Introduction

Asphyxia is exclusion of air from lungs, literal meaning is pulselessness or without throbbing pulse.1 Literally, the term asphyxia denotes absence of pulsation (Pulselessness), though its usage in Forensic medicine has generally come to mean a lack of oxygen. Actually asphyxia is best described as an interference with respiration due to any cause- mechanical, environmental or toxic. 2 Violent deaths resulting from asphyxia chiefly include Hanging. Asphyxial death forms one of the modes of death which may be suicidal, homicidal or accidental in nature. As a rule of thumb, hanging is considered as suicidal unless proved otherwise. 3 Apart from autopsy, the place, review of scene of crime, psychological state of deceased, substance abuse, employment etc. may add to the conclusion. Always with some stress, suicide by hanging is noted in productive age group of youngsters.

According to NCRB reports the incidence of suicides by hanging increasing every year by India, 31.5% in 2010, 32.2% in 2011, 37.0% in 2012. 4 The present study aims towards analysing socio- demographic pattern, causes precipitating factors for committing suicide by hanging in this region.

Materials and Methods

Observation and Results

The study was conducted on total 59 cases of alleged history of hanging that were brought to mortuary of SRTR Government Medical College, Ambajogai, Dist. Beed, Maharashtra, India, for post mortem examination. The period of study was from 1^st January 2018 to 31^st December 2018. During this period total number of autopsy conducted was 462. The table and results are self-explanatory.

Discussion

In this study, cases were divided in seven age groups. Maximum deaths were reported (20 cases ie. 33.89%) in 21-30 age group followed by (11 cases ie.18.64%) 51-60 years age group. Nine cases were from 11-20 year age group (Table 1). Similar finding were mentioned by Sharija S et al 5 as male preponderance was noted in her study group, also as well preponderance of female victims was noted in the younger age groups. Males committed suicide a little bit later, between 21 to 60 years. Waghmare P B. et al 6 also mentioned that, most commonly affected age group was between 21 to 30 years. Reason for that was Productive younger age group commonly vulnerable. Ashok Kumar Samantha et al7 also mentioned that age range of the victims from 11 – 40 years, where victims were under increased pressures and burdens of life. Shrinivas Reddy et al 8 states that, asphyxial deaths were more in age group of 21–30 years (34.93%) followed by 11-20 years (20.10%) and 31–40 years (17.80%) respectively. However Tanuj Kanchan9 mentioned that 3^rd to 5^th decades were the most affected age groups, together accounting for 75.7% (n=53) of the total hanging deaths, which is slightly differ from our study as second most common age group of 51-60 years. The study conducted at our hospital and author’s study at respective place shows co-relation between the age groups affected.

Among of 59 cases of hanging, 42 were males (71.18%) and 17 were females (28.81%). Male female ratio was 2.5:1 (Table 2). Similar findings were shown by Tanuj Kanchan 9 as majority of the victims were males (n=53, 75.7%). Sharija S. et al 5 mentioned that, Majority of male victims were manual labourers (45%). Shrinivas Reddy et al 8 also mentioned that, incidences of asphyxial death among males were 259 (59.14%) deaths and in females were 179 (40.86%) deaths. The study conducted at our hospital and authors study at respective place shows co-relation between the male and female pattern affected.

Among males, maximum number of cases 10 (23.80%) were found in age group 51-60 years followed by 9 cases (21.42%) in age group 21-30 years and 8 cases (19.04%) in age group 21-30 years and no case from age group below 10 years, however study carried out by Tanuj Kanchan 9 shows 3^rd to 5^th decades were the most affected age groups, together accounting for 75.7% (n=53) of the total hanging deaths, which is the only finding having co-relation with our study as other authors Sharija S. et al, Waghmare P. B. et al 6 and Ashok Kumar Samantha et al, 7 Shrinivas Reddy et al 8 shows 21-30 years age group as the affected age group shows little bit similar from their findings as second most common finding in male age group.

Among females, maximum number of cases 11 (64.70%) were found in 21-30 age group followed by 4 cases (09.52%) in age group 11-20 years and 01 case each (05.88%) from age group 51-60 and 31-40 years. No case from age group below 10 years (Table 3). Similar findings were noted by Sharija S. 5 Waghmare P B et al 6 states that, Out of 21 married women, 10 women had committed suicide within 07 years of marriage. The study conducted at our hospital and authors study at respective place shows co-relation between the female age group affected.

