Suicide by drowning: a 20-year review.
ABSTRACT Drowning as a method of suicide is known to occur, but has primarily been described in environments with readily available access to water, such as coastal regions. In this study, we describe and analyze a series of suicidal drownings occurring in a noncoastal area of Texas. Between 1977 and 1996, 52 cases of suicidal drowning were investigated at the Southwestern Institute of Forensic Sciences in Dallas, Texas. Such deaths accounted for only 0.85% of all suicides and 4% of all drowning deaths. In contrast. suicidal drownings reportedly account for 2.8 to 8.9% of all suicides in regions with easy access to water. As with other studies of suicidal drowning, the victims are usually sober white males over the age of 40 years. Our results also confirm that certain individuals who commit suicide by drowning use weights to facilitate the process. A detailed analysis of the cases is provided. as is a synopsis of several questions that may aid in determining the manner of death in suicidal drowning cases.
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ABSTRACT: The paper presents a unique case of a complex suicide committed by a young man, mostly probably triggered by a disappointment in love. The uniqueness of the suicide lies in the fact that the victim inflicted several deep stab wounds on himself, in the chest and abdomen, while standing partly submerged in the sea and, having done so, he dropped and disappeared in the water. The postmortem examination showed, apart from deep wounds in the trunk, characteristics of drowning that manifested itself in the form of aqueous emphysema of the lungs. Suicide was clearly determined on the basis of the circumstances preceding death, the location, and arrangement of the trunk wounds and the testimony given by a witness of the incident. The circumstances preceding the suicidal act clearly suggest an underlying undiagnosed mental disorder.Journal of Forensic Sciences 07/2013; · 1.31 Impact Factor
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ABSTRACT: BACKGROUND: Drowning deaths constitute a significant proportion of unnatural deaths globally. In Sweden and other high-income countries, drowning deaths have decreased. This study investigates the epidemiology and current trends of unintentional, intentional, and undetermined drowning deaths with emphasis on the presence of alcohol and other drugs. METHODS: During an 18-years period, 5,125 drowning deaths were autopsied in Sweden. Data on cases including toxicological analysis on alcohol, pharmaceutical drugs, and illicit drugs were obtained from the National Board of Forensic Medicine. RESULTS: During the study period, the annual incidence of drowning deaths in Sweden was 3.1/100,000 inhabitants and decreased on average by about 2% each year (p<0.001). The highest incidence was found among males and in middle/older age groups. The incidence increased 3% for each year of age. Children/adolescents (<=18 years) constituted 5% of all drowning deaths. Of all drowned females in the study, 55% (847/1,547) committed suicide, which was a significantly higher proportion compared with males (21%, 763/3,578) (p<0.001). In total, 38% (1,656/4,377) of tested drowned persons had alcohol in their blood and the mean concentration was 1.8 g/l. In the unintentional drowning group, intentional drowning group, and the undetermined group, the proportion of alcohol positive was 44%, 24%, and 45%, respectively. One or several psychoactive drugs were present in the blood in 40% (1,688 /4,181) of all tested persons and in 69% (965/1,394) of tested persons who died from suicidal drowning. The most common drug was benzodiazepines (21%, 891/4,181). Illicit drugs were detected in 10% (82/854) of tested persons. CONCLUSION: Presence of alcohol and drugs were frequent and may have contributed to the drowning deaths. The incidence of drowning deaths significantly decreased during the study period. Males and the middle/older age groups had a higher incidence compared to females and children. Suicidal drowning was common especially among women. Alcohol and drugs are significant contributors in drowning deaths in Sweden and should be considered as part of a comprehensive prevention program.BMC Public Health 03/2013; 13(1):216. · 2.32 Impact Factor
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ABSTRACT: Suicide is one of the leading causes of death in multiple age groups. Therefore, it is important that radiologists be aware of this commonly encountered entity. Attempted suicide may take a variety of forms; those discussed by the authors include sharp force injury, immolation and inhalation, ingestion, hanging, firearm use, jumping from a height, and drowning. Certain radiologic findings are commonly seen in cases of attempted suicide and other self-injurious behaviors. In some cases, especially when the patient is unconscious or is unwilling to provide a history, it may not be apparent that suicide has been attempted until characteristic imaging findings are recognized. Correct identification of suicide attempts on the basis of such findings will ensure that these patients receive appropriate psychiatric treatment. When a suicide attempt is unsuccessful, it is important to be familiar with the complications that may contribute to delayed mortality and morbidity. The radiologist plays an integral role in the acute medical or surgical management of patients who have attempted suicide. In addition, imaging examinations may provide useful forensic information. ©RSNA, 2012.Radiographics 11/2012; 32(7):2005-2024. · 2.73 Impact Factor
REFERENCE: Wirthwein DP, Barnard JJ, Prahlow JA. Suicide
by drowning: a 20-year review. J Forensic Sci 2002;47(1):131–136.
