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Globally, suicide is a leading cause of mortality among teenage children and adolescents. Alcohol and other substances of abuse may influence both the decision to commit suicide and the choice of method. However, only few studies focused on toxicological findings in child suicides. The aim of this study was to map postmortem toxicological findings in child suicides in Sweden. Data on age, sex, suicide method and toxicology in 500 suicides (age 8–17 years) in 2000–2022 were retrieved from the National Board of Forensic Medicine database. Descriptive statistical analyses were performed to examine associations between sex, age, suicide method and toxicology findings. Positive toxicological findings were present in 210 cases (42 %), most frequently among deaths from poisoning and jumping from a high place. Licit drugs were the most common substances (30 %), followed by alcohol (14 %). Antidepressants were the most frequently detected licit drugs and were significantly more common in females (p = 0.002). Among toxicology positive cases, hypnosedatives were detected in 15 % of cases, narcotic analgesics in 9 %, and central stimulants in 6 %. Alcohol was equally common in both sexes, with a mean blood alcohol concentration (BAC) of 1.15 g/L. More than half (57 %) of the alcohol positive cases had BAC levels ≥ 1 g/L. The most common alcohol combinations were with narcotic analgesics and central stimulants. Illicit drugs were rare (n = 14), mainly cannabis. These findings offer insights into child suicides and may inform future suicide prevention strategies targeting children.

The goal of a medico-legal autopsy is primarily to determine the cause and manner of death. To this end, the pathologist often uses auxiliary analyses, including histology. However, the utility of routine histology in all medico-legal autopsies is unknown. Earlier studies on the utility of routine histology have shown inconsistent effects, with some studies recommending it and others rejecting it. To study the degree to which histology informs on the underlying cause of death, we sent autopsy reports from suspension-, immersion-, fire-, and traffic-related deaths to senior board-certified forensic pathologists and had them assess the cause of death, first without knowledge of the histological findings and then with knowledge thereof. Fifty cases were identified in each of four subgroups: fire-, immersion-, suspension-, and traffic-related deaths. The autopsy reports were anonymized, and the histological findings and conclusions were removed. Two board-certified forensic pathologists independently reviewed the reports in each subgroup and assessed the manner and underlying cause of death (including their certainty of this assessment on a five-level scale) with and without access to histological findings. The probability of changing the underlying cause of death posthistology was low in all study groups. There was a slight increase in the degree of certainty posthistology in cases where the underlying cause of death was not changed, but only when the antehistology certainty was low. Our results suggest that histology does not meaningfully inform on the underlying cause of death in suspension-, immersion-, fire-, and traffic-related deaths except when antehistology certainty is low.

Background: Sweden’s firearm legislation obligates physicians to report patients that are deemed unsuitable to possess a firearm. This study aimed to explore the involvement of firearm use in firearm fatalities and to evaluate physician reporting concerning cases of firearm deaths.

Methods: Fatal firearm suicides and homicides in Sweden were studied for the years 2012–2013, accidental deaths and undetermined manner of deaths for the period 1987–2013. Police reports and autopsy protocols were collected from the National Board of Forensic Medicine, healthcare data in 1 year before the fatality from the National Board of Health, and information about physician reports and firearm licences from the Swedish Police.

Results: A total of 291 firearm deaths (213 suicides, 52 accidental deaths, 23 solved homicides and 3 cases with undetermined manner of death) were identified. Firearm suicides were positively correlated with the number of licensed firearm owners. Legal firearm use predominated in firearm suicides and accidental deaths, illegal in homicides. No suicide victim or shooter in an accidental death was previously reported by a physician to the police according to the firearm law. The majority of the shooters in accidental deaths and suicides had no registered health care visits. Less than half (42%) of all suicide victims had a previous health care contact due to mental health problems. Conclusions: Not one single suicide victim nor any shooter in accidental deaths in the present study had been reported according to the firearm law, bringing the evidence of a suboptimal framework.