UNASSIGNED: Despite being relatively rare in our country, murder-suicide phenomena have garnered increasing media attention over the years. However, actual data on their prevalence and characteristics remain limited. This study aims to describe and characterize all murder/suicide events reported at the Institute of Forensic Medicine in the Province of Messina, with a particular focus on distinguishing between cases of filicide/suicide and dyadic deaths.
UNASSIGNED: A retrospective observational analysis of judicial cases from 2018 to 2023 was conducted. Injuries were primarily localized to the head, neck, and chest for women, and to the head for men. In the case of filicides, death occurred through an asphyxiation mechanism, followed by the mother\'s suicide by hanging or falling.
UNASSIGNED: Within the scope of the medical examiner\'s activities, it is clear that acquiring more information through a standardized technical investigation and adopting a uniform approach could enhance the quality of the forensic service provided daily. This improvement, which would be in the interest of institutions and civil society, could be achieved through the sharing of procedures at both national and international levels.

UNASSIGNED: To determine the manner of death (MOD) and, there-fore, to classify the event as natural, suicidal, homicidal, or accidental is an essential and routine task in forensic medicine. The evaluation of MOD presents numerous difficulties due to unusual anamnestic and circumstantial data, in addition to autopsy findings and postmortem findings.
UNASSIGNED: A mini review of the literature on the topic was performed. Here we report two cases of uncommon self-inflicted multiple GWs (SMGWs) to the head and thorax, suspected of killing. The presence of more than one gunshot wound is suggestive of homi-cide, especially when they involve the head. A review of the literature on the topic was performed on PubMed\'s database, showing, although considered infrequent, cases documenting SMGWs are not rare.
UNASSIGNED: In the cases reported, the initial suspicion of involvement of third persons was excluded through the examination of the death scene, post-mortem (CT and autopsy) findings and clinical-circumstantial data. The analysis derived from the review of the related literature allowed us to highlight the presence of common findings which should be considered in the evaluation of such cases.

BACKGROUND: Bipolar disorder (BD) has a high disease burden and the highest mortality risk in BD comes from suicide. Bipolar disorder type II (BD-II) has been described as a milder form of bipolar disorder; however, extant literature is inconsistent with this description and instead describe illness burden and notably suicidality comparable to persons with bipolar I disorder (BD-I). Towards quantifying the hazard of BD-II, herein we aim via systematic review and meta-analysis to evaluate the rates of completed suicide in BD-I and BD-II.
METHODS: We conducted a literature search on PubMed, OVID (Embase, Medline) and PsychINFO databases from inception to June 30th, 2023, according to PRISMA guidelines. Articles were selected based on the predetermined eligibility criteria. A meta-analysis was performed, comparing the risk of completed suicide between individuals diagnosed with BD-I to BD-II.
RESULTS: Four out of eight studies reported higher suicide completion rates in persons living with BD-II when compared to persons living with BD-I; however, two of the studies reported non-significance. Two studies reported significantly higher suicide completion rates for BD-I than BD-II. The pooled odds ratio of BD-II suicide rates to BD-I was 1.00 [95 % CI = 0.75, 1.34].
CONCLUSIONS: The overarching limitation is the small number of studies and heterogeneity of studies that report on suicide completion in BD-I and BD-II.
CONCLUSIONS: Our study underscores the severity of BD-II, with a risk for suicide not dissimilar from BD-I. The greater propensity to depression, comorbidity and rapid-cycling course reported in BD-II are contributing factors to the significant mortality hazard in BD-II.

