Abstract
The aim of this retrospective socio-demographic analysis is to identify those at higher risk of suicidal hanging in the region of Delhi and the National Capital Region. All deaths due to suicidal hanging from January 2016 to December 2019 reported in the Vardhman Mahavir Medical College and Safdarjung Hospital were included. Suicidal hanging accounted for 2.67% of total autopsied cases; 21–30 years old represented 42.62% of the victims. Male:female ratio was 1.7:1 and 38.37% of cases were from the adjoining areas of Vasant Kunj and Vasant Vihar. Therefore, a preventive strategy should focus concern on young adults, the male sex, and areas of Vasant Kunj and Vasant Vihar.
Introduction
Hanging from the neck, which may be effected by constricting all or part of the circumference of the neck by a ligature in which the force applied to the neck is derived from the gravitational drag of the weight of the body or part of the body. It may cause death by multiple mechanisms that act either independently or in concert like stretching of the carotid complex causing reflex cardiac arrest, venous and arterial occlusion, airway obstruction, disruption of the spinal cord, etc. It is the most common mode of suicide worldwide. In 2019, hanging accounted for 53.6% of total suicidal deaths followed by consumption of “poison” (25.8%) in India.1–3
The study of the pattern of suicidal deaths in a region helps in assessing the social and psychological state of mind of the population. 4 The method depends on several factors such as availability of means, knowledge about lethal effectiveness, and victim’s motivation. Among males and females, the choice of method of suicide is more complexly determined. 5
Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital is the apex teaching institute situated in New Delhi, the national capital of India and accepts cases from Delhi and the National Capital Region (NCR). The aim of this retrospective socio-demographic analysis is to identify those at higher risk of suicidal hanging in the region of Delhi and NCR and help in the development of preventive strategies.
Materials and method
This retrospective study was conducted in the Department of Forensic Medicine, VMMC, and Safdarjung Hospital, New Delhi in the year 2021.
Selection of cases – inclusion criteria
All the cases were brought to the mortuary wing of Safdarjung Hospital for medico-legal autopsy with an alleged history of suicidal hanging and later confirmed by police investigations and autopsy from January 2016 to December 2019. The cases without alleged history of hanging but which later during autopsy came out to be a case of suicidal hanging from January 2016 to December 2019.
Source of information
Autopsy reports. Inquest papers.
Statistical analysis
The presentation of the categorical variables has been done in the form of numbers and percentages (%). The quantitative data with normal distribution were presented as the means ± SD and median with 25th and 75th percentiles (interquartile range). The data entry was done in the Microsoft Excel spreadsheet and the final analysis has been done with the use of Statistical Package for Social Sciences (SPSS) software, IBM manufacturer, Chicago, USA, version 21.0.
Results/observations
A total of 11,325 autopsies were conducted at the mortuary of VMMC and Safdarjung Hospital, New Delhi, of which 2.69% (n = 305) were suicidal hanging deaths during the study period of four years, as shown in Table 1.
Year-wise distribution of total autopsied cases.
Month and time-wise distribution
Maximum (13.14%) cases were seen in the month of May and minimum (3.61%) in January. Both males and females follow the same seasonal trends, i.e. maximum cases in summer (February–May, M = 71, F = 51), followed by a rainy season (June–September, M = 64, F = 32) and winter (October–January, M = 57, F = 30). Across the day, the highest incidence was observed between 6:01 pm to 12:00 midnight (n = 68) in males and between 12:01 pm to 6:00 pm (n = 42) in females and lowest between 12:01 am to 6:00 am in both sexes as shown in Table 2 and Figure 1.
Month-wise distribution of study subjects.
Distribution of time of incidence.
Sex and age-wise distribution
The total number of males and females were 192 (62.95%) and 113 (37.05%), respectively, with a male: female ratio of 1.7:1. Third decade of life (n = 130, 42.62%) showed the maximum number of cases as shown in Table 3. In comparative sex analysis, females were more vulnerable during the second and third decades, and males in the third to fourth decades of their lives as shown in Figure 2.
Age, sex, and nationality-wise distribution of study subjects.
Distribution of age (years) by sex.
Religion-wise distribution
Of all victims, 274 (89.84%) were Hindu, followed by 24 Muslims (7.87%) and 3 Christians (0.98%), as shown in Figure 3.
Distribution of religion of study subjects.
Area-wise distribution
Maximum number of cases were from the area under the jurisdiction of the police station Safdarjung Enclave (n = 57, 18.69%) followed by the police stations Vasant Kunj South (n = 49, 16.07%), Vasant Kunj North (n = 34, 11.15%), and Vasant Vihar (n = 34, 11.15%) as shown in Figure 4.
Distribution of concerned police station of study subjects.
Place of hanging-wise distribution
A total of 262 victims (85.9%) hanged themselves indoors, with the house (84.26%) being the preferred location, as shown in Figure 5.
