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.     

Schizophrenia and suicide: a 10-year review of Kentucky medical examiner cases

The risk of suicide is significantly increased in schizophrenics; it is estimated that 10-13% of individuals suffering from schizophrenia commit suicide. Schizophrenia is marked by psychotic exacerbations and remissions, with persistent deterioration in baseline functioning with each relapse. We present a 10-year (1993-2002) retrospective review of Medical Examiners' cases of suicide of schizophrenic victims. Twenty-nine cases were between the ages of 20 and 75 (mean age of 41.6 years). The majority of victims were male (62.1%) and Caucasian (86.2%). The leading method of suicide for both males and females was firearm injury (48.3%) mostly of the head, followed by overdose (20.7%), and hanging (13.8%). A comprehensive investigation of the biopsychosocial factors is warranted in cases of schizophrenics who commit suicide. This study offers an insightful analysis pertaining to the determination of intent in formulating the manner of death in this unique population.     

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.     

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.     

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.     

Childhood Fatalities in New Mexico: Medical Examiner‐Investigated Cases, 2000–2010

To better understand risk factors and populations at risk of childhood fatalities, a review of all records of childhood deaths (≤19 years) between 2000 and 2010 from New Mexico's statewide medical examiner was conducted. Annually, 313–383 childhood deaths were investigated (3820 total). Males and American Indians were overrepresented (62% and 20.4% of deaths, respectively). The most common manner of death was natural (44.8%), followed by accidental (31.4%), homicide (8.8%), suicide (8.8%), and undetermined (4.1%). Infants under 1 year of age accounted for 41.4% of deaths. Motor vehicle crashes were responsible for the majority of accidental deaths (69%), followed by unintentional overdoses (6.9%), and drowning (5.3%). Gunshot wounds, either intentional or unintentional, caused 10.7% of childhood deaths. Complete medico‐legal investigation of childhood fatalities is needed to provide public health agencies with adequate data to evaluate and prevent childhood deaths.     

Child and adolescent victims in forensic autopsy: a 5-year retrospective study

Children of more than 3 years of age and adolescents have been largely overlooked in the forensic literature, especially the 4-9 age group. Thus, the present study was undertaken to address this particular issue of child and adolescent victims in forensic autopsies. On a 5-year period (2000-2004) in Quebec province (Canada), all forensic autopsy cases of children and adolescents from 4 to 19 years of age were retrospectively studied. A total of 223 cases of child and adolescent deaths (148 males, 75 females; 6.6% of all forensic autopsies) were reviewed. Age, gender, manner of death and cause of death were analyzed for all victims organized into three groups of age: 4-9, 10-14, and 15-19. Moreover, homicide cases (n = 54) are further analyzed in terms of method(s) used (firearm, sharp force, asphyxia, blunt force, intoxication). This 5-year retrospective study may contribute to a better understanding of typical deaths in the 4-19 group of age and therefore, bring a working basis for the forensic pathologist or medical examiner/coroner.     

Phencyclidine: a 5-year retrospective review from the New York City Medical Examiner's Office

We report here a 5-year retrospective review of autopsy cases from the New York City Medical Examiner's Office that demonstrated phencyclidine (PCP) in the blood. There were a total of 138 cases. There were 52 deaths because of mixed drug intoxication: the blood PCP concentrations in these cases ranged from <1 to 598 ng/mL. There were 80 violent deaths in which PCP was quantified in the blood but was unrelated to the cause of death. There were five nonviolent deaths in which PCP exclusively was detected. In four of these, there were preexisting medical conditions that could also have contributed to death. In these, the highest PCP concentration was 361.3 ng/mL, a concentration lower than seven of the individuals in our violent death category. This suggests that lower concentrations may be fatal with comorbid conditions.     

Evaluation of Non‐Natural Deaths among Veterans: New Mexico Medical Examiner‐Investigated Deaths, 2002–2011

While it is recognized that veterans have increased rates of depression, post‐traumatic stress disorder (PTSD), suicide, and substance use disorders, rates of homicide and unintentional injury deaths in veterans have been minimally investigated. We evaluated all non‐natural deaths in New Mexico veterans between 2002 and 2011 in comparison with non‐natural deaths among non‐veterans. We reviewed all decedents in New Mexico with a history of military service and investigated by the medical examiner, excluding natural deaths and deaths due to fall from standing height. The most common manner of death was unintentional injury (62%), most of these deaths due to motor vehicle accidents (29%) followed by unintentional overdose (26%). Suicide rates among veterans were consistently higher than the general population. The most common mechanism of suicide in men was gunshot wound (72%), and intentional overdose in women (49%). Services are needed for veterans that are tailored to all ages and both sexes.     

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.     

Suicidal Drug Overdoses in New Mexico: A 5‐year Retrospective Review

To better understand the changing toxicology trends in suicidal drug overdoses in the setting of an increased national trend of multidrug overdoses, a retrospective review of electronic records from New Mexico's Office of the Medical Investigator database was performed between 2008 and 2012 to assess the drug type and current risk factors in suicide deaths. Information on demographics, circumstances, suicide risk factors, toxicology findings, and death certificates was collected and analyzed. Three hundred and forty‐two suicide cases of suicide overdoses were identified. Decedents were predominantly female (61.8%). Scene investigation revealed risk factors including suicide ideation (47.4%), previous suicide attempts (38%), and suicide note (38%). Psychiatric illness was present in 72% of cases, with depression being the most common illness. Chronic pain was seen in 27.2% of cases. Most deaths were attributed to multiple drugs (76%). Utilizing the toxicology information will assist in creating public awareness and provide a framework to support targeted efforts to attempt to prevent future suicides.     

