Journal of Forensic and Legal Medicine 37 (2016) 15e21

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Journal of Forensic and Legal Medicine

j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m

Original communication

Two decades of adolescent suicides assessed at Milan University's

medicolegal unit: Epidemiology, forensic pathology and
psychopathology
Carlo Alfredo Clerici a, Guendalina Gentile b, Matteo Marchesi c, Enrico Muccino b,
Laura Veneroni a, Riccardo Zoja b, *
a
degli Studi di Milano, Via Fratelli Cervi 93, 20090
Sezione di Psicologia, Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Universita
Segrate MI, Italy
b
degli Studi di Milano, Via Luigi Mangiagalli
Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Universita
37, 20133 Milano, Italy
c
Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy

a r t i c l e i n f o a b s t r a c t

Article history: Aim: to analyze the cases of suicide committed by adolescents in and around the city of Milan over a 20-
Received 6 November 2014 year period (1993e2012).
Received in revised form Materials and methods: cases of suicide involving individuals between 10 and 19 years of age were drawn
4 June 2015
from 20,757 autopsies performed by the Medico-legal Unit at Milan University. Seventy-eight cases were
Accepted 19 September 2015
Available online 3 October 2015
considered (20 females and 58 males, with the ratio of 1:2.9), and their clinical and circumstantial
histories, epidemiology, forensic pathology and psychopathological issues were analyzed.
Result: Adolescents were involved in 2.23% of all suicides committed in Milan during the period
Keywords:
Adolescence
examined. The “mean” victim is a male without psychiatric disease, aged between 16 and 19, that
Suicide commits suicide outdoors.
Forensic pathology Conclusions: In the majority of cases, there were no premonitory signs, nor any particular contingent or
Psychopathology remote reason that might explain these violent deaths, which therefore remain “impulsive”.
© 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

1. Introduction in and around a large European city (Milan) with a view to

Adolescence is a complicated time of life characterized by major
psychological and physical changes. It has recently been attracting
more and more attention in various fields of medicine and among
mental health specialists. One of the peculiar traits that distin-
guishes adolescence from childhood lies in a marked increase in
self-destructive phenomena and suicidal behavior, and this is an
area that has yet to be studied thoroughly. Suicide is a particularly
disconcerting event. It is the third cause of death among adoles-
cents in the industrialized world, after accidents and neoplastic
diseases.1,2 The phenomenon is consequently an important public
health issue that necessitates an adequate understanding so that
appropriate prevention schemes can be developed to deal with it.
The aim of this study was to analyze the suicides involving ad-
olescents that occurred from 1 January 1993 to 31 December 2012
* Corresponding author. Tel.: þ39 02 5031 5685; fax: þ39 02 5031 5724.
E-mail address: riccardo.zoia@unimi.it (R. Zoja).
contributing to a better understanding of the causes and dynamics
of this phenomenon, exploring the demographic and psychological
factors, the situations associated with adolescent suicide and the
methods used by these young people to take their own lives.
2. Materials and methods
A retrospective analysis was conducted on 20,757 autopsies
performed over a period of 20 years (1993e2012) at the Legal and
Insurance Medicine Section of the University of Milan, which serves
a territory comprising the city itself and a part of the surrounding
province. For this type of study (based on records), in Italy an
approval of the institutional ethics committee is not required, due
to anonymity of the reported data. By a research on the comput-
erized database, we selected (out of a total of 3494 suicides) the
deaths involving adolescents, between 10 and 19 years of age, ac-
cording to the definition of ‘adolescent’ adopted by the World
Health Organization.3

http://dx.doi.org/10.1016/j.jflm.2015.09.016
1752-928X/© 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
16 C.A. Clerici et al. / Journal of Forensic and Legal Medicine 37 (2016) 15e21

