MULTIFACTORIAL ANALYSIS OF HANGING DEATHS IN CENTRAL INDIAN POPULATION: A CROSS SECTIONAL STUDY

Dr. Laxmikant S. Rathod 1 , Dr. Laxman Gangadhar Phad 2 and Dr. Jaydeo Laxman Borkar 3 . 1. Resident DoctorIII, Dept of Forensic Medicine Gmchnagpur. 2. Assistant Professor Dept of Forensic Medicine Gmchaurangabad. 3. Associate Professor Dept of Forensic Medicine Gmchnagpur. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 5 (10), 1814-1820 1815 highlights our social duty to prevent the precipitating factors as it is great loss to family, nation and also to the world.
National crime record bureau 2014 report 4 , Out of total suicidal cases in India, hanging was leading means to adopt suicide accounting 41.8 % cases. In India the percentage share of the means as a hanging adopted in committing suicides during 2012-2014 is increasing, it was 37.0% in 2012, 39.8% in 2013 and 41.8% in 2014 so become the top most means adopted for suicide as it is a sure and rapid death. These suicidal deaths are the ghostly figures holding a noose, but saying nothing.
Along with the asphyxia by obstruction of the air passage, the possibility of occlusion of veins and arteries, fracture of cervical vertebrae and vagal inhibition are also present in combination with each other or separately in hanging death cases. It is easy to diagnose hanging when one finds the classical features. However all features are seldom present together. The application of pressure on the neck often results in findings, which are quite variable. 5 The present study was conducted to evaluate the socio-demographic profile, place of hanging, ligature material, ligature point of suspension and type of hanging and post-mortem findings in hanging deaths.
Observation and results:-Out of the total 212 hanging deaths, male were involved in 74.06% cases and female in 25.94% cases with male female ratio of 2.85:1. The minimum age of suicidal hanging for male was 13 years and maximum age was 80 years. The minimum age of suicidal hanging for female was 15 years and maximum age was 80 years. Two cases of accidental hanging was seen in age group 0-10 year age group. The peak incidence of hanging death was noted in age group of 21-30 years seen in 33.49% cases followed by 31-40 years in 24.06% cases. The young age group less than 20 years were more common (16.03%) than old age above 50 years (10.85%). Suicidal hanging was seen in 99.06%, accidental hanging in 0.94% and none of the cases of homicidal hangings were observed during the study.   The ligature mark over the neck was obliquely placed seen in 96.70% and horizontally placed in 03.30%. The ligature mark over the neck was completely encircling the neck seen in 20.28% cases and incompletely encircling the neck in 79.72% cases. It was observed that position of knot on left side of occiput seen in 29.72% cases, right side of occiput in 16.51% cases and mid occiput in 3.77%. Thus most common place of knot was back of nape of neck seen in 50% cases. Least common position of knot was chin seen in 1.89% cases. Atypical hangings were seen in 96.23% cases as compare to typical in 03.77% cases.
Out of 212 hanging cases a single ligature mark over the neck were present in 93.40% cases, double in 06.13% cases and multiple in 00.47% cases. Dribbling of saliva seen in 29.72% cases of hanging death and absent in 70.28% cases of hanging death. Tongue clinched between teeth or protruding out present in 26.88% cases of hanging death. Gross contusion of neck muscle were seen in 0.94% cases, fracture of hyoid bone present in 00.94% cases, fracture of thyroid present in 0.47% cases, and no fracture of cervical vertebrae and cricoid cartilage were seen.  14 (2014). Male predominance due to the fact that males have double burden of family responsibility. They expected to earn for family and bear all responsibility and work hard accordingly in competitive world so vulnerable to more stress and tension as compare to female. On the other hand females have more accommodative to changing mentally and traumatic circumstances and they have strong emotional binding with their family and children. It might be due to the reason that in their region female were less educated and repeatedly got tortured physically and mentally by husbands for various family problems and dowry so they go beyond So accidental hanging might be due to lack of care and attention by the parent towards infant and curiosity of child who was ignorant and unaware about consequence of playing. The maximum number of hanging deaths observed in age group 21-30 years due to fact that this is transit phase of life in which there is transformation from student life where they were protected by parents to an adult life where they were expected to start earning and take responsibility of family associated with increase aggressive behaviour and easy loss of temper.

