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Abstract

Mechanical asphyxia, a significant cause of accidental, suicidal, and homicidal deaths, merits comprehensive analysis to inform prevention strategies, medico-legal investigations, and the administration of justice. This prospective observational study profiles cases of mechanical asphyxia based on autopsy findings from a tertiary care centre in Raichur over 18 months.

Out of 450 autopsied cases, 79 were identified as mechanical asphyxia deaths. Data on demographic characteristics, the manner and circumstances of death, and time of the incident were collected and analysed.

The majority of the asphyxia cases involved males (60.8%) with a notable prevalence in the 21–40-year age group (55.7%). Urban residents constituted 59.5% of the cases. A significant number of victims were unmarried (58.2%) and unemployed (67.1%). Morning times saw the highest occurrence of asphyxial deaths (29.1%). Suicide was the predominant manner of death (72.2%), with hanging being the most common method employed (60.8%). Familial disputes, academic failures, and financial crises were the primary circumstances leading to these deaths.

This study underscores the complex interplay of demographic and socioeconomic factors in mechanical asphyxia deaths, with a significant finding being the high incidence among young, unemployed males. The timing and methods of asphyxial deaths shed light on potential preventive measures. The data advocate for targeted public health interventions and underscore the need for comprehensive support systems to mitigate factors contributing to the high rates of mechanical asphyxia, particularly those stemming from social and economic pressures.

Keywords

Asphyxia mechanical asphyxia prospective study autopsy suicide hanging

Introduction

The word Asphyxia is derived from Greek (a = not; sphyzein = to throb), meaning without throbbing or pulse, which occurs soon after asphyxia, that is, on exclusion of air from lungs.¹ Asphyxia can be Mechanical/violent, Pathological Toxic/Chemical, Positional, Traumatic or Iatrogenic.² Mechanical asphyxia per se is a broad term in which enough external pressure is applied to the neck, chest or other areas of the body, or the body is positioned in such a way that respiration is difficult or impossible.³ The phenomenon of mechanical asphyxia is frequently encountered in a wide array of incidents, including accidents, traumatic physical altercations, and occupational hazards, and is of particular interest within forensic pathology due to its implications in cases of homicide and homicide involving compressive forces.

Suicide is the most common form of Mechanical Asphyxia, in India, it has seen a dramatic rise over the years. In 2022, the suicide rate increased by 4.2%, reaching 12.4 per 100,000 population—the highest recorded rate in 56 years.⁴ The regional variations and cultural contexts further complicate the understanding of other forms of mechanical asphyxia across India. Raichur, a district in Karnataka, exemplifies this challenge. While national data offers a broader perspective, it often fails to capture the specific nuances and contributing factors at the regional level. Limited research exists on the patterns and risk factors contributing to mechanical asphyxia deaths in Raichur, hindering the development of targeted preventive measures and interventions.

This prospective study, conducted at the autopsy centre of a Tertiary Care hospital in Raichur, aims to address this critical gap by investigating the incidence, demographics, and circumstances surrounding mechanical asphyxia deaths in the region. By leveraging the unique vantage point of an autopsy centre, we got a deeper understanding of the often-hidden stories behind these fatalities.

Materials and Methods

This research was conducted as a prospective observational cross-sectional study at a tertiary care centre in Raichur, extending from November 2019 to April 2021. The primary focus was on delineating a comprehensive profile of mechanical asphyxia cases through an autopsy-based analysis.

The samples for this study were selected based on cases that were brought for autopsy at the Department of Forensic Medicine. Inclusion criteria were set to encompass all autopsied individuals within the study period, where mechanical asphyxia was determined as the cause of death, as confirmed by detailed autopsy reports. Excluded from the study were cases where the cause of death was unclear or pending further investigation, and cases without comprehensive autopsy records.

The study collected a wide array of data on each case, which included Demographic Information, Circumstantial Data, Inquest details, and Autopsy Findings. The collected data underwent analysis using Microsoft Excel.

The study protocol was reviewed and approved by the Institutional Ethics Committee vide IEC letter number Staff/2019-20/12, dated 17-09-2019. In all cases, data was anonymised and handled with the utmost confidentiality to respect the privacy of the deceased and their families.