ABSTRACT: Drowning as a method of suicide is known to occur,
but has primarily been described in environments with readily avail-
able access to water, such as coastal regions. In this study, we de-
scribe and analyze a series of suicidal drownings occurring in a
noncoastal area of Texas. Between 1977 and 1996, 52 cases of sui-
cidal drowning were investigated at the Southwestern Institute of
Forensic Sciences in Dallas, Texas. Such deaths accounted for only
0.85% of all suicides and 4% of all drowning deaths. In contrast,
suicidal drownings reportedly account for 2.8 to 8.9% of all suicides
in regions with easy access to water. As with other studies of suici-
dal drowning, the victims are usually sober white males over the age
of 40 years. Our results also confirm that certain individuals who
commit suicide by drowning use weights to facilitate the process. A
detailed analysis of the cases is provided, as is a synopsis of several
questions that may aid in determining the manner of death in suici-
dal drowning cases.
KEYWORDS: forensic science, suicide, drowning, manner of
The body recovered from water poses many challenges to the
forensic pathologist. Oftentimes, mere identification of subjects is
complicated by decomposition. The determination of cause and
manner of death in such cases can be an equally daunting chal-
lenge. In some instances, many of the essential questions sur-
rounding such deaths are left unanswered even after performing an
autopsy. Davis offers an approach to such complex cases (1). Nev-
ertheless, the essential question of whether the individual was alive
prior to entering water must be answered. To date, there is no sin-
gle “test” available to unequivocally demonstrate that an individual
recovered from water actually drowned in water. Hence, the diag-
nosis of drowning is one of exclusion. A diagnosis of drowning is
typically rendered when a body is found in water and subsequent
autopsy and toxicology are negative. Another useful means in mak-
ing the required determinations in cases of suspected drowning is
the analysis of antecedent factors. Of particular interest are those
drowning incidents in which antecedent factors indicate suicide as
manner of death. The vast majority of drowning deaths are acci-
dental and the characteristics of these cases are well described
(2–5). However, the phenomenon of suicidal drowning is less well
described. Herein, we report our experience with such cases and
compare our findings to those in the literature.
Materials and Methods
The Southwestern Institute of Forensic Sciences (SWIFS) serves
the population of Dallas County and the greater metropolitan area
of Dallas as well as several surrounding rural areas. The greater
metropolitan area population of Dallas (excluding Forth Worth)
was 2 055 000 in 1980 and 2 898 000 in 1994 (6). The following
parameters were assessed in this study: age, race, sex, medical and
psychiatric history, autopsy findings, toxicology, site of drowning,
and circumstances surrounding the deaths.
