Complex suicides: 21 cases and a review of the literature

Abstract

Abstract Background The use of more than one potentially lethal method together and sequentially to complete suicide is called “complex suicide.” Complex suicides are divided into two groups: planned and unplanned. This study aimed to discuss with literature 21 complex suicide cases identified after a 2-year retrospective study. Results This study included 21 complex suicide cases. Eleven were classified as planned complex suicides, and 10 were labeled as unplanned complex suicides. The average age of all cases was 42.5 ± 17.7 (min: 19, max: 76) years. Suicide notes were present in six (28.5%) cases. Fifteen victims (71.4%) suffered from psychiatric diseases. Twelve victims ingested a toxic dose of medication, nine cases jumped from a height, eight cases used stabbing, six cases used hanging, two cases ingested a corrosive substance, two cases drowned, two cases inhaled a toxic gas, one case ingested cyanide, one case ingested insecticide, and one case used suffocation with a plastic bag. In two cases, three methods of suicide were used together. In the current study, “corrosive substance intake + cyanide intoxication” and “corrosive substance intake + jumping from a height” were defined for the first time and have not been previously described in the literature. Conclusions Complex suicides are highly likely to be potentially mistaken for murder. The cause of death in these cases can be determined with a comprehensive autopsy along with a detailed examination of the scene, statements of relatives, and eyewitnesses.