A meta-analytic review of the frequency and patterning of laryngohyoid and cervical fractures in cases of suicide by hanging

The frequency and distribution of fractures are commonly utilized to assist in interpreting the manner of death. In cases of alleged suicide by hanging, however, the evidence base for the frequency and patterning of laryngohyoid and cervical vertebrae fractures resulting from such blunt force traumatic events is limited and so fractures cannot be reliably used to assist in interpreting the manner. Using meta-analytic techniques, this study aimed to estimate frequency and distribution of fractures in the context of relevant intrinsic and extrinsic variables. A systematic review of the literature identified 20 studies with relevant data (8523 cases of suicide by hanging). Meta-analyses identified the frequency and distribution of fractures present and how fracture frequency was affected by the subgroups of age, sex, completeness of suspension, ligature knot position and study design. Results indicated that fracture frequency was variable, there was no unique patterning, and high levels of heterogeneity were present in all variable sub-groups. Age was the only subgroup to show differences. Findings suggest that neck fracture frequency is inconsistent and cannot be predicted by the chosen variables. Subsequently, neck fractures in isolation should not be given weight in medico-legal interpretations of a hanging death as suicidal.     

Understanding deliberate indifference to suicide in corrections facilities: A review of recent legal cases

The US corrections system is the largest provider of mental health care in the country. Suicide is a leading cause of death in corrections facilities with rates of inmate suicide being far higher than the national average. Suicide is an event that can lead to legal action against the facility, staff, and treating health-care providers. Some claims are based on medical malpractice. In this setting, claims may also be brought based on violations of the detainee's constitutional rights. Pretrial detainees and prisoners, alike, have a constitutional right to adequate medical and psychiatric care through the Fourteenth Amendment and Eighth Amendment, respectively. But, there is limited information on constitutional claims made against correctional health-care providers for cases of inmate suicide. To help bridge this gap, the authors conducted a search of federal legal case decisions involving claims against health-care providers for deliberate indifference to a detainee's serious illness or injury in the event of attempted suicide or death by suicide over a 5 year period from 2016 to 2021. Fifteen cases were identified. Five themes emerged from the cases, which could serve as bases for claims against health-care professionals: receiving screening, mental health assessment, treatment, documentation, and attention to facility policies. The cases and their clinical significance are summarized in this article. The materials provide an overview of the problems surrounding correctional suicides and can serve as practice pointers in the corporeal setting.     

105例生前精神异常的水中尸体回顾性分析

目的：分析生前精神异常的水中尸体的特点,为此类案件鉴定和分析提供参考。方法调查2010年1月至2014年6月上海市公安局水上公安局检验的所有生前精神异常的水中尸体档案105例,对死者一般情况、尸检情况、案情调查情况和疾病史进行统计分析。结果自杀104例,死者受教育程度较低,天气较暖时案件较多,尸体多在2d内被发现。多数死者没有自杀史,没有遗书,但在临死前出现行为、心理的异常变化。抑郁症、抑郁状态和精神分裂症是主要的精神障碍类型,仅有9名死者曾坚持进行正规治疗。结论精神异常是投水自杀的高危因素,监护人员应该警惕患者的异常行为,特别是气温转暖时。     

Suicide Bombers in Iraq, 2003–2010: Disaggregating Targets Can Reveal Insurgent Motives and Priorities

Extending data reported by Mohammed Hafez in 2007, we compiled a database of 1,779 suicide bombers who attempted or completed attacks in Iraq from 2003 through 2010. From 2003 through 2006, monthly totals of suicide bombers show a pattern different from the pattern of non-suicide insurgent attacks, but from 2007 through 2010 the two patterns were similar. This biphasic pattern indicates that suicide attacks sometimes warrant separate analysis but sometimes are just one tactic in a larger envelope of insurgent violence. We also show that only 13 percent of suicide bombers targeted coalition forces and international civilians, primarily during the early years of the conflict, whereas 83 percent of suicide bombers targeted Iraqis (civilians, members of the Anbar Awakening Movement, Iraqi security forces, and government entities) in attacks that extended throughout the duration of the insurgency. These results challenge the idea that suicide attacks are primarily a nationalist response to foreign occupation, and caution that “smart bombs” may be more often sent against soft targets than hard targets. More generally, our results indicate that suicide attacks must be disaggregated by target in order to understand these attacks as the expression of different insurgent priorities at different times.     

