

The files of the Forensic Science Center in Adelaide, South Australia, were examined for all cases listed as suicide in which death had been caused by the use of a sharp instrument during the 20-year period from January 1981 to December 2000. Fifty-one cases were identified, consisting of 35 men and 16 women. The age range was 23 to 83 years (mean 49 years) representing 1.6% of total suicides (513182). Fatal injuries included incised wounds to the arms in 51.4% of men (n = 1835) compared with 87.5% of women (n = 1416), incised and stab wounds to the neck in 40% of men (n = 1435) and 25% of women (n = 416), and stab wounds to the chest or abdomen in 28.6% of men (n = 1035) and 12.5% of women (n = 216). In 8 cases, multiple sites were involved. The use of sharp instruments in suicide was favored by older, rather than younger, individuals, with a tendency for women to incise their wrists. Hesitation marks were present in 23 cases (54%) and scarring of the wrists from previous suicide attempts in 5 cases. Although this study demonstrated a higher number of men than women committing suicide by using sharp objects, this method of suicide remains uncommon.     

Combined homicide-suicide in Galveston County

Combined homicide-suicides have been classified based on the psychopathology of the perpetrator and the nature of the relationship between perpetrator and victim(s). To further understand the nature of this tragic phenomenon and to test the validity and practicality of a previously suggested classification system, investigators systematically collected data on all combined homicide-suicide events that occurred in Galveston County, Texas over a continuous 18-year period (n = 20). The most common psychopathological finding for perpetrators was high serum alcohol levels that suggested intoxication. Most combined homicide-suicides fell into one of the relational categories and most of these, as predicted, were of the consortial type, possessive subtype. As expected, due to the small sample size, the less common types of combined homicide-suicide were not represented in this sample.     

Pathologic features of childhood pedestrian fatalities

A retrospective analysis of 68 cases of fatal childhood pedestrian accidents in South Australia that occurred over a 20-year period from January 1977 to December 1996 was undertaken. The age range was 12 months to 16 years (average, 7.6 years), with a male to female ratio of 41:27. The most common site of significant injury was the head (91.2%), followed by the abdomen (50%), chest (47.1%), and neck (38.2%). The most frequently encountered significant injury combinations involved the head, chest, and abdomen (14.7%); the head and chest (11.8%); and the head, neck, and abdomen (11.8%). Injuries were severe, consisting of extensive compound and comminuted skull fractures, neck fractures, and massive intraparenchymal brain and internal organ damage with avulsions and fragmentation. Non-life-threatening limb injuries occurred in 88% of cases. A distinct subgroup involved infants and younger children playing in driveways at home who were hit by reversing vehicles. The injuries were often of such a severe nature that death was instantaneous and with no possibility of successful medical intervention. More deaths occurred during the winter than summer months.     

House-fire and drowning deaths among children and young adults

House fires and drownings remain frequent causes of pediatric and young adult mortality and morbidity, yet have received less attention than other causes of injury to the young. To investigate the gender, racial and socio-economic components of these problems, as well as the contribution of chronic disabilities, all deaths in a single state over a 7-year period in the birth through 24-year-old population were studied. Females and males overall had no appreciable differences in house-fire mortality. Females from birth through age 4 were more at risk, however, than older females of dying in house fires, but did not appear at more risk than males of the same age. Nonwhite males under age 4 were much more at risk than white males. Nonwhite females compared similarly to white females, both in the birth through 4-year age range, as well as in the overall population studied. Males had more drowning deaths overall than females, with most of the difference attributable to a large male predominance in the 15- through 24-year age group. Furthermore, males in this age group were much more likely to drown than were younger males. Both males and females in this age group were at particular risk if they had a past history of seizures. No other gender or racial differences could be determined, either in the overall population or in the separate age groups, except in victims greater than 4 years of age many more deaths were found in the lower three socio-economic quintiles than in the higher two.(ABSTRACT TRUNCATED AT 250 WORDS)     

