A scoping review of strangulation and hanging: determining suicide from concealed homicide in equivocal death cases.

There has been limited investigation on the cross-over between suicide and homicide: when should suicide be considered concealed homicide? A scoping review was undertaken examining hanging and ligature/manual strangulation deaths, including suicides and homicides staged to appear as suicides. Three types of manner of death indicators were identified: scene, decedent and medical. Scene factors suggestive of staging in hanging and strangulation cases include certain aspects of the victim's hair, jewellery and clothing, evidence of clean-up, and unexplained absence of items. The decedent's mental illness, previous suicide attempts and psychological distress remain risk indicators, but protective factors warrant consideration. Medical indicators are controversial, especially for fractures. Views that manual strangulation relates solely to hands around the neck are simplistic and fail to account for other lethal manual methods. Hanging cases need to be thoroughly investigated, particularly when a female decedent is discovered by an intimate partner.