BACKGROUND: Evidence is lacking on the risk of suicide-related behaviors (suicidal ideation, suicide attempt, suicide death) in youth with type 1 diabetes (T1D).
OBJECTIVE: We aimed to 1) determine the prevalence of suicidal ideation, suicide attempts, and suicide deaths in adolescents and young adults (AYA) with T1D aged 10-24 years; 2) compare suicide-related behavior prevalence in youth with and without T1D; and 3) identify factors associated with suicide-related behaviors.
METHODS: A systematic search was conducted in MEDLINE, Embase, and PsycInfo up to 3 September 2023.
METHODS: We included observational studies where investigators reported the prevalence of suicide-related behaviors among AYA aged 10-24 years with T1D.
METHODS: We collected data on study characteristics, data on prevalence of suicide-related behaviors, and data on associated factors.
RESULTS: We included 31 studies. In AYA with versus without T1D, pooled prevalence of suicidal ideation was 15.4% (95% CI 10.0-21.7; n = 18 studies) vs. 11.5% (0.4-33.3; n = 4), respectively, and suicide attempts 3.5% (1.3-6.7; n = 8) vs. 2.0% (0.0-6.4; n = 5). Prevalence of suicide deaths ranged from 0.04% to 4.4% among youth with T1D. Difficulties with T1D self-management were frequently reported to be associated with higher rates of suicide-related behaviors. However, findings on the association of glycemic levels and suicide-related behaviors were inconsistent.
CONCLUSIONS: There was a considerable level of heterogeneity in meta-analysis of both suicidal ideation and suicide attempts.
CONCLUSIONS: Suicidal ideation and suicide attempts are prevalent in AYA with T1D. Current evidence does not suggest that these rates are higher among AYA with T1D than rates among those without.

Several studies have been performed to recognize the main features in homicide and suicide sharp wound-related death, revealing that a single cutting wound to the neck is an infrequent event in suicide cases, and several hesitation marks near the fatal injury are usually present. We report a case of an atypical self-inflicted cutthroat injury without tentative marks involving a 79-year-old female. The weapon used, a kitchen knife, was found at the crime scene. The wound had clean margins, and no other incisions were found. Scene circumstances, namely the absence of signs of a break-in, the victim found on the bed, the knife located near the body, the vital wound in an accessible site, and the absence of defense injuries, collectively support a likely suicide. A literature review was also performed to compare forensic data of the case presented with the other 6 cases reported regarding atypical suicide characterized by a single incising cut to the throat without hesitation marks. Given the few cases reported and the lack of gross descriptions and histopathological data available in the literature, additional knowledge of such a case may help forensic pathologists in the identification of suicidal events when a single neck injury is observed. In this frame, suicide by a unique single incising cut to the throat without hesitation marks near the lethal injury may be observed as an atypical presentation, and the crime scene investigation, together with additional background information of the deceased, aid in the identification of the manner of the death.

BACKGROUND: Suicidal hanging resulting in decapitation is rarely documented. This discussion involves a case of a 35-year-old man found decapitated in his residence\'s garden. A systematic literature review on hanging-induced decapitation was conducted to comprehensively investigate and compare the case to existing literature. The study aims to identify frequently described post-mortem findings in cases of suicidal hanging leading to decapitation.
METHODS: A 35-year-old man was found decapitated in his garden, with a jute strap and chimney debris nearby. The cervical region was completely severed along the dorsoventral and craniocaudal plane, exposing internal structures. A ligature mark was present, along with Amussat\'s sign and Simon\'s bleeding.
METHODS: The systematic review of the literature followed PRISMA standards, analyzing 3622 publications from Google Scholar, PubMed, and Scopus databases up to 2023. Inclusion criteria comprised cases of complete or incomplete decapitation resulting from hanging, available in full-text and written in English.
RESULTS: 16 articles on hanging-induced decapitation met the selection criteria; 22 cases were analyzed. Studies, mostly from Europe, showed a mean victim age of 44.3, all male. Fall height ranged from 1 m to 18 m, with various suspension media. Most cases displayed complete decapitation, primarily between cervical vertebrae C1 and C3. Some cases noted collateral findings.
CONCLUSIONS: Complete crime scene investigation and thorough post-mortem examination are crucial for reconstructing events, especially with confounding elements. Precise evidence collection and literature comparison are essential to understand the case and substantiate the forensic pathologist\'s hypothesis in court.