Suicidal decapitation using a tractor loader: a case report and review of the literature

In forensic practice, decapitated bodies are predominantly associated with decapitation by wheels of trains or with postmortem dismemberment following homicide. In the suicidal context, decapitation accounts for less than 1% of total suicide. Apart from decapitation by trains, other encountered methods involve suicidal hanging and vehicle-assisted ligature suicide. Reported here is a unique case of suicidal decapitation in a 45-year-old man using a tractor loader at the foot of a silo, on his farm. The head was recovered in the loader and there were several impact spots from the loader as well as blood on the silo wall. The autopsy revealed a complete decapitation wound with the severance plane located between the third and fourth cervical vertebra. A 1.5 cm wide abrasion on the anterior part of the neck and abrasions under the chin were noted. This very unique case of intentional suicidal decapitation is the first reported case of a planned system intended to create decapitation outside the unique case of homemade guillotine and the more common decapitation by train.     

Unusual suicide with a chainsaw

Described here is a case of suicide with the use of a chainsaw. A female suffering from schizophrenia committed suicide by an ingenious use of a chainsaw that resulted in the transection of her cervical spine and spinal cord. The findings of the resulting investigation are described and the mechanism of suicides with the use of a chainsaw is reviewed. A dry bone study was realized to determine the bone sections, the correlation between anatomic lesions and characteristics of chainsaw. The damage of organs and soft tissues is compared according to the kinds of chainsaw used.     

Police officers who commit suicide by cop: a clinical study with analysis

Suicide by cop has become a familiar topic among members of law enforcement, mental health professionals, and the general public. This paper presents two cases where police officers chose to commit suicide by getting other police officers to kill them. The two police officers studied, by examination of closed case files, were found to be similar to civilians who committed suicide by cop on several demographic (gender, age, history of mental illness, and suicide attempts), and situational (stress factors, trigger) variables. The cases help us to understand possible motives and management for individuals who choose to end their life in this manner.     

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.     

Study of an economic issue as a possible indicator of suicide risk: a discussion of stock prices and suicide

There were more than 30,000 suicides in 1998 in Japan, and since then, the numbers have remained high. In 2009, the number of suicides per a day was c. 90. This phenomenon constitutes a major social problem. One of the major reasons for the rapid increase in the number of suicides appears to be the worsening economic problems. It is therefore necessary to research the relationship between economic issues and suicide. In this study, we examined the relationship between the value of the Nikkei Stock Average and suicide rates in Japan. The value of the Nikkei Stock Average may be related to suicide among men. On the basis of the results, relevant researchers and organizations should understand the factors that relate to suicide to better carry out specific suicide prevention measures.     

Ecstasy and suicide

Deaths due to the ring-derivative amphetamines are not common and are usually accidental involving dehydration and hyperthermia. Suicides from 3,4-methylenedioxymethamphetamine (MDMA) and related ring-derivative amphetamines overdose are rare. A 15-year-old female who had a history of depression and previous suicide attempts was found dead with a suicide note. Toxicology demonstrated lethal serum concentrations of MDMA (9.3 mg/L), with 34 mg/kg of MDMA in the liver, 2.4 mg/L in the urine, and 530 mg/kg in the stomach. The cause of death was MDMA toxicity, the manner suicide. While MDMA may be detected in victims in other drug-related or traumatic deaths, it is only rarely used in isolation in suicide, with a predominance in the 21- to 25-year-old range. Despite the rarity of such events, the possibility of a nonaccidental manner of death should be considered when high levels of MDMA and associated amphetamines are found at autopsy.     

FORENSIC Autopsy of People Having Committed Suicide in 2002 and in 2012: Comparison of Epidemiological and Sociological Data

This work compares epidemiological and sociological data on persons having committed suicide in 2002 and in 2012 through a retrospective study of every suicide case having led to an autopsy at the Institute for Forensic Medicine of Lyon in 2002 and in 2012. The study included sociodemographic data, medical data, and toxicological data. A total of 486 cases were included (242 cases in 2002 and 244 cases in 2012). People committing suicide were on average older in 2012 than in 2002 with a larger proportion of over 55. There was also an increase in the proportion of psychiatric antecedents (p < 0.001). Whatever the date of death by suicide, the most affected age range is the 45–54. The results highlight the necessity of bolstering the prevention plans, in particular for people over 45.     

Planned complex suicide: an unusual case

Abstract:  We report an unusual case of planned complex suicide. The victim was a woman aged 67 years, who was found dead in her bath in a state of advanced putrefaction. A plugged-in hairdryer was submerged in the water and the electrical fuses in the room had short-circuited. A kitchen knife lay below the body of the victim, whose left forearm bore incisions suggestive of wrist-cutting. At autopsy, no sign suggesting electrocution could be observed because of the advanced state of putrefaction of the body. Toxicological analysis revealed massive ingestion of tianeptine (blood concentration 15.5 mg/L). Although the exact cause of death could not be determined because of the state of the corpse, meticulous examination of the scene and information obtained from the victim's relatives led to the conclusion of suicide.     

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.