Content uploaded by Jeffrey Barnard
Author content
All content in this area was uploaded by Jeffrey Barnard on Oct 31, 2018
Content may be subject to copyright.
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.
... A recent study of suicidal drowning in 32 OECD countries (2012-2014) ranks the Netherlands second-high [58]. Other national study on suicidal drowning report a portion between 7.2 and 31% [32,[51][52][53][59][60][61][62]. The incidence of suicide by drowning in all studies is consistently highest in the age groups of 70 years and above [52,53,56,59,63,64]. ...
... Other national study on suicidal drowning report a portion between 7.2 and 31% [32,[51][52][53][59][60][61][62]. The incidence of suicide by drowning in all studies is consistently highest in the age groups of 70 years and above [52,53,56,59,63,64]. Most studies find that women are more likely to commit suicide by drowning than men, although there are significant gender differences between countries and regions [52,53,56,[62][63][64][65][66]. ...
... In a database that includes 160,460 suicides in 16 European countries over a 5-years period, drowning accounted for 3% of all male and 7.8% of all female suicides; the highest percentage was 25.5% in Irish women and the lowest percentage was 0.3% for Estonian men [63]. Several other non-European studies [54,56,59,64] and one systematic review [62] also show that of all suicide methods, drowning constitutes a small portion. Several recent studies have detected a decreasing trend in drowning by suicide [54,62,64]. ...
Introduction
Incompleteness of fatal drowning statistics is a familiar problem impeding public health measures. Part of the problem may be that only data on accidental drowning are used and not the full potential of accessible data.
Methods
This study combines cause-of-death certificates and public prosecutor’s court documents between 1998 and 2017 to obtain an aggregated profile. Data are also used as a basis for a trend analysis.
Results
The dataset includes 5571 drowned persons (1.69 per 100,000). The highest risk group are persons above the age of 50. Demographic differences are observed between suicide by drowning, accidental drowning, and drowning due to transportation (0.72, 0.64, 0.28 per 100.000) and between native Dutch, and Dutch with western and non-western background (1.46, 1.43, 1.76 per 100.000). Non-residents account for another 12.2%. When comparing the periods 1998–2007 with 2008–2017, the Standard Mortality declines for suicide drowning and accidental drowning among persons with a native Dutch and non-western background. Single regression analysis confirms a decrease of drowning over the full period, breakpoint analysis shows an increase in the incidence of the total number of drowning, suicide by drowning and accidental drowning starting in 2007, 2008 resp. 2012.
Discussion
Compared to the formal number of fatal accidental drowning in the Netherlands (n = 1718; incidence 0.52 per 100,000), the study identifies 350% more drowning. Differences in demographic data and the recent increase needs to be explored for public health interventions.
... From epidemiologic studies of drowning's series of cases [2,[4][5][6][7][8][9][10][11][12], the following data can be deduced: drowning deaths per day. Drowning death rates vary by state. ...
... • Drowning fatality rates are greater in men than in women (men ranging from 75% to 90% and women ranging from 10% to 25%), though this difference decreases in suicides (54% men, 46% women) [5]. ...
... Males predominant in drownings (73.4%), in accordance with all the literature [4,7,11,12,27]. Nevertheless, this difference diminishes in suicides, having noted 55.4% of males in our series, in accordance with the findings of Wirthwein et al. [5] who found 54% of males. The sex distribution also differs in bathtub drownings, where women drown more frequently (67.3% women). ...
Introduction
Drowning is a significant public health problem worldwide and the WHO reported that drowning is the world’s third leading unintentional injury death. Nevertheless, there is still uncertainty regarding the estimate of local and global drowning deaths. In addition, the postmortem diagnosis of drowning is challenging and the physiological mechanisms of death by drowning are complex and not very well understood.
Purpose
To analyze a large series of bodies retrieved from the water in Connecticut (U.S.) in order to compare epidemiologic and toxicological data with those of the literature, as well as to examine the weights of the lungs and brains in drowning deaths.
