Cluster hanging suicides in the young in South Australia

Retrospective review of hanging suicides in individuals aged ≤ 17 years was undertaken at Forensic Science South Australia, Australia, over two 5-year periods: 1995-1999 and 2005-2009. Seven cases of hanging suicides were identified from 1995 to 1999, with a further 14 cases from 2005 to 2009, an increase of 100% (p < 0.001). Hanging accounted for 33.3% of all suicides in this age group (7/21) from 1995 to 1999, compared with 93.3% of the total number of suicides (14/15) in the second 5-year period. In contrast, Australian national data from 1998 and 2008 showed a 30% decrease in hanging suicides in the young, from one case/100,000 population in 1998 to 0.7 in 2008. Cluster suicides occur in the young and are often initiated by direct communication. As it is possible that Internet-based social sites may facilitate this phenomenon, investigations should include an evaluation of the victim's Internet access given the potential risk of similar actions by peers.     

Planned and unplanned complex suicides: a 5-year retrospective study

The notion of planned and unplanned complex suicides first appeared in 1974 by Marcinkowski and, since then, no systematic study of complex suicides has been published in the English forensic literature. Here, the authors present a 5-year retrospective study of complex suicides. Nineteen complex suicides were reviewed: five unplanned and 14 planned, including the first case of an unplanned complex suicide in a woman. All cases were analyzed in terms of gender, age, methods of suicide, the presence of a suicide note, and past suicide attempts, and statistically compared with a 50-case sample of simple suicides. A further comparison was established with compiled data from the literature. Similarities were revealed regarding incidence of complex suicides, male gender predominance, and types of methods used. In contrast, results showed a higher average age for planned complex suicide victims. Finally, the authors discuss the application of the complex suicide definition.     

Trends in Adult Suicides in New Mexico: Utilizing Data from the New Mexico Violent Death Reporting System*

Abstract: Although many suicide prevention programs focus on youth suicides, data indicate the vast majority of suicides occur among adults (18–64 years). In 2005 New Mexico joined the Centers for Disease Control and Prevention’s National Violent Death Reporting System, collecting data on suicides, homicides, and unintentional firearm fatalities to better inform state and national prevention programs. We utilized data collected by the New Mexico Violent Death Reporting System in its first 2 years of operation (2005 and 2006) in order to define the demographic patterns of adult suicides in the state and characterize risk factors. A total of 526 suicides occurred among adults during this time, with the majority being male (78.5%) and White non‐Hispanic (56.7%). The highest incidence was in adults between 45 and 54 years (28.1%). Firearms were the most commonly used mechanism, and “current depressed mood” the most commonly identified risk factor. High rates of adult suicide indicate the need for targeted prevention programs.     

Case series of completed suicides by burning over a 13-year period

Suicide by burning is an extreme act that is uncommon in the United States and throughout the Western world. The characteristics of people who complete such acts are not well understood. To address this issue, we examined the death records of the King County Medical Examiner's Office in Washington State over the 13 years from 1996 to 2009. Twenty-five cases of suicide by burning were identified and used to characterize decedent demographics, circumstances of death, and motivating factors. Compared to other methods of suicide, burning demonstrated a significant overrepresentation of decedents who were women, 40-59 years of age, and Asian/Pacific Islander. They also tended to have previous psychiatric illness and/or substance abuse issues. Self-burning predominantly occurred at the decedent's residence with the intent of suicide given. There was no unifying theme in motivating factors. Together, these data represent the characteristics of people whose death is because of suicide by burning in King County, Washington.     

Recent trends in suicides utilizing helium

Retrospective review of cases of suicide involving helium inhalation was undertaken at Forensic Science South Australia over a 25-year period from 1985 to 2009. No cases of helium-related suicides were identified in the first 15 years of the study, with one case between 2000 and 2004 and eight cases between 2005 and 2009. Australian data were also reviewed from 2001 to 2009 that showed 30 cases between January 2001 and June 2005, compared to 79 cases between July 2005 and December 2009, an increase of 163%. A review of Swedish data between 2001 and 2009 showed no cases between January 2001 and June 2005, compared to seven cases between July 2005 and December 2009. Thus, all three areas showed recent and striking increases in cases of suicide involving helium inhalation. Given the availability of helium and the recent promotion of this method of suicide, it is quite possible that this may represent a newly emerging trend in suicide deaths.     

Alcohol ingestion and age of death in hanging suicides

Retrospective review of 100 consecutive, nondecomposed cases of suicide because of hanging was conducted at Forensic Science SA, Australia. Alcohol was detected in 38 cases (38%). The percentage of victims who had ingested alcohol significantly decreased with age (r(2)=0.81), with alcohol detected in 57.1% of those aged ≤24 years, compared to 28.5% of those aged between 55 and 64 years, and 0% of those aged ≥65 years. A similar linear relationship between alcohol ingestion and age was found for cases with blood alcohol levels >0.05 g/100 mL (r(2)=0.73). The mean ages of those with detectable alcohol (35.2 years) levels >0.05 g/100 mL (35.1 years) and levels >0.1 g/100 mL (37.2 years) were all significantly less than in those with no detectable alcohol (44.4 years) (p<0.005, <0.005, <0.05 respectively). A clear relationship between alcohol ingestion and younger age was shown in hanging suicides.     

