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.     

Hanging: suicide or homicide?

Death by Hanging: Suicide or Homicide. Six cases of homicidal hanging and murder presented as suicidal hanging are recorded. Suspension followed strangulation by ligature or throttling and head injuries in 4 cases. Distinction between homicide and suicide was easy in 5 cases: two of the perpetrators gave themselves up to the police, one committed suicide immediately after he had hanged his 15 year old daughter; in two cases tracks of blood, heavy injuries of the victims, and traces of robbery were obvious. Unless the victim is an infant or an adult person incapacitated by drink, disease, or drugs, or unless there are several assailants murder is difficult to accomplish. Distinction between murder and suicide may be impossible by an examination of the body alone. Detailed investigation of the scene, reconstruction of the position of the suspended body, examination of the rope, the knots, the direction of the fibres on the rope may serve to discover homicidal hanging. - Compared to suicidal hanging homicide has a frequency of about 1% in our autopsy material. However, we cannot estimate the number of obscure cases.     

Suicide squad: Boko Haram’s use of the female suicide bomber

Boko Haram first began using the tactic of suicide bombings in 2011 and in 2014 started using female suicide bombers. This research focuses on gender differences in the use of suicide bombers. The data were collected using open sources from June 16, 2011 to June 15, 2018. Using this longitudinal data, trends are described over that 7-year period, focusing on the use of females. A majority of the suicide bombings target civilians in Nigeria, Cameroon, Chad, and Niger. More than half of the bombers were women and girls, some as young as 7?years old, and there were more than 60 incidents where the bomber was below the age of 15. More female bombers were used to targets civilians, whereas men were used more often to target government, police, and military targets. Female suicide bombers were used in Cameroon, whereas males were used more often in Nigeria. Additionally, females used suicide belts or vests, whereas men carried out the overwhelming majority of vehicle-borne suicide bombings. In many cases, the use of the women as bombers involved coercion. The unprecedented use of female suicide bombers, particularly young girls, should be a focus of policy moving forward.     

Epidemiology of suicide by hanging in Transkei, South Africa

To describe the epidemiology of suicide by hanging, in Transkei region of South Africa. This is a record review of the autopsy register from 1993 to 2003. There is an increasing trend of hangings from 5.2 per 100,000 to 16.2 in 2003. The highest was in the 20- to 29-year age group. The least number of hangings of 2.2 per 100,000 was in those over 70 years of age. Males (86.4%) outnumber females. The ratio of male to female suicide is 6.4:1. The 2 youngest suicide victims were also males aged 9 years. Peak of these hangings is in May and November and least in September. There is increasing trend of hanging especially among young adults between 20 and 29 years old.     

Unusual attempted suicide by shooting through heart

Gunshot wounds in the heart are frequent suicidal injuries, especially in men. Most of them are lethal, but some cases of survival due to immediate and proper surgical treatment are reported. However, survival without specific treatment is extremely rare.In our case, a 44-year man attempted suicide by home-made shooting device. A special 12 cm long and 2.5 mm wide needle-like missile entered his body at the left anterior part of his chest, passed through the heart and lower lobe of right lung and exited at the right side of his back. The patient was able to move normally and he also looked for medical help immediately after attempting suicide. We found large atypical-shaped entrance wound on the anterior part of the chest, which was surgically treated, and tiny pointed exit wound under the right scapula. The patient was stable from cardio-circulatory and respiratory aspects from the time of admission to discharge from the hospital. We found only minimal pericardial bleeding (up to 10 mm thick) and there was no need for surgical intervention. In the next 2 weeks the haematoma absorbed spontaneously. The gunshot injury healed without any complication. Paranoid psychosis was diagnosed by psychiatrist and this probably had been the cause of attempting suicide.We think that the favorable outcome of the proved heart gunshot injury in our patient was due to the needle-shaped low-energy missile, which caused only tiny gunshot (stab) hole in the heart. Such a heart injury caused only minimal bleeding into the pericardial sac without heart tamponade.     