Material and Method
We conducted a descriptive, retrospective, population-based analysis of all bodies retrieved from the water and subjected to a forensic autopsy at the Office of the Chief Medical Examiner in Connecticut (2008-2020, n=500). Variables collected were sex, age, date of death, location of drowning, season, type of water, cause of death, manner of death, circumstances of death, signs of decomposition, BMI, brain weight, lung weight, presence of pulmonary edema, stomach contents, and toxicological analysis.
Results
The death rates of drownings in Connecticut ranges from 0.75–1.28/100000/year. They occurred predominantly in males (73.4%) and most were accidents (75.6%), though this gender difference diminishes in suicides (55.4% of males). Sex distribution is also different in bathtub drownings, where women drown more frequently (67.3%). Weights of the brains (p=0.013) and lungs (p<0.001) were higher in saltwater drownings.
Conclusions
Drowning is more frequently an accident involving men, except for suicides where there is only a slight difference among sex. Heavy lungs and cerebral edema continue to be identified in numerous drowning deaths. These anatomic findings, however, must still be interpreted in the context of the entire case investigation. Weights of the brains and lungs are higher in salt water, although these organs’ weights are mostly dependent on other variables such as BMI and decomposition.
... Drowning is the third leading cause of unintentional (accidental) death worldwide [1], with an estimated 200,000 to 500,000 deaths per year [2][3][4][5][6][7][8][9][10][11][12][13]. Therefore, many epidemiological studies of drowning cases have been conducted [2][3][4][5][6][7][8][9][10][11][12]. ...
... Drowning is the third leading cause of unintentional (accidental) death worldwide [1], with an estimated 200,000 to 500,000 deaths per year [2][3][4][5][6][7][8][9][10][11][12][13]. Therefore, many epidemiological studies of drowning cases have been conducted [2][3][4][5][6][7][8][9][10][11][12]. Despite these research efforts, global and regional drowning death estimates remain uncertain. ...
Drowning is a common cause of accidental death worldwide, and it continues to be a serious public health problem. However, diagnosing drowning is a challenging task in forensic investigation because it is difficult to prove actual drowning and other submerged deaths with the autopsy techniques that are currently in use. Here, we show biomarkers that may be helpful for the diagnosis of drowning. We divided the experimental animals into four groups (drowning, postmortem submersion, hypoxia, and control) to evaluate the expression patterns of extracellular signal-regulated kinase 1/2 (ERK1/2). On gene expression analysis, only ERK2 was found to be significantly increased in the drowning groups compared to the other cases. In the immunoblot analysis, phosphorylated ERK2 (p-ERK2) was found to be upregulated in the drowning groups. Immunohistochemical staining also showed that p-ERK in alveolar cells revealed a granular pattern in the drowning groups. However, the expression pattern of ERK2 over time after drowning differed between the freshwater and seawater drowning groups. Taken together, these results indicate that ERK2 may be useful for distinguishing between drowning and postmortem submersion if the postmortem interval (PMI) of drowning is short. Conversely, if the PMI is long from the time that death occurs until the discovery of dead bodies, it is possibly more helpful for identifying between freshwater and seawater drowning.
... A corpse may find itself in a water body in various circumstances. Some people commit suicide by drowning themselves (Copeland A. R., 1987;Avis S. P, 1993;Byard R. W., 2001;Wirthwein D. P. et al., 2002;Salib E., Agnew N., 2005;Todt M. et al., 2014), including suicides after committing a murder (Melez İ. E. et al., 2014). Many people drown by accident (see Lunetta P. et al., 2004;Szpilman D. et al., 2012). ...
Objectives
The main objectives of this paper are to define the issues related to a search for a drowned corpse, fishing it out and procedures to take evidence when the victim’s body has not been found.
Material and methods
A case analysis was performed in which the criminal covered up traces by drowning the corpse. An extensive study in this regard was conducted covering 500 criminal cases concluded with a final and binding judgement. Finding a corpse in a lake 24 years after the crime is a case described in detail in this paper. The authors obtained the consent of the District Prosecutor and the District Court in Olsztyn for publishing the case materials.
