A woman discovering a man who has committed suicide by hanging himself from a balcony MET DP868023

Suicide by hanging is the intentional killing of oneself (

suicide Suicide is the act of intentionally causing one's own death. Risk factors for suicide include mental disorders, physical disorders, and substance abuse. Some suicides are impulsive acts driven by stress (such as from financial or ac ...

) via suspension from an anchor-point such as an overhead beam or hook, by a rope or cord or by jumping from a height with a

noose A noose is a loop at the end of a rope in which the knot tightens under load and can be loosened without untying the knot. The knot can be used to secure a rope to a post, pole, or animal but only where the end is in a position that the loop can ...

around the neck.

Hanging Hanging is killing a person by suspending them from the neck with a noose or ligature strangulation, ligature. Hanging has been a standard method of capital punishment since the Middle Ages, and has been the primary execution method in numerou ...

is often considered to be a simple suicide method that does not require complicated techniques; a study of people who attempted suicide by hanging and lived usually suggests that this perception may not be accurate. It is one of the most commonly used suicide methods and has a high

mortality rate Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a particular Statistical population, population, scaled to the size of that population, per unit of time. Mortality rate is typically ...

; Gunnell ''et al''. gives a figure of at least 70 percent. The materials required are easily available, making it a difficult method to prevent. In the

International Statistical Classification of Diseases and Related Health Problems The International Classification of Diseases (ICD) is a globally used medical classification that is used in epidemiology, health management and clinical diagnostics, diagnosis. The ICD is maintained by the World Health Organization (WHO), which ...

, suicides by hanging are classified under the code X70: "Intentional self-harm by hanging, strangulation, and suffocation.""Trends". Hanging is divided into suspension hanging and the much rarer drop hanging⁠ ⁠— the latter can kill in various ways. People who survive either because the cord or its anchor point of attachment breaks, or because they are discovered and cut down, can face a range of serious injuries, including cerebral anoxia (which can lead to permanent

brain damage Brain injury (BI) is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors. In general, brain damage refers to significant, undiscriminating trauma-induced damage. A common ...

), laryngeal

fracture Fracture is the appearance of a crack or complete separation of an object or material into two or more pieces under the action of stress (mechanics), stress. The fracture of a solid usually occurs due to the development of certain displacemen ...

cervical fracture A cervical fracture, commonly called a broken neck, is a fracture of any of the seven cervical vertebrae in the neck. Examples of common causes in humans are traffic collisions and diving into shallow water. Abnormal movement of neck bones or pie ...

, tracheal fracture, pharyngeal laceration, and carotid artery injury. Ron M. Brown writes that hanging has a "fairly imperspicuous and complicated symbolic history". There are commentaries on hanging in antiquity, and it has various cultural interpretations. Throughout history, numerous famous people have died due to suicide by hanging.

Medical effects and treatment

People who survive hanging report seeing flashing lights and hearing ringing sounds. The neck of people who are hanged are usually marked with furrows where the ligature had constricted the neck. An inverted V mark is also often seen. Because of the pressure on the jaw, the tongue is sometimes protruding, causing it to dry.Riviello, Ralph (ed) (2010)
''Manual of Forensic Emergency Medicine: A Guide for Clinicians''

Jones & Bartlett Learning Jones & Bartlett Learning, a division of Ascend Learning, is a scholarly publisher. The name comes from Donald W. Jones, the company's founder, and Arthur Bartlett, the first editor. History In 1988, the company was named by ''New England Busine ...

. pp. 15–7. Depending on the circumstances,

petechia A petechia (; : petechiae) is a small red or purple spot ( 1 cm in diameter) and purpura (3 to 10 mm in diameter). The term is typically used in the plural (petechiae), since a single petechia is seldom noticed or significant. Causes Physical t ...

e may be present on the eyes, face, legs, and feet.