Marital status:-
In the present study depending on the marital status, victims of hanging deaths were married seen in 61.80% and unmarried in 37.26%. Widows were noted in 0.94% cases of hanging deaths. Similar findings present in the study done by Vijayakumari N. 15

Religion:-
In the present study the hanging deaths were more common in Hindu religion seen in 76.42% cases followed by Buddhist in 21.70% cases. In Muslim and Christian religion hanging deaths were 1.42% and 00.46% respectively. Similar findings were present in the study of Waghmare PB et al 12  in these studies suggests the work pattern of the people in that area. Also urbanization, modernization with rapidly growing population with competition causes maximum number of hanging in unemployed.

Socioeconomic Status:-
Depending on the socioeconomic status lower class and upper lower class account for maximum number of hanging 61.80%, followed by lower middle class and upper middle class 33.96%. This finding is similar to study done by Tirpude BH et al 18 (2010). The high rate of hanging deaths among lower class could be due to financial problems with low income, an individual cannot fulfil the daily needs of family. Lower socioeconomic status is linked to domestic crowding, a condition which has negative consequences for adults and children, including higher psychological stress and poor health outcomes.

Education status:-
In the present study the hanging deaths were common in victims those were educated up to secondary/ matriculate education seen in 44.34% cases followed by primary education in 20.76% cases, higher secondary education in 17.46%. Hanging deaths is more prevalent in persons with low education level attributed to many factors such as low income and unstable job to these persons.

Suicide note of Hanging:
Out of 212 cases of hanging deaths, 11.32% cases had left suicide note. Suicide note was absent in 88.68% cases of hanging deaths. This finding is similar with Vijayakumari N. 15 (2011), Waghmare PB et al 12 (2014), This may be attributed to the fact that hanging is done due to a sudden impulse and this may be causative factor for less percentage of suicide notes being written.

Reason of Hanging:
Most common reason for hanging deaths were domestic quarrel seen in 25.94% cases followed by financial problems in 15.57% cases. Other reasons like organic disease accounts for 14.15% cases, failure in love and affair accounts for 13.21% cases, psychiatric illness accounts for 12.74% cases, family problem constitutes 09.91% cases, Exam failure constitutes 04.24% cases, alcohol addiction accounts for 3.30% cases also present. The present study is in accordance with the study of Vinita VE et al 17 (2014) Bardale R. et.al 20 (2011). In spite of modernization and urbanization domestic issue still remain the most common predisposing factors for hanging. The marriages were arranged and those few who dared to have love affairs marriages were faced with stiff opposition.

Place of hanging:-
In present study the most common place for hanging were home seen in 95.24% and other least common place were hostel, hotel, forest, public place. It is because these study carried out in rural district where joint family, small homes diverts them to choose other secure and lonely place other than home and also due to the fact that they were related to forest and farm work as compare to our study in metropolitan city. So the secure places other than home were also selected.  17 (2014).Reason behind that is most of these cases were occur in homes where they use chair or stool to reach the point of suspension and push them away to hang completely to achieve the motive of suicide without any risk of survive.

Encircling of ligature mark over neck:-
In the present study, ligature mark was completely encircling the neck in 20.28% cases and incompletely encircling the neck of the victim in 79.72%. It was due to the reason that there is a gap at nape of neck due to hair coming between ligature material and skin below it. This also may be due to any materials like cloths or hairs of female 1819 comes between ligature material and skin below it and also may be due to the pull on knot away from the point of suspension over neck creating a gap.

Position of knot and type of hanging according to position of knot:-
In the present study the most common position of knot was back of nape of neck seen in 50% cases. Least common position of knot were chin seen in

Internal findings in neck:-
In the present study the gross contusion in neck muscles was present in 00.94% cases, fracture of thyroid cartilage in 00.47% cases, fracture of hyoid bone present in 00.47% cases, no fracture of cricoid cartilage and cervical vertebrae present observed.
The present study is similar to Saisudheer T.et al 16 (2012), Waghmare PB et al 12 (2014), These variations in the frequency of hyoid bone fractures in hanging cases may be the bone is having natural joints between the body and the greater horns. In teenagers and young adults, the joints are cartilaginous and mobile and they calcify irregularly as the age increases in middle and later life

Conclusions:-
Hanging deaths were mostly suicidal, male predominance seen in hanging deaths Hanging deaths were more common in married than unmarried. Hanging deaths were more in Hindus; Most of victims of hanging deaths were form urban area. The unemployed and labourers were more vulnerable. Most of the victims of hanging deaths belong to upper lower class. Domestic quarrel and financial problem were common reason for hanging. Home is preferred place for hanging. Ligature material used for hanging was mostly soft in consistency. Complete hanging was more as compare to incomplete. Single turns and fixed knot of ligature material was most common. Mostly the ligature mark was above the level of thyroid cartilage, obliquely placed and incomplete. Most common position of knot was at the back of neck.