Our analysis was conducted in two stages:
- first we examined the necroscopy charts compiled by the Sec-
tion's technicians at the time when a victim's relatives came to
officially recognize the body; these charts contain the suicide's
personal details and clinical history, and describe the circum-
stances of their death. The personal data analyzed in this study
included: gender, age, year and month of death, nationality,
prior suicide attempts or suicidal intentions, pathological
medical history, use of medication, alcohol, tobacco smoking,
substance abuse, level of formal education, and the place where
the suicide was committed. Moreover, during the study, the
Authors verified if the forensic pathologist had previously
written on the necroscopy charts the reason explaining the
suicide, according to what had emerged from the interview with
parents. Basing on this interview and on the available circum-
stantial details about the personal clinical histories, an attempt
to at least partially perform a psychological autopsy was made.
Although the psychological autopsy conducted by a mental
health specialist is not among the procedures set in Italy in cases
of suicide, it is important to point out that the interview with
family members at the time of compilation of necroscopy charts
allows a partial reconstruction of data concerning the psycho-
logical and psychopathological anamnesis (deceased's socio-
demographic characteristics, life events, psychiatric and suicidal
history of the family, the deceased's somatic or psychiatric dis-
eases, previous attempted suicides and psychological or psy-
chiatric treatment before death).
- then we examined the reports prepared by the Section's tech-
nicians after completing the medicolegal autopsy, which pro-
vided details relating to the wounds identified on the bodies and
the injury that proved fatal.
3. Results
Seventy-eight cases met our inclusion criteria (0.37% of all the
autopsies performed in 20 years), corresponding to 2.23% of all the
suicides occurring during the period considered.
3.1. Gender and age
The gender and age distribution of the adolescent suicide cases
was as follows: 20 (25.5%) were female, and their age ranged be-
tween 13 and 19 years (mean 15.95 years), and 58 were male
(74.5%) and were between 10 and 19 (mean 16.32) years old; the
male to female ratio was 3:1.
When the correspondence between gender and adolescent age
was tested (Table 1), the number of suicides was seen to increase
with age, particularly in males. Furthermore, male gender would
thus showed a slightly “precocious tendency” to commit suicide,
preceding the girls by approximately 3 years.
3.2. Distribution by year and month
The events were analyzed in terms of the time of their occur-
rence, by year (Fig. 1) and by month in each year (Fig. 2). The year-
to-year figures varied (with no cases at all in 2003), tending to
indicate a decline in the number of cases over time.
The monthly trends of the suicides suggested a higher frequency
before the summer and in January, the month with the highest
number of suicides; fewer cases occurred in autumn and winter,
the lowest figures coinciding with the months of February and
October.
3.3. Nationality
In our series, most of the cases (68 adolescents) were of Euro-
pean nationality, while the others were Asian (six), American
(three), and African (one). Among the Europeans, 62 (79.5% of all
cases) were Italian, while the other 6 cases (7.7% of all cases) were
Romanian (two), and Albanians, French, Polish and Swiss (in one
case each). The only African was Senegalese. Of the six Asians, three
were Chinese and the others were of Arabian, Korean and Philip-
pine origin (one for each ethnic group). The three Americans all
came from Central or South America (Salvador, Brazil and Peru).
3.4. Prior suicidal ideation
As part of this study, we also considered any prior attempts at
suicide or suicidal ideation, identifying 7 cases (9%) among those
aged between 16 and 18 who had already attempted to commit
suicide, and 5 of these 7 adolescents were taking pharmacological
treatment for depression. Any prior attempts at suicide were ruled
out for 47 cases (60% of all cases), while the available information
was unreliable for the other 24 (31% of all cases).
Suicidal ideation were confirmed in 13 cases (17% of all cases), in
adolescents aged from 13 to 18. Twenty cases among all the victims
suffered from psychiatric disorders (17 had depression for which
they were receiving pharmacological treatment, one had a bipolar
disorder and was being treated with lithium, and two suffered from
psychosis); prior suicidal inclinations were ruled out in 42 cases
(54% of all cases), and no reliable information was available for the
remaining 23 (29% of all cases).

Table 1
Age and gender distribution of the adolescents.

