A study on the incidence of suicide by hanging in the sub-region of Transkei, South Africa

Subarachnoid Hemorrhage Confirmed by Magnetic Resonance Imaging in a Patient with Brain Death owing to Hypoxic Encephalopathy Following Suicide by Hanging

Although true subarachnoid hemorrhage (SAH) is an atypical complication owing to suicide by hanging, pseudo-SAH can often develop because of hypoxic encephalopathy. Therefore, differentiating pseudo-SAH from true SAH using brain computed tomography (CT) is often challenging. In Japan, an individual's cause of brain death must be determined to be eligible for organ donation, regardless of whether true SAH is involved or not. Herein, we report a case of SAH confirmed by magnetic resonance imaging (MRI) in a patient with brain death owing to hypoxic encephalopathy following suicide by hanging. A 48-year-old man attempted suicide by hanging. Upon arrival at the hospital, he developed pulseless electrical activity with apnea. Although spontaneous circulation returned within a few minutes of his arrival, spontaneous breathing did not recover. The patient was in deep comatose state without response to pain stimulation, brainstem reflexes, or electrical activities on an electroencephalogram. Consequently, the patient met diagnostic criteria for clinical brain death based on the Japanese organ transplantation law. Brain CT revealed global hypoxic injury and high density in the basal cisterns and subarachnoid space. Brain MR T2*-weighted imaging revealed low intensity at the left Sylvian fissure underlying the hematoma. These findings indicated brain death owing to hypoxic encephalopathy following hanging, and incidental true SAH was confirmed by MRI. Donor surgery and organ transplantation were performed. Spontaneous SAH can often develop secondary to hanging, and brain MRI can effectively determine whether the cause of brain death involves true SAH.

Epidemiology of Suicide by Hanging in Fars Province, Iran (2011-2019): A Population-based Cross-sectional Study

OBJECTIVES

Hanging is a common method of attempted suicide. This study investigated the epidemiological profile of attempted and completed suicides by hanging in southern Iran.

METHODS

This cross-sectional study was performed on 1167 suicide attempts by hanging between 2011 and 2019. All data related to suicide attempts by hanging were collected from the Fars Suicide Surveillance System. The trends in suicide cases and the mean age of attempted and completed suicides were plotted. The chi-square test was used to identify suicide-related factors. Crude rates of incidence, mortality, and standardized fatality during the study period were calculated. Finally, logistic regression was used to identify the predictors of death in individuals who attempted suicide.

RESULTS

The mean age of those who attempted suicide was 33.21±16.82 years; the majority were male (80.5%). The rate of attempted and completed suicide by hanging were 3.50 and 2.79 per 100 000 people, respectively. The case-fatality rate was calculated as 79.34%. The results of our study indicated an increasing trend in suicide attempts by hanging. The likelihood of death was 2.28 times higher in individuals with a previous history of suicide attempts and 1.85 times higher in those with a psychological disorder.

CONCLUSIONS

The findings of this study suggest an increasing trend in attempted and completed suicide by hanging, especially among individuals with a history of suicide attempts and psychological disorders. It is necessary to take action to reduce the rate of suicide attempts and identify the underlying causes of suicide attempts by hanging.

The Demographic Profile of Suicidal Hanging Deaths in North India

BACKGROUND

Suicidal hanging is the most prevalent means of suicide worldwide, particularly among young people, and reveals the state of mental health in certain indigenous populations. According to the National Crime Records Bureau, hanging was the most frequent cause of suicide in India in 2019 and 2020, accounting for 53.6% and 57.8% of total suicidal deaths.

AIM

The current study examines the seasonal distribution of suicide-hanging fatalities in Rishikesh, Uttarakhand, as well as the male and female incidence.

METHODS

A four-year retrospective examination of autopsy data at the All India Institute of Medical Sciences (AIIMS), Rishikesh, from October 2018 to July 2022. A total of 1720 autopsies were performed during this period with 130 (7.56%) suicidal hangings.

RESULTS

Males were disproportionately impacted (n=100, 76.92%). The ratio of men to women is 3.33:1. The mean ages of the males and females were 33.09 ± 12.59 and 24.9 ± 7.84 years, respectively. The majority of deaths occur in the third decade of life. The summer months saw the highest number of deaths (April-June).

