An Epidemiological Study of Hanging Cases Brought to the Mortuary of A Teaching Hospital of Tripura

Description

Abstract (English)

Background: According to WHO, 800000  people die due to suicide every year and becomes the top three causes of death among males and females aged 15 – 44 years¹⁰.  According to the NCRB (National Crime Reports Bureau) report 2009 & 2015, in India, the major correlates of suicide were family problems (23.7%), illness (21%) [including insanity/mental illness (6.7%)], unemployment (1.9%), love affairs (2.9%), drug abuse/addiction (2.3%), failure in examination (1.6%), bankruptcy or sudden change in economic status (2.5%), poverty (2.3%) and dowry dispute (2.3%)¹².  Hanging is a common and accessible method of committing suicide. There is an increasing tendency for suicides by hanging in India. The profile of victims in hanging includes married females or unmarried males in the age group of 21-30 years, stressors in the form of unemployment, harassment for dowry, prolonged illness, failure in examinations, financial interpersonal problems¹⁹.  Number of people committing suicide in Tripura in 2015 is 746 (of which number of hanging is 528)¹². However, there is scarcity of data regarding the true extent of the problem as well as the epidemiological aspects of hanging in this state of Tripura. In this context, the present study was undertaken to generate an epidemiological database which in turn will help the law enforcing agencies and the concerned NGOs to take steps and create awareness among the vulnerable strata of the population of the state. Methods: This cross-sectional descriptive study was carried out among the  deceased persons autopsied at Agartala Government Medical College & G.B. Pant Hospital having the history & signs of hanging. Study Duration was one and half year (January 2019 – June 2020). Data collection was started after approval of the synopsis by the ethical committee and acceptance by the university. All cases of asphyxial deaths with hanging as cause of death were accepted as inclusion criteria whereas any such dead body which is putrefied was considered as exclusion criteria. All the autopsy cases fulfilling the inclusion and exclusion criteria during the study period were selected. Complete enumeration technique (census) was followed to select the study subjects. Data was statistically analysed. Results: 176 asphyxial deaths with hanging as cause of death was studied for a duration of one and half year. Majority (24.4%) of the study subjects belonged to 31 – 40 years of age group followed by 21 – 30 years and 41 – 50 years (22.7% and 15.3% respectively). Mean age was 38.0 (±16.3) years. 76.1% of the study subjects were male and 23.9% were female. Proportion of married, unmarried, widow/widower and divorced/separated were 72.2%, 18.8%, 9.1% and 0% respectively. Among the females, 47.6% were menstruating at the time of hanging. 54.5% of the study subjects were from rural area while 45.5% of them from urban area. 19.9% of the study subjects were farmer followed by business activity (16.5%) and home maker (14.8 %). majority of the subjects were from middle class family (69.9%) followed by lower middle (23.9%) and upper middle class (4.5%).  Among the victims, previous suicidal attempts were present only in 5.7% cases. In majority cases (21.0%) psychiatric disorders were the main motive for hanging.  Atypical hanging was most common found in the study subjects. 65.3% of the study subjects had complete hanging while 34.7% of cases had partial hanging. In 91.5% cases ligature mark was present above the thyroid cartilage and the mark was interrupted in 79% of cases. Dribbling of saliva was found in 74.4% cases and in 58.0% cases tongue was protruded out. Thyroid cartilage and hyoid bone were found fractured in 2.3% and 1.7% cases respectively. Conclusion: Atypical hanging was most common as per classification of hanging based on position of knot. In most of the cases, ligature mark was prominent and was present above the level of thyroid cartilage. More than half of the cases, the knot were on right side of the neck. Dribbling of saliva from the angle of mouth was observed in majority cases. Thyroid cartilage and hyoid bone were found in most of the cases. Majority of the victims were from young age group. Clothing material was the main ligature material. More than two third of the incidents were happened in indoors. Psychiatric disorders were the main motive for hanging. Majority of the study subjects did not have addiction.