Criteria for homicide and suicide on victims of extended suicide due to sharp force injury

This report is about the findings in association with the extended suicides of nine victims killed by sharp force. All victims were killed by sharp force. The perpetrators were predominantly the parents, the victims their children. Regarding the criteria for differentiating self-inflicted injuries from injuries inflicted by another person, the victims' injuries presented patterns usually found solely in suicides. Thus eight of nine cases presented tentative and hesitation injuries, in three of five cases areas of injury covered by clothing had been exposed beforehand. Despite extremely narrow intercostal spaces in children, injuries to the bones in thoracic stabbing were avoided more often than not (four of seven cases). Only the criterion "defence injury" occurred nearly as often as in homicide victims (three of nine cases). The psychopathology of extended suicide can explain this pattern. The perpetrator's motive is characterised by his pseudoaltruistic belief to save the loved ones from a world that is in his opinion unacceptable. A fusion or integration of the victim into the perpetrator's own self is based on an identity problem. Physical interrelation of forces between perpetrator and victim restricts the victim in his defence and presents an important prerequisite for acquiring the patterns of described injuries.     

Planned complex suicide: report of three cases

Three cases of planned complex suicide in a 3-year period are reported. A 40-year-old man was found dead, in his garage, hanging by his neck, with a gunshot in the head from a pen gun. A 50-year-old man was found dead in the sea with a gunshot to his head. A third man was found in a field hanging by a tree and burned. The investigation of the scenes and the methods used pointed toward a suicidal etiology. The main difference between planned complex suicide and those cases defined in medicolegal literature as combined suicides lies in the complex mechanism used by the victim as a protection against the failure of one of the mechanisms.     

Stud guns revisited: report of a suicide and literature review

Stud guns (powder-actuated fastening tools) are a commonly used construction tool. Accidental injuries and fatalities are no longer frequent, presumably because of current safety features and practices. A case of an intentional fatal wound (suicide) is described. A literature review of stud gun injuries is also presented.     

Nail-gun injuries. Accident, homicide, or suicide?

It may be difficult to distinguish industrial accidents from suicide attempts or even assaults or homicide. Nail guns are relatively new industrial tools that can produce severe or fatal injuries. The configuration of the nail on patients' radiographs after such injuries can be helpful in determining the cause of injury. Steel nails that are bent are due to a ricochet and thus indicate accidental injury. Straight-nail injuries to the co-workers of nail-gun users are most likely due to over-penetration of the substance being nailed or accidental mid-air firing; however, intentional injury cannot be ruled out. Extremity injuries caused by straight steel nails in nail gun users are the result of carelessness or poor technique, but suicide should be considered when straight nails cause wounds to the chest, head, or abdomen.     

The use of mental status in death certification of suicide

A 5-year study (1982-1986) illustrates the use of mental status in death certification of suicide in 182 consecutive cases from Marion County, Oregon, U.S.A. The presence of specific mental illness was documented in Part II of the filed death certificate whenever sufficient data supported such a diagnosis. This study represents, so far as we are aware, the first use of mental illness in the routine death certification of suicide. The study subjects were described in terms of sex; age group; the presence or absence of a suicide note; the anatomical cause of death (Part I of the death certificate); and the presence of mental illness, severe physical illness, or alcohol abuse (Part II of the death certificate) as contributive to the death. About half (97 of 182 = 53.30%) of the study group was diagnosed as suffering from a major affective disorder. Another portion (18 of 182 = 9.89%) was classified as schizophrenic. A subgroup of 18 men, all of whom were residents of state mental or correctional institutions at the time of death, was also briefly described.     

A peculiar case of suicide

A young woman was found dead on the floor of an abandoned office in the center of the city. The body showed numerous wounds on the front, a piece of wood was caught in the mouth and the opening of the larynx was completely obstructed by a piece of glass. At the beginning it was thought to be a homicide but later resulted to be a suicide through numerous and unusual means. Before the suicide, the woman tried to kill her young 5 year old son, but the child managed to get away.     