CONCLUSION

This data may be used to identify persons with a higher chance of committing suicide by hanging and can be utilized to help people through a nationwide suicidal prevention program that employs a multi-disciplinary team approach. Epidemiological studies should evaluate the psychosocial characteristics of men and women separately to identify the population at risk and develop preventative approaches.

LIMITATIONS

This is a single-center, retrospective study.

Non-aneurysmal and non-traumatic subarachnoid hemorrhage after attempted suicide by incomplete hanging

Hanging is a common method of suicide that is being reported more frequently in many countries. Several complications including injuries to the cervical spine, neck vessels, and brain can occur after attempted suicide by hanging. There are only a few reports of brain computed tomography and magnetic resonance imaging of hanging victims. The most common abnormality was diffuse cerebral edema. A subarachnoid hemorrhage is an atypical complication by suicidal hanging. We report a case of a female patient who presented to an emergency department with altered mental status after attempting suicide by incomplete hanging. The patient was diagnosed with a non-aneurysmal and non-traumatic subarachnoid hemorrhage. This case shows that spontaneous subarachnoid hemorrhage can develop due to a sudden elevation of intracranial pressure, as occurs with hanging.

Hanging Deaths: A Retrospective Study Regarding 260 Cases

Hanging is a form of asphyxia caused by external pressure on the upper airways deriving from a band tightened by the gravitational weight of the body. During a 33-year period from 1983 to 2015, there were 260 hanging deaths examined at the Brescia Institute of Forensic Medicine (Northern Italy), which represented approximately 40% of all the asphyxial deaths recorded during this period. Almost all of the cases were represented by suicidal events, 1 case was a homicide event and there also was a case of sexual asphyxia. Eighty-two percent of the victims were men; 18% were women. There was an increasing tendency in the ages between 20 and 60 years, and the highest number of cases was observed in the 41- to 50-year age group (23% of the cases). The most common place chosen by the victim was the home setting followed by isolated outdoor places. The most common ligature material was a rope. The pathological findings were evaluated in all cases.

Suicide Ideation in Adolescent South Africans: The Role of Gender and Coping Strategies

With an increasing number of studies showing a rise in adolescent suicidal behaviour and a wealth of literature concerning adolescent coping strategies, this study examined both these issues within a South African context. The interplay between social, political, and economic factors in South Africa, with its history of apartheid, must impact upon the lives of adolescents living in this country and play a role in stress, depression, and feelings of hopelessness, helplessness, and possible suicidal ideation. The objectives of the study were to determine the coping strategies exhibited by a South African sample of adolescents, the relationship between these coping strategies and suicidal ideation, and to investigate whether gender had any influence on this relationship. This study therefore aimed to get a better understanding of the relationship between the variables: suicidal ideation, coping strategy, and gender. Such research is important in learning to understand how adolescents cope, in order for caregivers and professionals in the field to be able to identify potential suicide ideators through their behaviours and coping strategies. A sample of 161 adolescents in grade eleven completed a demographic questionnaire, the Positive and Negative Suicidal Ideation Scale (PANSI), and The Coping Across Situations Questionnaire (CASQ). The findings indicated the majority of the sample (51 %) had a positive outlook on life, feeling optimistic about the future most or a good part of the time. Further results showed that males and females followed the same pattern of coping by scoring highest on the functional coping strategies and lowest on the dysfunctional one. There was a significant difference between males and females on each coping strategy, with females scoring higher than males in each case. Correlation studies indicated a positive significant relationship between active coping (functional coping strategy) and positive suicidal ideation scores (positive outlook on life) and between withdrawal (dysfunctional coping strategy) and negative suicidal ideation scores (negative outlook on life). Results for each gender differed, with the female sub-sample revealing significant correlations between functional coping strategies and positive suicidal ideation scores, while the only significant correlation found within the male sub-sample was between the dysfunctional coping strategy and negative suicidal ideation scores.

