1
|
Commins C, Bolster M, Mulligan L. To investigate the pattern of neck injuries and the role of toxicology in cases of hanging and manual/homicidal ligature strangulation in Ireland between 2016 - 2020: A retrospective review and analysis. J Forensic Leg Med 2024; 103:102686. [PMID: 38692099 DOI: 10.1016/j.jflm.2024.102686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/10/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Abstract
The pattern of neck injuries sustained in fatal cases of external compression to the neck is recorded during Post Mortem Examinations (PME), to assist in the interpretation of the circumstances that led to death. In this study, the PMEs performed for 298 cases of hanging and strangulation occurring between 2016 and 2020 in Ireland were retrospectively reviewed for the purpose of recording and collating the external and internal neck injuries observed during each PME, as well as the toxicology results for each decedent. Statistical analysis was performed to investigate potential novel associations between anthropometric variables pertaining to the decedents and the PME findings in cases of hanging and strangulation, serving to add further data to the existing body of research in this area and to assist in the resolution of future cases of hanging or strangulation where there are conflicting findings. In completing statistical analysis, it was found that there was no discernible association between the occurrences of cartilaginous neck fractures (CNFs) with increasing ligature width. Positive associations between increasing weight and BMI of the decedents were identified, and a significantly positive association between the increasing height of the decedent and the incidence of CNFs were identified. Analysis of the toxicology demonstrated that antipsychotics were implicated most frequently in cases of incomplete and complete hanging associated with CNFs and that opioids were implicated most frequently in cases of manual and ligature strangulation associated with CNFs. OBJECTIVE To record the pattern of neck injuries sustained in retrospective cases of hanging and manual/ligature strangulation and to collate these findings so as to provide scientific evidence to support the interpretation of the findings in future cases of suicidal hanging and homicidal manual/ligature strangulation for the purpose of medicolegal investigation. To analyse the associations between the occurrence of neck fractures and anthropometric variables pertaining to the victims in cases of complete hanging. STUDY DESIGN The reports of 298 Post Mortem Examinations (PMEs) performed for cases of hanging and manual/homicidal ligature strangulation between 2016 and 2020 in Ireland were retrospectively reviewed. Pseudoanonymised data sets were recorded for each report, which included the following parameters: neck injuries (soft tissue and cartilaginous), weight, height, BMI and ligature width, toxicology, noose position, ligature material, tongue protrusion, sex and age. Permission for the use of this data was sought from the pathologists and coroners involved in these cases. The data was analysed according to descriptive statistical methods and logistic regression analysis. RESULTS Logistic regression analysis was undertaken to examine the associations between unit increases in ligature width and increases in a set of physical characteristics of the decedents (weight, BMI and height) with the occurrence of CNFs. Increasing ligature width was not found to increase the likelihood of a CNF occurring, where the Odds Ratio (OR) for this event occurring was 0.9596. Unit increases in body weight and BMI were found to increase the likelihood of the occurrence of a CNF with ORs of 1.0166 and 1.0607 respectively. Increasing height of the decedent yielded an OR = 4.64, demonstrating that CNFs are significantly more likely to occur with increasing height (CI 95 %: 0.2915, 73.9559). CONCLUSIONS According to the statistical analysis performed for this study, increasing weight, height and BMI are parameters of the decedents which increase the likelihood of the occurrence of CNFs in cases of complete hanging.