Age Gender

Females Males

10 0 2
11 0 2
12 0 4
13 2 0
14 3 4
15 2 4
16 1 11
17 3 5
18 4 14
19 5 12
Fig. 1. Graphical representation of the annual distribution of the suicides.
 C.A. Clerici et al. / Journal of Forensic and Legal Medicine 37 (2016) 15e21
Fig. 2. Graphical representation of the monthly distribution of the suicides.
3.5. Pathological medical history
The cases of adolescent suicide were also investigated in terms
of any prior clinical conditions (Table 2). Single physical or psy-
chiatric conditions were documented in 22 cases altogether (28%),
i.e. 5 individuals with physical diseases and 16 with psychiatric
disorders; one of them had a known history of substance abuse and
also suffered from a genetic disease (cystic fibrosis). Another 4
adolescents (5%) had multiple conditions, involving depression in
three cases (associated with eating disorders in two cases, and
cardiopathy in one), and psychosis associated with anorexia in the
fourth. For 53 cases (67%), the families reported no associated
diseases or disorders.
3.6. Pharmacological treatments
We examined the adolescents' use of drugs e for treatment or
pleasure - classified according to whether they were used alone or
in combination, and whether they had generic or psychoactive
effects.
Seventeen of the adolescents (21.8%) were taking drugs: 15
(88.2%) were using only one type of drug (2 were generic and 13
were psychoactive drugs); the other two (11.7%) were on combi-
nations of drugs relating to the neuropsychiatric sphere (antide-
pressants and antipsychotics associated with benzodiazepines).
Four of the 14 adolescents taking antidepressants (tricyclic
Table 2
Adolescents' physical diseases and mental disorders.
Single conditions
Multiple conditions
17
antidepressants in 8 cases and selective serotonin reuptake in-
hibitors [SSRI] in 6) were under age (one was 12, one was 13, and
two were 17 years old); two of them were taking SSRI, and two
were on tricyclic antidepressants. Sixty-one (78.2%) of the adoles-
cents who committed suicide were taking no medication.
3.7. Alcohol, tobacco and illicit drug use
When we investigated alcohol consumption, it emerged that 15
adolescents (19% of the sample, between 15 and 19 years of age)
drank alcohol: 13 of them were moderate drinkers, while 2 were
chronic alcohol abusers. The remaining 81% did not drink. As for
smoking habits, we identified 23 adolescents (30%) as regular
smokers, with 17 of them smoking more than 20 cigarettes a day,
and the other 6 smoking less; the remainder of our sample (70%)
were non-smokers according to their families. Concerning the use
of illicit drugs, 4 of the adolescents (5%) reportedly used
cannabinoids.
3.8. Formal education/occupation
All of the adolescents were attending school: five (6.4%) were in
grades 1 to 5: 42 (53.8%) were in grades 6 to 8; and 31 (39.7%) were
in grade 9 or higher. Three of those in 9th grade or higher (3.8%)
also had jobs (as a printer, a hairdresser and butcher's shop assis-
tant), for which they were paid a regular wage. Only one of the
adolescents (1.2%) already had a secondary-school diploma and
was employed in a commercial office, again receiving a regular
salary. The other adolescents (98.8%) were not engaged in any
occupational capacity.
3.9. The place where the suicide was committed
This can be divided generically into two settings: at home and
elsewhere. The suicides were committed at home in 34 cases
(43.6%), most often in the adolescent's bedroom (14 cases; 41%),
followed by the garden (7 cases; 20.6%), the stairwell (5 cases;
14.7%), the bathroom or kitchen (3 cases each; 8.8%), and the cellar
or loft (1 case each; 2.9%).
Places outside the home were chosen for 44 of the suicides
(56%). They included both public places (overground or under-
ground railway station, hospital, public park, inner-city road, canal,
stadium, community center, secondary school) and work places
(factory). Among the former, there was a prevalence (in absolute
terms) of roads (21 cases; 48%), followed by overground or un-
derground railway stations and public parks (5 cases each; 11.4%),
then hospital courtyards (3 cases; 6.8%), and a municipal commu-
nity center, a canal, a stadium, a school and a factory (in one case
each; 2.3%).
No. of cases
Cardiopathy 1
Epilepsy 1
Cystic fibrosis 1
Cancer 1
Ulcer 1
Drug dependence 1
Bipolar disorder 1
Depression 14
Psychosis 1
Depression þ anorexia 2
Depression þ hypertension 1
Psychosis þ anorexia 1
18 C.A. Clerici et al. / Journal of Forensic and Legal Medicine 37 (2016) 15e21
3.10. Reason
The frequency distributions of the reasons for committing sui-
cide indicated that in 81% of our cases the reasons remained un-
known; and for the families the suicide was entirely unexpected.
In 15 cases (19%), the adolescents explained what had led them
to take their lives in a letter of goodbye (13 cases) or text message (2
cases) sent to members of the family or friends. “Difficult” re-
lationships with parents were at the top of the list, particularly
involving mothers having issues with the adolescent's lifestyle (in
one case) or constant requests for money (two cases). Other reasons
concerned the family discovering that their child was taking drugs