Child Abuse-Related Homicides in New Mexico: A 6-year Retrospective Review

Abstract:  We retrospectively reviewed autopsy records at a statewide medical examiner's office in order to identify and characterize deaths due to child abuse. In a 6-year period in New Mexico, the medical examiner investigated 45 deaths determined to be child abuse-related. Decedents were predominantly male (68.9%), Hispanic White (53.3%), and all were 5 years of age or younger, with a median age of 1 year. Head injuries were the most common cause of death (44.4%), followed by battered baby syndrome (15.6%). Relatives were involved as alleged perpetrators in 80% of the cases, with the father most often implicated (36.1% of cases), and 88.9% of child abuse injuries resulting in death occurred in the family's residence. Toxicology was positive in 26.7% of cases, but only two cases had substances of abuse present. Information on risk factors such as prematurity, parental age, and history of abuse was also collected.     

Death caused by myocarditis in Wayne County, Michigan: a 9-year retrospective study

This paper reviews 72 cases of death caused by myocarditis between the years 1996 and 2004, autopsied at the Office of the Wayne County Medical Examiner in Michigan. Myocarditis as a cause of sudden and unexpected death represented 1.3% of all natural deaths in Wayne County during said period. The year 1999 contained the highest number of deaths of this cause (18), where the average number of myocarditis deaths was 8 per year for this 9-year span. In this study, each case was reviewed based on information gathered from investigative, autopsy, and toxicology reports. Significantly, 58% of these cases were male, and 63.4% were African American. Myocarditis caused death in every age group between 7 months and 67 years, but adults between the ages of 19 and 67 were most significantly affected (75%). Flu and/or cold were the most common symptoms experienced in the days directly proceeding death (28%), followed by shortness of breath (17%) and sudden collapse (15%). Sixty-nine percent of these 72 cases were pronounced dead after ACLS (advanced cardiac life support) protocol by emergency medical services or hospital attendants. Cardiomegaly was observed in 24 cases of adults aged 19 or older (54%), and flabby/soft myocardial tissue was observed grossly in 16% of all 72 cases.     

Taking Responsibility for an Act Not Committed: The Influence of Age and Suggestibility

Inherent in false confessions is a person taking responsibility for an act he or she did not commit. The risk of taking such responsibility may be elevated in juveniles. To study possible factors that influence individuals' likelihood for taking responsibility for something they did not do, participants in a laboratory experiment were led to believe they crashed a computer when in fact they had not. Participants from 3 age groups were tested: 12- and 13-year-olds, 15- and 16-year-olds, and young adults. Half of the participants in each age group were presented with false evidence indicating liability. Additionally, suggestibility was investigated as a potential individual-difference factor affecting vulnerability to admissions of guilt. Results showed that younger and more suggestible participants were more likely than older and less suggestible participants to falsely take responsibility. Implications of these findings for juvenile justice are discussed.     

Elderly suicide: a 10-year retrospective study

The suicide rate in the 65-year and older age group has been increasing since 1980. The elderly attempt suicide less often than younger people but are successful more often. The authors retrospectively reviewed all cases referred to the Forensic Pathology Section of the Medical Examiners' Office at the Medical University of South Carolina (Charleston, SC) from January 1988 through December 1997. The cases of suicide in victims 65 years and older totaled 78, accounting for 11.5% of all suicides reviewed. Of these 78 cases, 41% were autopsied and 59% were externally examined. All of the cases were initially analyzed as to age, race, sex, and method of suicide. Files also were reviewed to determine time of year of the suicide, toxicology results, psychiatric history, social history, medical history, and whether a suicide note was left. The ages of these suicide victims ranged from 65 to 94 years; men comprised 85% of the victims, and whites, 94%. The male-to-female and white-to-black ratios were 6:1 and 15: 1, respectively. The average age of the victim was 73 years. Gunshot wound was the most common method of suicide, accounting for 80.7% of the cases. Other methods included overdose (6.4%), hanging (3.8%), fall from height (2.6%), incised wounds (2.6%), drowning (2.6%), and carbon monoxide poisoning (1.3%).     

