Complex Suicide: A Dilemma for the Forensic Pathologist—A Case Series with Literature Review

Suicide is a frequent cause of death, often executed through a particular method or means, and also one of the foremost causes of mortality worldwide. Complex suicide refers to instances where more than one method is employed to achieve death and these can be either planned or unplanned. The present series of six cases emphasises the necessity of a comprehensive medicolegal death investigation, which must include not only the performance of a complete forensic autopsy and toxicological evaluation but also the collection of collateral information through interviews with relatives, friends, potential witnesses, suicide notes and digital information to ascertain the cause and manner of death accurately. In this case series comprising six cases, the most commonly employed method of suicide was hanging, frequently in combination with self-smothering and self-inflicted incised wounds. This was followed, in order of frequency, by thermal burns and ingestion of corrosive substances. A combination of hanging and self-smothering was observed in cases one and six. Furthermore, cases two and six exhibited hanging associated with self-inflicted incised wounds, along with evidence of smothering. The remaining cases demonstrated varied patterns, including thermal burns in association with incised wounds. In one case, ingestion of corrosive substances combined with self-inflicted incised wounds was documented. All six cases involved male individuals, indicating male predominance in this series.