Between 1977 and 1996, the forensic pathologists of SWIFS in-
vestigated 52 suicidal drowning incidents. Thirty-one cases were
from Dallas county and 21 from surrounding counties. Autopsies
were performed in 50 of the 52 cases investigated. The 52 cases of
suicidal drowning comprised 0.85% of all suicides (6082 total) and
4% of all drowning deaths (1303 total) during 1977–1996. During
this time span, drowning was one of the least common forms of sui-
cide, following firearm (65%), drug/toxin (13%), hanging (8%),
carbon monoxide (7%), blunt force (2%), sharp force (1%), thermal
(1%) and other (1%) (Fig. 1). The manner of death in the nonsuici-
dal drowning deaths was deemed accident in 1178 cases with 40 un-
determined and 33 homicides (Fig. 2). Of the 52 cases of suicidal
drowning, 28 (54%) subjects were male and 24 (46%) were female.
Among the males, there were 20 Caucasians, six blacks, one orien-
tal, and one Hispanic individual. Eighteen of the females were Cau-
casian and the remaining six black. Ages ranged from 21 to 84 years
among males and 23 to 82 among females. Among males, 15 (54%)
were older than 40 years, of which eight (29%) were ?60. In con-
trast, among females, 16 (67%) were older than 40 years, of which
10 (42%) were ?60. Twenty-nine (56%) drowning incidents oc-
curred in lakes or ponds, nine in pools, six in bathtubs, five in rivers
or creeks, one in an outdoor fountain, one in a waste pit and one in
a well. Thirty-seven percent of the subjects were discovered at or
near their homes and 63% were found in remote locales. Alcohol
was discovered in the blood of 21 subjects, of which 13 exhibited
early to moderate decomposition. Six decedents exhibited blood al-
cohol levels exceeding 100 mg/dL. Twenty-four (46%) had drugs
other than alcohol in their system, but in only four cases was the
level of drug(s) near or above lethal range. Twenty subjects had a
history of psychiatric illness and/or drug/alcohol abuse. Twenty-six
persons were recorded as having suicidal ideation; ten had a history
of previous suicide attempt(s), including three who previously at-
tempted drowning. Six drowning incidents were witnessed, and sui-
cide notes were discovered in 19 cases (37%). Four subjects were
found with various weights fastened to their bodies. Two subjects
were found submerged within motor vehicles.
The following paragraphs are a more detailed breakdown of the
52 cases. Table 1 summarizes the cases. Nineteen cases (36.5%,
Darren P. Wirthwein,1M.D.; Jeffrey J. Barnard,1M.D.; and Joseph A. Prahlow,2M.D.
Suicide by Drowning: A 20-Year Review*
1Southwestern Institute of Forensic Sciences, 5230 Medical Center Drive,
2South Bend Medical Foundation and the Department of Pathology, Indiana
University School of Medicine, South Bend Center for Medical Education at the
University of Notre Dame, South Bend, IN.
* This paper was presented at the 51st Annual Meeting of the American
Academy of Forensic Sciences in Orlando, FL.
Received 16 March 2001; accepted 25 April 2001.
Copyright © 2002 by ASTM International
JOURNAL OF FORENSIC SCIENCES
Cases 1–19) were accompanied by a suicide note and had investi-
gations which revealed no evidence of foul play. Of the remaining
cases, six persons (11.5%, Cases 20–25) were witnessed entering
the water, and subsequent police investigation revealed no evi-
dence to suggest that the subjects’ drowning was not self inflicted.
Case 26 was a combined homicide/suicide in which the subject
shot his wife and then was witnessed leaving the scene of the homi-
cide to be discovered 24 h later in a stock tank. Among the re-
maining 26 cases, two subjects (Cases 27 and 28) had lethal or near
lethal blood levels of a tricyclic antidepressant; one subject (Case
29) was found in a pool with superficial incised wounds of the
wrists; five subjects (Cases 30–34) had a history of prior suicide at-
tempt(s), two of whom previously attempted drowning, and ten
subjects (Cases 35–44) were recorded as having suicidal ideation,
of which three gave exact descriptions of how they would eventu-
ally commit suicide by drowning.