Psychosocial correlates of suicidal ideation in rural South African adolescents

Suicide is a prevalent problem among young people in Southern Africa, but prevention programs are largely absent. This survey aimed to identify the behavioral and psychosocial correlates of suicidal ideation among adolescents in Limpopo. A two-stage cluster sample design was used to establish a representative sample of 591 adolescents. Bivariate correlations and multiple linear regression analyses were conducted. Findings show that suicidal ideation is prevalent among adolescents. The psychosocial factors perceived social support and negative feelings about the family and the behavioral factors forced sexual intercourse and physical violence by the partner were found to increase the risk of suicidal ideation. Depression mediated the relationship between these psychosocial and behavioral risk factors and suicidal ideation. This study increased our understanding of the psychosocial and behavioral predictors of adolescent suicidal ideation. The findings provide target points for future intervention programs and call for supportive structures to assist adolescents with suicidal ideation.

Suicide and related health risk behaviours among school learners in South Africa: results from the 2002 and 2008 national youth risk behaviour surveys

BACKGROUND

Attempted and completed suicide constitute a major public health problem among young people world-wide, including South Africa (SA). Suicide attempt and completed suicide increase during the adolescent period. One in 5 adolescents considers attempting suicide, but statistics are frequently unreliable.

METHODS

Data for this study were derived from the 2002 and 2008 South African Youth Risk Behaviour Surveys (YRBS). The study population comprised grades 8, 9, 10 and 11 students in governmental schools in the nine provinces of SA (N = 10,699 in 2002 and 10,270 in 2008). Key outcome measures were suicide ideation and suicide attempts.

RESULTS

Of the total sample, 18% of the students in 2002 and 19% in 2008 reported to have seriously considered and/or made a plan to commit suicide during the past six months (Suicide ideation), whereas 18.5% of students in 2002 and 21.8% in 2008 reported that they had attempted suicide at least 1 time during the past six months. On both suicide measures girls have higher prevalence scores than boys, and older school learners score higher than younger learners. In addition, 32% of the learners reported feelings of sadness or hopelessness. These feelings contributed significantly to the explanation of suicide ideation and suicide attempt next to being the victim or actor in violent acts and illegal substance use.

CONCLUSION

The prevalence of suicide ideation and suicide attempts among South African adolescents is high and seems to be influenced by a wide spectrum of factors at the demographic, psychological and behavioural level. Hence, more research is needed to determine the behavioural and psychological determinants of suicide among youngsters in order to develop comprehensive intervention strategies for suicide prevention and care.

Epidemiology of suicide in South Africa: Setting an agenda for future research

This article offers a synthesis and critical overview of published studies on the prevalence and correlates of completed suicide in South Africa. It examines the evidence that suicide is a serious public health problem and highlights what remains unknown about suicide in South Africa. Reflections are offered on the implications of these studies for subsequent research. Focus areas are suggested for future research in order to provide the information needed to inform public health efforts to reduce the morbidity and mortality associated with suicidal behaviour. This article is of interest to scholars who seek to plan suicide research in South Africa, public health officials who wish to design suicide prevention programmes, and others who wish to gain an overview of the prevalence and correlates of completed suicide in the country.

Attitudes of psychologists and nurses toward suicide and suicide prevention in Ghana: a qualitative study

BACKGROUND

One way of preventing suicide has been increasing awareness among health care professionals of their own attitudes and taboos toward suicide and its prevention.

OBJECTIVE

The purpose of this study was to understand the attitudes of health professionals toward suicidal behavior and its prevention in Ghana.

METHODS

A total of 17 informants (9 clinical psychologists and 8 emergency ward nurses) in an urban center were interviewed using a semi-structured interview guide. Interpretative Phenomenological Analysis (IPA) was used to analyze the data.

RESULTS

We found that the attitudes of these health workers toward suicide and suicide prevention seemed to be transiting between morality and mental health. The psychologists generally saw suicide as a mental health issue, emphasized a caring and empathic view of suicidal persons and approached suicide prevention from a health-service point of view. Mental health education and improvements in primary health care were reported as practical approaches toward suicide prevention. The nurses on the other hand, held a moralistic attitude toward suicide as a crime, viewed suicide persons as blameworthy and approached suicide prevention from a proscriptive perspective. Informal approaches such as talking to people, strengthening the legal code against suicide and threatening suicidal persons with the religious consequences of the act were also indicated as practical approaches to suicide prevention. Educational level, clinical experience with suicidal persons, and religious values, are discussed as influencing the differences in attitudes toward suicide and suicide prevention between psychologists and nurses.