Pediatric drowning: a 20-year review of autopsied cases: I. Demographic features

Drowning is a significant cause of childhood mortality in the developed world. Males and preschool-aged children are overrepresented in most series of pediatric drowning. To obtain a better understanding of age- and gender-related factors, a retrospective review of autopsy records over a 20-year period (1984-2003) for cases of drowning (exclusive of bathtub drownings) was performed. Sixty-three consecutive cases of drowning were identified in 45 males and 18 females (ratio 2.5; P = 0.0007). The ages ranged from 9 months to 17 years, and most cases occurred in the 0- to 4-year age group (57%). Boys tended to be older than girls (5 years 9 months versus 4 years 4 months; P = 0.2133). Sites of drowning were open water (48%) and pools (44%), with children drowning in open water being significantly older than those drowning in pools (6 years 6 months versus 4 years 6 months; P = 0.0462). Most boys drowned in open water (53%), whereas most girls drowned in pools (50%). Resuscitation was attempted after the drowning episode in 84% of cases, with children aged 4 years or less having significantly higher rates than older children (P = 0.0346). The present study highlights differences in the pattern of drowning according to age and sex and may aid in developing targeted educational and preventative campaigns.     

Accidental sharp force injury fatalities.

The authors review all accidental sharp force injury deaths investigated at the Southwestern Institute of Forensic Sciences from 1990 to 1999. Twenty-two cases of accidental sharp force injury were identified, accounting for 0.29% of all accidental deaths (9,562) during the 10-year study period. Included in this series are 5 incised wounds, 11 stab wounds, 4 chop wounds, and 2 deaths caused by dog attacks. About half of the cases involved some type of motorized machinery. The victims' ages ranged from 2 years to 71 years, with most deaths occurring in older teenagers and younger adults. Male subjects (17) were involved much more frequently than female subjects (5). In 50% of the cases, ethanol or other drug use was a possible underlying contributing factor in the accident. The cases are briefly reviewed, and the importance of detailed investigation in manner-of-death certification is emphasized.     

Suicide in children and adolescents: a 10-year retrospective review

Suicide is second only to accidents as the most common cause of death for children and adolescents age 10 to 19 in Canada. All of the pediatric cases that were referred to the Hamilton Regional Forensic Pathology Unit from 1993 to 2002 were reviewed. For the purpose of this study, pediatric deaths were defined as deaths in the age group of 1 day up to and including 19 years of age. Specific criteria for suicide were applied to each case, independent of the manner of death issued by the coroner. The criteria were 3-fold. First, homicide had to be ruled out by the police investigation and autopsy findings. Second, the method had to be consistent with self-infliction. Finally, there had to be some evidence of suicidal intent. Questionable cases were discussed among the authors, and if reasonable intent could not be established, then the case was excluded. The autopsy and police reports were examined in detail regarding age, sex, location and method of suicide, presence of suicide notes, and any contributing psychologic factors or stressors. Of the 501 pediatric autopsies performed during the 10-year period, 31 (6%) met the criteria of suicide. The majority of cases (87%) were in older adolescents (age 15 to 19), and the male to female ratio was 2.4:1. Psychologic factors were identified in some of the cases, including depressed mood (77%), suicidal ideation (45%), previous suicide attempts (23%), and drug or alcohol problems (19%). Most of the suicides (61%) occurred in the victim's home, and 12 (39%) cases left a suicide note. In 9 cases (29%), alcohol or street drugs were detected postmortem, though in 8 cases toxicology was not performed. Hanging (48%) was the most common method of suicide, followed by firearms (13%), poisoning (10%), drowning (10%), and blunt force vehicular trauma (10%). Almost 60% of the male suicides were by hanging. No specific trend was identified in the 9 female suicides. These results were compared with similar studies within Canada and other countries. Overall, the method of suicide is dictated by what is convenient and readily available, though the acceptance of various suicide methods can change over time. Suicide prevention efforts should be tailored to address local trends.     

