Suicide, depression and thyroid dysregulation: An unusual case of unplanned complex suicide. (March 2023)

• Record Type: Journal Article
• Authors: Baldino, Gennaro; Mondello, Cristina; Sapienza, Daniela; Stassi, Chiara; Bottari, Antonio; Gualniera, Patrizia; Asmundo, Alessio; Ventura Spagnolo, Elvira
• Is Part Of: Legal medicine. Volume 61(2023)
• Publication Date: 2023-03
• Subjects: Complex suicides -- Self-stabbing -- Unrecognized thyroiditis -- Fall from height -- Forensic pathology; Medical jurisprudence -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Medical jurisprudence; Periodicals; 614.1
• DOI: 10.1016/j.legalmed.2022.102187
• Languages: English
• ISSNs: 1344-6223

Abstract

Highlights: In the forensic literature, complex suicides (planned and unplanned) are rare events. This is the first suicide case with self stabbing and fall from hight. PMCT images are usefull to clarify the precise path of the blade. The resolution of complex cases benefits of a multidisciplinary approach. The thyroid dysfunction represents a possible substrate for depression. There is a correlation between Hashimoto's thyroiditis and increased risk of death by suicide. Abstract: Complex suicides are rare events pursued by the victims by means of two or more different fatal methods and can be further classified in planned or unplanned depending on the simultaneous or sequential application of the methods, respectively. The multiplicity of the injuries detected can frequently lead to misinterpretations, thus making a multidisciplinary approach of utmost importance. Here an unusual unplanned complex suicide was described discussing the post-mortem data leading to the forensic diagnosis; moreover, a focus on the depression cause was reported. The case regarded a 48-year-old man with a recent diagnosis of depression who self-stabbed his neck and, subsequentially, fallen from height. Data obtained from autopsy, histology, radiology and toxicology were described, highlighting the main findings for achieving the differential diagnosis between suicide and homicide. Moreover, microscopic findings compatible with an unrecognized thyroiditis led to consider the thyroid dysfunction as a possible substrate of depression, suggesting it potential effect on suicidal behaviour.