Collapse
|
2
|
Mahesar RA, Khalil H, Shaikh S, Kalhoro A, Rajar AB, Memon MA, Mamun MA. Exploring suicidality in the aftermath of the 2022 flood in Pakistan: insights from newspaper reports. CNS Spectr 2024; 29:1-3. [PMID: 37581285 DOI: 10.1017/s1092852923002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Rameez A Mahesar
- Department of Media & Communication Studies, Shah Abdul Latif University, Khairpur, Pakistan
| | - Hadia Khalil
- Department of Media & Communication Studies, Sindh Madressatul Islam University, Karachi, Pakistan
| | - Sadia Shaikh
- Benazir School of Business, Benazir Bhutto Shaheed University, Karachi, Pakistan
| | - Aqsa Kalhoro
- Institute of Public Health, People's University of Medical and Health Sciences for Women, Shaheed Benazirabad, Pakistan
| | - Allah B Rajar
- Department of Community Medicine Muhammad Medical College, Ibn-e-Sina University, Mirpur Khas, Pakistan
| | - Momina A Memon
- Department of English, Shaheed Benazir Bhutto University, Shaheed Benazirabad, Pakistan
| | - Mohammed A Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
- Department of Public Health, University of South Asia, Dhaka, Bangladesh
| |
Collapse
|
3
|
Groves S, Lascelles K, Hawton K. Experiences of clinical staff who work with patients who self-harm by ligature: An exploratory survey of inpatient mental health service staff. J Psychiatr Ment Health Nurs 2023. [PMID: 37904647 DOI: 10.1111/jpm.12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/30/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT Self-harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self-harm. Most fatal and non-fatal suicidal behaviours in inpatient settings are a result of ligature use. There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self-harm by ligature. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Key issues related to self-harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self-harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self-harm by ligature. Working with self-harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self-harm by ligature, and unsupported after responding to a ligature incident. WHAT ARE THE IMPLICATIONS FOR PRACTICE Training about self-harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self-harm, and acknowledgement of the emotional impact on staff. Support for staff members who respond to ligature incidents should be available for all staff members who respond to self-harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. ABSTRACT INTRODUCTION: Self-harm by ligature is a common form of self-harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self-harm. AIM We explored the experiences of clinical staff who work with patients who self-harm by ligature. METHOD A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. RESULTS 275 staff members participated. Challenges most frequently reported about working with self-harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. DISCUSSION Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self-harmed by ligature. IMPLICATIONS FOR PRACTICE There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self-harm by ligature.
Collapse
Affiliation(s)
- Samantha Groves
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Karen Lascelles
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Keith Hawton
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| |
Collapse
|
4
|
Etgen T, Stigloher M, Förstl H, Zwanzger P, Rentrop M. Systematic analysis of nonfatal suicide attempts and further diagnostic of secondary injury in strangulation survivors: A retrospective cross-sectional study. Health Sci Rep 2023; 6:e1572. [PMID: 37795312 PMCID: PMC10545888 DOI: 10.1002/hsr2.1572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/12/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023] Open
Abstract
Background and Aims Data on nonfatal suicide attempts in Germany are sparse. The study aimed to analyze data on nonfatal suicide attempts and consecutive diagnostic steps to identify secondary injuries after strangulation. Methods All admissions after nonfatal suicide attempt in a large Bavarian psychiatric hospital between 2014 and 2018 were reviewed and the methods were analyzed. Results A total of 2125 verified cases out of 2801 registered cases of nonfatal suicide attempts were included in further analysis. The most common methods were intoxication (n = 1101, 51.8%), cutting (n = 461, 21.7%), and strangulation (n = 183, 8.6%). Among survivors of strangulation with external neck compression (n = 99, 54.1%), no diagnostic steps were performed in 36 (36.4%) patients and insufficient imaging in 13 (20.6%) patients. Carotid artery dissection was detected in two (4.0%) of 50 patients with adequate neuroimaging. Conclusions This study provides details on nonfatal suicide attempts in Germany. Slightly more than half of the patients with strangulation underwent adequate diagnostic work-up, with 4.0% being diagnosed with dissection. Further studies with systematic screening for dissection after strangulation in psychiatric hospitals are recommended to reduce possible under-reporting.