Differences in Psychosexual Development Among Child,Peer, and Mixed Juvenile Sex Offenders

Researchers have examined a number of typologies of juvenile sex offenders, including victim age. Using data from psychological evaluations and the Multiphasic Sex Inventory-II (MSI-II; [Psychological assessment of sex offenders, 2010 ]), this study compared child offenders (i.e., victims were more than 4 years younger), peer offenders (i.e., victims were 4 years younger or less), and mixed offenders (i.e., both child and peer victims) on variables including victim, offender, and offense characteristics, and psychosexual development. Peer offenders had more severe sexual offenses, prior status/nonviolent charges, and issues with sexual functioning. Mixed offenders began offending at a younger age and were indiscriminate in gender and relationship of the victim. Mixed offenders were also more likely than child and peer offenders to have prior sex offender treatment, meaning they had previously failed treatment. As juvenile sex offenders are a heterogeneous group, these research findings suggest that child offenders, peer offenders, and mixed offenders’ treatment needs differ from each other.     

Age differences in eyewitness testimony

This study examined age differences in eyewitness testimony. Children, three and six years of age, and adults interacted with an unfamiliar man for 5 minutes. Four or five days later, the witnesses answered objective and suggestive questions, recalled what happened, and tried to identify the confederate from a target-present photo line-up. The adults and 6-year-olds did not differ in their ability to answer objective questions or identify the confederate, but 6-year-olds were more suggestible than adults and recalled less about the event. Compared to the older age groups, the 3-year-olds answered fewer objective questions correctly, recalled little about what happened, and identified the confederate less frequently. In addition, they were the most suggestible. The experiment extends our knowledge of children's ability to provide accurate eyewitness reports to a very young age group and to a situation in which participants are not merely bystander witnesses but instead directly interact with the confederate.     

Police officers' perceptions of older eyewitnesses

Purpose. This study examined United Kingdom police officers' perceptions about older witnesses (>60 years) and their thoughts about employing the cognitive interview (CI) with this group. Method. A questionnaire was used to assess officers' opinions about current interviewing protocols for older witnesses, including the CI, and to explore the challenges involved with interviewing older witnesses. Results. Over half of the officers surveyed perceived older witnesses to be less reliable and less thorough than younger witnesses. Many officers lacked confidence in dealing with the emotional distress and memory loss often displayed by older witnesses and victims. Several officers stated they were inadequately trained and had insufficient time to devote to interviewing in general. Moreover, the number of officers who considered the CI to be helpful with older witnesses was roughly equivalent to the number of officers who believed it was not. Conclusions. These results suggest that police officers, like mock jurors, consider older adult witnesses and victims to be less reliable and thorough than younger adult witnesses. Furthermore, the results indicate that many officers are not always satisfied with their interviews of older witnesses and victims. Implications for officer training are discussed.     

Children rearing children: A study of reportedly maltreating younger adolescents

This ex post facto study of officially reported child abuse and neglect incidents examined the demographic and dynamic variables associated with reportedly maltreating adolescent mothers of differing ages. A sample of one half of all the incidents reported within Maricopa County, Arizona, was drawn for the period January 1, 1976, through December 31, 1978 (N =5,098). Adolescent mothers were compared on the basis of their age at the time of the incident, and were categorized as younger adolescents (less than 16 years of age) and older adolescents (16 to 19 years of age). It was found that this total sample of adolescents was faced with pressures such as those found within the general, non-age-specific maltreating population. However, the younger adolescent was faced with the greatest financial stress, yet was less likely to be receiving any income supplement. Additionally, the younger adolescent was more likely to be a minority group member, was less likely to be married, and the maltreating situation involved neglect of children. In sum, the reported situation was likely to have been a direct result of the financial, educational, employment, and life experience limitations found in the adolescent's environment. Discussion of the findings reported that the younger adolescent parent's problems were rooted in basic survival and environmental stabilization needs. Implications and suggestions for further research are also presented.     