(one case) or involved in illicit activities (bag snatching or robbery)
because they received notice of police investigations concerning
their child (one case). Other reasons mentioned had to do with
existential malaise, an empty life (in 3 cases), and being afraid to
live (2 cases). Problems at school, in the sense of a poor academic
performance or failure to pass end-of-year exams, were the motives
behind 2 suicides, while only one of the adolescents in our sample
mentioned sentimental reasons.
Other reasons for committing suicide concerned one adolescent
discovering that he had been adopted (by a family of alcoholics to
boot), and another had suffered the derision of peers when his
homosexuality was discovered. None of the suicides were explicitly
attributable to physical diseases.
3.11. Forensic pathology
The second part of our study involved a retrospective exami-
nation of the autopsy reports to obtain further information on the
methods and means used to commit suicide, the body regions
affected, and the cause of death.
The chosen methods were all straightforward and involved
contusions in the majority of cases (47 suicides), prompted by
jumping from height in 37 cases (48%), and vehicular impact in 10
(13%). Mechanical asphyxia was involved in a total of 18 cases,
achieved by hanging in 15 cases (19%), suffocation with a plastic bag
in 2 (2%), and drowning in one (1.5%). Then came the firearms used
by 6 adolescents (8%), burning and chemical injuries in 3 cases each
(3.5%), and a sharp blade in one (1.5%).
Fig. 3. Distribution of the sample of adolescents by method chosen to commit suicide.
When we examined which methods were chosen by males and
females (Fig. 3), we found that none of the girls committed suicide
by burning, suffocating with a plastic bag, using a sharp blade, or
drowning. These methods were exclusive to the male gender, while
they also resorted to all the other methods too. Both genders
showed a preference for jumping from height, followed by hanging
among the boys and vehicular impact among the girls.
3.12. Means of self-destruction
As concerns the means used, dividing our sample by gender
(Table 3), the adolescents who committed suicide at home used
tools that were readily available (plastic shopping bags, a kitchen
knife, their father's properly-licensed pistols and hunting guns,
clothing and household linens, DIY tools, medicines, carbon mon-
oxide from their mother's car).
The adolescents who died outside the home used means that are
not particularly controlled, their use is not limited and they are not
difficult to access: this was true of those who jumped from height
or under the wheels of a train, and of those who bought petrol from
a pump in the case of burning, or drowned themselves in water.
3.13. Sites of fatal lesions and causes of death
The body regions most often affected by the fatal injuries were
divided into single and multiple regions. Single injuries proved fatal
in 30 adolescents (38.5%): the head was involved in 9 of them (30%),
who died of brain and skull lesions and destruction of the brain-
stem; the neck was involved in 15 adolescents (50%), who died of
mechanical asphyxia by hanging; the chest was the site of fatal
injury in 5 cases (16.5%), with mechanical asphyxia being due to
drowning and pulmonary visceral lesions; finally, the abdomen was
involved in 1 case (3.5%), and the adolescent died of abdominal-
hepatic injuries. In the 48 adolescents (61.5%) who died of multi-
ple injuries, the body regions involved included the head (36 cases;
75%), chest (10 cases; 21%), and abdomen (2 cases; 4%). With 45
cases in all (58%), the head was the body region most often affected,
followed by the neck and chest (in 15 cases each; 19%), and the
abdomen (3 cases; 4%).
In the group of multi-district lesions, we also included the in-
juries involving the whole body (11 cases) and the adolescents who
died under the wheels of a train (10 cases), who had multiple
skeletal and visceral lesions all over the body (head, neck, chest,
abdomen, upper and lower limbs), and also the three suicides
committed by burning. The causes of death correlated with these
multiple sites included detachment of the trunk, detachment of
bodily parts, burns extending over more than 95% of the body
surface, skull, brain and spinal lesions, and injuries to the chest and
abdomen, or the chest and pelvis.
4. Discussion
Suicide in adolescence has developed into an important public
health problem in many countries, becoming one of the primary
causes of death in this age group. In the area and period considered
in the present study, it was the second cause of death, preceded
only by road accidents.
In Italy, the adolescent suicide phenomenon has rarely been
studied in representative samples due to several limiting factors,
which include a certain reluctance to classify suicides as such
because of a certain social stigma attached to them (less so nowadays
than in the past), so they were attributed to accidental causes if there
was any room for doubt. Research based on surveys on the general
population commonly lacks information on the medical and psy-
chopathological history of people who commit suicide4e6 and few
 C.A. Clerici et al. / Journal of Forensic and Legal Medicine 37 (2016) 15e21 19