Global functioning and suicide among Chinese rural population aged 15-34 years: a psychological autopsy case-control study

As the relationship between global functioning and young suicide remains unclear in rural China, this study was aimed to explore the relationship between them. Data of 391 rural suicides and 416 controls, all aged 15-34 years in three provinces in China were used for this study. The Global Assessment of Functioning (GAF) scale was adopted to assess global functioning of suicides and controls. The results showed that GAF score was stronger than mental illness in predicting suicide in China. Different correlates of GAF score were found between suicides and controls. Unsurprisingly, GAF score was significantly correlated with mental illness in both suicides and controls. Different characteristics were also found among three types of suicide which were classified using GAF score. Assessing global functioning is useful and GAF scale should be regularly used in suicide prevention practice.     

Suicides in the young people of Geneva, Switzerland, from 1993 to 2002

Suicides in Geneva in those less than 25 years old, from 1993 to 2002, were reviewed. Scenes investigations, autopsy findings, toxicology results, and psychiatric history (when available) were examined. There were 65 cases. The average annual suicide rate was 11/100,000. Seventy-seven percent were male, and 23% were female. The youngest was 12 years old and most of the victims were 18 years old and over (89%). For men, the use of firearms was the most common method (38%), followed by fall from height (16%) and drowning (10%). For women, fall from height was the most frequent (40%), followed by firearms and medication overdoses (20% each), hanging (13%), and drowning (7%). Toxicological analysis was performed in 41% of the cases and showed that alcohol was present in 26% and other drugs in 67% of these cases. The most common drugs present were benzodiazepines, cannabis, and cocaine.     

Adolescent and young adult suicide: a 10-year retrospective review of Kentucky Medical Examiner cases

The compilation of all suicidal causes of death attained the third highest ranking of mortality between the ages of 15 and 24 following unintentional deaths and homicide in the United States, accounting for approximately 4000 deaths in 2002. A variety of biopsychosocial factors may contribute to adolescent suicidal behavior, including psychiatric disorders, risk-taking behaviors, and lack of a cohesive family unit. The authors conducted a 10-year (1993-2002) retrospective review of 108 Medical Examiner cases of suicide ages 11-17 and 358 cases ages 18-24 in Kentucky, which represents two thirds of the Coroner cases in the state. The majority of victims were male and Caucasian. The major causes of death were the same for the two age groups, specifically, firearm injury (72.2% and 70.7%), hanging (22.2% and 18.7%), and drug intoxication (2.8% and 5.3%). An integrated Coroner-Medical Examiner system profits in the public health arena by providing collaborative research data for policy decisions. The prevalence of youth suicide by firearm should prompt further discussion regarding ways to better identify high-risk adolescents and young adults and restrict pediatric access to unsecured household firearms.     

Suicidal electrocution in Sydney: a 10-year case review

A retrospective study was undertaken of all cases of death due to suicidal electrocution in Sydney, Australia between 1996 and 2005. A total of 25 cases were identified with 20 cases (80%) as a result of direct attachment to an electrical outlet and five cases (20%) as a result of immersion in a body of water with an electrical appliance. Twenty of the 25 individuals were men (mean age = 57 years, range 22-90) and five were women (mean age 67, range 53-88). At least 35% of decedents were either currently working or had worked as electricians. Electrical timers had been used in eight (32%) cases, the fuse blown in one case, but the remaining 16 (64%) bodies were "live" on arrival of witnesses or electricity personnel. This study demonstrates the phenomenon of electrical suicide as a regular occurrence in Sydney. We highlight the need for investigators and emergency workers to remain vigilant upon discovery of electrical suicides, due to the fact that most bodies remain electrically active after death.     

自杀方式与性别和年龄关系548例分析

目的分析国内5个城市地区采取不同自杀方式人群的性别和年龄特征。方法收集上海、金华、武汉、娄底、都匀城市地区警方处理的548例自杀案例,根据自杀方法将案件进行分类,研究各种自杀方法的人群年龄和性别特征,结果在各种自杀方式的年龄分析中,高坠和自缢的自杀者平均年龄最大(约55岁),溺水、自缢次之(约49岁)、口服毒物较为年轻(约45岁),而CO中毒自杀者平均年龄最小(约37岁)。在自杀方式的性别差异中,男性更多地出现了锐器自杀(52:24),自缢(67:33)和高坠(55:45),女性则在溺水自杀中占据多数(58:42)。结论每种自杀方式涉及到的人群的性别和年龄特征差异明显,CO中毒自杀的自杀者最为年轻;男性更倾向于用机械性损伤的方式来自杀。     

