Overview of the suicidal phenomenon in twenty-years autopsies at the Legal Medicine Unit of Pavia

Background: Suicide still represents an unsolved issue worldwide and suicidal behaviours are often difficult to detect and prevent. The aim of the study is to investigate the phenomenon of suicide in cases analysed by the Unit of Legal Medicine of Pavia, North-Western Italy, from 1999 to 2019, providing qualitative-statistical data, representing a starting point to investigate further the risk factors related to suicide. Methodology: For each autoptic case, the following variables were taken into consideration: personal data (age and sex), social status (employment, marital status), medical history (organic and/or psychiatric conditions) and forensic evaluations (time, circumstances and method of death, the presence or not of a ‘suicide note’ and previous anticonservative behaviours). Results: Were found 724 confirmed suicide cases, with an average annual rate of 34 ± 12. Mean age at suicide 50.2 ± 20.2-year-old, male/female ratio 3. Some characteristics linked with suicide were discussed: male sex (71.8%), age range 31–60 years (50.7%), asphyxia method of death (46.1%) of which 68% by hanging, cardiovascular disease (3%), previous anti-conservative attempts (7.7%), retirement (22.4%), unemployment (7.2%), separation/divorce (8%). We detected a lower percentage of mental illness: depression (26%), alcohol (4%) and drugs abuse (3%). Conclusion: It is essential to monitor suicidal risk factors to efficiently intervene through targeted prevention campaigns, according to cross-national and temporal variation. Forensic medicine approach, as shown, could give a wide perspective over the suicide phenomenon, mainly in its social and ethical connotations.