Riccardo Zoja

Background: Suicide methods chosen by victims are particularly critical in suicide risk research. To differentiate suicide deaths, it is usual to categorize them as violent and nonviolent depending on the detrimental method chosen by the victims. Caustic ingestion, for example, is traditionally considered as a nonviolent suicide method. It results in severe consequences for the human body and it is associated with high levels of lethality. Methods: In this study, we retrospectively analyzed suicides that occurred between 1993 and 2021 in Milan (Italy) and that underwent autopsy. We compared a sample of 40 victims that ingested caustic substances with a sample of 460 victims of other chemical ingestion, and a sample of 3962 victims from violent suicide. Univariate analyses and univariate logistic regression models were performed. Suicides from caustic poisoning were significantly older, had a higher mean number of diseases and were more affected by psychiatric diseases compared to other chemical ingestion victims. By contrast, caustic suicides, compared to violent suicides, had a more balanced gender ratio, a higher mean number of diseases, were more affected by psychiatric diseases, had a higher rate of complex suicides (more than one modality), and had victims who died more frequently inside instead of outside. In logistic regression models, age was the only feature differentiating caustic from other chemical ingestion suicides while the features differentiating caustic from violent suicides were gender, mean number of diseases and suicide place. Conclusions: Suicides by caustic ingestion showed substantial differences compared to violent suicides, with a higher severe profile. However, some differences were reported comparing caustic ingestion to other chemical ingestion as well. Thus, we argue whether it is more appropriate to differentiate the suicidal ingestion of caustics from both violent and nonviolent suicide methods.

Introduction Inpatient suicide in hospitals is a worrying phenomenon that has received little attention. This study retrospectively explored the socio‐demographic, clinical, and suicide‐related characteristics of hospital inpatient suicides in Milan, Italy, which were collected at the Institute of Forensic Medicine during a twenty‐eight‐year period (1993–2020). In particular, this study compared the features of hospital inpatient suicides in patients with and without psychiatric diagnoses. Methods Data were collected through the historical archive, annual registers, and autopsy reports, in certified copies of the originals deposited with the prosecutors of the courts. Results Considering the global sample, inpatients were mainly men ( N = 128; 64.6%), with a mean age of 56.7 years (SD ± 19.8), of Italian nationality ( N = 176; 88.9%), admitted to non‐psychiatric wards ( N = 132; 66.7%), with a single illness ( N = 111; 56.1%), treated with psychotropic medications ( N = 101; 51%), who used violent suicide methods ( N = 177; 89.4%), died of organic injuries ( N = 156; 78.8%), and outside the buildings ( N = 114; 72.7%). Comparing psychiatric and non‐psychiatric inpatients, suicide cases with a non‐psychiatric diagnosis were predominantly men ( N = 48; 76.2%), hospitalized in non‐psychiatric wards ( N = 62; 98.4%), assuming non‐psychotropic drugs ( N = 37; 58.7%), and died in outside hospital spaces ( N = 54; 85.7%). Conclusions A fuller characterization of suicide among hospitalized inpatients requires systematic and computerized data gathering that provides for specific information. Indeed, this could be valuable for inpatient suicide prevention strategies as well as institutional policies.