Sociodemographic and Autopsy Findings in Hanging-Related Deaths: Evidence from Isparta, Türkiye

Abstract

Objective Suicide is a major public health issue affecting millions of people worldwide. In particular, hanging has increasingly become a more frequently chosen method of suicide. Understanding the characteristics of suicide cases is of great importance for the development of effective prevention strategies. This study examined suicide cases by hanging that occurred within a specific region. Autopsy findings, along with the location and time of the incident and the sociodemographic characteristics of the individuals, were evaluated collectively to identify factors associated with this type of suicide. Material and Method This retrospective observational study examined findings from 80 autopsies conducted due to hangingrelated deaths in Isparta province, Türkiye, between 2012 and 2020, as well as data about the individuals. Variables such as sociodemographic characteristics, type of hanging, autopsy findings, material used, history of psychiatric illness, suicide note, and contributing factors were defined categorically. Statistical differences between variables were assessed using the chisquare test, and the significance level was set at p < 0.05. Results The majority of the examined cases consisted of male individuals (n = 58, 72.5%). Cervical vertebral fractures were significantly more frequent among individuals aged 65 years and older compared to other age groups (p < 0.05). The use of scarves among women and the presence of hyoid bone fractures among men were found to be statistically significant (p < 0.05). Suicide cases were most frequently observed during the autumn season (n = 30, 37.5%) and predominantly occurred within home environments (n = 56, 70%). Conclusion The findings reveal that suicide is associated with demographic and environmental factors and that age and gender are significantly correlated with certain autopsy findings. The data obtained indicate that suicide prevention strategies should be developed by focusing on both individual and environmental risk factors.

Keywords

• Autopsy
• Forensic medicine
• Prevention
• Suicide

References

1. 1. Turecki G, Brent DA. Suicide and suicidal behaviour. The Lancet. 2016;387(10024):1227–39.
2. 2. WHO. Suicide [Internet]. World Health Organization [cited 2024 Dec 8]. Available from: https://www.who.int/news-room/ fact-sheets/detail/suicide
3. 3. Kurtulus A, Nilufer Yonguc G, Boz B, Acar K. Anatomopathological findings in hangings: a retrospective autopsy study. Med Sci Law. 2013;53(2):80–4.
4. 4. Sudak H, Maxim K, Carpenter M. Suicide and Stigma: A Review of the Literature and Personal Reflections. Acad Psychiatry. 2008;32(2):136–42.
5. 5. Arya V, Page A, Gunnell D, Dandona R, Mannan H, Eddleston M, et al. Suicide by hanging is a priority for suicide prevention: method-specific suicide in India (2001–2014). J Affect Disord. 2019 Oct;257:1–9.
6. 6. Russo MC, Verzeletti A, Piras M, De Ferrari F. Hanging deaths: a retrospective study regarding 260 cases. Am J Forensic Med Pathol. 2016;37(3):141–5.
7. 7. Biddle L, Donovan J, Owen-Smith A, Potokar J, Longson D, Hawton K, et al. Factors influencing the decision to use hanging as a method of suicide: qualitative study. Br J Psychiatry. 2010;197(4):320–5.
8. 8. Cantor CH, Baume PJM. Access to Methods of Suicide: What Impact? Aust N Z J Psychiatry. 1998;32(1):8–14.