The pattern of neck injuries sustained in fatal cases of external compression to the neck is recorded during Post Mortem Examinations (PME), to assist in the interpretation of the circumstances that led to death. In this study, the PMEs performed for 298 cases of hanging and strangulation occurring between 2016 and 2020 in Ireland were retrospectively reviewed for the purpose of recording and collating the external and internal neck injuries observed during each PME, as well as the toxicology results for each decedent. Statistical analysis was performed to investigate potential novel associations between anthropometric variables pertaining to the decedents and the PME findings in cases of hanging and strangulation, serving to add further data to the existing body of research in this area and to assist in the resolution of future cases of hanging or strangulation where there are conflicting findings. In completing statistical analysis, it was found that there was no discernible association between the occurrences of cartilaginous neck fractures (CNFs) with increasing ligature width. Positive associations between increasing weight and BMI of the decedents were identified, and a significantly positive association between the increasing height of the decedent and the incidence of CNFs were identified. Analysis of the toxicology demonstrated that antipsychotics were implicated most frequently in cases of incomplete and complete hanging associated with CNFs and that opioids were implicated most frequently in cases of manual and ligature strangulation associated with CNFs.
OBJECTIVE: To record the pattern of neck injuries sustained in retrospective cases of hanging and manual/ligature strangulation and to collate these findings so as to provide scientific evidence to support the interpretation of the findings in future cases of suicidal hanging and homicidal manual/ligature strangulation for the purpose of medicolegal investigation. To analyse the associations between the occurrence of neck fractures and anthropometric variables pertaining to the victims in cases of complete hanging.
METHODS: The reports of 298 Post Mortem Examinations (PMEs) performed for cases of hanging and manual/homicidal ligature strangulation between 2016 and 2020 in Ireland were retrospectively reviewed. Pseudoanonymised data sets were recorded for each report, which included the following parameters: neck injuries (soft tissue and cartilaginous), weight, height, BMI and ligature width, toxicology, noose position, ligature material, tongue protrusion, sex and age. Permission for the use of this data was sought from the pathologists and coroners involved in these cases. The data was analysed according to descriptive statistical methods and logistic regression analysis.
RESULTS: Logistic regression analysis was undertaken to examine the associations between unit increases in ligature width and increases in a set of physical characteristics of the decedents (weight, BMI and height) with the occurrence of CNFs. Increasing ligature width was not found to increase the likelihood of a CNF occurring, where the Odds Ratio (OR) for this event occurring was 0.9596. Unit increases in body weight and BMI were found to increase the likelihood of the occurrence of a CNF with ORs of 1.0166 and 1.0607 respectively. Increasing height of the decedent yielded an OR = 4.64, demonstrating that CNFs are significantly more likely to occur with increasing height (CI 95 %: 0.2915, 73.9559).
CONCLUSIONS: According to the statistical analysis performed for this study, increasing weight, height and BMI are parameters of the decedents which increase the likelihood of the occurrence of CNFs in cases of complete hanging.

The use of an electric drill to commit suicide is rare in forensic practice. The aim of the work is to present the first case of this kind from the Upper Silesia. The results of post-mortem examinations and the results of prosecutor\'s examination of case files containing medical documentation from the patient\'s treatment were analyzed. People with mental disorders and diseases may choose unusual methods of taking their own lives, such as using an electric drill. This may cause investigators a lot of doubt as to whether the event was really a suicide. In addition to full post-mortem diagnostics, it is particularly important in such cases to assess the medical history of the deceased, often with the participation of a psychiatrist as a consultant.
Wykorzystanie wiertarki elektrycznej w celu dokonania samobójstwa jest rzadkie w praktyce medyczno-sądowej. Celem pracy jest przedstawienie pierwszego tego rodzaju przypadku z terenu Górnego Śląska. Analizie poddano wyniki badań pośmiertnych oraz wyniki badań prokuratorskich akt sprawy zawierających dokumentację medyczną z leczenia pacjenta. Osoby z zaburzeniami i chorobami psychicznymi mogą wybierać nietypowe metody odebrania sobie życia, takie jak np. użycie wiertarki. Może to powodować duże wątpliwości śledczych, czy zdarzenie miało rzeczywiście charakter samobójstwa. Oprócz pełnej diagnostyki pośmiertnej, szczególnie ważna w takich przypadkach jest ocena przeszłości chorobowej zmarłego, nierzadko z udziałem psychiatry jako konsultanta.

