Amy E. Austin

Recent Trends in Suicides Utilizing Helium

Abstract:  Retrospective review of cases of suicide involving helium inhalation was undertaken at Forensic Science South Australia over a 25‐year period from 1985 to 2009. No cases of helium‐related suicides were identified in the first 15 years of the study, with one case between 2000 and 2004 and eight cases between 2005 and 2009. Australian data were also reviewed from 2001 to 2009 that showed 30 cases between January 2001 and June 2005, compared to 79 cases between July 2005 and December 2009, an increase of 163%. A review of Swedish data between 2001 and 2009 showed no cases between January 2001 and June 2005, compared to seven cases between July 2005 and December 2009. Thus, all three areas showed recent and striking increases in cases of suicide involving helium inhalation. Given the availability of helium and the recent promotion of this method of suicide, it is quite possible that this may represent a newly emerging trend in suicide deaths.

Suicide in forensic practice – an Australian perspective

In Australia from 1997 to 2006, there were 23,254 suicides recorded, with suicide being the 14th leading category of death in 2008. Of 2191 deaths in that year there were 1151 hangings (53% of cases), 506 poisonings (23%), 170 firearm deaths (8%), 121 falls from heights (6%), 45 drownings and submersions (2%), 43 deaths due to intentional contact with sharp objects (2%), and 155 deaths due to other methods (7%). However, the interpretation of data is not always straightforward. For example, problems arise in comparing Australian data with that from overseas due to different systems for reporting, gathering and classifying cases. Research that relies on national, international and/or large city suicide data may obscure specific local issues and trends, and care should be exercised when interpreting suicide data over particular time periods, as the number of ‘open’ coronial cases at the time of annual data collection may alter the number of suicide deaths reported yearly by central authorities. The conduct and quality of autopsies in different countries is also variable. Thus, when data are analysed and apparent trends discerned these issues should be born in mind.

Cluster Hanging Suicides in the Young in South Australia

Abstract:  Retrospective review of hanging suicides in individuals aged ≤17 years was undertaken at Forensic Science South Australia, Australia, over two 5‐year periods: 1995–1999 and 2005–2009. Seven cases of hanging suicides were identified from 1995 to 1999, with a further 14 cases from 2005 to 2009, an increase of 100% (p < 0.001). Hanging accounted for 33.3% of all suicides in this age group (7/21) from 1995 to 1999, compared with 93.3% of the total number of suicides (14/15) in the second 5‐year period. In contrast, Australian national data from 1998 and 2008 showed a 30% decrease in hanging suicides in the young, from one case/100,000 population in 1998 to 0.7 in 2008. Cluster suicides occur in the young and are often initiated by direct communication. As it is possible that Internet‐based social sites may facilitate this phenomenon, investigations should include an evaluation of the victim’s Internet access given the potential risk of similar actions by peers.

Causes of community suicides among indigenous South Australians

A retrospective review of suicides occurring among Aboriginal people in the community in South Australia over a 5-year period was undertaken from January 2005 to December 2009. Twenty-eight cases were identified, consisting of 21 males (age range 16-44 years, mean 29.9 years) and 7 females (age range 23-45 years, mean 32.0 years). Deaths in all cases were caused by hanging (100%). Toxicological evaluation of blood revealed alcohol (39.3% of cases), cannabinoids (39.3%), benzodiazepines (10.7%), opiates (7.1%), antidepressants (7.1%), amphetamines (3.6%) and volatiles (3.6%). This study has demonstrated that the method of suicide overwhelmingly preferred by indigenous victims in South Australia is hanging. The precise reasons for this preference are uncertain, however, an indigenous person in South Australia presenting as a suicide where a method other than hanging has been used would be exceedingly uncommon, raising the possibility of alternative manners of death.