CONCLUSION

Health workers in Ghana need training in suicidology to improve both knowledge and skills relevant for suicide prevention.

Adolescent suicidality as seen in rural northeastern Uganda: prevalence and risk factors

BACKGROUND

Suicidal behavior in adolescence is a public health concern and has serious consequences for adolescents and their families. There is, however, a paucity of data on this subject from sub-Saharan Africa, hence the need for this study.

AIMS

A cross-sectional multistage survey to investigate adolescent suicidality among other things was undertaken in rural northeastern Uganda.

METHODS

A structured protocol administered by trained psychiatric nurses collected information on sociodemographics, mental disorders (DSM-IV criteria), and psychological and psychosocial risk factors for children aged 3-19 years (N = 1492). For the purposes of this paper, an analysis of a subsample of adolescents (aged 10-19 years; n = 897) was undertaken.

RESULTS

Lifetime suicidality in this study was 6.1% (95% CI, 4.6%-7.9%).

CONCLUSIONS

Factors significantly associated with suicidality included mental disorder, the ecological factor district of residence, factors suggestive of low socioeconomic status, and disadvantaged childhood experiences.

A psychological autopsy study of suicidal hanging from Cuttack, India: focus on stressful life situations

Factors and stressful life situations associated with suicidal hanging in a sample from India were studied with a view to explore preventability. Information was collected on consecutive suicidal hanging victims in a 2-year period from various sources including family members through psychological autopsy method. Out of 662 autopsies involving suicide during the study period, 104 had used hanging as the method. Age group of 21-30 years, married females, unmarried males, dowry related stress, unemployment, prolonged illness, failure in examinations, relationship and financial problems were associated more frequently with suicidal hanging. Stresses stemming from social practices and perceptions are linked with considerable number of suicidal hanging, which suggest priority areas for intervention.

Review on plants with CNS-effects used in traditional South African medicine against mental diseases

The majority of the population in South Africa use traditional health care to treat various mental conditions. In this review, we present ethnobotanical information on plants used by the traditional healers in South Africa to treat mental illnesses, specifically epilepsy, depression, age-related dementia and debilitative mental disorders. Details of the recent scientific studies conducted on some of these plants are reviewed. Extracts of Searsia chirindensis, Cotelydon orbiculata and Leonotis leonurus have shown in vivo anticonvulsant activity. Extracts from Searsia dentata and Searsia pyroides showed spontaneous epileptiform discharge in mouse cortical slices, and acted as NMDA-receptor antagonists. Apigenin, amentoflavone and agathisflavone with affinity to the benzodiazepine site on the GABA(A)-receptor were isolated from Searsia pyroides. Naringenin with affinity to the GABA(A)-benzodiazepine receptor was isolated from Mentha aquatica. Agapanthus campanulatus, Boophone disticha, Mondia whitei and Xysmalobium undulatum exhibited antidepressant-like activity in three in vivo models for depression. Amaryllidaceae alkaloids with activity to the serotonin transporter were isolated from Boophone disticha. The alkaloid mesembrine, which act as a serotonin reuptake inhibitor, was isolated from Sceletium tortuosum. Investigations of plants used to treat age-related dementia and debilitative mental disorders lead to the isolation of a number of Amaryllidaceae alkaloids with acetylcholinesterase inhibitory activity from Boophone disticha and Crinum species. Extracts of Mentha aquatica, Gasteria croucheri, Ruta graveolens and Scotia brachypetala inhibited MAO-B. Naringenin was isolated from Mentha aquatica as a MAO inhibitor. Only a small number of the more than 300 southern African plant species reported to treat or affect the CNS have been scientifically evaluated. Very few of the active compounds have been isolated and identified.

