Complex (Multimodality) Suicides in New York City: 2008-2017

Complex (or multimodality) suicides pose a challenge for forensic pathologists, because they are infrequent and can be mistaken for the more frequent multiple-injury homicides. Complex suicides are suicides in which 2 or more self-inflicted injurious modalities are used. Among all suicides, this specific type has an incidence of 1.5% to 5%. 1 Few publications exist that examined complex suicides, with the largest review discussing only 19 cases. 2,3 To address the need for better characterization of complex suicides, a 10-year retrospective review was conducted of the database of the New York City Office of Chief Medical Examiner. This is the largest case review to date, with 93 complex suicide cases studied and the first American study contributing to this field. Results provide information regarding the demographics of decedents, incidence of mechanisms used, and mechanisms used in series. Results show that in New York City (NYC), complex suicides predominantly include asphyxia, blunt trauma, and drug toxicity. In addition, suicides in NYC occur at a similar incidence to their US national incidence, and demographics of decedents and most common injury mechanisms mirror those of simple suicides in NYC. However, injury mechanisms do not mirror those that are most common nationally. This contrasts with published data and provides a novel insight into suicide modalities in NYC.