Survived stab to the heart in a schizophrenic man

Schizophrenia is associated with a significant risk of suicide. According to recent research, 10-15 % of all schizophrenic patients die by suicide. It is not uncommon that the victims show sharp force injuries, so that the forensic pathologist first has to differentiate between self-infliction and involvement of another person. The authors' case report presents a 68-year-old schizophrenic patient who committed suicide by jumping out of a window of his apartment located on the second floor after inflicting multiple stab wounds to his thoracic region. At autopsy, an older stab wound to the apex of the heart was detected. In the criminal investigation, a suicide attempt made 13 days before could be ascertained. As the patient did not want to be taken to a hospital at that time, the injury had never been examined or documented. Since there was no evidence suggesting homicide, the older stab to the heart was interpreted as a tentative injury.     

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.     

An unusual case of suicide by means of a pneumatic hammer.

We describe an extraordinary case of a 49-year-old man who committed suicide by using a pneumatic hammer. As an industrial accident was initially assumed, difficulties in determining the manner of death are discussed. In addition, the ability to perform activity and evidence of a protracted agony in a situation of extensive cerebral destruction are considered. To our knowledge, no such case of suicide has ever been reported.     

Seat belt induced transection of the trachea in a child on the lap of an adult

As a victim of his parents' suicide, a three-year-old boy was found dead on the lap of the passenger in the left front seat of a car that dove from the wharf and crashed into the sea. He died from the transection of trachea due to shoulder belt in the absence of the signs of drowning. The seat belt paradoxically injured the child on the passenger's lap in the traffic accident. The popular custom of Japanese parents of holding their children on their laps in cars is dangerous, while another custom of killing their children upon suicide of parents or couples should be socially and legally controlled.     

Autoerotic asphyxial death initially misinterpreted as suicide and a review of the literature.

Death during autoerotic activities is of special concern to law enforcement officials, medical examiners, the family of the decedent, and society in general. As in the probing of any violent demise, accurate identification, management, and preservation of all physical evidence; complete photographic documentation of the scene and the body; reconstruction of the scene; and interviews with the family and acquaintances (psychological autopsy) are mandatory for proper study, evaluation, and interpretation of the case. Because of a lack of knowledge on the part of many people, including professionals, about these activities and the fact that many autoerotic fatalities share common characteristics with suicide and homicide, these cases are often misinterpreted. The authors present a case of autoerotic accidental asphyxial death which was initially misinterpreted as suicide.     

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%).     

"Insanity" in civil law

The issue of "insanity" is rarely alluded to in the area of civil law. As a consequence, the legal standard for insanity is not clearly understood by many psychiatrists. The standard derives from case law and is based upon statutory law in the criminal sector. A civil case will be presented where the question of "insanity" was raised. In this case an individual committed suicide and his insurance company refused to pay the beneficiaries of his life insurance policy based upon a provision in his policy that excluded payment in situations of suicide. His beneficiaries sued, claiming that the deceased was insane at the time of his suicide and therefore not responsible for his actions. The standard for insanity in New Jersey and the reasoning of the psychiatrists will be presented.     

Suicide using a hand grenade

The authors describe an unusual case of suicide that required particular attention to establish whether the victim was murdered, was preparing a terrorist attack or had committed suicide. Examination of the corpse and the crime scene, as well as testimonies, led the authors to determine the real cause of death, namely, an unusual method of suicide.     

Medicolegal aspects of witnessed suicide due to gunshot to the head. Part 1: Circumstances and psychopathology

In the USA the frequency of witnessed suicide, i.e. suicide committed in the presence of at least one further individual, is reported to range between 5 and 15%. As up to now no detailed analysis of this special issue has been given in the medicolegal literature, this article presents and discusses a number of cases including 8 males and 1 female (age 19-58 years, mean 41.2 years) who had all committed suicide by inflicting a gunshot to the head. In 3 cases post-mortem blood alcohol concentrations of 1.73, 1.88 and 2.23 g/kg respectively were observed. Toxicological tests produced negative results. 5 cases had a medical history of psychiatric disorder with endogenous depression in 3, chronic alcohol abuse and drug abuse with concomitant psychosis in one case each. As far as the motives were known, domestic arguments were of prevailing importance. With one exception the suicides were committed at home. In 6 cases one witness was present, in 2 cases 2 individuals and in one case 22 persons witnessed the suicide. The reported cases are discussed in comparison with the psychiatric-psychological classification according to McDowell et al. with the aim to provide a solid and comprehensive medicolegal method to distinguish between homicide and suicide. Furthermore aspects of psychiatric sequelae and psychological support of the witnesses, which are also of importance for the forensic pathologist called to the scene, are discussed.     