Distribution of indoor/outdoor of study subjects.
The manner of death was suicidal in all cases.
Discussion
Suicide not only prematurely ends an individual’s life, but immensely affects the lives of people around him or her. Religious, social, and cultural values play an important role. 3 , 6 , 7 Risk factors for suicide are multiple, complex, and interdependent. Some of them are physical illness, mental illnesses, drug, or alcohol abuse, disturbed or broken relationships and family, problems related to work or law, money problems, etc. 8 , 9 This study focuses on the distribution of sex, age, place of hanging, season, time of hanging, and jurisdiction of police stations. Here, too, the number of male victims is more than female as seen in almost all published studies associating the higher tendency to commit suicide by hanging with the male sex. 10 It is seen that males predominantly work outside and earn livelihoods for them and their families, and thus face an increase in stress, pressure, and financial burden that may explain this situation.
In this study, suicidal hanging was seen in all age groups except the first decade, and it is predominantly in the third decade of life which is the most important phase of an individual where one is professionally, socially, and emotionally most active and goes through tremendous stress. This finding is like other studies worldwide. 5 , 6 , 9 , 11 , 12 In females, a younger age group of 11 to 30 years is most vulnerable, and it accounted for nearly two-thirds of the female mortalities by suicidal hanging. In the Indian context, most women marry during the second and third decade of their lives and face increased mental, physical, and social stress leading to acute precipitating events. In males, death due to suicidal hanging was more common during the third and fourth decades of life as with increasing age the expectations of family, society and increasing financial burden leads to chronic stress. A similar study conducted in the rural setup of southern India by Prasad et al. found that acute and/or chronic stress was present in nearly all subjects. Chronic stress is observed more in males and older subjects as compared to females and younger ones. 13
Among victims, the majority were Hindus followed by Muslims and only three were Christians as the population distribution in this region is comprised of a Hindu majority followed by Muslims and very few Christians. Suicide being considered “haram” and strictly forbidden in Islam might be a reason for fewer cases among Muslims. 14
An increase in hanging cases was seen from 2016 to 2018; however, 2019 showed a dip in the numbers. Like other studies, maximum cases were reported in the summer and fewer cases in winter and rainy seasons. 5 , 6 In males, the highest incidence of suicidal hanging was observed between 6:01 pm to 12:00 midnight, whereas in females, it was seen between 12:01 pm to 6:00 pm. This may be that men mostly work in offices during the day and return home late in the evening, while women spend most of their daytime alone at home after kids and husband leave for school and work. In their studies, Preti and Miotto found evidence of seasonality in violent suicides like hanging and suggested the biological determination of seasonal vulnerability in association with the circannual rhythms of central serotonin neurotransmission. 15 , 16 In addition, mood can be influenced by latitude and climate factors such as daytime, daily temperature, daylight, and humidity, as suggested by some studies. 17 , 18
In the present study, victims were from the jurisdiction of 44 police stations from different parts of Delhi and NCR. About two-fifths (41.96%) of the total cases were from the area under the jurisdiction of adjoining police stations, namely Vasant Kunj North, Vasant Kunj South, Vasant Vihar, and Kishangarh of south-west Delhi. Further studies are needed to understand the reasons behind many cases of suicidal hanging from this area. Also, in our study the victim’s own home was the most common place of death followed by isolated outdoor places, as in other studies.19–22 The house is the preferred location as it offers privacy for the victims.
Conclusion
Hanging is the most common method of suicide worldwide. In this study, suicidal hanging accounted for 2.67% of the total autopsied cases and the most common age group was 21–30 years. Males were more often victim, than females as is the case in almost all published studies associating the suicidal hanging to masculine sex. Maximum numbers of deaths occurred during summer with home being the preferred place. About half of the cases were from Vasant Kunj North, Vasant Kunj South, Kishangarh, and Vasant Vihar. Therefore, a prevention strategy should focus on young adults, the male gender, and more extensive studies to understand the reasons behind the many suicidal hangings in these areas.
Footnotes
Acknowledgements
We would like to thank and acknowledge Mr Bhawesh Chandra Jha (Medical Lab Technologist) and Dr Abu Tahir (Intern), Department of Forensic Medicine and Toxicology, Vardhaman Mahavir Medical College and Safdarjung hospital, New Delhi, for helping in data collection.
Author contributions
Aditya Anand – Conception and design of the work. Sanjay Kumar – Approved the version to be published. Surya Kiran Panga – Performed data analysis and interpretation, drafting the article. Laiba Ashraf – Collected the data and designed the analysis. Dibya Sharma – Contributed analysis tools. Sarvesh Tandon – Critical revision of the article.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethical approval
Ethical clearance for this study was obtained from the Institution’s Ethical Committee, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi prior to the conduction of study (S. No. IEC/VMMC/SJH/Project/2021-06/CC-153).