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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 5  |  Issue : 1  |  Page : 55-58

Retrospective study of sociodemographic profile of suicidal cases by hanging in a tertiary care hospital at Puducherry


Department of Forensic Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India

Date of Submission19-Mar-2019
Date of Acceptance04-Jul-2019
Date of Web Publication19-Jun-2019

Correspondence Address:
Joshima Janardhanan
Department of Forensic Medicine, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Puducherry - 605 014
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_9_19

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  Abstract 


Introduction: Hanging is one of the most common methods of committing suicide worldwide as it is believed to cause instant relatively painless death.
Objectives: The objective of this study is to analyze the sociodemographic profile, ligature material used, and place of incidence among the victims who committed suicide by hanging.
Materials and Methods: The data required for the study were collected and analyzed from all cases of hanging autopsied at a tertiary care center.
Results: It was found that most of the victims belonged to younger and middle age groups. Most cases were males, and majority of the victims opted an indoor location to commit suicide. Ligature materials used in majority of the cases were either synthetic or jute rope. Most of the victims were either unemployed or had worked in harsh conditions which depict their socioeconomic status.
Conclusion: Analyzing the various sociodemographic features of suicide victims is the initial step in formulating effective preventive efforts from a sociological perspective.

Keywords: Hanging, retrospective study, sociodemographic profile, suicide, vulnerable


How to cite this article:
Subramanyam S, Janardhanan J, Sanjana R, Keerthi R, Kumar R M, Vicuna V S, Jairish AP. Retrospective study of sociodemographic profile of suicidal cases by hanging in a tertiary care hospital at Puducherry. J Curr Res Sci Med 2019;5:55-8

How to cite this URL:
Subramanyam S, Janardhanan J, Sanjana R, Keerthi R, Kumar R M, Vicuna V S, Jairish AP. Retrospective study of sociodemographic profile of suicidal cases by hanging in a tertiary care hospital at Puducherry. J Curr Res Sci Med [serial online] 2019 [cited 2019 Sep 18];5:55-8. Available from: http://www.jcrsmed.org/text.asp?2019/5/1/55/260644




  Introduction Top


According to the World Health Organization (WHO), over eight hundred thousand people commit suicide every year all over the world.[1] In India, every year >1 lakh people commit suicide and it accounts for 17.5% of all suicidal deaths in the world.[2] According to the National Crime Records Bureau, Puducherry reported the highest number of suicidal cases in India (36.8%) in 2012 of which 75.4% were by hanging.[3] Hanging is the most common method of committing suicide as it is believed to offer a rapid and relatively painless death, and there is no cost involvement other than that of the ligature material. This retrospective study was conducted in a tertiary care hospital in Puducherry with the aim to identify the sociodemographic profile of vulnerable members of target population.

Objectives

The objective of this study is to analyze the sociodemographic profile, ligature material used, and place of incidence among the victims who committed suicide by hanging.


  Materials and Methods Top


This study was carried out at a tertiary care center in Puducherry. It is a record-based retrospective study. The data required for the study were collected and analyzed from all the cases of hanging autopsied at a tertiary care center from 2015 to 2017.

Inclusion criteria

All hanging cases who were designated as suicide after full police investigations, postmortem examination, and toxicological examination were included in the study.

Exclusion criteria

The exclusion criteria of this study were as follows:

  1. Hanging cases with an ambiguous history
  2. Unidentified bodies found hanging.


Sociodemographic details of victims were extracted from the police inquest report and from the postmortem report. All the data collected were kept confidential to protect the identity of the study participants. The current study was approved by the Institute Research Committee, and ethical clearance was obtained.


