title: Self-destruction by multiple methods during a single episode: a case study and review of the literature.
abstract: BACKGROUND
  Although the prevalence of suicide in the world is not clear, however, the reported rates of suicides are consistently higher among men tan women regardless of age group.
  
  
  METHODS
  A case employing multiple methods during a brief time of self-destructive behavior is presented. A 44-year-old postmaster who was under criminal investigation by his head office for embezzlement, leaped down a high river cliff and drowned after an initial attempt to commit suicide by hanging from the bridge over the river. The autopsy and scene investigations were both employed and very helpful.
  
  
  RESULTS
  Three different methods of suicide were apparent in this instance: hanging, leaping down the cliff and drowning as was evidenced by the autopsy and positive diatom test. The complexity of this case was the planned protection against the failure of one method employed to commit suicide. The methods used were all highly lethal ones. There was neither history of previous suicide attempts nor psychiatric disorder.
  
  
  CONCLUSIONS
  Although the cause of death may appear clear at autopsy in cases of self-destruction by multiple highly lethal methods during a single episode, scene investigation is important for the forensic pathologist to understand the whole story of the case and determine the manner and actual cause of death. Scene investigation and autopsy is emphasized as part of the whole postmortem investigation of death in cases of unusual suicide using multiple methods of self-destruction.
authors.affiliation: Department of Pathology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. pngwalali@muhas.ac.tz
authors.forename: M P
authors.initials: MP
authors.lastname: Ng'walali
authors.forename: S Shigeyuki
authors.initials: SS
authors.lastname: Tsunenari
mesh_terms: D000328:Adult; D001344:Autopsy; D002423:Cause of Death; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D016728:Self-Injurious Behavior; D013405:Suicide