Of the eight remaining cases, one man (Case 45) left the hospi-
tal against medical advice after learning of his HIV positive status
and diagnosis of pneumonia for which he was told he had “2 days
to live unless treated.” He was found two days later, fully clothed
in a lake with no evidence of injury. Two persons (Cases 46 and 47)
had a history of psychiatric hospitalization and two others (Cases
48 and 49) were reportedly depressed due to breast cancer. One
man (Case 50) was reportedly depressed over the recent overseas
departure of his girlfriend and one woman (Case 51) was report-
edly distraught over the possibility that she had “cancer on her
face” (autopsy demonstrated no evidence of malignancy). The last
decedent (Case 52) was found nude in a hotel fountain with her
clothing folded neatly nearby. She was seen the previous evening
apparently praying and exhibiting bizarre behavior.
In our series, four persons were found with various weights at-
tached to their bodies. One man (Case 41) was recovered from a
lake with anchors loosely tied about his neck and ankles. Interest-
ingly, he had recently told others exactly how he planned to drown
himself. One male subject (Case 18), accompanied by a suicide
note, was found in a pond with a bucket loosely tied to his wrists.
He likely filled the bucket as he entered the water to facilitate the
process. One man (Case 39) who was reportedly having marital
problems and suicidal ideation was found in a stock pond with a
concrete block loosely tied around his ankles. The remaining man
(Case 50), reportedly depressed over the departure of his girlfriend,
was found in a waste pit with a block loosely tied around his neck.
Investigations in each of these cases revealed no evidence of foul
play, and the autopsy and toxicology findings failed to demonstrate
any explanation for death other than drowning.
A recent article in Morbidity and Mortality Weekly Report indi-
cates that there are significant regional variations in suicide rates
and methods among populations that are not fully explained by dif-
ferences in demographic variables (7). In a short paper in 1989,
Lester reported data indicating that states bordering on oceans or
the Great Lakes have higher rates of suicide by drowning compared
to noncoastal states (8). Unfortunately, few reviews of suicide by
drowning are available in the forensic literature. Furthermore, we
were unable to find any detailed American studies of suicide by
drowning from noncoastal regions.
In a 5-year study, Copeland reported 70 cases from Miami in
which drowning and suicide were listed as cause and manner of
death (9). This number accounted for 4.5% of all suicides (1569 to-
tal) during this period of time. The decedents were characteristi-
FIG. 1—Relative frequencies of suicide methods (6082 cases;
FIG. 2—Manner of death in drowning cases (1303 cases; 1977–1996).
cally white males over age 40 and were frequently found in the At-
lantic Ocean, Biscayne Bay, canals, or in pools. A suicide note was
present in less than 1/3 of the cases. Alcohol and drugs were infre-
quent findings. Interestingly, Helpern reported a similar percentage
of suicide by drowning (3%) in New York City nearly 50 years ago
In another 5-year study from Newfoundland, Avis reported 22
cases of suicide by drowning (3). This number accounted for 8.9%
of all suicides (247 total) during this period of time. Most subjects
were males over age 50 and nearly 90% of the subjects were found
in the Atlantic Ocean. Drowning was the leading method of suicide
among females over age 50. Greater than 90% of subjects had neg-
ative blood alcohol concentrations.
Cairns et al. reported 60 cases of suicide by drowning which
comprised 26.7% of 225 drowning deaths over an 8-year time span
in Auckland, New Zealand (4). The manner of death in the remain-
ing cases was deemed accident in 150 cases with 14 undetermined
and one homicide. A 27 year study of drowning deaths from
Sevilla, Spain yielded a total of 314 deaths due to submersion as-
phyxia, of which 179 (57%) were accidents, 134 (42.67%) were
suicides and one case (0.33%) was a homicide (5). In another study
from Sevilla by the same authors, 10% of all suicides were due to
drowning, behind falling (jumping) from a height (39%), hanging
(17%) and poisoning (16%) (11,12).
Most recently, in a 4-year study from Broward County Florida,
Davis reported 25 cases of suicidal drowning (13). This repre-
sented 2.86% of 873 total suicides which is relatively low in light
of the ready access to water in this geographic area. Nearly 70% of
subjects were over 60 years of age, with a slight male preponder-
ance. Swimming pools, canals, and lakes were the most common
locales. Suicide notes were present in 32% of cases. Alcohol was
present in 24% and drugs in 32%.