UNASSIGNED: Suicide by firearm is a significant public health concern in specific regions of the world. Depending on firearm availability, any type of firearm may be used, including handguns, shotguns, and long rifles. Common entrance wound sites in suicidal gunshot wounds include the head, with classic gunshot wound locations including the temple, the forehead, the submental aspect of the chin, and inside the mouth. Occasionally, suicidal gunshot wounds occur in atypical body locations such as the back of the head and neck. Given their relative rarity, suicidal gunshot wounds in these regions may be mistaken for homicides. In this report, we present 5 cases of suicidal gunshot wounds to the back of the head and/or neck. In our series, we focus on differentiating each case from homicides involving gunshot wounds in similar areas of the head and neck.

OBJECTIVE: Previous systematic reviews on mental health in athletes have found athletes to be at a potentially increased risk for mental health diagnoses compared to the public. Multiple cross-sectional studies have examined suicide behaviour within different athlete populations, but there is a need for a comprehensive review to synthesize and identify risk factors and epidemiology regarding suicide behaviour in the elite athlete population, especially as it compares to the general population.
METHODS: A systematic literature search was performed in MEDLINE, EMBASE, Scopus, and Web of Science from 1990 to January 2023. Inclusion criteria included original peer-reviewed research articles examining suicidal ideation, suicide attempt, or suicide completion within elite athlete populations. Exclusion criteria included athletes participating in high-school or Paralympic level sports, studies that did not report results regarding elite athletes and non-athletes separately, and non-peer reviewed work. All studies were screened for inclusion by two independent reviewers. The primary outcome variables extracted from included studies included rates, risk factors, and protective factors for suicide behaviour. The study quality and risk of bias was evaluated for each study using the Joanna-Briggs Institute (JBI) critical appraisal tools.
RESULTS: Of the 875 unique studies identified, 22 studies, all of which were cross-sectional in nature, met the inclusion criteria. Seven studies evaluated previous athletes, 13 studies evaluated current athletes, and two studies included a combination of previous and current athletes. Seven studies involved varsity college athletes, nine involved professional athletes of various sports, and six focused on international or Olympic level athletes. The rate of suicidal ideation in professional athletes ranged from 6.9 to 18% across four studies, while the rate in collegiate athletes ranged from 3.7 to 6.5% across three studies. Ten studies compared athletes to the general population, the majority of which found athletes to be at reduced risk of suicidal ideation, suicide attempt, and suicide completion. Only one study found athletes to have increased rates of suicide compared to matched non-athletes. Risk factors for suicide behaviour identified across multiple studies included male sex, non-white race, older age, and depression. Player position, athletic level, sport played, and injuries showed trends of having limited effect on suicide behaviour risk.
CONCLUSIONS: This review suggests that elite athletes generally demonstrate reduced risk of suicidal ideation, suicide attempt, and suicide completion compared to the general population. Coaches should remain aware of specific factors, such as male sex, non-white race, and higher athletic level, in order to better identify at-risk athletes. Limitations of this review include the heterogeneity in the methodology and athlete populations across the included studies. Therefore, future targeted research is essential to compare suicide behaviour between sports and identify sport-specific suicide risk factors.
BACKGROUND: PROSPERO Registration: CRD42023395990.