Forensic investigation of complex and complicated suicides in Attica, Greece: a 12-year retrospective study

The purpose of this study was to examine the prevalence and characteristics (victims' profiles, circumstances surrounding the incidents, and methods employed) of complex and complicated suicides over a 12-year period in the broader area of Athens, Greece. A retrospective analysis of 5,568 autopsy cases performed at the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens from January 1, 2011, to December 31, 2022, was carried out. Out of a total sample of 5,568 autopsies, 360 suicide cases were identified, among which 14 (3.9%) were classified as complex suicides, and one case (0.3%) was identified as complicated suicide. Among the victims, 78.6% were males. The age range of the victims varied between 25 and 82 years old. The most prevalent method of complex suicide was the use of sharp objects followed by jumping from a height (42.8%). The next most common combination of methods was poisoning (21.4%) along with hanging. Prior suicidal attempts and suicide note were mentioned in 16.7% and 8.3% of the cases respectively. Overall, a total of 9 different methods were used in the above 14 cases. Only half (50.0%) of the victims had an established psychiatric diagnosis. In determining the cause of death in cases of a complex or complicated suicides, it is of utmost importance for the forensic pathologist to gather and analyze all available information provided by the police, the victim's relatives along with a thorough investigation of the scene, a detailed autopsy and a toxicological analysis.