9. 9. Hunt IM, Windfuhr K, Shaw J, Appleby L, Kapur N. Ligature Points and Ligature Types Used by Psychiatric Inpatients Who Die by Hanging: A National Study. Crisis. 2012;33(2):87–94.
10. 10. Gunnell D, Bennewith O, Hawton K, Simkin S, Kapur N. The epidemiology and prevention of suicide by hanging: a systematic review. Int J Epidemiol. 2005;34(2):433–42.
11. 11. Joo S, Wang S, Kim T, Seo H, Jeong J, Han J, et al. Factors associated with suicide completion: A comparison between suicide attempters and completers. Asia-Pac Psychiatry. 2016;8(1):80–6.
12. 12. Abd-Elwahab Hassan D, Ghaleb SS, Kotb H, Agamy M, Kharoshah M. Suicidal hanging in Kuwait: Retrospective analysis of cases from 2010 to 2012. J Forensic Leg Med. 2013;20(8):1118–21.
13. 13. Reisch T, Hartmann C, Hemmer A, Bartsch C. Suicide by hanging: Results from a national survey in Switzerland and its implications for suicide prevention. PloS One. 2019;14(9):e0220508.
14. 14. Bhosle SH, Zanjad NP, Dake MD, Godbole HV. Deaths due to hanging among adolescents – A 10-year retrospective study. J Forensic Leg Med. 2015;29:30–3.
15. 15. Cibis A, Mergl R, Bramesfeld A, Althaus D, Niklewski G, Schmidtke A, et al. Preference of lethal methods is not the only cause for higher suicide rates in males. J Affect Disord. 2012;136(1–2):9–16.
16. 16. Balci Y, Albek E. Suicide in the Province of Eskişehir, Turkey: The Approach of Forensic Medicine. Turk J Med Sci. 2003;33(1):43–7.
17. 17. Üzün İ, Büyük Y, Gürpinar K. Suicidal hanging: fatalities in Istanbul retrospective analysis of 761 autopsy cases. J Forensic Leg Med. 2007;14(7):406–9.
18. 18. Kadı G, Çekiç EG, Erbaş M, Balcı Y. Otopsisi yapılan olgularda etil alkol düzeyinin değerlendirilmesi. Muğ Sıtkı Koçman Üniversitesi Tıp Derg. 2017;3(3):1–4.
19. 19. Schwalbe CS, Gearing RE, MacKenzie MJ, Brewer KB, Ibrahim R. A meta-analysis of experimental studies of diversion programs for juvenile offenders. Clin Psychol Rev. 2012;32(1):26–33.
20. 20. Möller-Leimkühler AM. The gender gap in suicide and premature death, or: why are men so vulnerable? Eur Arch Psychiatry Clin Neurosci. 2003;253(1):1–8.
21. 21. Värnik P. Suicide in the world. Int J Environ Res Public Health. 2012;9(3):760–71.
22. 22. Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. The Lancet 2002;360(9339):1083–8.
23. 23. Stack S. Suicide in the media: a quantitative review of studies based on non-fictional stories. Suicide Life Threat Behav. 2005;35(2):121–33.
24. 24. Jayaprakash S, Sreekumari K. Pattern of Injuries to Neck Structures in Hanging—An Autopsy Study. Am J Forensic Med Pathol. 2012;33(4):395.
25. 25. Nikolić S, Živković V. Cervical spine injuries in suicidal hanging without a long-drop—patterns and possible underlying mechanisms of injury: an autopsy study. Forensic Sci Med Pathol. 2014;10(2):193–7.
26. 26. Nikolic S, Micic J, Atanasijevic T, Djokic V, Djonic D. Analysis of Neck Injuries in Hanging. Am J Forensic Med Pathol. 2003;24(2):179–82.
27. 27. Suárez‐Peñaranda JM, Álvarez T, Miguéns X, Rodríguez‐Calvo MS, De Abajo BL, Cortesão M, et al. Characterization of Lesions in Hanging Deaths. J Forensic Sci. 2008;53(3):720–3.
28. 28. Lasota D, Pawłowski W, Krajewski P, Staniszewska A, Goniewicz K, Goniewicz M. Seasonality of suicides among victims who are under the influence of alcohol. Int J Environ Res Public Health. 2019;16(15):2806.
29. 29. Kalediene R, Starkuviene S, Petrauskiene J. Seasonal patterns of suicides over the period of socio-economic transition in Lithuania. BMC Public Health. 2006;6(1):40.
30. 30. Christodoulou C, Efstathiou V, Michopoulos I, Gkerekou M, Paraschakis A, Koutsaftis F, et al. The economic crisis in Greece and its impact on the seasonality of suicides in the Greater Athens Area. Psychiatry Investig. 2016;14(1):16.
31. 31. Holopainen J, Helama S, Björkenstam C, Partonen T. Variation and seasonal patterns of suicide mortality in Finland and Sweden since the 1750s. Environ Health Prev Med. 2013;18(6):494–501.
32. 32. Meel BL. Epidemiology of suicide by hanging in Transkei, South Africa. Am J Forensic Med Pathol. 2006;27(1):75–8.
33. 33. Demirci S, Dogan KH, Erkol Z, Deniz I. A Series of Complex Suicides. Am J Forensic Med Pathol. 2009;30(2):152–4.
34. 34. Habenstein A, Steffen T, Bartsch C, Michaud K, Reisch T. Chances and Limits of Method Restriction: A Detailed Analysis of Suicide Methods in Switzerland. Arch Suicide Res. 2013;17(1):75–87.
35. 35. Balcı Y, Göçeoğlu ÜÜ, Kıymet ME, Seçkin Ç. Autopsy findings of suicidal hanging in Mugla, Turkey. Med Sci Law. 2022;62(2):105–12.
36. 36. Yildiz A, Savci O, Eroglu I, Cayli E. The suicidal deaths in Isparta: A 10-year retrospective autopsy study. Med Sci Int Med J. 2021;10(3):1.
37. 37. Cuchara B, Díaz FJ. An 8-year retrospective study on suicides in Washington, DC. Am J Forensic Med Pathol. 2020;41(1):18–26.
38. 38. Persons JE, Hefti MM, Nashelsky MB. Epidemiology of suicide in an Iowa cohort. Public Health. 2019;177:128–34.
39. 39. Milner A, Sveticic J, De Leo D. Suicide in the absence of mental disorder? A review of psychological autopsy studies across countries. Int J Soc Psychiatry. 2013;59(6):545–54.
40. 40. Sher L. Suicide in individuals with no psychiatric disorders: what makes you vulnerable? QJM Int J Med. 2024;117(5):313–6.