Forensic pathological study of complex and complicated suicides: A twelve-year case series in Genoa (Italy)

Generally, the term complex suicide refers to a form of suicide in which more than one traumatic method is applied, simultaneously or consecutively, through multiple self-injurious actions using different methods and involving various bodily sites. A distinctive feature of complicated suicides is the failure of the initial attempt of the self-suppressive method that, nonetheless, results in death due to a subsequent accidental occurrence. In such cases, forensic pathologists and coroners are faced with the challenging differential diagnosis that generally includes homicide as well as suicide. We retrospectively analyzed autopsies from complex and complicated suicides registered at the Medicolegal bureau of Genoa (Italy) from 2006 to 2017. In the considered period, nineteen cases of complex suicides were identified and with only one case of a complicated suicide. In our series, the most frequent method of complex suicide was the cutting of the wrists followed by (unplanned) hanging for a total of eight cases (42.1%). The next most common cause (21% of cases) involved the jumping from a height after wrist cutting. In each case, it was necessary to meticulously examine the crime scene, reconstruct the chain of events, confirmed by the testimonies of relatives or eyewitnesses, review any medical history, particularly for psychiatric conditions, and perform a thorough autopsy so as to firmly establish the methods and causes of death.