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%).     

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.     

Determination of questionable suicide as a homicide by studies of criminal stains

In a woman found dead with cuts on both arms in a domestic sauna plastered with blood were assumed next to a bleed to death. The question self-infliction or by a third party of arm injuries could not be decided. By investigation of blood traces only could be clarified the cause of death. The husband had strangled his wife and inflicted several cuts on both arms with a razor blade to simulate suicide. Afterwards, he also inflicted several cuts on himself with a razor blade with the intention of suicide. He survived these injuries.     

Simulation of homicide to hide child's suicide

A case of pretending a homicide to conceal a child suicide is reported in which characteristic findings of the postmortem examination and conclusions from the analysis of forensic autopsy series provided substantial support for the police investigation. In the late night hours of a spring day the police authorities were informed that a 10-year-old girl had been found dead on a playground near its parents' house. As injuries of the neck were recognized by the police officers a homicide investigation was initiated. The post mortem examination showed a furrow symmetrically slanting from the front to the nape of the neck, discrete punctate haemorrhages of the skin of the face and numerous 'tram-line' bruises of the back, buttocks and extremities. These findings indicated as cause and manner of death suicidal hanging following corporal punishment. Confronted with these conclusions the mother immediately made a corresponding confession.     

Case reports of suicide with an electric drill

In this report, three cases of suicide by an electric power drill are described. In the first case, a man aged 51 was found with four penetrating wounds of the head and chest. The second case involves a 56-year-old man who suffered a penetrating craniocerebral injury and the third case involves a 53-year-old man who suffered one head injury and two chest injuries. In the first two cases, the victims were found dead. In the third case, the victim survived his injuries for 28 hours. The case histories and the post-mortem examinations revealed no evidence of homicide.     

Automatic rifle injuries: suicide by eight bullets. Report of an unusual case and a literature review

A 25-year-old man committed suicide by shooting himself with eight bullets fired from a military rifle set on automatic. This rifle has two firing modes: an automatic mode and a self-loading, single-shot mode. Using this case as an example, some important aspects of firearm injuries are discussed with special emphasis on those points that are relevant to automatic military rifles and most applicable to forensic pathology practice. Some of the pathologic features of firearm wounds are reviewed and the role of the pathologist is discussed. Lastly, the most important points that help the pathologist to determine the type or nature of a firearm death--that is, whether it is an accident, homicide, or a suicide--are discussed. Classically, the number of the firearm wounds is used to differentiate suicide from homicide. As in the case reported here, however, when an automatic rifle or a military rifle set on automatic is used, the number of wounds is not a reliable indicator of the type of 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。     

Suicide with two guns represents a special type of combined suicide

Suicide by simultaneous gunshots with two firearms is rare. The case of a 90-year-old man who killed himself with two 6.35 mm pistols fired at the temples at the same time is presented. The victim was found dead on the terrace of his home; two guns and two cartridges were present near the corpse. Cases of suicides with two guns published in the literature are compared, and the Italian cases are illustrated briefly. The authors describe the circumstances and autopsy findings that permitted the assertion that it was a case of suicide and to exclude an homicide and show, by figures, the three-dimensional reconstruction of cranial shooting injuries. The use of two guns is considered a representation of a special type of "combined suicide" or "planned complex suicide."     

The insanity defense to suicide

The certification of suicide as the manner of death can result in either the complete loss or a significant reduction in life insurance benefits to the victim's survivors. It is, thus, not uncommon for these beneficiaries to contest suicide as the manner of death. Insanity is a recognized defense in law against suicide. It is recognized in law that, in some cases, an insane man cannot intentionally destroy himself. However, it is also recognized that life insurers can exclude suicide by an insane man from coverage. This article discusses the common law doctrines upon which the insanity defense to suicide is based, with references to judicial opinions from cases which involve contested suicides and the issue of insanity.