Multiple injuries in suicide simulating homicide: Report of three cases

Multiple inflicted injuries in traumatic deaths usually indicate homicide. Three cases are reported where homicide was initially suspected due to findings at the death scene and the apparent nature of the injuries however, after investigation, involvement of any other individuals in the deaths could be excluded. Case 1: A 52-year-old male was found with multiple stab wounds. At autopsy, 36 stab wounds were identified, the majority of which were superficial. Only two stab wounds had penetrated deeply. Case 2: A 19-year-old female was found with three gunshot entry wounds to the right temple and a .22 calibre automatic rifle resting across her lap. Case 3: A 47-year-old female was found with numerous haematomas and three deep head wounds in keeping with trauma from impact with a blunt object. A high level of clozapine was detected on toxicological analysis of blood and a history of schizophrenia was reported. Although multiple self-inflicted wounds are most often caused by sharp objects such as knives, on occasion multiple gunshot wounds and rarely, blunt trauma may also be encountered. Careful integration of scene and autopsy findings may be required to avoid misinterpretation of the circumstances and manner of death.

Skin messages in suicide--an unusual occurrence.

Notes are found in only a minority of cases of suicide and occasionally may involve writing messages on skin surfaces. A prospective study was undertaken for cases of suicide with skin messaging over a 12-year period from 1/1/2000 to 31/12/2011. A total of 498 cases of suicide were examined with only 2 cases (0.4%) having suicide notes written on their skin. Both cases involved young males (aged 18 and 30 years respectively) with the deaths occurring by hanging. In both cases typical parchmented ligature marks were present around the neck running up to the point of suspension. Both decedents had written messages on their hands/arms expressing mixtures of sorrow and hopelessness. There were no other suicide notes present. It is not clear whether writing on skin rather than on more conventional material suggests that the suicide may not have been planned, or instead that the decedent wanted to ensure that the message was found. Messages on skin may be slightly different to messages written on other surfaces, as space is limited and pens and markers may not write as effectively. An additional problem with skin messages is their vulnerability to erasure, making clear documentation of these findings at the scene important.

The role of forensic pathology in suicide

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.

Head impalement - An unusual form of suicide

An 80-year-old man with pancreatic adenocarcinoma and depression was found with his head impaled on a bolt that had been screwed into a hole that had been drilled in the floor of a shed at his home address. Once the bolt was in place the decedent had winched a heavy weight above it, using a pulley that he had attached to the metal roof frame, and the front fork of a bicycle frame. The latter had been bolted to a nearby work bench as a winching device. After the weight had been positioned, he had placed his head over the bolt and cut the rope with a kitchen knife. The impact of the falling weight had forced his head onto the bolt with penetration of the cranial cavity. The complexity of the design of the suicide apparatus is exceedingly rare in our experience and the time taken to set up the device indicated that there had been a considerable degree of premeditation. The finding of complex apparatus at a death scene may provide useful information in ascertaining the manner of death and also in providing some indication as to the decedents level of determination to succeed.

Prison suicides in South Australia: 1996-2010

Forty‐eight deaths occurring in prisons in South Australia were identified between January 1996 and December 2010, including 25 cases of suicide (mean age = 37 years; median age = 34 years; age range = 24–70 years). Most suicides were due to hanging (23/25; 92.0%) with victims using bedding, belts, or shoelaces attached to cell shelves, air vents, doors, or other accessible projections. There were no suicides attributed to drug overdose or sharp force injury. Over a third of all suicides (39.1%) occurred during the first month of confinement, with 26.1% of cases occurring within the first week. There was one suicide reported after 2 years of imprisonment. Given that suicide in state prisons currently occurs at a rate approximately eight times that of the general South Australian community, it appears that the subset of incarcerated individuals represents a group in need of effective preventive strategies to enable more appropriate provisions of existing prisoner resources.

Body mass index and suicide

AbstractIt has been suggested that there is a connection between depression and an increased body mass index (BMI). As depression is related to suicide, a South Australian cohort study was performed to test whether a high BMI may also characterize victims of suicide. Body mass indexes from 100 consecutive cases of suicide (male-to-female ratio, 1:1) taken from the files of Forensic Science South Australia in Adelaide, Australia, were compared with BMIs from 100 sex- and age-matched control cases, where deaths were due to accidents, homicides, or natural diseases. No significant differences in BMIs and BMI categories were found between the 2 groups. However, when cases were subclassified according to the method used, BMIs were noted to be considerably lower in hangings than in both the control group as well as in victims who died of alternative means of suicide (P < 0.001). An association between an increased BMI and suicide could not be substantiated in this local study. However, the reasons for the decreased BMIs in hangings require further consideration that may assist in understanding more about particular victim subgroups.