Complex and complicated suicides in Friuli (1993–2017)

Abstract

Complex suicides involve more than one suicide method. According to the intention of the victim, they are classified as ‘planned’ when the use of more than one suicide technique has been previously devised by the victim and ‘unplanned’ when the first method turns out to be too painful or insufficient to cause death, and the individual then resorts to other means of suicide. Complicated suicide, on the other hand, is a term that was introduced by Töro and Pollak, in which a failed act of suicide is followed by traumatisation, which has a fatal outcome. This type of death must be distinguished from complex suicides. From a sample of 1160 fatalities (837 males) between 1993 and 2017, we identified 20 (1.72%) cases of complex suicide and three (0.26%) cases of complicated suicide. We considered age, sex, psychiatric history, previous suicide attempts, suicide methods and eventual secondary traumatisation. We also compared planned and unplanned complex suicides. The results show a higher number of planned complex suicides (16 vs. 4), a prevalence of males ( n = 17) and adults (median age = 48 years, range 21–74 range). Plastic bag suffocation and gas inhalation ( n = 8) were the most commonly used methods. Firearms ( n = 4) were used exclusively by males in planned complex suicides. Wrist and forearm cuts ( n = 5) were found in four unplanned and one planned complex suicides, and all of the cases with known previous suicidal attempts ( n = 3) involved planned complex suicides. Complicated suicides concerned three male victims in two failed attempts of hanging and an unforeseen carbon monoxide intoxication following a non-fatal gunshot to the mouth, confirming the rarity of these fatalities.

Emerging issues in the approach to submerged bodies: Water-related deaths in Friuli, northeastern Italy (1993–2020). Analysis of post-mortem reports and some unusual cases

“…Two victims were found to have been under the influence of cocaine: one of these was a 51-year-old man who was the victim of a complex suicide in his boat at sea, due to liquefied petroleum gas inhalation and drowning. 14 Details are summarized in Table 2.…”

Postmortem forensic toxicology cases: A retrospective review from Milan, Italy

“…For example, Pelletti et al [3] made a study at the Bureau of Legal Medicine of Bologna from 2013 to 2017 reporting the increasement of prescription drugs in complex suicides. Another study, analyzed all the fatalities of an Italian region (Friuli‐Venezia Giulia) from 1963 to 2017 focusing on complex suicides and finding a total of eight cases of Plastic Bag Suffocation (PBS) combined with gas inhalation and 4 male individuals that committed planned complex suicides with firearms, however the toxicological findings were not considered in this study [4]. Barranco et al [5], from the Bureau of Legal Medicine of Genoa, selected complex and complicated suicides from 2006 to 2017, finding one death of complex suicide performed with a combination between benzodiazepines, alcohol and wrist cutting.…”