Development and Initial Evaluation of a Suicide Prevention Curriculum for Domestic Violence Hotline Workers

Despite evidence of an intersection between suicide risk and intimate partner violence (IPV), crisis hotlines tend to focus on callers at-risk for suicide or callers involved in IPV, but not both. In an effort to begin to address this gap, we developed and conducted an initial pilot test of a suicide prevention curriculum for hotline workers at the National Domestic Violence Hotline (NDVH), highlighting the intersection of these two public health issues. A mixed methods approach was used as a first step to assess the impact of the 3-h suicide prevention training for 42 domestic violence hotline workers. Results showed significant increase in knowledge regarding suicide risk from pre to post-training and a high degree of satisfaction among attendees. Focus groups conducted with hotline workers 3 months after training indicated a greater willingness to engage callers in suicide screening and prevention efforts. A 6-month follow-up focus group with NDVH managers revealed that suicide prevention had become more integrated in the agency culture, a finding that was consistent with an environmental scan of the workplace that showed an increase in displays of suicide prevention information. In sum, suicide prevention training can be feasibly incorporated into domestic violence hotline workers’ roles. Limitations and suggestions for future studies are discussed.     

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.     

Suicide by multiple blunt head traumatisation using a stone

Apart from collisions with road or rail vehicles and falls from height, self inflicted blunt force is a rare suicide method and mainly seen in psychiatric patients. The paper presents a rare case of suicide by active blunt force. A 68-year-old man committed suicide by repeatedly hitting his head with a stone. He sustained a craniocerebral trauma and finally died from hypothermia due to the low outdoor temperature. According to the relatives, the man was not diagnosed with a mental disorder or suicidal tendencies. Uncommon manners of self-harm are challenging for those involved in the investigation, and a differentiation between suicide, accident and homicide can only be made in synopsis of all findings.     

Suicide by a circular saw

The case of a suicide of a 32-year-old female using an electric circular saw is herein described. The decedent was suffering from depression and was found dead in her room. Beside her right hand was lying a circular saw, which was not running. The autopsy revealed a large gaping wound measuring 15.5 cm in length on the right side of her neck. The right external carotid artery, the right internal jugular vein, and the right internal carotid artery were cut and the injury reached to the cervical vertebra. Therefore, the cause of death was exsanguination. An individual who commits suicide with an electric saw, such as a chain saw, band saw, and circular saw is rare; in particular females rarely select this method as the means of suicide. However, we herein report the case of a female patient with a psychiatric disease who successfully committed suicide with a circular saw.     

Complex suicide by two gunshots to the chest and consecutive hanging: circumstances and aspects of reconstruction

In cases of suicidal gunshots, the capacity to act may be preserved for a certain period of time, so that the suicide may be completed with another method. In the presented case a 74-year-old man was found hanged on the first floor of his house with two gunshot wounds in the chest. Both on the ground and the upper floor traces of suicidal acts were detected. As shots to the precordial region suggest rapid incapacitation, a suicide extending over two floors seemed almost impossible without knowledge of the cause of death and evaluation of the ability to act. The autopsy findings confirmed vital signs of hanging. Moreover, a through-and-through gunshot wound of the chest and abdomen affecting the spleen and a shot lodged in the body without injuring the lung were found. The injury findings thus sufficiently explained the preserved ability to act. The presented case shows characteristics of a complex suicide not yet described so far, but could be clearly classified as suicide in congruity with the pertinent literature.     

