CASE FILICIDE-SUICIDE: A CASE REPORT ON TRIPLE HANGING

Dyadic deaths involve deaths that occur when two or more persons die together or one after another in the same incident. Filicide-suicide is a variant of homicide-suicide which includes the killing of children by a parent. We bring here a rare case of a father with his two children found hanging in a shed with a use of single ligature material, nylon rope. The children were of age three and five years. It happened when wife of the man had run away with another man leaving them behind for 15 days.


INTRODUCTION
Filicide-suicide is a special category of homicide-suicide event where the victim(s) are children and the perpetrator are one of the parents or both. 1 Filicide is a complicated and multifactorial crime. Because of its complex nature, it is difficult to establish traits that consistently apply to its perpetrators and victims. 2 However, through careful evaluation of the existing literature, certain trends can be identified. In developed countries, shooting is found to be the most common method of homicide and suicide. 3 This paper presents a rare case from rural area of Eastern Nepal where homicide of children is followed by suicidal death of the father.

CASE REPORT
A male aged 35 years committed suicide by hanging after killing his son and daughter of 5 years and 3 years, respectively through hanging. The site was about 200 meters away from their home. Hanging was done by means of a single ligature material (nylon rope) tied in a bamboo used as a roof of a shed and displayed. Hanging was incomplete in all case. History furnished from the police/ relatives revealed that his wife had run away with another man leaving them behind for 15 days.
The father was a simple man, farmer by occupation with no known history of psychiatric illness as revealed by their relatives. However, after his wife left him, he was in a state of mental trauma and solitude.
Postmortem examination revealed a ligature mark on the neck of all the deceased and was incomplete, running obliquely upwards to the back. Ligature mark was deficient posteriorly due to presence of scalp hair. Face appeared pale. Bluish discoloration of lips was present on all the deceased. Postmortem lividity was present on both upper limbs as glove pattern. Tongue was bitten in case of father and daughter. Neither salivary dribbling from the angle of the mouth nor any salivary stains was observed in the chest area of the victims.
The neck structures were dissected and showed dry, hard, and pale glistening subcutaneous tissue below the ligature mark. Sternocleidomastoid and platysma muscles were intact. Hyoid bone and thyroid cartilages were intact. All internal organs were congested. The cause of death was opined as asphyxia due to ante-mortem hanging by means of ligature.

DISCUSSION
Murder-suicide/homicide-suicide/dyadic death all refers to an incident where a homicide is committed followed by the perpetrator's suicide almost immediately or soon after the homicide. 4 Studies also mention that twice as many fathers as mothers committed filicide-suicide and older children are more often victims than infants which is like our case including older children. 5 Maternal filicide, child murder by the mother, may occur either alone or as part of a joint filicide-suicide. 6 In Nepal, hanging is the most common method of committing suicide, followed by poisoning. 7 Many reported cases involves two individuals whereas occasional reports have reported filicide-suicide involving three persons. 1 We found one similar case from India, where the mother killed both her children by hanging them one by one from a ceiling fan in the same room and later committed suicide by hanging in another room. 1 Single ligature material, with each end of cloth was used for hanging by a couple during suicidal pact was reported in literature which is similar to our study where single ligature is used by three victims. 8 Parental motives for filicide-suicide included altruistic and acutely psychotic motives and are the basis of this case report. 9 One of the study also mentioned altruistic males to be the common victim of filicide suicide which contrast to our case. 10 As in Nepal social values plays a vital role in ones lives and altruistic nature causing this type of heartfelt incidence. Research have shown that parents frequently showed evidence of depression or psychosis and had prior mental health care. 11 Atypical features of this case include young aged children along with father using single rope as a ligature material. Filicidesuicide, tragically, is a permanent act, and the key to avoiding the devastating effects, for the perpetrator, the victim, and the community, is prevention. ACLNOWLEDGEMENT