Results

The detailed analysis of autopsy reports conducted over the specified period revealed that out of 450 autopsy cases, 79 (17.6%) were identified as deaths due to mechanical asphyxia. The demographic, educational, and circumstantial data associated with these cases provided a comprehensive view of the profile of mechanical asphyxia victims within the study’s context.

Demographic Profile

Gender Distribution

Among the 79 mechanical asphyxia cases, there was a predominance of male victims (60.8%, n = 48) compared to female victims (39.2%, n = 31), resulting in a male-to-female ratio of 1.5:1.

Age Distribution

The most affected age group was 21–40 years, accounting for 55.7% (n = 44) of the cases. This was followed by the 0–20-year age group, which comprised 31.6% (n = 25). Ages 41–60 years represented 10.2% (n = 8) of the cases, and the least represented group was those older than 60 years, accounting for only 2.5% (n = 2).

Area of Residence

A significant portion of the deceased hailed from urban areas (59.5%, n = 47), compared to 36.7% (n = 29) from rural areas, with 3.8% (n = 3) of the cases having an unknown residential status.

Socio-economic and Marital Status

Marital Status

The study found that 38.0% (n = 30) of the deceased were married, 58.2% (n = 46) were unmarried, and the marital status was unknown in 3.8% (n = 3) of the cases.

Level of Education

A noticeable distribution was seen in the educational levels of the victims, with 34.2% (n = 27) having completed a degree and 32.9% (n = 26) having received higher primary education. Illiterate individuals and cases with unknown educational backgrounds and illiterate constituted 6.3% (n = 5) of the total cases (Figure 1).

Figure 1.

Distribution of Education Status-wise Distribution of Cases.

Employment Status

Employment status was another critical factor, with 29.1% (n = 23) of the deceased being employed, whereas a significant majority (67.1%, n = 53) were unemployed. The employment status of 3.8% (n = 3) of the cases remained unknown.

Circumstantial Data

Time of Incidence

The distribution of the incidents over different times of the day revealed that 29.1% (n = 23) occurred during the morning, followed by 25.3% (n = 20) in the afternoon, and 20.3% (n = 16) in the evening. The early morning incidents accounted for 16.5% (n = 13), and night-time incidents were at 5.1% (n = 4), with 3.5% (n = 3) of incidents having an unknown time of occurrence (Figure 2).

Figure 2.

Distribution of Incidents in Relation to the Time of the Day.

Manner of Death

Suicide was identified as the most common manner of death, accounting for 72.2% (n = 57) of the mechanical asphyxia cases. Accidental deaths followed at 20.3% (n = 16), and homicidal deaths were the least at 5.1% (n = 4), with an unknown manner of death in 2.4% (n = 2) of the cases.

Motive of Death

Apart from accidental asphyxia in 20.25% (n = 16) cases, the various personal and social factors were attributed as motives in the remaining cases (n = 63), those including family issues (29.1%), failure in exams (13.9%), love failures (10.1%), financial issues (8.9%), job-related issues (6.3%), marriage problems (3.8%), and no motives mentioned in 3.8% of the cases. Chronic illness was mentioned in 2.4% of the cases, and in the homicidal cases, revenge was noted as a motive in 1.3% (Figure 3).

Figure 3.

Distribution of Motive for Death Among All Cases.

Types of Asphyxia

Incidence of Asphyxial Deaths

Hanging emerged as the most common type of mechanical asphyxia (60.8%), followed by drowning (32.9%). Traumatic asphyxia accounted for 3.8% of the cases. Other forms, including strangulation and throttling, constituted 1.3% of the mechanical asphyxial deaths (Figure 4).

Figure 4.

Distribution of Type of Mechanical Asphyxia.

Discussion

The current study aimed to elucidate the profile of mechanical asphyxia cases through an exhaustive analysis of autopsy reports at a tertiary care centre in Raichur. The findings corroborate and expand upon existing literature, offering insights into demographic patterns, socioeconomic status, educational backgrounds, and the circumstances leading to mechanical asphyxia deaths.

