Analysis of Suicide Notes: An experience in Eskişehir City İntihar Notlarının Analizi: Eskişehir Deneyimi - PDF

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Brief Report / Kısa Araştırma Makalesi Doi: /npa.y7000 (Archives of Neuropsychiatry 2014; 51: ) (Nöropsikiyatri Arşivi 2014; 51: ) 275 : An experience in Eskişehir City İntihar Notlarının

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Brief Report / Kısa Araştırma Makalesi Doi: /npa.y7000 (Archives of Neuropsychiatry 2014; 51: ) (Nöropsikiyatri Arşivi 2014; 51: ) 275 : An experience in Eskişehir City İntihar Notlarının Analizi: Eskişehir Deneyimi Kenan KARBEYAZ 1, Harun AKKAYA 2, Yasemin BALCI 3, Beyza URAZEL 4 1 Forensic Medicine Institution, Eskişehir Branch Office, Eskişehir, Turkey 2 Forensic Medicine Institution Presidency, İstanbul, Turkey 3 Department of Forensic Medicine, Muğla Sıtkı Koçman University, Faculty of Medicine, Muğla, Turkey 4 Department of Forensic Medicine, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey ABSTRACT Introduction: It is estimated that a million people around the world die by suicide each year. It has been reported that a note was left in 5%-43% of the suicides. In this study, it we aimed to evaluate and discuss suicide notes in our city which is situated in Western Anatolia and where several universities are located. Method: All forensic deaths in Eskişehir in 10-year period between 2001 and 2011 were evaluated. Forensic investigation files were assessed. After investigation, Out of 399 cases, 168 (42.1%) cases, who were determined to have left a suicide letter, telephone message (sms) or message via social network sites, were included in the scope of the study. Results: It was found that 95 (56.5%) of all cases had left a suicide letter, 69 (41.1%) cases had sent a telephone message to a person or more than one person, 4 (2.4%) cases had written notes about suicide and death in social networking sites. Conclusion: A suicide note is an important finding in suicide cases to clarify the case. However, the note should be confirmed by investigation to be accepted as evidence. (Archives of Neuropsychiatry 2014; 51: ) Key words: Suicide, letter, forensic psychiatry Conflict of Interest: The authors reported no conflict of interest related to this article. Introduction It is predicted that worldwide, one million people die annually because of suicide. It has been reported that the rate of suicide is approximately 16/100,000, and one person dies because of suicide every 40 s (1). In USA, suicide is the second cause of mortality for the year age group and the third cause of mortality in the year age group (2). People who commit suicide sometimes leave a note to say goodbye to apologize to those who they leave alone or to explain the reason of the act (3,4). It has been reported that a suicide note is left in 5 43% of suicide cases (4,5,6). In a study performed in Australia, it was found that a suicide note was left in 33% of 1051 suicide cases (7). Suicide notes are generally left in communal areas where everybody can see them (6,8). ÖZET Giriş: Dünyada her yıl bir milyon insanın intihar nedeniyle öldüğü tahmin edilmektedir. İntiharların %5-%43 ünde intihar notu bırakıldığı bildirilmiştir. Bu çalışmada Batı Anadolu da bulunan ve üniversite şehri olan ilimizde intihar notlarının değerlendirilmesi amaçlanmıştır. Yöntem: Eskişehir de 2002 ile 2011 yılları arasındaki 10 yıllık dönemde, adli nitelikli ölümlerin tümü değerlendirildi. Adli soruşturma dosyaları incelendi. İntihar ettiğine karar verilen 399 olgu içinden intihar mektubu, telefon mesajı (sms) veya sosyal paylaşım siteleri aracılığıyla intihar notu bıraktığı saptanan 168 (%42,1) olgu çalışma kapsamına alındı. Bulgular: Tüm olguların 95 inin (%56,5) intihar mektubu bıraktığı, 69 unun (%41,1) bir ya da birden fazla kişiye sms attığı, 4 ünün (%2,4) ise sosyal paylaşım sitesine intihar ve ölüm ile ilgili notlar yazdığı saptandı. Sonuç: İntihar olduğu düşünülen olgularda intihar notu, olayın aydınlatılması için önemli bir bulgudur. Ancak delil kabul edilebilmesi için soruşturma sonucunda doğrulanması gerekir. (Nöropsikiyatri Arşivi 2014; 51: ) Anahtar kelimeler: İntihar, mektup, adli psikiyatri Çıkar Çatışması: Yazarlar bu makale ile ilgili olarak herhangi bir çıkar çatışması bildirmemişlerdir. Suicide notes are one of the elements reflecting the psychological situation of the person in the best way. In addition, these notes are among the most important evidence enlightening the forensic process and the person s approach to suicide (4,8,9). The analysis of suicide notes contributes to understanding the reason that resulted in the person committing suicide (8). In this