Original CommunicationRetrospective study on suicidal cases by sharp force injuries
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.
References (36)
- et al.
Harakiri and suicide by sharp instruments in Japan
Forensic Sci
(1973) - et al.
Eight cases of suicide by self-cutting or – stabbing: consideration from medico-legal viewpoints of differentiation between suicide and homicide
J Clin Forensic Med
(1997) - et al.
Suicide by self-stabbing
Forensic Sci Int
(1992) - et al.
Tentative injuries in self stabbing
Forensic Sci Int
(1983) - et al.
Criteria for homicide and suicide on victims of extended suicide due to sharp force injury
Forensic Sci Int
(2003) Multivariate analysis (‘forensiometrics’) – a new tool in forensic medicine. Differentiation between sharp force homicide and suicide
Forensic Sci Int
(1998)- et al.
Patterns in sharp force fatalities – a comprehensive forensic medical study: part 2. suicidal sharp force injury in the Stockholm area 1972–1984
J Forensic Sci
(1988) - et al.
Suicide in a large West German city (1985–1989)
Versicherungsmedizin
(1992) - et al.
Economic crisis and suicide in Geneva: 1991–1995
Arch Kriminol
(1998) - et al.
Tod durch scharfe Gewalt. Kriminologische und kriminalistisehe Aspekete
Arch Kriminol
(1991)
Uber ungew6hnliche suizidale Stichverletzungen
Arch Kriminol
Unusual self-inflicted injuries simulating a criminal offence
Int J Legal Med
An unusual suicide by stabbing: a case report
Med Sci Law
Retrospective investigation of medico-legal autopsy cases involving mentally handicapped individuals
Jpn J Legal Med
Sharp injury fatalities in New York City
J Forensic Sci
Clinicopathologic features of fatal self-inflicted incised and stab wounds: a 20-year study
Am J Forensic Med Pathol
Suicides by sharp force: typical and atypical features
Int J Legal Med
Forensic pathology
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