Results
Neither the process of the corpse search nor fishing it out were carried out properly in the case under study. The large number of search attempts was caused by poor coordination of the search groups and by using unsuitable tools. Most methods were ineffective given the small size of the package resting on the water reservoir bed.
Conclusions
A search for a drowned corpse requires good cooperation between the search team and law enforcement authorities and later with forensic medicine specialists in establishing the cause of death.
... Furthermore, adolescents with history of suicide attempts and those who were self-injured (not in a fatal way) had more changes of committing suicide (134,135). The most common means of suicide were drugs intoxication, firearms accessibility, railway suicide, jumping from heights, hanging, drowning or inhaling exhaust fumes (136)(137)(138)(139)(140). ...
The COVID-19 pandemic impacted on the mental state of young adults, adolescents and children and was highly researched through the scientific community. Restrictive measures enhanced the psychological consequences of COVID-19 in their lives, altering their emotional state. Thus, the purpose of this systematic review is to describe the impact of COVID-19 in children, adolescents and young adults, giving special focus in Mood Disorders, depressive symptoms and suicide or suicide attempts, during the pandemic. A research in following databases was conducted up to December 28, 2020: Pubmed, Google Scholar, EMBASE, SCOPUS, ERIC, ProQuest and PsycInfo. During the COVID-19 pandemic, children presented mild to moderate depressive symptoms, while adolescents moderate to severe depressive symptoms. Concerning young adults, they also presented mild to moderate depressive symptoms, while in some studies severe to extremely severe depressive symptoms were reported. Suicidal ideation was described in all groups, with different extent in each one. Only one suicide by a teenage girl was reported, during that time. Identifying risk factors for developing depressive symptoms and subsequently leading to Depressive Disorders could be beneficial not only for individuals, but also for their families, peers and health professionals. Preventive programs, in accordance with assessment and treatment, could provide more safety and confidence in youths, promoting their well-being.
Drowning is defined as death by suffocation in a liquid. In contrast, near-drowning is defined as survival beyond 24 h after a drowning accident. Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid.
In the present Research, Biblical verses describing drowning are presented: "And Moses stretched forth his hands over the sea; and the sea returned to his strength when morning appeared….and the waters returned, and covered the chariots, and the horsemen, and all the host of Pharaoh that came into the sea after them; there remained not so much as one of them". Here, "Egyptians were dead upon the sea shore" (Exodus 14:27,28,30).
This research deals with the definition, the characteristics, the pattern, epidemiology, the outcome, including drowning-related deaths, and the coping strategies.
Drowning locations and activities differ by age and ethnicity which require targeted intervention strategies.
The Research presents the coastal drowning, female drowning, drugs and alcohol use, rescue-related fatalities, falling from a medium-height bridge, epilepsy, suicidal, and pediatric patient drowning.
The prevalence of drowning varies in different countries presented in this research.
The outcomes of drowning include cardiac arrest, respiratory failure, gastric mucosal lesions, neurological complications, and the death.
Numerous strategies can be used to prevent and manage the drowning.
In the recent years, the diagnostic possibilities have been validated through scientific research and have shown medicinal value in the diagnostics and the management of conditions associated with the drowning.
This research has shown that the awareness of the drowning has accompanied humans during the long years of our existence.
Drowning deaths are commonly seen in most forensic pathology practices. Experienced forensic pathologists perform autopsies and assign a cause and manner of death in such cases as a matter of routine. Deaths due to pulmonary overexpansion injury and subsequent air embolism are far less common and typically involve individuals who have been breathing compressed gas at depth, generally SCUBA (self-contained underwater breathing apparatus) divers. This review outlines the pathophysiological basis of these two forensic pulmonary issues and recommends an approach to performing and interpreting the results of a forensic autopsy when faced with such cases.
The determination of the cause of death of a person whose body is found in the water requires careful investigative work on the part of both police and pathologists. Opinions as to cause and manner of death should not be derived from the autopsy alone but must result from a logical correlation of data regarding victim identity, circumstances, autopsy laboratory findings.