Collapse
Affiliation(s)
- Thorleif Etgen
- Klinik und Poliklinik für Psychiatrie und PsychotherapieTechnische Universität MünchenMünchenGermany
- Klinik für Neurologie, KlinikumTraunsteinGermany
| | - Manuel Stigloher
- Klinik und Poliklinik für Psychiatrie und PsychotherapieTechnische Universität MünchenMünchenGermany
| | - Hans Förstl
- Institut für Geschichte und Ethik der MedizinTechnische Universität MünchenMünchenGermany
| | - Peter Zwanzger
- Department of PsychiatryLudwig Maximilian UniversityMünchenGermany
- kbo‐Inn‐Salzach‐Klinikum, Klinik für Psychiatrie, Psychotherapie und PsychosomatikWasserburg am InnGermany
| | - Michael Rentrop
- Klinik und Poliklinik für Psychiatrie und PsychotherapieTechnische Universität MünchenMünchenGermany
- kbo‐Inn‐Salzach‐Klinikum, Klinik für Psychiatrie, Psychotherapie und PsychosomatikWasserburg am InnGermany
| |
Collapse
|
5
|
Bednarova A, Habalova V, Iannaccone SF, Tkac I, Jarcuskova D, Krivosova M, Marcatili M, Hlavacova N. Association of HTTLPR, BDNF, and FTO Genetic Variants with Completed Suicide in Slovakia. J Pers Med 2023; 13:jpm13030501. [PMID: 36983683 PMCID: PMC10059737 DOI: 10.3390/jpm13030501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Since suicide and suicidal behavior are considered highly heritable phenotypes, the identification of genetic markers that can predict suicide risk is a clinically important topic. Several genes studied for possible associations between genetic polymorphisms and suicidal behaviors had mostly inconsistent and contradictory findings. The aim of this case-control study was to evaluate the associations between completed suicide and polymorphisms in genes BDNF (rs6265, rs962369), SLC6A4 (5-HTTLPR), and FTO (rs9939609) in relation to sex and BMI. We genotyped 119 completed suicide victims and 137 control subjects that were age, sex, and ethnicity matched. A significant association with completed suicide was found for BDNF rs962369. This variant could play a role in completed suicide, as individuals with the CC genotype were more often found among suicides than in control subjects. After sex stratification, the association remained significant only in males. A nominally significant association between the gene variant and BMI was observed for BDNF rs962369 under the overdominant model. Heterozygotes with the TC genotype showed a lower average BMI than homozygotes with TT or CC genotypes. FTO polymorphism (rs9939609) did not affect BMI in the group of Slovak suicide completers, but our findings follow an inverse association between BMI and completed suicide.
Collapse
Affiliation(s)
- Aneta Bednarova
- 2nd Department of Psychiatry, Faculty of Medicine, Pavol Jozef Safarik University, University Hospital of Louis Pasteur, 041 90 Kosice, Slovakia
- Correspondence: ; Tel./Fax: +421-55-615-27-22
| | - Viera Habalova
- Department of Medical Biology, Faculty of Medicine, Pavol Jozef Safarik University, 040 11 Kosice, Slovakia
| | - Silvia Farkasova Iannaccone
- Department of Forensic Medicine, Faculty of Medicine, Pavol Jozef Safarik University, 040 11 Kosice, Slovakia
| | - Ivan Tkac
- 4th Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, University Hospital of Louis Pasteur, 041 90 Kosice, Slovakia
| | - Dominika Jarcuskova
- 1st Department of Psychiatry, Faculty of Medicine, Pavol Jozef Safarik University, University Hospital of Louis Pasteur, 040 11 Kosice, Slovakia
| | - Michaela Krivosova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Matteo Marcatili
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, 209 00 Monza, Italy
| | - Natasa Hlavacova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| |
Collapse
|
6
|
Marrone M, Cazzato G, Caricato P, Angeletti C, Ingravallo G, Casatta N, Lupo C, Vinci F, Agazzino G, Stellacci A, Oliva A. Diagnostic Methods in Forensic Pathology: A New Sign in Death from Hanging. Diagnostics (Basel) 2023; 13:diagnostics13030510. [PMID: 36766615 PMCID: PMC9914265 DOI: 10.3390/diagnostics13030510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To evaluate the usefulness of studying vital injuries at the sternal head insertion of the sternocleidomastoid muscle in the medico-legal assessment of death by hanging. MATERIALS AND METHODS Study material was obtained from eight bodies of people who died from hanging. The control group included as many specimens collected from people who died from traumatic causes other than hanging (precipitation from medium to large heights and traffic accidents). The structures under study were examined histologically with a BX-51 light microscope (Olympus). An analysis of the extravasated erythrocytes was performed by counting the number per mm2 in the histologic section on 10 HPF (400×), and Student's t-test for a comparison of the averages was applied for all parametric values. The authors noted that the key finding, indicative of the subject's viability at the time of discontinuation, was the presence of recent hemorrhagic infiltrate (in the absence of hemosiderin) at the tendon insertion of the sternocleidomastoid muscle and the proximal part of the muscle itself. RESULTS All specimens tested were positive for the presence of hemorrhagic infiltrate at the portions tested in a statistically significant manner. In contrast, in the control cases there was no or, where present, no statistically significant (p < 0.05) presence of recent hemorrhagic infiltrate. The limitation of the study is the low number of samples examined. In any case, the results obtained are strongly indicative of the possibility of using this type of forensic pathological investigation in cases where there is a doubt in terms of a differential diagnosis between hanging (suicidal type) and suspension of a corpse in a simulation of hanging.