Asphyxiation by Occlusion of Nose and Mouth by Duct Tape: Two Unusual Suicides

Abstract:  The most recent U.S. statistics (2005) determined that 22.2% of suicides are by suffocation. This number likely includes suicidal hanging. Based on previous reports the majority of nonhanging suicidal asphyxiations are accomplished by securing a plastic bag over the head. We report two instances of a far less common method of suicidal asphyxiation, occlusion of the nose and mouth by duct tape. One was a 47-year-old man with a history of paranoid schizophrenia with suicidal ideation and the other was a 52-year-old man who was depressed due to gambling debts. The value of scene investigation, including review of available video surveillance to determine the manner of death is highlighted.     

A distant-range, suicidal shotgun wound of the back

The case being reported is one of a shotgun fatality with a thoracic back wound. A 23-year-old man was shot from a distance with trajectories going from back to front and on a nearly horizontal level. These findings observed in the autopsy could represent homicide, but scene investigation and police records were interpreted and it became clear that the case was suicide. Thus, this case shows that the determination of the manner of death requires a careful forensic investigation including autopsy findings, scene investigation, and reconstruction of the events.     

Planned Complex Occupation‐related Suicide by Captive‐bolt Gunshot and Hanging*

Abstract: Planned complex suicides are committed by using two or more previously planned methods simultaneously to make sure that death will occur even if one method fails. Herein, we presented a case of occupation‐related planned complex suicide, committed by captive‐bolt gunshot and hanging. A 29‐year‐old man, who worked as a butcher, was found dead in the stable, hanging by the neck with a captive‐bolt gun embedded in the forehead region of his head. The hanging was complete. Along the bolt canal were bone fragments, and at the end of the path was the punched‐out fragment of the skin and soft tissue. There were no fractures of the hyoid bone and laryngeal cartilages, and a superficial hemorrhage was present in the right sternocleidomastoid muscle. Our case underlines the utility of forensic autopsy and death scene investigation in reconstructing the mechanism of death, as well as the dynamics of the event.     

Antidepressants at Autopsy in Hispanic Suicidal Youth in Miami‐Dade County,Florida*

Abstract: Controversy has surrounded the use of antidepressants and suicidal behaviors in youth. This study reviewed the Medical Examiner’s Office records of 253 persons aged 24 years or younger classified as suicides in Miami‐Dade County, Florida, from 1990 to 2007. Information was collected regarding demographic information, suicidal characteristics, psychiatric and psychosocial factors, and toxicology results. Eighty‐five percent of the sample was men, and 53.4% of the subjects were Hispanic. Consistent with previous literature, the existence of antidepressants at autopsy was rare; present in only 6% (n = 15) of the victims. The occurrence of antidepressants was not significantly different between Hispanics (n = 7) and non‐Hispanics (n = 8). The incidence of antidepressants was weakly correlated with a tendency to be men and no history of psychiatric illness. The presence of antidepressants in Hispanic youth suicide victims was similar to non‐Hispanics.     

Prevalence and effects of violence against women in a rural community in Minia governorate, Egypt

This study was carried out to investigate prevalence and the characteristics of domestic violence (DV) against women in a rural area in Minia governorate, Egypt, as well as its physical and psychological consequences. Seven hundred and seventy-two women were interviewed. Sociodemographic data were collected; the WHO questionnaire was used to identify the abuse; the Structured Clinical Interview for DSM IIIR (SCID) to detect psychiatric disorders. Abused females constituted 57.4% of the total sample. There were significant relationships between DV and low education, low income, higher number of children, and husband's education. Psychiatric disorders occurred in 18% of the sample. There were statistically significant relationships between psychological and physical abuse of women and the occurrence of psychiatric disorders. In conclusion, DV against women was related to various negative health outcomes, and it is recommended to be given its real importance in both Forensic Medicine Council and in psychiatric assessment.     

Recent Firing Range Suicides in South Australia

Abstract: Two cases are reported from South Australia, where deaths occurred that were due to single self‐inflicted gunshot wounds to the head in individuals who were visiting indoor firearm ranges. Case 1: A 54‐year‐old man visiting an indoor firing range placed a .357 magnum handgun to his head and fired one shot. Case 2: A 23‐year‐old woman who was being instructed in firearm usage at an indoor firing range placed a 9 mm handgun to her head and fired one shot. In both cases, deaths were due to cerebral laceration with skull fracture. Firing ranges may be utilized by individuals who are seeking weapons for suicide attempts, and suicide may be successfully undertaken at such locations even while a victim is under direct supervision. In jurisdictions, where firearm ownership is strictly legislated, it may be that clubs can inadvertently provide access to firearms for this type of activity.