Analysis of suicide hanging deaths in South Bangalore: A three-year retrospective study

Introduction

Worldwide, hanging is one of the most used suicide methods and hanging is the second most common method employed to commit suicide in India.1 Hanging is a type of violent mechanical asphyxial death which is caused by complete or partial suspension of body by the ligature material, encircling the neck and force of constriction being at least part of the weight of body. When no part of the body touches the ground, such a suspension is referred to as complete hanging. And when some part of the body is in contact with the ground after hanging, it is referred to as partial hanging. While complete hangings are mostly suicidal in manner, partial hanging is regarded as ‘almost always’ suicidal.2 When the ligature is applied around the neck, the knot is positioned at the nape of neck just below the occiput in the midline, such a hanging is called typical hanging and when it is situated at any place away from the nape of neck in the midline it is referred to as atypical hanging.3

Materials and Methods

The study material consisted of 1656 medicolegal autopsies conducted in the department of forensic medicine and toxicology, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka between January 1^st 2011 to December 31^st 2013 making it a period of three years. Of these, 552 cases (33.3%) were deaths due to hanging. Among them 519 hanging deaths were suicidal in manner (94.02%). These suicidal hanging deaths were studied retrospectively after obtaining clearance from the institutional ethical clearance committee.

Results

During this study period, a total of 1656 cases were brought for post-mortem examination out of which 552 (33.3%) deaths were due to Hanging. Of them, 519 Hanging deaths were suicidal in manner (94.02%). The different variables studied were age, sex, socio-economic status, educational qualification, motive, time, type of suspension and position of knot. The highest number of victims 225 (43.35%) belonged to age group of 21-30 years, where mean of age among this group was 26 years. (Table 1) Males dominated females in number of deaths. 325 victims were males (62.62%) and 194 victims were females (37.38%). (Table 2) Among the victims 58.38% belonged to lower socio-economic stratum. (Table 3) Majority of the victims (25.8%) were having an educational qualification up to preuniversity. Shared statistics of 24.85% and 24.08% were victims holding education up to higher primary and basic degree respectively. (Table 4) The most common motive could not be determined and hence categorized as unknown weighing 38.15%, however the second most common motive was found to be a serious family dispute accounting to 36.03%. (Table 5) Majority of the victims committed suicide between 12AM to 6AM which amounted to 40.66% of the total cases. (Table 6) While estimating the suicidal hanging deaths based on type of suspension, we observed that majority of the victims died in complete suspension (66.09%) while the remainder 33.9% died in partial suspension. (Table 7) When we estimated suicidal hanging deaths with respect to the position of knot, we observed that 52.4% of the victims fell under typical hanging category and 47.6% fell under atypical hanging category. (Table 8)

Discussion

Understanding a complex phenomenon like suicide in a country as diverse as India through studies of varying strengths and limitations is quite a challenge with the added burden of under-reported suicides. In this section we attempt to compare our findings with studies made by other researchers on the same topic to arrive at an appropriate conclusion. Majority of the decedents in our study belonged to 21-30 years age group (43.35%) which correlates with findings made by Murkey et al, Kitulwatte et al., Shrivastava et al, Jagtap et al. and Goswami et al.8, 9, 10, 11, 12 However it did not correlate with the findings made by Rao.13 This difference could be due to a greater number of autopsies studied by Rao in his three-year study period which amounted to 968, while we observed only 519 suicidal hangings. Males predominated females in number of deaths (62.62%) as usual and correlated with researchers Kitulwatte et al, Shrivastava et al, Jagtap et al. and Goswami et al.8, 9, 10, 11, 12 with marginal difference in the percentage such as 86.6%, 67.5%, 76.7% and 60% respectively. However, it did not correlate with this finding made by Rao.13 This non-correlation could be due to the higher number of autopsies studied and regional difference of the studied population.

When we compared the socioeconomic and educational background in which we observed majority belonged to lower socioeconomic stratum (58.38%) and higher primary schooling, similar findings were made by Shrivastava et al, Jagtap et al and Murkey et al.,2 but it did not correlate with the study made by Dekal V et al.14 This non-correlation could be explained due to change of time as Dekal V et al conducted their study in the same place as ours between 2004-2006 for a period of two years. A majority of the victims committed suicide between 12AM to 6AM which correlated with the observations made by Dekal V et al. Based on the type of suspension, our study revealed that maximum number of decedents died in complete suspension (66.09%) and this finding correlated with observations made by Rao, Kitulwatte et al, Shrivastava et al and Goswami et al. Based on the position of knot our study showed majority of decedents were victims to typical hanging (52.4%) which correlated with observations made by Jagtap et al, Goswami et al, Kumaret al.15 and Kitulwatte et al and Rao. However, it did not correlate with observations made Shrivastava et al.10 This non-correlation could be due to regional difference of the studied population by Shrivastava et al.10

Conclusion

Males predominantly seem to be victims to suicidal hangings. People in their third decade of life, lower socio-economic strata, and those with family disputes appear to be more vulnerable to suicides by hanging. The time to commit suicide was in the mid-night for the majority and we believe that the reason is in-hand with the psychology of accumulating courage during the daytime. It would be inappropriate to say that people with low education are more vulnerable to suicidal hanging as we have noticed that there was no significant percentage gap between basic degree holders and pre-university students. In-fact we believe that education status has contributed only towards the most common method of hanging which being a complete & typical type. We thereby conclude that in order to reduce the number of suicides by hanging, regular suicide risk assessments in therapy services must be provided to these vulnerable group of people if and when identified.

Source of Funding

Nil.

Conflict of Interest

Nil.