Changes in the Frequency and Clinical Features of Suicide Attempts in the Midwestern Area of Kanagawa after the Great East Japan Earthquake

The aim of this study was to investigate the relationship between the clinical features of suicide attempts and the Great East Japan earthquake in Kanagawa. We enrolled 592 patients who attempted suicide and were hospitalized for inpatient treatment. Clinical features were compared between before the earthquake (A) and after the earthquake (B) groups. The number of suicide attempts increased from 286 to 306. The rate of increase in suicide attempts in men was the highest in the age group of 40–59 years. The frequency of joblessness, family psychiatric histories, precipitating event, and alcohol intake at suicide attempt was significantly higher in the B group than in the A group. The number of patients in serious condition in the B group was significantly higher than that in the A group. Other clinical features related to suicide in people who were indirectly affected by the earthquake disaster should be investigated to develop targeted prevention strategies.     

Acute Influence of Alcohol,THC or Central Stimulants on Violent Suicide: A Swedish Population Study

Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico‐legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC), or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the nonviolent method self‐poisoning and alcohol‐/illicit drug‐negative suicide decedents. Multivariate analysis was conducted, and the results revealed that acute influence of THC was related to using the violent suicide method–– jumping from a height (RR 1.62; 95% CI 1.01–2.41). Alcohol intoxication was not related to any violent method, while the central stimulant‐positive suicide decedent had a higher, albeit not significant, risk of several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.     

Prison Suicides in South Australia: 1996–2010

Forty‐eight deaths occurring in prisons in South Australia were identified between January 1996 and December 2010, including 25 cases of suicide (mean age = 37 years; median age = 34 years; age range = 24–70 years). Most suicides were due to hanging (23/25; 92.0%) with victims using bedding, belts, or shoelaces attached to cell shelves, air vents, doors, or other accessible projections. There were no suicides attributed to drug overdose or sharp force injury. Over a third of all suicides (39.1%) occurred during the first month of confinement, with 26.1% of cases occurring within the first week. There was one suicide reported after 2 years of imprisonment. Given that suicide in state prisons currently occurs at a rate approximately eight times that of the general South Australian community, it appears that the subset of incarcerated individuals represents a group in need of effective preventive strategies to enable more appropriate provisions of existing prisoner resources.     

Precision Terror: Suicide Bombing as Control Technology

Suicide bombing can be understood as a technology that successfully integrates people, cultures, and hardware into precise, intelligent, lethal weapons systems. Lacking access to the sophisticated electronic guidance systems of their enemies, terrorists have developed a cost-effective alternative technology by using social and cultural pressure to convert human beings into guidance systems for terrorist ordnance. This demonstrates that while terrorists tend to be imitative in their technologies, they can still be effective and difficult to predict. A significant implication that arises from this discussion is that the American tendency to assume that “high-tech” devices will automatically confer an advantage on the United States in the struggle against terrorism should be reconsidered.     

Suicide bombers in Western literature: demythologizing a mythic discourse

In facing the challenge of suicide terrorism today on a global scale, it is tempting to attribute the phenomenon to cultural or religious behavior patterns observed solely in non‐Western countries. Yet recent scholarly research on its possible cultural or religious origins has led less to convincing and satisfactory results than to an unresolved aporia between arbitrariness and contingency. By the same token, little notice is taken of the fact that, in Western history and literature, actions and figures can be found whose development and strategies conspicuously resemble those of today’s suicide bombers. A series of such analogous examples in Western literature from antiquity to the present is explored in order to provide deeper insights into situational and systemic factors at work beyond cultural and religious determinants. To more effectively counter suicide terrorism, alternative policies are proposed with the vision of a peaceful coexistence of diverse cultures and religions.     

Factors related to recidivism for youthful offenders

Little is known about youth who were previously placed in a detention facility and what factors predict a subsequent recidivism to placement. This study of a two-county juvenile offender population (one urban and one rural) investigates what demographic, educational, mental health, substance dependence, and court-related variables predict recidivism to detention placement. Findings from logistic regression analysis indicate that seven variables significantly predict juvenile offenders’ recidivism placement, some expected and some unexpected. Predictors that made recidivism more likely include youth with a previous conduct disorder diagnosis, a self-reported previous suicide attempt, age, and number of court offenses. Conversely, predictors that made recidivism less likely include race (Caucasian), a previous attention-deficit hyperactivity disorder diagnosis, and a misdemeanor conviction. These findings indicate that the use of a community-based suicide and mental health screening and referral approach may help to identify and assist these high-risk youth in receiving needed services prior to juvenile court involvement or during delinquency adjudication.