Drowning as a method in complex suicides: forensic insights and a systematic review

Abstract

Background: Drowning is a frequent cause of suicidal death, resulting in a significant but preventable global health problem. Utilization of two or more deadly procedures at the same time is known as a complex suicide (CS). CS is categorized as unplanned and planned. Planned complex suicide (PCS) encompasses the augmentation of the lethality of the selected method to raise the chances of death. Unplanned Complex Suicide (UCS) occurs when an individual’s initial suicide method fails, prompting an improvised switch to a second, different lethal method to ensure death. Main body: This review was aimed to outline the characteristics of drowning as a method used in complex suicide cases within the forensic context. Online databases (PubMed, Scopus, and Web of Science) were searched between 2000 and February 2025. Our search strategy focused on identifying case reports/studies and case series. Seventeen articles were identified that fulfilled review inclusion criteria, describing 25 cases. Suicides were classified as planned in 16 cases, while 9 cases were labeled as unplanned. The most frequent method, with drowning, was poisoning, along with stabbing and sharp-force injuries. The least frequent methods included mechanical asphyxia, vehicle crashes, and electrocution. Conclusions: Complex suicides involving drowning are rare and can be hard to diagnose, as they may mimic homicides or accidents. This review analyzed 25 cases from 17 studies, finding that most were planned and often combined with methods like poisoning or stabbing. Recognizing CS death patterns supports accurate forensic evaluations and emphasizes the magnitude of mental health care and suicide prevention.