A forensic medical evaluation of patients presenting to Akdeniz University Faculty of Medicine Hospital with a history of suicide attempt and self-harm

Suicide attempts and self-harms constitute major public health problems with significant medical, psychiatric, and forensic implications. From a forensic–medical perspective, comprehensive assessment of demographic characteristics, suicide methods and motives, psychiatric and substance-use history, injury severity, life-threatening conditions, and treatment processes is essential both for accurate medicolegal documentation and for the development of effective prevention strategies. This study aimed to examine, from a forensic–medical standpoint, the characteristics of patients presenting to hospital following suicide attempts or self-harms and to compare the resulting data with existing literature in order to contribute to the scientific evidence base. Between 1 January 2014 and 31 December 2024, a total of 906 cases who presented to Akdeniz University Hospital due to suicide attempt or self-harm and had sufficient information recorded in the digital patient record system were included in the study. Of these cases, 91,5% (n=829) involved suicide attempts, while 8,5% (n=77) involved self-harm. Among the cases presenting to the hospital as a result of suicide attempts (n=829), 56,8% (n=471) were female and 43,2% (n=358) were male. Among the cases presenting due to self-harm (n=77), 63,6% (n=49) were male and 36,4% (n=28) were female. Suicide attempt cases (n=829) most frequently presented during the spring season, accounting for 29,6% (n=245), followed by summer with 26,9% (n=224), autumn with 22,6% (n=187), and winter with 20,9% (n=173). It was determined that the cases predominantly presented on weekdays (n=609; 73.5%), most commonly on Wednesdays (n=136; 16.4%), followed by Tuesdays (n=129; 15.6%) as the second most frequent day, and Mondays (n=121; 14.6%) as the third most frequent day. Among suicide attempt cases (n=829), hospital presentation frequency during daytime hours was observed to begin increasing from 09:00 onwards, with a progressively more pronounced increase in presentation frequency as the hours advanced after midday. Between 12:00 and 15:00, 11,3% of cases presented to the hospital, followed by 16,4% between 15:00 and 18:00 and 16,8% between 21:00 and 24:00. Between 18:00 and 21:00, 15,2% of cases presented; although there was no increase compared with the preceding time interval, the high frequency of presentations persisted. The most frequent time of presentation was between 00:00 and 03:00 (n=178; 21,5%), and it was determined that 53,5% of cases presented between 18:00 in the evening and 03:00 at night. Between 03:00 and 09:00, the presentation frequency was 10,7%. Among cases who attempted suicide on weekdays, 58,9% (n=359) presented to the hospital between 18:00 and 06:00, outside of standard working hours. The mean age of patients who attempted suicide was 29,2 years (SD 12.5), with ages ranging from 11 to 90 years. The mean age among male patients (n=358) was 33,3 years (SD 13.1; range 12–90), whereas the mean age among female patients (n=471) was 26,2 years (SD 11.1; range 11–66). The highest frequency of suicide attempts was observed in the 25–34 year age group (26,3%, n=218), while the lowest frequency occurred in individuals aged 65 years and older (1,4%, n=12). Regarding marital status, 55,7% (n=462) of cases were single, 30,8% (n=255) were married, and 10,0% (n=83) were divorced. In cases of attempted suicide, the frequency of single women (59.4%) is higher than that of single men (50.8%). However, in cases of attempted suicide, the frequency of married men (35.0%) is higher than that of married women (27.6%). All four cases of engaged individuals who attempted suicide were women. Educational status data were available for 527 cases; among these, 15,4% (n=81) were primary school graduates, 32,6% (n=172) were secondary school graduates, 34,7% (n=183) were high school graduates, and 15,9% (n=84) were university graduates. Drug intake was the most frequently used suicide method, accounting for 67,0% (n=556) of cases. Among female patients (n=471), the most common suicide method was drug intake (77,9%, n=367). Among male patients (n=358), drug intake was also the most frequently used method (52,8%, n=189). Among cases (n=64, 7,7%) involving the use of sharp or penetrating instruments, 54,7% (n=35) were male and 45,3% (n=29) were female. Among cases (n=62; 7,5%) involving firearm use, 88,7% (n=55) were male and 11,3% (n=7) were female. Among cases (n=54; 6,5%) involving non-pharmaceutical toxic substances, 61,1% (n=33) were male and 38,9% (n=21) were female. Among cases (n=13; 1,6%) involving hanging, 84,6% (n=11) were male and 15,4% (n=2) were female. Among cases (n=38) involving combined suicide methods, 60,5% (n=23) were male. Although suicide attempts by jumping from a height were more frequent among females (78,1%, n=25) than males (21,9%, n=7), this method accounted for only 5,3% of all female suicide attempts. Among the 566 suicide attempt cases for whom the ingested drug group was known, antidepressants were used in 30,4% of cases (n=123 females, n=49 males), non-steroidal anti-inflammatory drugs in 29,2% (n=111 females, n=54 males), paracetamol in 23,9% (n=93 females, n=42 males), and antibiotics in 14,0% (n=51 females, n=28 males); these drug groups were observed more frequently among females. Antipsychotics were used in 19,8% of cases (n=54 females, n=58 males) and were more commonly observed among males, whereas the number of female and male cases who had ingested anxiolytic medications, which were observed in 13,1% of cases, was equal. Among individuals who attempted suicide by injuring themselves with a firearm, 20,7% (n=13) were in the 35–44 age group, 19,0% (n=12) were in the 45–54 age group, and 17,5% (n=11) were in the 25–34 age group. Where as, among those who attempted suicide by injuring themselves with a sharp or piercing instrument, 41,1% (n=37) were in the 25–34 age group, while 22,2% (n=20) were in the 15–19 age group. In 30,9% (n=256) of attempted suicide cases, injuries were determined not to be amenable to treatment by basic medical intervention. Injuries amenable to basic medical intervention were significantly more frequent among cases involving drug ingestion (75,9%, n=350), whereas injuries not amenable to basic medical intervention were significantly more common among cases involving jumping from a height (90,0%, n=27) and firearm use (100,0%, n=62). Injuries not amenable to basic medical intervention were more frequent in males (56,3%, n=144) than in females (43,7%, n=112). Life-threatening conditions were identified in 19,4% (n=161) of attempted suicide cases, and 61,5% of these cases involved male patients. Among patients presenting due to self-harm (n=77), 39,0% (n=30) had injuries or findings not amenable to treatment by basic medical intervention, and 13,0% (n=10) sustained injuries that were life-threatening. In 74 out of 77 cases reporting self-harm, marital status was known, and men were significantly more prevalent in all single, married, and divorced groups (64,0%, 61,5%, 60,0% respevtively). Among cases with a documented psychiatric disease history (n=436), 19,7% (n=86) had a history of psychiatric illness without a specified diagnosis. Of the 350 cases with a recorded diagnosis of psychiatric illness, 40,3% (n=141) had a history of depression, 13,4% (n=47) of anxiety disorder, 10,6% (n=37) of bipolar disorder, and 10,3% (n=36) of alcohol/substance dependence. In patients diagnosed with psychiatric illnesses, conducting a "Suicide Risk Assessment" as a standard procedure during routine check-ups and implementing appropriate treatment and support programs can be beneficial in reducing suicide risk. Of the 110 (13,3%) cases with life-threatening conditions and a recorded history of psychiatric illness, 65,5% (n=72) were recorded as having a history of psychiatric illness. There were 196 cases (23,6%) whose injuries were not of a mild nature remediable by basic medical treatment and for whom documented information regarding a history of psychiatric illness was available; among these cases, 59,7% (n=117) were found to have a history of psychiatric illness. It should be remembered that all suicide attempts and self-harms are forensic cases, and doctors are required to prepare forensic reports regarding these incidents. Blood alcohol positivity at hospital admission was detected in 25,2% (n=209) of suicide attempt cases. Among 526 cases for which the location of the incident was known, 79,3% (n=417) occurred in the patient's place of residence. For 659 cases (79,5%), a reason for the suicide attempt was documented in the medical history. Among these cases, family conflict or involvement in a divorce process was reported as the reason for the suicide attempt in 24,1% (n=159), reasons related to mental illness in 22,3% (n=147), problems related to parents in 19,1% (n=126), and problems related to a close friend or partner (romantic relationship) in 17,9% (n=118). Through media and education, society should be made to understand that it is acceptable for individuals to seek psychological and psychiatric support during difficult times and when they are struggling with emotional coping, and that they should not hesitate to do so. Records indicated that 240 patients had previously attempted suicide on one or more occasions. Healthcare professionals, particularly emergency department physicians, who examine, treat, and evaluate patients following suicide attempts have both medical and medico-legal responsibilities. Increasing awareness among healthcare professionals and ensuring appropriate psychiatric support for individuals who attempt suicide may help prevent subsequent and more severe suicide attempts and may contribute to a reduction in suicide-related mortality.