Suicide classification - clues and their use

1. Suicide classification-clues and their use A study of 122 cases of suicide and undetermined manner of death P. Lindqvist, L. Gustafsson / Forensic Science International 128 (2002) 136–14 Yuthapaisan

2. Objective The purpose of this study is to analyse which clues that appear most determinant for forensic pathologists in certifying suicide. Guidelines to support the police investigation as well as the medico-legal examination can probably reduce the number of undetermined cases in cases of possible suicide.

3. Classification of manner of death is important • next-of-kins • insurance issues • research and public health policies

4. Classification in Sweden • natural • self-intended • intentionally caused by another • accidental or undetermined

5. Factors of study • age and gender - previous suicide attempts • mental disorder - alcohol-dependency • suicidal communication - suicide intent • blood (BAC) and urine-alcohol concentrations - toxicological

6. Group of study • autopsied at the Institute of Forensic Medicine in Umea° from • September 1983 through December 1985 • - residing in Va¨sterbottens County (245,181 inhabitants in 1984) • - who’s death was certified as suicide (n = 100) or as undetermined • manner of death (n = 22).

7. The term alcohol-dependency • the forensic pathologist used the term ‘‘chronic alcoholism’’ • in the death certificate. • the deceased was diagnosed or described as an alcoholic in • medical records and/or police reports. • - hepatic cirrhosis and/or steatosis was found and no other • explanation than high alcohol consumption was at hand.

8. Age and gender 122 subjects 91 (75%) 31 (25%) males females suicides undetermine suicides undetermine 45 years (18–87) 48 years (31–63) 39 years (18–66) 56 years (41–70)

9. Blood alcohol test : positive blood alcohol test suicides undetermine 100 22 negative positive positive negative 31 (mean 1.7 g/l; range 0.3–5.9) 69 16 (mean 2.7 g/l; range 0.3–5.0) 6

10. Cause of death related to manner of death in 122 cases of suicide and undetermined death

12. Three clues with the highest explanatory value in determining manner of death among 122 cases of suicide and undetermined deaths a Cases that deviated from the found decision-making pattern of the forensic pathologists.

13. Greater uniformity, consistency and transparency in the classification of suicide is thus desirable and we support the efforts to construct internationally applicable guidelines for certifying suicide. A good teamwork between the police and forensic pathologists is thus of crucial importance not only to reduce the number of undetermined cases but also to secure that the subsequent specified classification of manner of death is correct

14. Validity • autopsied at the Institute of Forensic Medicine in Umea° from • September 1983 through December 1985 • the problems of death by poisoning with illegal drugs have • increased, especially in urban areas. • the pathologists used an indirect method in order to understand • the classification.

15. Conclusion The difficulties in determining manner of death in possible suicides are linked to certain causes of death, in particular poisoning. Operational criteria for designating a death ‘‘suicide’’ can be helpful given that the quality of the primary data collection is good.

16. Thank you