Prevalence and Characteristics of Co‐Offending Recruiters

Previous examinations of co‐offending have identified a subset of high‐rate offenders who commit crimes with a large number of co‐offenders, most of whom are younger and less criminally experienced. These so‐called “recruiters” are of particular interest to researchers and practitioners, because of their potential role in facilitating offending onset and recidivism among their co‐offenders. In this paper, data on 61,646 individuals detected by a large UK police force are used to identify offenders who fitted the recruiter profile, and to compare their individual and offending characteristics with those of non‐recruiters. In total, 86 recruiters were identified. In multivariate analyses, recruiters were found to be older than non‐recruiters and were typically involved in property crimes. In addition, they tended to offend in criminal groups that were more heterogeneous and stable than non‐recruiters. These findings suggest that a small but identifiable group of recruiters can be detected using official data and that these individuals may be important targets for police attention and court treatment.     

Homicide-suicide in the change of time

Homicide-suicide is a rare event compared to suicide and homicide alone. A comparison of the statistical figures of two studies for Hamburg (1950-1961 and 1990-2005) shows a significant development within the last 40 years: the total number of homicide-suicides committed by women has decreased considerably, probably due to a better medical and psychiatric care and greater economic independence, whereas the number of male perpetrators has remained constant. However, these perpetrators are younger now. As far as the methods are concerned, shooting is now the most common means of killing instead of poisoning by coal gas in former days.     

Cultural influence on the incidence and choice of method of suicide in Saudi Arabia.

The present study was undertaken to explore how racial and cultural factors could possibly influence suicidal rates and patterns in Saudi Arabia. During the 10-year period from 1986 to 1995, 221 cases of suicide were examined at the Medico-legal Center, Dammam, Saudi Arabia. The suicide rate for the entire population averaged 1.1/100,000 population per annum. The male-to-female ratio was 4.5:1. The highest suicide rate was among the age group from 30 to 39 years (44.3%), followed by the age group from 20 to 29 years (32.6%), and the lowest suicide rate was among the age group <20 years (1.8%). The rate in the group >60 years was also low (3.2%). Immigrants formed 77% of the cases, and of these, Asians accounted for 70% of the overall cases and Indians showed the highest suicidal rates (43%). The most common means of suicide chosen was hanging (63%), followed by jumping from heights (12%) and gunshot injuries (9%); death from poisoning accounted for only 6% of cases. This study showed an increasing rate of suicide during the second 5-year period compared with the first 5-year period.     

Differences in suggestibility between 5–6 and 10–11 year olds: The relationship with self confidence

Abstract

Differences in suggestibility and recall between 5–6 and 10–11 year olds were investigated. It was hypothesized that younger children would be more suggestible than older children and that differences in self confidence between older and younger children would influence these differences. It was also predicted that older children would recall more information than younger children, and that this age difference would be less strongly influenced by self confidence. Forty-one 5 and 6 and fifty-six 10 and 11 year olds were interviewed about a video they had witnessed. Several factual and misleading questions were asked, and the percentage of correct answers to the factual questions (to measure recall) and the percentage of incorrect answer to the misleading questions (to measure suggestibility) were calculated. The level of self confidence of the children was measured with six items of the Behavioural Academic Self Esteem Scale (BASE), reflecting self confidence. The outcomes supported the hypotheses: Younger children were more suggestible than older children and this difference disappeared when controlled for self confidence. Older children gave mere information about the event than younger children, and these age differences were, to much less extent, influenced by their self confidence.