Table 3
Method and means used to commit suicide.

Method Means No. of cases Gender Total

Males Females

Hanging Leather trouser belt 2 1 1 15

Power cord 2 1 1
Fabric belt 1 1 0
Rope 5 4 1
Skipping rope 1 0 1
Window shutter cord 1 1 0
Dog's lead 1 1 0
Shoelaces 1 1 0
Bed sheet 1 1 0
Drowning Water 1 1 0 1
Vehicular impact Overground train 5 5 0 10
Underground train 5 0 5
Sharp blades Kitchen knife 1 1 0 1
Firearms Pistol 5 4 1 6
Hunting gun 1 1 0
Chemicals Antidepressants 2 1 1 3
Carbon monoxide 1 1 0
Plastic bag suffocation Shoppers 2 2 0 2
Burning Petrol þ fire 2 2 0 3
Fire 1 1 0
Precipitation Jump from height 37 26 11 37

studies have analyzed the phenomenon of attempted and failed
suicide in depth on the strength of A&E records, or referrals to adult
psychiatric wards or developmental neuropsychiatry services.7
An approach that can shed light on the dynamics of suicide in
general, and in adolescence in particular, is the psychological au-
topsy,8 the purpose of which is to conduct a systematic examina-
tion of the personal, medical and family history, and the social and
environmental issues of each case.
To the best of the authors' knowledge, no studies have been
conducted in Italy to consider the psychological autopsies on ad-
olescents who have committed suicide. The present work attempts
to at least partially make up for this shortcoming by drawing both
from the forensic pathologist's reports and from the available cir-
cumstantial and contextual details about the personal clinical his-
tories of the adolescents who committed suicide, based on in-depth
interviews with members of their families.
The demographic details of our sample do not differ signifi-
cantly from those of other published reports: the gender distribu-
tion coincided with a ratio of 1 females to 2.9 males. This is
consistent with the limited data available for Italy, according to
which males have a 2.1-fold higher likelihood of committing sui-
cide in adolescent age than females.4 Part of this gender-related
difference seems to be justified by the means chosen by the two
genders, since the literature generally indicates that the more
dependably lethal means are more often chosen by males.9 This
impression is confirmed by studies on failed attempts to commit
suicide, which indicate that females tend far more than males to
use narcotics and medicines to take their own lives.10
The gender-related differences in suicidal behavior and
attempted suicides have already been described in the literature,9
also distinguishing between cultural aspects that may justify such
differences in the two genders' suicidal behavior11,12. Here again,
part of the difference may stem from the fact that males tend to
choose more lethal means, and this may explain why there are
reportedly around three times more females than males who
attempt suicide and fail.10
Most suicides are implemented using readily available means
that are not liable to any particular control measures: it is only in
the case of firearms, that something should have been done to
prevent their misuse (also in the light of Italian legislation on
storage of firearms). The ready availability of firearms is described
as a factor that favors suicide, and in the USA firearms are the
means most often used by adolescents to commit suicide.13,14
Although there are reports of measures to restrict access to
potentially lethal tools generally having some effect,6 access to the
means used by the adolescents in our sample could not possibly
have been limited by any public prevention schemes.
It is noteworthy that the only three individuals in our sample
who committed suicide by burning were all of Italian nationality, in
contrast with a commonly-held assumption that this particular
method is influenced by ethnic factors.15
It is also worth noting the considerable proportion of foreign
adolescents among our cases (16 individuals; 20.5% of the sample),
bearing in mind that the percentage of foreign residents in Italy
only amounted to 7.4% of the population in 2012.16 This finding
might have to do with the social problems encountered by migrants
and their younger generation's difficulties in adapting to a new
lifestyle in a foreign country.
Judging from the literature, psychopathological conditions are a
factor that raises the risk of suicide.13,17,18 In the series examined
here, 20 of the 25 individuals (80%) were found positive for psy-
chiatric disorders, usually depression (17 cases, i.e. 60% of the sick
population), and 9% of the adolescents in our series (7 cases) had
attempted suicide before e this is lower than in other publications,
which report that 44%e71.8% of people who commit suicide have a
history of previous attempts to take their own lives.19,20
The relatively small number of psychiatric diagnoses in our
sample (highlighted by the psychological and psychiatric data
collection communicated by family) could be evidence of a limited
diagnostic efficacy on the part of the psychosocial and public health
services for adolescents, or of families being reluctant to mention
any psychiatric problems the adolescent may have had. On the
other hand, there were numerous cases in which a psychiatric
diagnosis had been formulated and the adolescent who committed
suicide was taking psychoactive medication (with antidepressants
in particular). For some time now, there has been debate about
whether there is a higher risk of suicide during the course of
treatment with antidepressants, especially in underage patients.21
In the sample considered here, only three adolescents taking an-