  Results Top


During the study period from January 1, 2015, to December 31, 2017, a total of 604 cases were autopsied, out of which 65 cases were death due to hanging. The sociodemographic profile of victims such as age, sex, marital status, ligature material used, and place of hanging were analyzed using Microsoft Excel sheet (version Microsoft Office 365 2010) and are tabulated in [Table 1] and [Table 2].
Table 1: Age distribution of cases

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Table 2: Occupational status of cases

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Age

In our study, the age of the victims ranged from 15 years to 87 years. The cases were arbitrarily divided into nine groups with each group including a decade of years. Case distribution among various age groups is given in [Table 1].

Gender

In the present study, the number of males who committed suicide by hanging outnumbered females. Forty-six cases (70.73%) were male and 19 cases (29.23%) were female, as shown in [Figure 1].
Figure 1: Gender distribution of cases

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Marital status

More number of married individuals committed suicide by hanging than unmarried individuals, as shown in [Figure 2].
Figure 2: Marital status of cases

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Ligature material used

As per the present study, the ligature material used by majority of the victims was found to be synthetic or jute rope (38.46%). The other ligature materials used were nylon saree (27.69%), cotton dhoti (21.53%), dupatta (7.60%), cable wire (3.07%), and cotton towel (1.50%).

Place of hanging

Of 65 cases of suicidal hanging which were studied, 38 cases (58.46%) committed suicide indoors while 27 cases (41.53%) committed suicide outdoors.

Occupational status

The study also showed that majority of them were unemployed (32.30%). The occupational profile of the victims is depicted in [Table 2].


  Discussion Top


A multisite intervention study on suicidal behaviors by the WHO had revealed that it is possible to reduce suicidal death by brief and low-cost intervention in developing countries. It is important to study the socioeconomic conditions and cultural factors involved in hanging cases in order to identify the vulnerable people who are likely to commit suicide in a target population.

The study showed that majority of cases (35.4%) were between 31 and 40 years, and this was followed by 32.3% of cases in 21–30 years' age group. This is the most economically productive and active age group of any society. Various studies conducted by Elfawal and Awad,[4] Batra and Dongre,[5] Azmak,[6] Dixit et al.,[7] Luke et al.,[8] Morild,[9] Sharma et al.,[10] Singh et al.,[11] Uzün et al.,[12] Sharma et al.,[13] and Bhosle et al.[14] also document that majority of cases of hanging are usually found among the young and middle age groups. An individual who is in the prime of his or her life gets exposed to various stressful circumstances of life such as strained relationships, emotional instability, addictive behaviors, failure in examinations, and economic problems which can act as precipitating factors to commit suicide. However, other studies conducted by Simonsen[15] and Bowen[16] contradict this finding and found hanging as a preferred method of committing suicide among the elderly.

The present study also showed that majority of suicide victims were male (70.73%). This finding is similar to studies conducted by Elfawal and Awad,[4] Batra and Dongre,[5] Azmak,[6] Dixit et al.,[7] Luke et al.,[8] Morild,[9] Sharma et al.,[10] Singh et al.,[11] Uzün et al.,[12] Sharma et al.,[13] Bhosle et al.,[14] Nikolic et al.,[17] and Paparo and Siegel.[18] In a patriarchal society such as ours, it is not uncommon for a male to bear most of the family's burden, which becomes even more stressful when he is the only earning member of the family and fails to meet the economic needs of his family. Moreover, addiction to alcohol, which is alleged to be an important factor associated with suicide, is found to be more prevalent in males than in females in this study population. However, our study is in contrast to the studies conducted by Naik et al.,[19] Saisudheer and Nagaraja,[20] Rastogi and Kochar,[21] and Banerjee et al.,[22] where there is female preponderance in cases of suicide by hanging.

The study also finds that most of cases involved married individuals (64.6%), which is similar to studies conducted by Saisudheer and Nagaraja,[20] Udhayabanu et al.,[23] and Mohanty et al.[24] It might be due to the fact that the amount of responsibility, stress that arises out of career failure, economic instability, and inability to balance personal and professional life are more for a married individual than an unmarried person. An unmarried individual can weather a career failure or an economic depression as he does not have any additional responsibility of taking care of a family.

