Forensic investigation of complex and complicated suicides in Attica, Greece: a 12-year retrospective study

Forensic and psychopathological framing of complex suicides: A retrospective study over the last 30 years

Complex Suicide (CS) is defined as an unusual form of suicide in which several harmful methods are used, simultaneously or in succession, whose purpose is to avoid the possible ineffectiveness of one of the methods used to produce a certain fatal outcome. The study of CS is of great interest and plays a fundamental role in characterizing the knowledge of these rare events. We have retrospectively evaluated all CS cases examined at the Institute of Forensic Medicine of Milan from 1993 to 2022 (n = 75) with the aim of characterizing the deceased who have resorted to it. We also compared the sample of 75 CS cases with a sample of paired 115 "simple" suicides (with a single method). Our analysis revealed that the CS cases were carried out by a "typical" subject identified as an adult male, between 41 and 50 years old, suffering from psychiatric disorders and, in particular, major depressive disorder. The most frequent harmful mode was plastic bag suffocation associated with self-poisoning. CS cases used less violent methods than simple suicide controls. The pathological-forensic approach has brought to light elements that can be useful both for forensic professionals (pathologists and psychiatrists) in correctly classifying these unusual and challenging events and for clinicians working on the front line. Some profiles have been outlined that can be used to identify potentially vulnerable individuals who could benefit from increased health surveillance to treat and prevent suicide.

A singular case of complex suicide by hanging with hesitation marks by axe

We present a case of complex suicide concerning a 55-year-old man who hanged himself using a rope anchored to a beam on the terrace of his apartment. Multiple parallel linear wounds were observed on his head. At the crime scene, an axe stained with blood and hair was found resting against the wall adjacent to the stairs leading to the upper floor. Forensic investigations identify the cause of death as mechanical asphyxia due to the hanging, in a complex suicide characterized by hesitation marks inflicted on the head with an axe. This specific type of complex suicide has never been described in the literature.