tidepressants were under age, however, and the use of these drugs
is still widespread in Italy (albeit less so than in other settings, and
the United States in particular).
20 C.A. Clerici et al. / Journal of Forensic and Legal Medicine 37 (2016) 15e21
Several studies have identified a role for other conditions of
distress (not only psychopathologies) among the risk factors for
adolescent suicide, and particularly for behavioral, social and family
problems.18,20,22 These non-psychopathological risk factors include
conflict with parents, sentimental problems, difficulties at school,
issues relating to discipline and illicit behavior, and recent
bereavements.
It is worth mentioning an important finding in our series con-
cerning the messages and letters written to explain why the ado-
lescents committed suicide (15 cases); according to the specialist
literature, approximately 12e15% of all people committing suicide
leave a message of some sort,23,24 and in this study the percentage
increases to 19.2%.
Though the suicide is among the primary causes of death in
adolescent age, a surprisingly limited amount of research has been
done to describe the dynamics that induce young people to take
their own lives. While numerous studies have reported that distress
and emotional difficulties are by no means unusual in adolescence,
and that suicidal ideation is relatively common at this age, the role
of factors that can lead an adolescent to carry through such an
extreme gesture remain to be clarified. It is still hard to say in
general terms how adolescents planning their own death succeed
in overriding humans' natural instinct for self-preservation. Some
psychodynamic descriptions give the impression that the idea of
death becomes acceptable or even attractive to some individuals in
adolescent age. Suicidal fantasies are born in the adolescent mind
as part of the process that leads to their becoming aware of their
own mortality. Medical personnel, family members and educators
should all be made more sensitive to these issues, paying attention
not only to disorders of the clinical nature, but also to signs of
teenagers developing emotional, relational or psychosocial
difficulties.
In the present work, only a part of the victims had a psychiatric
condition underlying the suicide. Some adolescent suicides may
therefore be explained as part of a developmental paradigm, rather
than from a psychopathological standpoint.25 From reports on
clinical experiences, we know that the decision to commit suicide is
only sometimes made on the spur of the moment (due to some
narcissistic or depressive trauma). More often than not, the suicide
is elaborately planned in secret and the individual lets nobody
know what they have in mind. In such cases, when the person
commits suicide, it may seem sudden and inexplicable, with no
premonitory signs or significant events in the individual's clinical
or personal history. From the psychodynamic perspective, suicide
in adolescence generally has to do with individuals' relationship
with themselves, linked in turn with an intolerable disappointment
on discovering that reality does not stand up to their expectations.
Conditions in which the process of separation-identification has
remained incomplete would consequently be particularly insidious,
obliging individuals to resort to dynamics such as imitating their
peers and companions instead of constructing their own, genuinely
personal identity.25
The results of this study confirm the importance of the suicide
risk factors identified in the SAD PERSONS Scale26 about the like-
lihood of suicidal behavior, although nowadays there are no in-
struments incorporating both the high sensitivity (to identify
adolescents who will commit suicide) and the high specificity (to
identify adolescents who will not commit suicide). The present
study suggests to give adolescents presenting manifestations of
discomfort the possibility of a specialist support for mental health
(still not routinely available in the context of the Italian National
health service): this support should also be centered on the pre-
vention of suicide.
Concerning the limits of the work, the Authors underline that
most of the psychological and medical data are based on the
interview between the forensic pathologist and the relatives of the
victims, because all the clinical documentation are not strictly
required by the Judicial Authority in order to perform the autopsy.
The forensic pathologist usually has the entire clinical documen-
tation only in case of medical malpractice.
5. Conclusions
Although people of any age may commit suicide, a particular
effort should be made to prevent episodes involving adolescents:
not only parents, but also school teachers, sports trainers, and
anyone else dealing with adolescents must strive to identify any
young people at risk.
This paper analyzes the different factors that led teenagers to
suicide; it emerges that adolescent suicide only partly correlates
with psychopathological conditions: in fact, only a limited pro-
portion of the adolescent suicides in our sample had been diag-
nosed with psychopathologies, the majority apparently had no
such issues. So, the adolescent suicide often seems to be an
“impulsive” act.
Conflict of interests
The Authors declare that there are no conflict of interests.
Funding
None declared.
Ethical approval
This study has been performed accordance with the ethical
standards laid down in the 1964 Declaration of Helsinki and its later
amendments.
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