Cervical fracture A cervical fracture, commonly called a broken neck, is a fracture of any of the seven cervical vertebrae in the neck. Examples of common causes in humans are traffic collisions and diving into shallow water. Abnormal movement of neck bones or pie ...

s of the spine are rare unless the hanging is a drop hanging, which usually causes an injury known as hangman's fracture. Suspension hanging usually results in

cerebral hypoxia Cerebral hypoxia is a form of Hypoxia (medical), hypoxia (reduced supply of oxygen), specifically involving the human brain, brain; when the brain is completely deprived of oxygen, it is called ''cerebral anoxia''. There are four categories of c ...

and decreased

muscle tone In physiology, medicine, and anatomy, muscle tone (residual muscle tension or tonus) is the continuous and passive partial contraction of the muscles, or the muscle's resistance to passive stretch during resting state.O’Sullivan, S. B. (2007) ...

around the neck. According to Aufderheide ''et al''., the most common cause of death of hangings is cerebral hypoxia. Most people who are hanged die before they are found; the term "near hanging" refers to those who survive (at least for a while—for example, until they reach a hospital). Initial treatment of survivors follows the "usual priorities of airway, breathing, and circulation (ABC)". Treatment should be "directed at airway control with endotracheal intubation, ventilation using positive end expiratory pressure (PEEP), and

hyperventilation Hyperventilation is irregular breathing that occurs when the rate or tidal volume of breathing eliminates more carbon dioxide than the body can produce. This leads to hypocapnia, a reduced concentration of carbon dioxide dissolved in the blo ...

with supplemental oxygen to control

intracranial pressure Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury ( mmHg) and at rest, is normally 7–15 mmHg for a supine adu ...

". One study of people who experienced near-hanging who were treated appropriately at a hospital found that 77 percent of them survived.

Prevalence

According to Anton J. L. van Hooff, hanging was the most common suicide method in primitive and pre-industrial societies. A 2008 review of 56 countries based on

World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...

mortality data found that hanging was the most common method in most of the countries, accounting for 53 percent of the male suicides and 39 percent of the female suicides. In

England and Wales England and Wales () is one of the Law of the United Kingdom#Legal jurisdictions, three legal jurisdictions of the United Kingdom. It covers the constituent countries England and Wales and was formed by the Laws in Wales Acts 1535 and 1542. Th ...

, hanging is the most commonly used method, and is particularly prevalent in the group of males aged 15–44, comprising almost half of the suicides in the group. It is the second most common method among women, behind

poison A poison is any chemical substance that is harmful or lethal to living organisms. The term is used in a wide range of scientific fields and industries, where it is often specifically defined. It may also be applied colloquially or figurati ...

ing. In 1981 hanging accounted for 23.5 percent of male suicides, and by 2001 the figure had risen to 44.2 percent. The proportion of hangings as suicides in 2005 among women aged 15–34 was 47.2 percent, having risen from 5.7 percent in 1968. In the

United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...

it is the second most common method, behind firearms, and is by far the most common method for those in psychiatric wards and hospitals. Hanging accounts for a greater percentage of suicides among younger Americans than among older ones. Differences exist among ethnic groups; research suggests that hanging is the most common method among Chinese and

Japanese Americans are Americans of Japanese ancestry. Japanese Americans were among the three largest Asian Americans, Asian American ethnic communities during the 20th century; but, according to the 2000 United States census, 2000 census, they have declined in ...

. Hanging is also a frequently used method for those in custody, in several countries.

Related elements

Homicide Homicide is an act in which a person causes the death of another person. A homicide requires only a Volition (psychology), volitional act, or an omission, that causes the death of another, and thus a homicide may result from Accident, accidenta ...

s may be disguised as a hanging suicide.Wyatt, ''et al''.
p. 107
Features that suggest that the death is a homicide include the ligature marks being under the larynx, scratch marks on the ligature, and the presence of significant injury on the skin of the neck.

