The role of forensic pathology in suicide

Abstract

Suicide represents a significant category of preventabledeath in many countries and communities, and cases canoccupy a considerable amount of time in forensic practice.In Australia, suicide was ranked as the fourteenth leadingcategory of death in 2008, with 2,191 deaths [1]. In SouthAustralia in 2009, there were 198 suicides out of 1,272medicolegal autopsy cases that were performed at ForensicScience SA, the state forensic pathology facility, repre-senting approximately 16% of the total case load.Despite clear indications of deliberate self-destructiveacts in many instances, it is however, sometimes difficult inspecific cases to accurately designate the manner of deathas suicide. For example, suicide notes are present in only aminority of cases, and may not necessarily have beenwritten immediately preceding death. Cases where therehas been a fall from a height exemplify these issues e.g. dida victim fall (an accident), was he or she pushed (ahomicide), or did the victim jump (a suicide). Hangingdeaths may also present difficulties in classification as thisrepresents a very common method of suicide in manycommunities, but may also be responsible for death due tomisadventure in cases of sexual asphyxia, or homicide if adrugged or otherwise incapacitated individual is deliber-ately suspended. Similar problems may occur with deathsdue to drug toxicity, drowning, or in single occupant, singlemotor vehicle collisions. The pathological findings in thesecases may be of no assistance in determining the intentionof the deceased [2, 3].Other cases where there may be difficulty in theassessment and classification include complex suicideswhere more than one lethal method has been used, orwhere the scene has been altered by relatives to disguisethe true nature of the event, most often for religious orinsurance purposes. It may also be difficult to differentiatecertain suicide pacts from murder suicides [2].Further problems occur in the overall assessment ofsuicides when national data are solely relied upon tointerpret incidence and trends over time. Discrepancies inclassifications in different jurisdictions, with added delaysin finalizing cases, may mean that data capture varies fromdifferent areas, and that some deaths may be incorrectlyassigned to later years. It has been suggested in Australiathat a significant number of suicides have been classified as‘undetermined’ manners of death, resulting in under-reporting of suicide to the Australian Bureau of Statistics,the national data repository [4]. It has also been proposedthat the apparent recent decline in suicide rates in Australiamay be due to newly introduced changes in the AustralianBureau of Statistics data collection system [5]. Thus, notonly may national data be suspect, but meaningfulinternational comparisons may be compromised.Where does forensic pathology stand in all of this? Onestrength that forensic institutions have is that despite oftenrelatively low numbers of cases, there is a clear under-standing of where the cases came from, why certaindiagnoses have been arrived at, and how the data have beengathered. This means that studies from single institutionsthat service a specific geographical area may produce morereliable data than studies that have relied upon a largerbody of information that has been compiled from subsetswhere different diagnostic and classification criteria havebeen used, and where capture of all cases may not becomplete. Another disadvantage of national data is thatlocal trends involving small numbers may be lost if data arepooled.