An Unusual Suicide Inside a Grave with Two Gunshot Wounds to the Head—The Psychological Approach

Abstract: In this report, the authors present a case of suicide committed by a 66-year-old man, inside a grave at the local cemetery, with two gunshot wounds to the head. A multiple-paged, handwritten suicide note was found in an army type bag inside the victim’s car, while a second one was found in his house. Medicolegal examination of the body revealed two typical contact gunshot entrance wounds and one exit wound to the head. Toxicological analysis of the femoral blood was negative for alcohol and drugs. The history, scene and autopsy findings, along with further police investigation, indicated an obvious case of suicide. The literature is reviewed and discussed. We report this case as the place of suicide is extremely uncommon and as there is no mention of a gunshot suicide inside a grave in the current literature.     

Suicide in children and adolescents at a province in Turkey

Despite the well-documented increases in the rate of completed suicide among children, accurate knowledge of the characteristics of these suicides is limited. We examined all suicides by children and adolescents in Diyarbakir during 1999 and 2001. All of the cases were analyzed regarding the age, sex, method and location of suicide, time of year, and predictive factors. There were 56 children aged 11 through 19 years. Adolescents between 15 and 19 years of age constituted the overwhelming number (87%) of all the childhood suicides. Female children and adolescents predominated among the suicide victims (71%). The most frequent means of suicide were firearms (43%), hanging (28%), and jumping (16%), respectively. The majority of suicides occurred at the decedent's home (88%). Reasons identified were mainly psychiatric disorders, followed by troubles within the family. A prior suicide attempt or a note that was left by the decedent and elucidated the reason for the suicide was rare. There was no seasonal difference in rates of suicides.     

Youth suicide in New Mexico: a 26-year retrospective review

Although suicidal behavior in children and adolescents is a major public health problem, large-scale research on suicide in this population is uncommon. In this study, we reviewed autopsy and field reports for all pediatric suicide cases referred to the New Mexico Office of the Medical Investigator from 1979 to 2005. The age-adjusted suicide rate was 4.8 per 100,000. Psychologic stressors and parasuicidal behavior were identified in some cases. Seventy-six percent of suicides occurred in the victim's home or yard, and 25% left a suicide note. In 26% of cases, alcohol or other drugs were detected in postmortem. Gunshot wound was the most common method overall (58%), followed by hanging (30%). Although the age-adjusted suicide rate is higher in New Mexico than nationally, the trends in the population are similar. With a solid understanding of the circumstances, it may be possible to predict, and hopefully prevent, future cases of child and adolescent death.     

Correlates of law enforcement suicide in the United States: a comparison with Army and Firefighter suicides using data from the National Violent Death Reporting System

Law Enforcement (LE) officers are considered to be at elevated risk of suicide. This study explored variables associated with LE suicide and the extent they differentiated LE suicides from those within similar occupations considered at risk – Army and Firefighters. Using a public health database of violent deaths, the US National Violent Death Reporting System (NVDRS), the prevalence of and association between seven suicide variables (treatment for a mental health condition, Post Traumatic Stress disorder diagnosis, alcohol and substance abuse, job problems, intimate partner problems) and suicide within LE, Army and Firefighters was computed. Method of suicide and demographic characteristics were also identified. All of the suicide variables were associated with suicide in the three occupation groups. LE suicides were differentiated from Army and Firefighter suicides by being more strongly associated with job problems and suicide by females was more common. Implications for suicide prevention strategies within LE are discussed.     

Suicide by drowning: a 20-year review

Drowning as a method of suicide is known to occur, but has primarily been described in environments with readily available access to water, such as coastal regions. In this study, we describe and analyze a series of suicidal drownings occurring in a noncoastal area of Texas. Between 1977 and 1996, 52 cases of suicidal drowning were investigated at the Southwestern Institute of Forensic Sciences in Dallas, Texas. Such deaths accounted for only 0.85% of all suicides and 4% of all drowning deaths. In contrast. suicidal drownings reportedly account for 2.8 to 8.9% of all suicides in regions with easy access to water. As with other studies of suicidal drowning, the victims are usually sober white males over the age of 40 years. Our results also confirm that certain individuals who commit suicide by drowning use weights to facilitate the process. A detailed analysis of the cases is provided. as is a synopsis of several questions that may aid in determining the manner of death in suicidal drowning cases.