The role of self-immolation in complex suicides: A neglected topic in current literature Francesco Simonit a, *, Ugo Da Broi b , Lorenzo Desinan b, * a Dipartimento di Scienze Mediche, Chirurgiche e della Salute dell’Università di Trieste, Strada di Fiume 447, 34146 Trieste, Italy b Dipartimento di Area Medica, Medicina Legale, Università degli Studi di Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy A R T I C L E I N F O Article history: Received 22 September 2019 Received in revised form 18 November 2019 Accepted 19 November 2019 Available online 22 November 2019 Keywords: Self-immolation Self-ignition Self-inflicted burns Complex suicide Post mortem self-immolation A B S T R A C T Suicides involving more than one suicide method are termed “complex suicides” and need to be differentiated from murders. Self-immolation is the action of setting fire to oneself and is an infrequent method of suicide method in Western countries. However, burned corpses must be carefully examined because setting fire to a body after death can be a way of covering up a crime. Complex suicides involving self-immolation are rare, but careful analysis is necessary if we are to identify the manner of death. A systematic search of the literature concerning self-incineration in cases of complex suicides was carried out. This covered the age, gender and psychiatric condition of the victims, any history of previous suicide attempts, the existence of suicide notes, evidence of fire accelerants, signs of vital exposure to the fire, toxicology, the other suicide methods used in combination with burning and the characteristics of the burns. 46 cases were found in 22 papers published since 1985, but few of these studies provide any detailed analysis and in several cases many important data were missing. There is, therefore, a need to study this topic and to use an approach based on careful examination of the corpse, detailed investigation of the scene, toxicological examination and an evaluation of the victim’s physical and psychiatric state. © 2019 Elsevier B.V. All rights reserved. 1. Introduction Complex suicides are rare and involve the use of more than one suicide method. They are further classified into “primary complex” (planned) and “secondary complex” (unplanned) according to the intention of the victim [1–3]: in the former different suicide methods are employed simultaneously in order to guarantee death: in the latter, other methods are used after the failure of the first [4]. A wide spectrum of different combinations of suicide techniques has been reported in literature [2–17]. Suicide by self-burning is infrequent in Western countries [18–25], though a 1996 Bulgarian study suggested otherwise [26], and its involvement in complex suicides is very rare. A number of cases of self-immolation were related to political and social protests [21,27–29]. 2. Material and methods In December 2018 a PubMed and Google Scholar search was performed with the terms “complex suicide”, “self-immolation”, “self-ignition”, “self-incineration”, “suicide” AND “arson”, “suicidal arson” and “self-burning”. The full text versions of all original articles involving cases of self-burning were analysed in order to find cases of self- immolation performed in association with other suicide methods. The reference lists of all related studies were hand searched for further publications. Research included literature from both forensic and clinical studies (20 and 2 papers respectively). The articles by Lignitz and Strauch, Grimm and Sigrist, Leth and Hart-Madsen were found in the list of references in the article by Bohnert and Rothschild [30]. A case involving a 61-year-old woman was excluded [31] because she was stabilized in intensive care and survived. The woman had attempted suicide by burning herself (35 % TBSA) and ingesting S-Adenosylmethionine; she suffered from depression but no previous suicide attempts had been reported. Another case involving an elderly woman, who died as a result of ethanol intoxication and the inhalation of fumes after setting her * Corresponding author. E-mail addresses: simonit.francesco@hotmail.it (F. Simonit), ugo.dabroi@uniud.it (U. Da Broi), lorenzo.desinan@uniud.it (L. Desinan). http://dx.doi.org/10.1016/j.forsciint.2019.110073 0379-0738/© 2019 Elsevier B.V. All rights reserved. Forensic Science International 306 (2020) 110073 Contents lists available at ScienceDirect Forensic Science International journal homepage: www.elsevier.com/locat e/f orsciint