This study also found that 58.6% of cases committed suicide in indoor location which is similar to various studies conducted by Sharma et al.,[13] Simonsen,[15] Bhosle et al.,[14] Nikolic et al.,[17] Udhayabanu et al.,[23] Mohanty et al.,[24] Rawat and Rodrigues,[25] and Kumar et al.[26] Location which is selected by the victims may be someplace which can be accessed easily but at the same time gives them adequate privacy and seclusion so that the act of suicide could be completed without any external interventions.

On analyzing the ligature material, it was found that majority of victims used synthetic or jute rope (38.46%) and synthetic saree (27.69%) as ligature material, which is similar to findings of other authors like Simonsen,[15] Dixit et al.,[7] Luke et al.,[8] Uzün et al.,[12] Sharma et al.,[13] Bhosle et al.,[14] Nikolic et al.,[17] Mohanty et al.,[24] and Rawat and Rodrigues.[25] It shows that easily available materials were used as a ligature. Even though other ligature materials found in the present study such as cotton dhoti, dupatta, cable wire, and cotton towel are also easily available, their questionable reliability might be the reason for them not being used frequently as ligature material by the victims.

The current study also found that 32.30% were unemployed and 27.69% were employed as laborers at the time of their death. This finding is similar to studies by Bhosle et al.,[14] Rawat and Rodrigues,[25] and Kumar et al.[26] Earlier studies have correlated low socioeconomic status with increased incidence of suicide as negative ideas about life and suicidal ideation are found to be prevalent among individuals with economic depression, unmanageable debts, and food insecurity.[27]

Limitations of the study

This study was conducted in a small group of population, and the findings obtained cannot be significantly extrapolated to the rest of the wider population without conducting similar studies in other parts of the country. Various personal stressors were also not analyzed in this study.


  Conclusion Top


Suicide or attempted suicide is one of the major indicators of mental health of a population. It is also a drain on the workforce of the society as majority of the victims fall within the economically productive age group of the society as shown in this study. This study is an initial step toward a larger multicentric study where further analysis including the precipitating factors of suicide among younger victims can be analyzed and necessary sociological interventions can be made to prevent this socioeconomic burden on our society.[28]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Preventing Suicide: A Global Imperative, Executive Summary. Geneva, Switzerland: WHO Press; 2014.  Back to cited text no. 1
    
2.
Vijaykumar L. Suicide and its prevention: The urgent need in India. Indian J Psychiatry 2007;49:81-4.  Back to cited text no. 2
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3.
Accidental Deaths and Suicides in India, National Crime Records Bureau, Ministry of Home Affairs, Government of India; 2012.  Back to cited text no. 3
    
4.
Elfawal MA, Awad OA. Deaths from hanging in the Eastern Province of Saudi Arabia. Med Sci Law 1994;34:307-12.  Back to cited text no. 4
    
5.
Batra AK, Dongre AP. A Preliminary analysis of medico-legal autopsies performed over five years in a rural health district of Maharashtra state of India. J Forensic Med Toxicol 2003;20:41-6.  Back to cited text no. 5
    
6.
Azmak D. Asphyxial deaths: A retrospective study and review of the literature. Am J Forensic Med Pathol 2006;27:134-44.  Back to cited text no. 6
    
7.
Dixit PG, Mohite PM, Ambade VN. Study of histopathological changes in thyroid, salivary gland and lymph nodes in hanging. J Forensic Med Toxicol 200;18:1-4.  Back to cited text no. 7
    
8.
Luke JL, Reay DT, Eisele JW, Bonnell HJ. Correlation of circumstances with pathological findings in asphyxial deaths by hanging: A prospective study of 61 cases from Seattle, WA. J Forensic Sci 1985;30:1140-7.  Back to cited text no. 8
    
9.
Morild I. Fractures of neck structures in suicidal hanging. Med Sci Law 1996;36:80-4.  Back to cited text no. 9
    
10.
Sharma BR, Harish D, Singh VP, Sigh J. Ligature mark on the neck: How informative? J Indian Acad Forensic Med 2005;27:10-5.  Back to cited text no. 10
    