Demographic and Socioeconomic Observations

The predominance of male victims in mechanical asphyxia cases, with a male-to-female ratio of 1.5:1, aligns with similar studies conducted in various locations within Karnataka, including Raichur,⁵ Chitradurga,⁶ Tumkur,⁷ and Manipal,⁸ and also across various places across India like Khammam (Telangana),⁹ Thane (Maharashtra),¹⁰ Rajkot (Gujarat),¹¹ Delhi,¹² Varanasi (Uttar Pradesh),¹³ Jorhat (Assam),¹⁴ suggesting males are at a higher risk, except one study conducted at Guntur (Andhra Pradesh)¹⁵ where females (51.8%) outnumbered the males. This gender discrepancy, male majority, could be attributed to various socioeconomic factors and possibly greater exposure to risky behaviours among males. The most affected age group, 21–40 years, emphasises the vulnerability of younger adults, resonating with findings from other regions of Karnataka and India, indicating a national pattern where the prime of working age is most susceptible to such occurrences.

The higher occurrence of cases in urban areas (59.5%) could be linked to increased stressors and lifestyle factors associated with urban living. Socioeconomic aspects, including marital status and employment, illustrated that the majority of victims were unmarried and unemployed. Unemployment was a notable factor, implicating financial stress and potential social isolation as significant contributors to the risk of mechanical asphyxia, particularly in cases classified under suicides.¹⁶ The data on marital status has shown a reversal trend in Raichur⁵ as compared to a similar study conducted in the year 2015–2016 in which married victims (65.9%) were more than unmarried. A similar married victim majority was also found in the studies conducted at Chitradurga⁶ (63.9%) and Khammam⁹ (69.69%).

Educational Background and Circumstances Leading to Death

Moreover, the varied educational backgrounds, with a considerable portion having completed higher education, suggest that educational attainment does not necessarily mitigate the risk of encountering circumstances leading to mechanical asphyxia. Our observations showed a bit of variance with the similar studies conducted at Varanasi¹³ and Khammam⁹ in which the majority of victims completed higher secondary (24.66% and 44.59%), and illiterate accounted for 16.67% and 28.37%, respectively. This area highlights that higher education might, in some contexts, heighten expectations and pressures, thereby not acting as a protective factor against stressors leading to suicidal tendencies.

The circumstances leading to death highlighted familial issues, academic pressures, and financial woes as predominant triggers behind suicidal asphyxiation, aligning with the broader societal challenges noted in prior research conducted at various locations across India, like Guntur,¹⁵ Varanasi,¹³ and Ahmedabad.¹⁷ This underscores the need for targeted mental health interventions and support systems in addressing these pervasive stressors.

Temporal Patterns

The distribution of incidents across different times of the day indicates a varied temporal pattern, with the majority occurring in the morning (29.1%). Similar observations were found in the study conducted at Manipal⁸ and Varanasi,¹³ however, the majority of cases were during evening and night hours in the study conducted at Chitradurga.⁶ This temporal clustering may be influenced by factors such as routine activities, stressors related to daily life, or altered circadian rhythms. The time of incidence further provides vital clues into potential preventive strategies, with mornings and afternoons being particularly critical periods. The detailed exploration of temporal patterns contributes to understanding the context in which these incidents unfold.

Manner of Death

The observed preeminence of suicide as the primary manner of death in mechanical asphyxia cases (72.2%) underscores the critical role of mental health considerations in understanding and preventing such incidents. The high incidence of suicides aligns with studies conducted at Tumkur,⁷ Manipal,⁸ Varanasi,¹³ and Rajkot¹¹ emphasising the urgent need for mental health interventions and community support systems. The association of family issues (29.1%) and academic failures (13.9%) as primary motives for suicide emphasises the complex interplay of social, familial, and educational factors contributing to psychological distress. Addressing these underlying issues is paramount for effective suicide prevention strategies.

Accidental deaths, comprising 20.3% of cases, which is higher compared to other studies (Tumkur⁷ and Varanasi¹³), necessitate a closer examination of environmental and situational factors contributing to unintentional asphyxia. Public awareness campaigns on safety measures, especially in high-risk settings, may play a crucial role in mitigating accidental deaths. Homicidal deaths, though relatively less frequent (5.1%), highlight the need for a meticulous investigation into the motives and circumstances surrounding these cases. The rate is much lower compared to the study conducted at Rajkot¹¹ (15%), Manipal⁸ (10.3%), Tumkur⁷ (9.58%), and Varanasi¹³ (6.67%). The presence of revenge as a motive (1.3%) emphasises the interpersonal dynamics contributing to homicidal asphyxia cases, necessitating targeted interventions in interpersonal conflicts.