study, it was aimed to evaluate and discuss suicide notes in a university city found in western Anatolia. Methods All deaths with a forensic character were evaluated over a 10- year period between 2001 and 2011 in Eskişehir. Forensic investiga- Correspondence Address/Yazışma Adresi Dr. Kenan Karbeyaz, Adli Tıp Kurumu, Eskişehir Şube Müdürlüğü, Eskişehir, Türkiye Phone: Received/Geliş tarihi: Accepted/Kabul tarihi: Copyright 2014 by Turkish Association of Neuropsychiatry / Telif Hakkı 2014 Türk Nöropsikiyatri Derneği 276 Karbeyaz et al. tion files were examined. Among 399 subjects who were decided to have committed suicide, which was found by the result of forensic investigation, 168 (42.1%) who were found to have left a suicide note by way of a suicide letter, SMS, or a social networking site were included in the study. The suicide notes accepted as evidence by investigating prosecutors were included in the study. During investigations, criminal studies were performed, and the person s recent history and family and occupation relations were evaluated. The content of the notes were studied to accept suicide notes as evidence. The notes were accepted as evidence and were added to files as evidence, if no contradictory findings were detected at the end of the investigation. The subjects were examined in terms of age, gender, and occupation. The reasons for committing suicide included unrequited love or being abandoned, loneliness, economical causes, and morbidities. Data were evaluated using the SPSS 16 package program. Results When the investigation files of prosecutors were examined, it was found that 399 suicides occurred in our city over a 10-year period. In total, 168 (42.1%) of the 399 subjects left a suicide note by way of a letter, SMS, or a social networking site. It was found that 95 (56.5%) of all subjects left a suicide letter, 69 (41.1%) sent SMS to one or more people, and 4 (2.4%) wrote notes related to suicide or death on a social networking site. The youngest of the subjects who left a suicide note was 17 years and that the oldest was 56 years. The mean age was 25±9.5 years. The subjects were most commonly in the year age group (n=75, 44.6%). When all suicide cases were evaluated, there was a significant difference between age group and leaving a suicide note. The rate of leaving a suicide note was found to be 64.8% in subjects below 35 years and 15.3% in the subjects aged 35 years and older (p 0.001) (Table 1). The subjects in the year age group preferred SMSes or social network sites instead of letters in contrast to the other age groups (p 0.05) (Table 1). It was found that 120 (71.4%) subjects were males and 48 (28.6%) were females. There was no significant correlation between gender and leaving a note (p .05) (Table 1). It was found that the rate of leaving a suicide note by way of SMSes and social networking sites increased in subjects who committed suicide between 2007 and 2011 compared with those who committed suicide between 2002 and 2006 (p .05) (Table 2). In total, 32.7% of the subjects (n=55) were students. Twelves (21.8%) of the students left a letter, 39 (70.9%) sent SMS, and 4 (7.3%) wrote about their suicides on social networking sites. The distributions of occupation and gender of the subjects are shown in Table 3. Twenty-two (13.1%) of the subjects were house-daughters or housewives. Moreover, 38 (69.1%) of 55 students were males and 17 (30.9%) were females. When the forensic investigation files were examined, 142 (84.5%) of the 168 suicide notes included an explanation related to the reason of committing suicide and that 26 (15.5%) notes included only goodbyes and apologies. It was observed that subjects appealed for mercy from God in 87.5% (n=147) of suicide notes. In 15 (8.9%) cases, messages included rebellion and anger because there was no other remedy except for committing suicide. When the reasons of committing suicide were examined, 76 (53.5%) were because of unrequited love and being abandoned, 44 (31.0%) were caused by loneliness, 17 (12.0%) were caused by economic, reasons and 5 (3.5%) were caused by physical and psychological diseases. A significant relation was found between the reason of committing suicide and age group in the subjects who used statements, which could be a reason for committing suicide in the suicide notes they left (p .05) (Table 4). It was found that the most common reason for committing suicide was unrequited love and being abandoned for those below 35 years, and economic causes, morbidity, and loneliness for those above 35 years. Discussion Suicide notes are important evidence in terms of enlightening the event in forensic investigations (3,4). However, finding