Distinguishing Suicidal Hanging from Homicidal Ligature Strangulation – A Diagnostic Accuracy Study of Autopsy and Scene Findings

Introduction: Differentiating suicidal hanging from homicidal strangulation remains a critical challenge in forensic pathology due to overlapping scene findings, ligature patterns, and internal neck injuries. Accurate classification is essential for justice, mortality reporting, and public health surveillance. This study aimed to evaluate the diagnostic accuracy of autopsy, internal neck injury, and scene findings in distinguishing suicidal hanging from homicidal strangulation. Methods & Materials: This observational, cross-sectional autopsy-based forensic study analyzed 120 cases (95 suicidal and 25 homicidal) after excluding incomplete or decomposed cases. The study was conducted at the Department of Forensic Medicine at Dhaka Medical College from January 2022 to July 2022. The manner of death was determined through combined scene evidence, police inquest, and autopsy consensus. Data were collected using a structured pro forma, and statistical analysis was performed using SPSS (version 26.0). Results: Suicidal hangings were marked by oblique, non-continuous ligature marks above the thyroid cartilage, parchmentization, and no defense injuries, while homicidal cases showed horizontal marks, fractures, and signs of struggle. Sedatives were found only in homicides. The predictive model accurately distinguished suicides from homicides (AUC = 0.97, sensitivity = 97%, specificity = 92%). Conclusion: Careful assessment of the scene and autopsy findings can effectively differentiate suicidal hangings from homicidal strangulations. Oblique, non-continuous ligature marks above the thyroid cartilage and absence of defense injuries indicate suicide, while horizontal marks, internal trauma, and struggle signs suggest homicide.