Toxicological risk profiles in suicide: The forensic value of hair-based substance detection

Suicide is a major global cause of premature mortality and a critical public health concern. Chronic alcohol misuse and illicit drug use are well-established risk factors, but conventional post-mortem toxicology frequently fails to detect long-term substance exposure. Hair analysis represents a valuable forensic tool, enabling the reconstruction of pre-mortem behavioral patterns and offering insight into chronic substance use and its association with suicidal behavior.

This retrospective study examined 74 suicide cases (59 males, 15 females) from 2023 to 2024. Hair samples were analyzed for ethyl glucuronide to assess chronic alcohol consumption and screened for psychoactive substances. Demographic data, previous suicide attempts, and methods of suicide were also considered.

Chronic excessive alcohol use was identified in 75.7% of cases, with higher prevalence in females (93.3%) and individuals aged ≥ 65 years (88.9%). Illicit drugs were detected in 25.7% of cases, mainly cocaine (23.0%) and cannabis (17.6%). Polydrug use was found in 66.2% of subjects. Psychoactive drugs were frequently present: benzodiazepines in 63.5%, antidepressants in 36.5%, and antipsychotics in 10.8%. A prior suicide attempt was reported in 23.0% of individuals, with the highest rate among adolescents and young adults (29.4%).

These findings highlight age- and sex-specific toxicological patterns and support the forensic relevance of hair analysis in detecting chronic substance use. Integrating toxicological, clinical, and demographic data enhances post-mortem risk profiling and informs suicide prevention strategies targeting high-risk, underserved populations.