a suicide note does not necessarily mean that the event is a suicide case (8,9). In the study presented, the notes included in the forensic investigation file and accepted as evidence that the event was a suicide case were included in the study. It is controversial if suicide is weakness or a show of strength (10,11,12). Suicide has been an issue discussed by philosophy, sociology, and psychiatry throughout human history. According to existentialists, suicide is a person s right and not a crime (13). In our country, Dinçmen, who made great contributions to forensic psychiatry, stated that all subjects who committed suicide did not have psychological disorders, that suicide did not only reflect desperation and weakness, that it could be considered as an example of rebellion and courage, that each person had the right to end his/ Table 1. Distribution of the rate of leaving a suicide note by age group Age group Suicide note present Suicide note absent Total n % n % n % Below 35 years years and older Total X 2 =99.636, p .001, df=1 Karbeyaz et al. 277 her life, and that knowing this enabled the person to take life seriously (14). However, people are mostly religious in the city where our study was conducted. It was observed that the subjects appealed for mercy from God in 87.5% (n=147) of the suicide notes. In 15 cases (8.9%), suicide notes included messages containing anger because no other remedy was left except for rebellion and suicide. Table 2. Distribution of the form of leaving suicide note by age group Age group Note type SMS or social Suicide letter networking site n % p X 2 = df=2 Gender Male p .05 Female X 2 =1.766 df=1 Occupation House daughter, housewife Unemployed Student p .05 Worker X 2 = Officer df=6 Police-soldier Self-employed Time p X 2 = Total df=1 Table 3. Distribution of occupation groups by gender Occupation Gender Total group Male Female n % House daughter, housewife Unemployed Student Worker Officer Police-soldier Self-employed Total Table 4. Distribution of type of leaving a suicide note by age group Reason of suicide explained Age group Total Below 35 years 35 years and older n % Unrequited love or being abandoned Loneliness Economic reasons and morbidity Total X 2 =9.824, p .05, df=2 278 Karbeyaz et al. Independent of the reason and method, what is left from the person who committed suicide is sometimes only emptiness. Sometimes, a message reporting that a subject has succeeded in committing suicide or had to commit suicide is left. Assumptions related to leaving a suicide note as well as the act of committing suicide are considerably different. Suicide notes may include explanations related to the reason of committing suicide. In addition, it is thought that suicide notes may target punishing those left behind by leaving them under a conscientious load or protecting other people in a similar situation. Sometimes, suicide notes include only goodbyes and apologies to God (7,15,16,17,18,19,20,21). Suicide notes play an important role in revealing the process that made the subject commit suicide. In a study conducted in Ireland in which 42 suicide notes were examined, it was reported that 74% of the notes included apologies and goodbyes, 60% included love to those left behind, 48% included boringness of life, and 21% included advice to those left behind (22). When forensic investigation files were examined, it was found that 84.5% of the notes included explanations related to the reason of committing suicide and 15.5% included only goodbyes or apologies. The religious beliefs and cultural values of subjects who committed suicide are very important in terms of the subject s viewpoint of committing suicide (12). Accordingly, the thought of having committed a sin and apology may be predominant in the suicide note (23). In a study conducted in our country, it was reported that subjects who committed suicide had cleaned their axillary and pubic hair in accordance with Islamic rules on the same day; this was accepted as forensic evidence for the event to be considered as suicide (24). In the same way, it was found that subjects committed suicide just after worship (23). In the study presented, it was observed that 87.5% (n=147) of the suicide notes included apologies to God. It was found that subjects who left a suicide note were in the young age group and mostly males. Data related to age and gender were found to be compatible with studies related to suicide (25,26,27). In the distribution of occupation groups by gender, 6 women (12.5%) had a job, and the remaining females had no economic freedom. In studies related to female suicides, it was reported that socioeconomic status is a significant