Types of Asphyxia

The prevalence of hanging as the most common type of asphyxial death (60.8%) is consistent with past literature (Table 1) except in a study conducted at Patiala,¹⁸ reflecting the ease of accessibility and lethality of this method. Drowning, the second most frequent type (32.9%), underscores the significance of water safety measures, especially in regions with water bodies, except in studies conducted at Patiala¹⁸ and Ahmedabad.¹⁷ The occurrence of traumatic asphyxia (3.8%), strangulation, and other less common methods (1.3%) requires a nuanced investigation into the circumstances surrounding these incidents. Understanding the mechanisms and contexts of different asphyxial deaths is crucial for tailoring preventive measures and intervention strategies.

Table 1.

Regional Comparison of Types of Asphyxia.

Place (Study Year)	Hanging (%)		Drowning (%)		Strangulation (%)		Other (%)
Present study	60.8		32.9		1.3		5.0
Comparison with other places within Karnataka
Raichur⁵ (2015–2016)	46.8	↓	44.68	↑	2.12	↑	6.4	↑
Chitradurga⁶ (2012)	77.77	↑	8.33	↓	5.55	↑	8.35	↑
Tumkur⁷ (2006–2010)	61.19	↑	31.96	↓	4.34	↑	2.51	↓
Manipal⁸ (2008–2011)	56.3	↓	34.81	↑	8.8	↑	–
Belgaum¹⁹ (2009)	61.16	↑	28.15	↓	3.88	↑	6.81	↑
Comparison with other places outside Karnataka
Khammam⁹ (2016–2018)	52.02	↓	18.91	↓	5.4	↑	23.67	↑
Guntur¹⁶ (2017)	64.8	↑	20.1	↓	9.3	↑	5.8	↑
Hyderabad²⁰ (2018)	68.5	↑	27.1	↓	4.4	↑	–
Thane¹⁰ (2006–2015)	62.5	↑	31.2	↓	1.4	↑	4.9	↓
Delhi¹² (2012–2013)	60.73	↓	19.63	↓	14.6	↑	5.04	↑
Jorhat¹⁴ (2012–2013)	78.12	↑	20	↓	0.94	↓	0.94	↓
Varanasi¹³ (2016–2018)	57.33	↓	24	↓	4.67	↑	14	↑
Rajkot¹¹ (2014–2016)	37	↓	52	↑	5	↑	6	↑
Ahmedabad¹⁷ (2008–2010)	82.48	↑	3.09	↓	14.43	↑	–
Patiala¹⁸ (2000–2003)	24.3	↓	59.4	↑	5.4	↑	10.9	↑

Note: Data of the present study and the highest and lowest percentage among each type of asphyxia are marked in bold. The ↑/↓ signs indicate comparison data of more % or less % with respect to the present study.

Conclusion

Our study highlights the critical need for a comprehensive approach to address the multifaceted nature of mechanical asphyxia and contributes to the understanding of these deaths by highlighting the prevalence among young adults, males, and unemployed individuals. Suicide remains a significant concern, and addressing its underlying causes, particularly family issues and academic pressure, is critical. By understanding the demographic, educational, and circumstantial nuances, stakeholders can develop more targeted interventions to mitigate the factors contributing to these fatalities. Further research is considered crucial to develop effective prevention and intervention strategies to reduce the burden of these preventable tragedies.

Limitations

Our study is limited by its limited prospective nature and single-centre design, hindering generalisation to the broader population. Additionally, the study period may not capture seasonal or long-term trends.

Future Directions

Further research is needed to explore:

In-depth analysis of motives associated with suicide and self-harm, particularly among young adults.

Gender-specific risk factors for mechanical asphyxia deaths.

Prevention strategies targeting specific populations and methods of asphyxia.

Culturally appropriate interventions to address mental health challenges and promote help-seeking behaviours.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research,authorship and/or publication of this article.

Ethical Approval

Approved by Institutional Ethical Committee vide IEC letter dated 19-10-2019.

Funding

The authors received no financial support for the research,authorship and/or publication of this article.

Informed Consent

Informed consent is obtained from the next-of-kin of the deceased.

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