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
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Additional information and reprint requests:
Joseph A. Prahlow, M.D.
South 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
530 N. Lafayette Blvd.
South Bend, IN 46601
TABLE 2—Specific questions to answer when investigating suspected
suicidal drowning deaths.
A drowning death should be considered a possible or probable suicide if the
questions below can be answered in the affirmative. The more affirma-
tive answers, the more likely the drowning death is a suicide. Affirma-
tive answers for those marked with an asterisk (*) should be considered
strong evidence that the death is a suicide.
• Does the death investigation rule out homicide?
• Does the death investigation rule out accident?
• Does the death investigation suggest that suicide is a possibility?
• Did the victim leave a suicide note (or equivalent)?*
• Was the suicidal action witnessed by a credible witness?*
• Had the decedent recently expressed suicidal ideation?
• Was the decedent recently known to be depressed?
• Did the decedent recently experience a major, life-changing event typ-
ically considered a reason for committing suicide (cancer diagnosis,
discovery of spouse’s infidelity, financial disaster, etc…)?
• Had the decedent ever considered or attempted suicide in the past?
• Had the decedent expressed suicidal ideation and specifically men-
tioned drowning as a possible method of suicide?*
• Does the decedent have co-existing autopsy findings which are
consistent with suicide (overdose, incised wounds of wrists, etc…)?*