factor (25,26,27,28). Suicide notes may be in the form of leaving a letter, leaving a phone message, or leaving a message by way of the internet (6,29). With developing technology, it was found that SMSes and social networking sites were used instead of letters during the second 5 year-period included in the study. It was found that the young population used SMSes and social networking sites more frequently. The young subjects left longer and emotional messages as suicide notes, whereas the older subjects more frequently left brief notes. The reason for this was thought to be related to the fact that the young subjects mostly committed suicide because of unrequited love and being abandoned. In the and year age groups, the most common reason for committing suicide was found to be unrequited love or being abandoned. Educating youngsters and adolescents in terms of self-expression and expressing emotions and being prepared for and coping with negativities and directing them to receive assistance may contribute to a decrease in the number of suicides. In places where young ones are found intensively including universities, psychological consultancy units directed at preventing suicide should be generalized and encouraged. The city where this study was conducted is known as a university city with a high young population. It was recently observed that subjects in this age group report the situation by sending a message to a relative instead of leaving a suicide letter. In some SMS examinations, messaging a person with whom an emotional relationship was shared is accepted as evidence. In this study, suicide notes written on social networking sites were found in few cases. If notes written on social networking sites are examined long-term, they may give an idea about the psychological status of the subject in the recent past. Thus, more detailed information related to the event can be obtained from these networking sites (30,31,32,33). Two subjects who wrote a suicide note on social networking sites reported that they committed suicide because of loneliness, and two reported that they committed suicide because of unrequited love. Subjects who wrote suicide notes on social networking sites are found in literature only as case reports (30). However, it is thought that more suicide notes will be found in these social networking sites over time. Currently, people eliminate their loneliness through social networking sites, the use of which is gradually increasing. It is thought that there is a period, albeit a short one, to prevent suicide, especially in suicide notes shared through social networking sites. These sites should establish social and psychological supportive lines; the notes should be regarded when they are noticed, and one should try to prevent suicide. It is a low probability that a suicide note is found before the subject commits suicide. However, it should be regarded if it is found, and one should try to prevent suicide. In cases where there is a claim of suicide, a suicide note is a significant finding in revealing the reason behind the event. Suicide notes are one of the most important proofs that give an idea about the reason for committing suicide, the subject s viewpoint on suicide, and the psychological status of the subject. References 1. Swahn MH, Palmier JB, Kasirye R, Yao H. Correlates of suicide ideation and attempt among youth living in the slums of Kampala. Int J Environ Res Public Health 2012; 9: Sussman MP, Jones SE, Wilson TW, Kann L. The Youth Risk Behavior Surveillance System: updating policy and program applications. 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The Modified Scale for Suicidal Ideation: factors of suicidality and their relation to clinical and diagnostic variables. J Abnorm Psychol 1997; 106: Lester D. Are suicide bombers heroes? Psychol Rep 2010; 106: Robertson M. Books reconsidered: Emile Durkheim, Le Suicide. Australas Psychiatry 2006; 14: Minois G. History of Suicide, translated by Lydia G. Cochrane. 2nd Edition. London: The Johns Hopkins University Press; Dinçmen K. Deskriptiv davranış. Dinçmen K, editör Deskriptiv ve Dinamik Psikiyatri içinde. 1nci Baskı. İstanbul: Ar Yayın Dağıtım;1981;s Eisenwort B, Berzlanovich A, Willinger U, Eisenwort G, Lindorfer S, Sonneck G. Suicide notes and their importance to suicide research. The representativeness of suicide note writers. Nervenarzt 2006; 77:1355-6, , Loibl LM, Tran US, Hirner A, Voracek M. Lay theories of suicide: test-restest reliability and further validation of lester and bean s attribution of causes to suicide scale. Psychiatr Danub 2008; 20: Hokans KD, Lester D. 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