Suicidal hanging in Manipal, South India - victim profile and gender differences

Suicide is an important health hazard worldwide. Hanging is one of the preferred means of committing suicide in India. The current research is aimed to describe the victimologic profile and find the gender differences in suicidal hanging in Manipal, South India. A 10-year retrospective review of medicolegal autopsy records was conducted at the Department of Forensic Medicine and Toxicology, Kasturba Medical College, Manipal. A total of 70 cases of suicidal hanging autopsied during the study period spanning from January 1997 to December 2006 were identified. Data on suicidal hanging was obtained, analysed and compared for males and females using Microsoft Excel and Statistical Package for Social Sciences (SPSS) for Windows, version 10.0. Males were predominantly affected (male:female - 2:1). Maximum victims of suicidal hanging were Hindus in their 3rd decade of life. Mean age for males and females was 40.62 years and 29.96 years respectively. Maximum mortalities were noted during summer months. Identification of target population is the prime issue before the process of prevention and health promotion is initiated. A difference in pattern of suicidal hanging exists among males and females. Thus, psychosocial correlates should be addressed separately for males and females in epidemiological studies for identification of population at risk and strategies for prevention.

Pattern analysis of suicide mortality surveillance data in urban South Africa

The typical circumstances of suicide occurrence in post-apartheid urban South Africa are described. Data comprise suicide cases from all geographical locations (urban municipalities) where an injury surveillance system has full coverage. Typical patterns were identified by means of a classification technique applied to eight variables descriptive of the events, their victims, and the suicide level of the cities. Six suicide mortality patterns were identified, most being race-specific and each associated with particular suicide methods. Preventive strategies should target local communities and specific population subgroups, and be appropriate and responsive to their sociocultural needs.

Samsun İlinde Asıya Bağlı Ölümler

Ası intihar amacıyla sıklıkla seçilen bir yöntem olup, kaza ve cinayet olguları nadirdir. Tanımlayıcı tipteki bu çalışmada; ası sonucu ölen olguların demografik özelliklerinin belirlenmesi ve verilerin benzer çalışmalar ile karşılaştırılarak tartışılması amaçlanmıştır. Bu amaçla; Samsun’da 1997-2004 yılları arasında ölü muayenesi otopsi işlemi uygulanan 3261 adli ölüm olgusundan ası sonucu öldüğü belirlenen 61 olgu ile ilgili Samsun Adliyesi arşivinde bulunan kayıtlar retrospektif olarak incelenmiştir. Olguların 37 (%60,7)’si erkek, 24 (%39,3)’ü kadın olup, yaş ortalaması 32,38 + 14,15 (11-79) yıldır. Tüm olgularda orijin intihar olarak saptanmıştır. Olguların %77, Tinde ası eylemi ev ve eklentilerinde gerçekleştirilmiştir. Olguların %91,8’inde olay yeri inceleme tutanağı ve olay yeri krokisi bulunmakla birlikte, olay yerine veya ölene ait fotoğraflar %55,7’sinde mevcuttur. Olguların %77,1’i “tam ası” ve %82,0’si “tipik ası” şeklindedir. Telem tüm olgularda tespit edilirken, ası vasıtası olarak 32 (%52,5) olguda ip-urgan kullanılmıştır. Otopsi uygulanan 51 (%83,6) olgudan 38’inde boyun yumuşak dokularında ekimoz, 32’sinde hiyoid kemik ve/veya tiroid kıkırdakta kırık ve bir olguda da boyun omurlarında ayrılma saptanmıştır. Adli inceleme sürecinin uzamaması ve hatasız sonuçlara ulaşılabilmesi amacıyla, tüm adli ölümlerde olduğu gibi ası olgularında da, ayrıntılı olay yeri incelemesi yapılarak krokiler çizilmeli, fotoğraflar ile desteklenmeli, ölüm nedeni ve adli soruşturma-kovuşturma sırasında ortaya çıkabilecek olası sorunlarm açıklığa kavuşturulması için konunun uzmanları tarafından eksiksiz ve usulüne uygun otopsi yapılması gerekmektedir.Anahtar kelimeler: Ası, intihar, adli otopsi

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.