Cultural aspects

Historically, countries that have had a recent history of using hanging as a method of capital punishment tend to have a low rate of hanging suicides, which may be because such suicides were regarded as shameful, according to Farmer and Rodhe. Hanging, with its connection to justice and injustice, is what the

Department of Health and Aged Care The Department of Health, Disability and Ageing, previously the Department of Health and Aged Care, is the Australian Government department responsible for funding and regulation of health care, aged care and some disability programs. It also ...

of Australia calls a "particularly confronting display of resistance, defiance, individual control and accusatory blame"; it is "a rebuke and statement of uncaring relations, unmet needs, personal anguish, and emotional payback". A 2010 study by the ''

British Journal of Psychiatry The ''British Journal of Psychiatry'' is a peer-reviewed medical journal covering all branches of psychiatry with a particular emphasis on the clinical aspects of each topic. The journal is owned by the Royal College of Psychiatrists and publish ...

'' that investigated the motivations of people who had made a near-fatal suicide attempt found that those who had attempted a hanging considered it a painless, quick, simple, and clean method, while those who had opted for a different method held an opposing view.

China

There is a popular belief in Chinese culture that the spirits of those who have died by suicide by hanging will haunt and torment the survivors, because they had died in rage and with feelings of hostility and anger. Angry and oppressed women would use this method as an act of revenge. Lee & Kleinman write that hanging, the most common method in traditional China, was the "final, but unequivocal, way of standing still against and above oppressive authorities, often with the suicide ceremonially dressed prior to the ultimate act".

Ancient Rome

ancient Rome In modern historiography, ancient Rome is the Roman people, Roman civilisation from the founding of Rome, founding of the Italian city of Rome in the 8th century BC to the Fall of the Western Roman Empire, collapse of the Western Roman Em ...

, death by hanging—suicide or otherwise—was regarded as particularly shameful, and those who had died by this method were refused a burial.

Virgil Publius Vergilius Maro (; 15 October 70 BC21 September 19 BC), usually called Virgil or Vergil ( ) in English, was an ancient Rome, ancient Roman poet of the Augustan literature (ancient Rome), Augustan period. He composed three of the most fa ...

's ''

Aeneid The ''Aeneid'' ( ; or ) is a Latin Epic poetry, epic poem that tells the legendary story of Aeneas, a Troy, Trojan who fled the Trojan War#Sack of Troy, fall of Troy and travelled to Italy, where he became the ancestor of the Ancient Rome ...

'', for example, refers to the noose as ''nodum informis leti'' ("the coil of unbecoming death"). Timothy Hill writes that there is no conclusive explanation of why the stigma existed; it has been suggested that hanging was a method of the poor. The

Greeks Greeks or Hellenes (; , ) are an ethnic group and nation native to Greece, Greek Cypriots, Cyprus, Greeks in Albania, southern Albania, Greeks in Turkey#History, Anatolia, parts of Greeks in Italy, Italy and Egyptian Greeks, Egypt, and to a l ...

considered hanging as a woman's death because many women had died by this method. A study found that, in literary sources, 1.5–10 percent and 30 percent of suicides in the Roman and Greek civilizations, respectively, were by hanging.

Australia

Suicide by hanging is particularly common among

Indigenous Australians Indigenous Australians are people with familial heritage from, or recognised membership of, the various ethnic groups living within the territory of contemporary Australia prior to History of Australia (1788–1850), British colonisation. The ...

, who have a high suicide rate, especially among young men. Ernest Hunter and Desley Harvey suggest that hanging accounts for two-thirds of indigenous suicides. Hanging has deep symbolic meanings in Indigenous Australian culture, beyond those attached to the act generally.Tatz, Colin (2001)
''Aboriginal Suicide is Different: A Portrait of Life and Self-Destruction''
Aboriginal Studies Press. pp. 65–6. Hanging appears in indigenous art, film, music, and literature. There are reports of voices encouraging people to kill themselves, and of ghostly figures holding a noose, but saying nothing.Hunter, ''et al''., pp. 25, 29–30.