11.
Singh P, Marak F, Longkumer K, Momonchand A. Suicides in imphal. J Indian Assoc Forensic Med 2005;27:85-6.  Back to cited text no. 11
    
12.
Uzün I, Büyük Y, Gürpinar K. Suicidal hanging: Fatalities in Istanbul retrospective analysis of 761 autopsy cases. J Forensic Leg Med 2007;14:406-9.  Back to cited text no. 12
    
13.
Sharma BR, Harish D, Sharma A, Sharma S, Singh H. Injuries to neck structures in deaths due to constriction of neck, with a special reference to hanging. J Forensic Leg Med 2008;15:298-305.  Back to cited text no. 13
    
14.
Bhosle SH, Batra AK, Kuchewar SV. Violent asphyxial death due to hanging: A prospective study. J Forensic Med Sci Law 2014;23:1-8.  Back to cited text no. 14
    
15.
Simonsen J. Patho-anatomic findings in neck structures in asphyxiation due to hanging: A survey of 80 cases. Forensic Sci Int 1988;38:83-91.  Back to cited text no. 15
    
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Bowen DA. Hanging – A review. Forensic Sci Int 1982;20:247-9.  Back to cited text no. 16
    
17.
Nikolic S, Micic J, Atanasijevic T, Djokic V, Djonic D. Analysis of neck injuries in hanging. Am J Forensic Med Pathol 2003;24:179-82.  Back to cited text no. 17
    
18.
Paparo GP, Siegel H. Neck markings and fractures in suicidal hangings. Forensic Sci Int 1984;24:27-35.  Back to cited text no. 18
    
19.
Naik S, Patil DY. Fracture of hyoid bone in cases of asphyxial deaths resulting from constructing force around the neck. J Indian Acad Forensic Med 2005;27:149-53.  Back to cited text no. 19
    
20.
Saisudheer T, Nagaraja TV. A study of ligature mark in cases of hanging deaths. Int J Pharm Biomed Sci 2012;3:80-4.  Back to cited text no. 20
    
21.
Rastogi P, Kochar SR. Suicide in youth: Shifting paradigm. J Indian Acad Forensic Med 2010;32:45-8.  Back to cited text no. 21
    
22.
Banerjee G, Nandi DN, Nandi S, Sarkar S, Boral GC, Ghosh A. The vulnerability of Indian women to suicide a field-study. Indian J Psychiatry 1990;32:305-8.  Back to cited text no. 22
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23.
Udhayabanu R, Toshi S, Baskar R. Study of hanging cases in Pondicherry region. IOSR J Dent Med Sci 2015;4:41-4.  Back to cited text no. 23
    
24.
Mohanty S, Sethi A, Patnaik KK, Mishra A. Socioeconomic demographic study of suicide among the people in Southern town Berhampur of Odisha state (India). Austin J Forensic Sci Criminol 2014;1:1-6.  Back to cited text no. 24
    
25.
Rawat V, Rodrigues EJ. Medico-legal study of hanging cases in North Goa. Int J Forensic Sci Pathol 2015;3:110-8.  Back to cited text no. 25
    
26.
Kumar C, Rana N, Goyal AK, Tanna J, Pathak A, Patil VR. Epidemiology of cases of hanging at Vadodara, Gujarat. IRPMS 2015;1:23-6.  Back to cited text no. 26
    
27.
Ju YJ, Park EC, Han KT, Choi JW, Kim JL, Cho KH, et al. Low socioeconomic status and suicidal ideation among elderly individuals. Int Psychogeriatr 2016;28:2055-66.  Back to cited text no. 27
    
28.
Vijayakumari N. Suicidal hanging: A prospective study. J Indian Acad Forensic Med 2011;33:355-7.  Back to cited text no. 28
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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