Original Communication
Retrospective study on suicidal cases by sharp force injuries

https://doi.org/10.1016/j.jflm.2007.08.006Get rights and content

Abstract

A total of 65 suicidal cases due to sharp force injuries (cut and/or stab wounds) were investigated. Suicide by sharp force injuries accounted for 2.5% of all suicides in our prefecture during 1995–2005. The 65 victims were composed of 49 males and 16 females, and the age range of 50–70 years was most common. A history of psychiatric disease was found in 11 victims, and depression was the most common disease followed by schizophrenia. Of 65 cases, 8 victims had a history of previously attempting suicide. In 41 cases, a suicide note or will was found. Forty-six cases had pleural sharp force injuries. Interestingly, the remaining 19 deaths were due to a single sharp injury. Cutting injuries were predominantly located at the flexor side of the wrist (11 cases, 38%), followed by the neck (10 cases, 34%). On the other hand, stab wounds were most commonly located in the chest (17 cases, 49%). Tentative wounds, which were superficial cut wounds or stab wounds, were present in 37 cases (57%). In 27 of 37, hesitation marks were observed in close proximity. Tentative wounds more frequently appeared in cut injuries than in stab injuries. Of 28 cases with fatal cut or stab wounds localized in the trunk, 11 cases (39%) had clothing damage. In the discrimination between suicide and homicide, forensic pathologists should obtain information on victims and witnesses as well as investigating the scene and postmortem examination of the victim.

Introduction

The increase of suicide cases is a serious social problem in Japan. Cutting or stabbing is an uncommon method of suicide. Several lines of accumulating evidence demonstrated that the ratio of suicide by sharp force injuries to total suicidal cases was 2–3%.[1], [2], [3], [4] Moreover, Bajanowski et al.5 reported that the ratio of homicides to suicides by sharp weapon injury was 5:2. When forensic pathologists encounter cases of fatal sharp force injury, they are required to differentiate suicide from homicide based on the injury type, its location, and scene investigation by police. Classically, typical suicidal cases by sharp force injuries are associated with three of the following from the viewpoint of forensic pathology: (1) several (not multiple) injuries are observed at the possible site of self-infliction; (2) tentative wounds are present; (3) clothing damage(s) is absent. Thus, these three aspects can contribute to the discrimination of suicide by cutting or stabbing from homicide. However, several lines of accumulating evidence have reported suicidal cases with such unusual findings as multiple self-inflicted injuries, a single stab wound, no hesitation marks, or clothing injuries, which do not agree with the classical criteria as mentioned above.[6], [7], [8], [9] According to the previous study, Kondo and Ohshima10 mentioned that a psychiatric history with or without medical treatment was sometimes found in atypical suicidal cases, and suggested the importance of investigating the medical history of each victim as well as medico-legal inspection and/or autopsy.

In the present study, we retrospectively investigated suicides by fatal sharp force injuries, and discussed the medico-legal aspects of the differentiation between suicide and homicide.

Section snippets

Materials and methods

We investigated all inquest records collected between 1995 and 2005 in cooperation with the First Department of Criminal Investigation of Wakayama Prefectural Police Headquarters. The suicide-related records were carefully assessed by inquest doctors and were additionally confirmed by other medical doctors in our group. During 1995–2005, there were 2556 suicides in Wakayama Prefecture, among which, 65 cases (2.5%) were committed by sharp weapons. In each case, the victim’s details, including

Case profile

Among 65 suicides by sharp weapon injury, 49 were male, and the remaining 16 were female (Fig. 1). Their ages ranged from 18 to 86 years, and 36 (55%) were 50–70 years of age. A history of psychiatric disease was found in 11 victims (17%), in whom depression was the most common disease followed by schizophrenia. Of 65 cases, 8 had a history of previous attempted suicide. In 41 cases (63%), a suicide note or will was found. Concerning location (Table 1), 39 (60%) committed suicide at home: the

Discussion

It is needless to say that differentiating between suicide and homicide is one of the most important issues in forensic practice. In general, hanging is the most common method of committing suicide. When forensic pathologists encounter fatal cases due to sharp weapon injury, they should be careful to differentiate between suicide and homicide because unusual suicide cases have been reported.6 Thus, we performed a retrospective study on suicide cases due to sharp force injuries, and compared our

Acknowledgement

We thank the staff of the First Department of Criminal Investigation of Wakayama Prefectural Police Headquarters for their kind cooperation.

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