Pattern of Suicide Methods and Postmortem Toxicological Findings in Suicide-Related Deaths

Abstract

Suicide is a public health threat that leads to morbidity and mortality worldwide. In this study, we evaluated postmortem toxicological finding among forensic autopsies on suicidal deaths from 2010 to 2016 at the Legal Medicine Center of Zanjan Province (northwest of Iran). All suicide fatal cases were investigated to define the cause and manner of death. Toxicological analyses were performed using thin-layer chromatography, high-performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography, and gas chromatography equipped with nitrogen phosphorus detector. Demographic data (age, sex, educational level, residential location, and marital status), cause of death, and postmortem toxicological findings were extracted from forensic reports and were entered into the designed questioners. During this period, a total of 181 cases of suicide deaths were investigated. Among them, 74% were male. The most often used suicide method was hanging, followed by self-poisoning in young people. Aluminum phosphide was the most frequent poison detected in the fatal suicidal cases (33 cases), followed by opioids. Hanging and self-poisoning were the frequent suicidal method in young male population. It seems that psychological and social supports in young people along with restriction to easy access to drugs and poisons should be considered by policy making and healthcare authorities.

Investigation of polymorphic variants of SLC6A4, TPH-1, and TPH-2 genes in cases of completed suicide

“…In a study conducted with 2587 suicide-related deaths in Finland, it was found that men typically died through suicide by hanging and women through self-poisoning [57]. Another study on 181 cases that underwent post-suicide forensic autopsy in Iran reported that the most common suicide method was hanging in men, and consuming drugs and toxic substances in women [58]. In our study, it was found in 100 suicide cases that resulted in death that the most common method of suicide was by hanging in men, consistent with the literature, and the most common suicide method was also by hanging in women, which was contrary to other studies.…”

Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System

“…Sources focusing on fatal intoxication are forensic autopsy records (integrating circumstantial, autoptic, and toxicological data), forensic toxicology databases (collecting post-mortem blood levels), and the Office for National Statistics. Forensic studies accurately report the causes and manner of death inferred from comprehensive post-mortem investigations but usually address small single-center samples [ 12 – 16 ] and search for few drugs [ 17 – 19 ]. Databases reporting toxicological results present data from multiple centers, but not always allow to infer the intention behind the intoxication (i.e., whether homicidal, accidental, or suicidal) [ 20 ], as post-mortem blood levels are not representative of ante-mortem levels or of doses taken [ 20 – 22 ].…”

Substances Detected During Coroner Postmortem Toxicology Analyses in Poisoning- and Nonpoisoning-Related Suicides

“…Opioids, both prescribed and illicit, remain a concern in high-income countries . In contrast, pesticides often predominate in poisoning suicides in lower-income countries …”

“…4,8 In contrast, pesticides often predominate in poisoning suicides in lower-income countries. 8,9 Nationwide surveillance of suicide and self-harm is essential for detecting the emergence of new methods, including toxic substances used, to allow targeted means restriction and priority antidote development. 10 Indeed, means restriction to reduce public access to poisons is a populationlevel intervention associated with a decrease in suicide deaths by poisoning without a corresponding increase in other methods of suicide.…”