According to marital status, in our study 15 cases (25.42%) were unmarried, 44 cases (72.88%) married including one case was widow. (Table 4) Similar findings were noted by Waghmare P B et al 6 and he mentioned that, prevalence of suicide was more in married people. He noted that, out of 21 married women, 10 women had committed suicide within 07 years of marriage. However Sharija S et al 5 mentioned that, marriage does not seem to be a protective factor particularly for the males in Kerala unlike western data, where 55.8% of victims were married.

In our study, we found that, maximum number of cases 11 (18.64%) were reported in month of June followed by September 09 (15.25%), May 07 (11.86%), January 06 (10.16%), October and December 05 (08.47%) cases each, February 04 (06.77%), April and November 03 (05.08%) cases each, March, July and August 02 (03.38%) cases each. (Table 5) Similar findings were mentioned by Tanuj Kanchan, 9 she noted that, peak incidence of suicidal hanging among males was in June (n=8, 15.1%) and for females in September (n=5, 29.4%). Waghmare P. B. et al 6 mentioned that, relatively fewer cases occurred in monsoon season. The study conducted at our hospital and authors study at respective place shows co-relation with seasonal variation.

By occupation, most of deceased were farmer, Laborer and housewife 14 (23.72%) each. There were 08 (13.55%) students. (Table 6). Similar findings were mentioned by Sharija S et al, 5 she noted that, as majority of male victims were manual labourers (45%); majority of females were housewives (53.8%). Only a very small proportion of females were working women in the society. Unemployed persons constituted 15.5% of the victims, probably due to lack of social/financial support. Increased stress of daily life, faced by persons belonging to lower socio economic strata could have been the precipitating event. Kachare Rajesh et al 10 in their study reported that, 514 (82.90%) cases were of farmers followed by house wives 55 (8.87%). The study conducted at our hospital and authors study at respective place shows co-relation with occupation of victims.

Place of suicide was home in 36 cases (61.01%), tree at farm in 19 cases (32.20%) (Table 7). Waghmare P B et al6 reported home as a place of choice for committing suicide. Sharija S et al5 reported one case of youngest victims, a 11 year old boy and a girl who committed suicide at home, problems at school being cited as reason. They were not from the same school and were from different areas of the same city. The study conducted at our hospital and authors study at respective place shows co-relation with place of suicide.

In our study, we found the reason/predisposing factor for suicide by hanging was chronic alcoholism in 09(15.25) cases, chronic illness in 07(11.86%) cases and mental disorder in 06(10.17%) cases. No cause/ predisposing factor could be reviewed in 30 (50.84%) cases. (Table 8). Sharija S et al 5 also reported chronic alcoholism as predisposing factor in males (76.1%). Kerala is infamously renowned for high alcohol consumption rate when compared to the other major states of the country. Therefore this finding could be a reflection of the ill effects of increased alcohol consumption, on the community. Immediate psychological problems (33.7%), chronic illness (15.5%) and family problems (14.4%) were the other major causes for suicide. Waghmare P B et al 6 also mentioned that, ill heath due chronic disease contributes to cause of suicide. There is a obvious relation between alcohol consumption and suicidal tendency. However Ashok Kumar Samantha et al 7 mentioned that, With increasing disparity between the poor and the rich and due to high ambitions, these victims fall short of their expectations and who then adopts to commit suicide by hanging.

In our study, out of total 59 cases, 56 (94.91%) cases belongs to Hindu religion while 03 (05.08%) were Muslims. (Table 9). We have mentioned this parameter for academic purpose only. However no such data which will compare regarding religion wise distribution of cases have been found. However how much significant it is related with socio-demographic profile of victims of hanging cases clearly cannot be pointed out but higher the community in the region, maximum will be the cases.

Conclusion

The number of suicidal hanging cases is increasing day by day. A well designed and comprehensive programme is needed to identify the causative factors and prevention of suicidal behaviours. Appropriate education, influencing the media in their portrayal of suicidal news, reporting method, involvement of young generations in encouraging activities may reduce the rate of suicidal death by hanging in future.

Overall poverty, lack of job, family problems, defamation, social withdrawal and alcoholism are the main reason for hanging.

Hanging as a method of suicide is difficult to prevent but cautious screening of susceptible persons, careful watch and monitoring their behaviour and counselling can reduce suicide.

More suicide prevention options exist within controlled environments. Due to the complexity and peculiarity of controlled environments, we recommend suicide prevention assessments by external experts to effectively design in-house structural suicide prevention.

Source of Funding

None.

Conflict of Interest

None