Collapse
Affiliation(s)
- Maricla Marrone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Gerardo Cazzato
- Section of Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-3405203641
| | - Pierluigi Caricato
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Carlo Angeletti
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Giuseppe Ingravallo
- Section of Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Nadia Casatta
- Innovation Department, Diapath S.p.A., Via Savoldini n.71, 24057 Martinengo, Italy
| | - Carmelo Lupo
- Innovation Department, Diapath S.p.A., Via Savoldini n.71, 24057 Martinengo, Italy
| | - Francesco Vinci
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Gisella Agazzino
- Section of Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Alessandra Stellacci
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Antonio Oliva
- Section of Legal Medicine, Public Health Institute, Catholic University of the Sacred Heart, 20123 Milano, Italy
| |
Collapse
|
7
|
Choi NG, Marti CN, Choi BY. Three leading suicide methods in the United States, 2017-2019: Associations with decedents' demographic and clinical characteristics. Front Public Health 2022; 10:955008. [PMID: 36466504 PMCID: PMC9712777 DOI: 10.3389/fpubh.2022.955008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background and aims The U.S. suicide data show that use of lethal methods, specifically firearms and hanging/suffocation, has been increasing among young and middle-aged adults of both sexes over the past decades. In this study, we examined demographic and clinical correlates of use of firearms, hanging/suffocation, and poisoning as suicide methods among suicide decedents age 18+. Methods Data came from the 2017-2019 National Violent Death Reporting System (NVDRS; N = 94,454, age ≥ 18 at the time of suicide; 74,042 men and 20,412 women). We fit generalized linear models (GLMs) for a Poisson distribution with a log link to examine (1) changes in four suicide methods (firearms, hanging/suffocation, poisoning, and other) during the study period, controlling for sex and age group; and (2) correlates of firearms, hanging/suffocation, and poisoning use. Results In all age groups, 55% of men and 30% of women used firearms; 28% of men and 29% of women hanging/suffocation; 9% of men and 32% of women poisoning, and 8% of men and 9% of women "other" methods. Men age < 45 had higher likelihood of firearm and/or hanging/suffocation use than those age 45-64. Women age<45 also had higher likelihood of hanging/suffocation than those age 45-64. Prior suicide attempt history was associated with higher likelihood of poisoning in both sexes and hanging/suffocation in men; mental disorders/SUD were associated with higher likelihood of hanging/suffocation and poisoning in both sexes; physical health problems were associated with higher likelihood poisoning in both sexes and firearm use in men; relationship problems were associated with higher likelihood of firearm use; legal problems and job/financial/housing problems were associated with higher likelihood of hanging/suffocation in both sexes; and more crises were associated with higher likelihood of firearm use in both sexes. Implications The findings call for the following suicide prevention strategies: (1) restricted access to firearms; (2) improved access to mental health/substance use treatment; (3) improved long-term and palliative care services for those (mostly older adults) with physical health problems; (4) financial/housing support policies to mitigate economic hardship; and (5) more research to identify effective strategies to curtail the increasing use of firearm and hanging/suffocation among young and middle-aged adults.
Collapse
Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States,*Correspondence: Namkee G. Choi
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, United States
| |
Collapse
|