When comparing the demographic profiles of our cases to those
reported by Copeland, Avis and Davis, we see a similar older male
preponderance. However, our study group included a higher per-
centage of younger individuals. In our group, 40% of subjects were
less than 40 years of age as compared with 26% and 18% in the pa-
pers by Copeland and Avis, respectively. Our findings are also sim-
WIRTHWEIN ET AL. • SUICIDE BY DROWNING 133
TABLE 1—Summary of 52 cases of suicide by drowning.
JOURNAL OF FORENSIC SCIENCES
ilar to previous studies which indicate that, in contrast to cases of
accidental drowning, subjects who commit suicide by drowning are
Our experience would indicate that suicide by drowning is rare
in noncoastal areas. The infrequency of suicide by drowning in the
Dallas area may relate to its geography. Although there are many
lakes and ponds in the area, they are not as accessible as the major
bodies of water near Miami, Newfoundland, Auckland, and
Sevilla. In contrast, the high percentage of firearm related suicides
in Dallas likely stems from the fact that guns are readily available
to the general population.
The determination of cause and manner of death in subjects found
in water can be complicated by several factors, as alluded to in the
introduction. Davis has published an excellent article reviewing an
investigative approach to bodies found in water (1). Although the
autopsy and toxicology serve important roles in excluding causes
other than drowning, the forensic pathologist must often rely on an-
tecedent factors to assign cause and manner of death in such cases.
In a majority of the cases in our review, there seems to be ample ev-
idence to justify a rulling of “suicide.” In several cases, an “unde-
termined” manner might have been acceptable. In light of the retro-
spective nature of this study, in which autopsy reports and available
files were reviewed, it is possible that these determinations were
based in part on data currently unavailable for our review.
A final point that our data indicate is that not all decedents found
with weights tied to their bodies are victims of murder. In Cases 18,
39, 41, and 50, various objects were found attached to the dece-
dents’ bodies. When investigating these cases, it is obviously very
important to rule out homicide. Investigators should attempt to as-
certain whether or not the decedent, on his/her own accord, could
have attached themselves to and carried the weights.
In any alleged suicidal drowning, it is best to perform a com-
plete autopsy with toxicology. In addition, thorough death inves-
tigation is of utmost importance. Questions which should be
• Was the event witnessed?
• Was a suicide note present?
• Did the decedent know how to swim?
• What was the decedent wearing?
• Has the decedent attempted suicide in the past?
• Had the decedent ever demonstrated suicidal ideation?
• Did the decedent have any history of medical or psychiatric ill-
• What was the decedent’s mental status immediately prior to
Table 2 is a synopsis of several questions which may aid in deter-
mining the manner of death in suicidal drowning cases.
In conclusion, our data suggest that suicide by drowning is a rel-
atively rare phenomenon in noncoastal regions or regions lacking
easy access to bodies of water. Similar to the findings of others,
subjects are usually sober white males over age 40. Furthermore,
those who commit suicide by drowning sometimes use weights to
facilitate the process. Although generalizations can be drawn from
our data, each case must be viewed independently. Only after care-
ful study of each unique case and after exclusion of other causes,
can cause and manner of death be assigned as drowning and sui-
WIRTHWEIN ET AL. • SUICIDE BY DROWNING 135
NOTE: AIDS: acquired immunodeficiency syndrome; ASCVD: atherosclerotic cardiovascular disease; B: black; BAC: blood alcohol con-
centration; ca: cancer; dx: diagnosis of; ECT: electroconvulsive therapy; hx: history of; L: Latin; mm: mastectomy; n/a: not applicable (cir-
cumstances of drowning were such that the person’s ability or inability to swim probably did not matter); nd: not determined (review revealed
no record of whether or not person knew how to swim); O: oriental; s/p: status-post; unknown: the question was asked, but no-one was able
to answer the question with any degree of certainty; W: white.