A study of suicidal drownings was performed by using the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, U.S.A., during 1980-1984. A total of 70 cases were collected and analyzed as to the age, race, sex, and cause of death of the victim, along with blood alcohol content, the drugs detected at postmortem examination, the geographic location of the terminal incident, the scene circumstances, the presence or absence of a suicide note, and the reason for the suicide. Essentially, one deals with an older white male population, although all age groups can be affected. Members of the population studied frequently died from drowning alone, rather than from additional contributory causes. Most were sober and frequently without drugs detected. Most incidents occurred at home or in a canal, with the victim just "found floating". A note was absent approximately half the time. The reason for the act was depression concerning poor health, death of a loved one, financial problems, chronic pain, or being "tired of life". A discussion ensues about the approach a forensic scientist should have concerning such cases.
The determination of the cause of death of a person whose body is found in the water requires careful investigative work on the part of both police and pathologists. Opinions as to cause and manner of death should not be derived from the autopsy alone but must result from a logical correlation of data regarding victim identity, circumstances, autopsy, and laboratory findings.
During an eight year period in the Auckland coronial district, 225 persons over the age of fifteen years died from drowning and were subject to autopsy. Of these, 129 males and 21 females drowned because of accidents whilst 31 males and 29 females committed suicide by drowning. There was one homicide and in 14 cases it was unclear as to whether drowning was accidental or suicidal. At least half of the accidents showed analytical evidence of having consumed alcohol and in 37% of these the blood alcohol level was over 100 mg per 100 ml of blood. The activities in which the accidentally drowned were engaged at the time of their deaths are documented and the role of intercurrent illnesses in some drownings illustrated.
This study of recreational deaths in the "land of sun and fun" has pointed out several useful factors. Firstly, accidental deaths are more common than naturals. Secondly, the most common accidental death is drowning while swimming. The latter is not usually at public facilities, but rather at unsupervised uninstitutionalized surroundings. Finally, a younger population is involved with a frequent number of them with alcohol detected and/or drugs.
Autopsy protocols at the office of the Chief Forensic Pathologist were reviewed with respect to suicidal drowning. Within the years 1987 to 1991, 247 people have committed suicide in the Province of Newfoundland. Of that number, 22 committed suicide by drowning, representing 8.9% of all suicides, and the fourth leading cause of suicidal death. When considering suicide in the age group of 50 years and older, (n = 68), which accounts for 27.5% of all suicides, drowning represents 25% of all suicidal deaths, and within females in this group represents the most common form of suicidal death (45.5%). The presence of alcohol or other drugs is decidedly unusual in such victims. Of the 22 drowning suicides, 19 were committed in the ocean, two were committed in fresh water and one committed in a residential well. These results contrast to similar studies performed in locations in which access to water could be reasonably considered a factor in choosing a method of suicide.
Death due to submersion is of great interest from the medical-legal point of view, given the increase in nautical activity among children and adults alike over the past number of years. However, the lack of reliable statistical data concerning the impact of this specific form of death in our country must be emphasized. These are the circumstances that have led us to study the incidence of this form of death in a specific area. The population analyzed lived in the city of Sevilla during the period 1967-1993.
Autopsy protocols at the office of the Chief Medical Examiner were reviewed with respect to suicidal drowning. Between July 1, 1994 and June 30, 1998, there were 267 drownings and 873 people committed suicide in Broward County, Florida. Of those, 25 were suicidal drownings, representing 2.86% of all suicides, and overall the 8th leading cause of suicidal death. When considering suicide in the age group of 65 years and older, (n = 239), which accounts for 19.8% of the population and 27.4%, of all suicides, drowning represents 6.7% of all suicidal deaths, and within females in this group represents the third most common form of suicidal death (13.8%). The presence of alcohol or other drugs is less usual in elderly suicide victims than younger victims. Of the 25 drowning suicides, there was a preference for swimming pools, canals, and lakes as the locations of choice. Additional drowning and suicide related criteria were evaluated including marital status, mental health, clothing worn, previous attempts or threats, suicide notes, and personal effects at the scene; with the intention of establishing a profile for drowning by suicide. Given the relative abundance of water, the suicidal drowning rate appears to be lower than what might otherwise be anticipated.