Medicolegal evaluation of deaths by hanging in Antalya, between 2007-2016: autopsy results

The leading causes of death in Turkish people are accidents and natural deaths and it was followed by suicides. Hanging is the most commonly used suicide method currently without gender discrimination. In this study, 6863 cases of forensic examination and autopsy carried out by the Mortuary Department of Antalya Branch of the Forensic Medicine Council between 01.01.2007- 31.12.2016 were reviewed, retrospectively. Then 506 cases of hanging (7.4%) were also analyzed in terms of sociodemographic and medicolegal features. In cases of hanging, male/female ratio was 2,5 (363/143; M:%71.7, F:%28.3), the mean age of men was 41.8 (SD ± 17.1) and women was 44.7 (SD ± 22.7). Examination of the cases, in which the origin of hanging was determined, revealed that 499 (98.6%) of cases were suicide and 5 (1.0%) were accident, of these accident cases 2 of them were girls, aged 1 and 6, who were hanged by the rope of the swing they were playing, 1 of them was a 80-year-old woman who was hanged by her sweater when she fell from the tree and her sweater got stuck on a branch, another one was a 6-month-old boy who was hanged by a blanket, the last one was a 2-year-old boy who were hanged from the railing by the rope of his pacifier, while origins of 2 of the cases were unable to be determined due to advanced decomposition. Fifty-nine (11.7%) of the cases had at least one previous suicide attempt. Of all 506 hangings, 11 (2.2%) were cases of complex suicide while 495 (97.8%) of them were isolated hanging cases. Ligature choices were rope for 328 (64.8%) of the victims and 26 of them (5.1%) used scarf or kerchief. Most of the hanging cases were typical hanging (n=495, 97.8%) and the rest were atypical (n=44, 8.7%). In 125 (24.7%) of these cases suspension were complete and in 117 cases (23.1%) were incomplete. Nearly all (n: 502; 99.2%) of the victims had hyperemic lines around the ligature, although 4 (0.8%) of the victims did not. In 416 (82.2%) of the cases, varied marks at neck organs and soft tissues or muscles were found. When the findings on bones and cartilages regarded, fracture in thyroid cartilage was seen in 299 (59.1%), in hyoid bone in 200 (39.5%), in both hyoid and thyroid in 141 (27.8%). Fractures in thyroid cartilage (n=299, 59.1%), hyoid bone (n=200, 39.5%) and in both of them (n=141, 27.8%) were found. Vertebral fracture and dislocation was detected in 7 cases (1.4%). Examination of toxicological analyzes revealed that ethyl alcohol or methyl alcohol was detected in 86 cases (17%) and narcotic drugs detected in 24 cases (4.7%). Also, antidepressants were found in 66 cases (32%), analgesic or antiinflammatory drugs in 46 cases (22.3%), antipsychotic and antiepileptic drugs in 24 cases (11.7%). The results showed that all of the data of suicide by hanging in Antalya and its surroundings were similar to other regions of Turkey and all the world. As a result, in order to prevent suicides which are an important public health problem, it is important to keep the suicide statistics in a more systematic way in our country. Preventive programs should be organized by identifying risk factors and risky groups, attention should be paid to ensure regular psychiatric support especially for those with previous suicide attempts.