Adolescence is a phase of physical and psychological development that spans from puberty to legal adulthood. During this phase, they are exposed to various hazards which can lead to unnatural deaths by distorting physical, mental and social wellbeing.

Unnatural deaths are known to claim a substantial number of lives globally. Unnatural death means a death which is caused by external means e.g., injury or poisoning that includes death due to homicide or suicide, and death caused in an accidental manner.^[1] These unnatural deaths in adolescents are related to many cultural and socioeconomic factors in a geographical area. WHO defines an adolescent as an individual aged between 11- 19 years i.e. those in the second decade of their lives. Medico-legally this age group occupies a very important area of study. Around 1.2 billion people, or, one in six of the world population belongs to the adolescent group. In India about 21% (243 million) of population are adolescents.^[2]

Adolescents are known to be moody, insecure, argumentative, impulsive, reckless and rebellious. In this age group testosterone and oestrogen give rise to a competitive streak, adventure, sexual excitement to opposite sex, and at the same time depression. ^[3] These changes increase violence and mortality rate in adolescents. Studies show that about 70% of deaths among adolescents are due to preventable causes such as accidents, homicides and suicides. ^[4] This is a cause of concern as adolescents are the future of our nation and they constitute the major demographic and economic force.

The purpose of this study is to analyse unnatural deaths in adolescents. This study might help in providing valuable information and may be used by society and law enforcement authorities to prevent such mortalities. The aim and objectives of the present study were to analyse the socio-demographic profile of the adolescent victims of unnatural deaths and to analyse the cause and manner of unnatural deaths in adolescents.

Aim of the study: To find out the pattern of unnatural deaths among adolescents.

Objectives of the study: 1. To enumerate the various types of unnatural death amongst the adolescent deceased.

2. To enumerate the cause and the manner of death amongst the adolescent deceased.
3. To identify any association between the aetiology of unnatural deaths with the sociodemographic profile of the deceased.

MATERIALS AND METHODOLOGY

Study design: Retrospective descriptive observational study.

Study period: The study was conducted for two years from January 2023 to December 2024.

Study area: Department of Forensic Medicine and Toxicology, IPGME&R and SSKM Hospital, Kolkata.

Study population: All the deceased in the age group of 10-19 years which were brought for medicolegal autopsy at IPGME&R and SSKM Hospital have been included in this study.

Inclusion criteria: All male and female deceased in the age group of 10-19 years have been included in this study.

Exclusion criteria:  

1. Decomposed, mutilated and skeletonised bodies were excluded.
2. Unknown dead bodies where the exact age could not be established were excluded.
3. Unknown dead bodies where the cause of death could not be determined were excluded.
4. Cases where the history regarding the circumstances of death were inadequate were excluded.

Sample size and sampling procedure: All the cases of adolescents in the age group of 10-19 years which came for medicolegal autopsy at our tertiary care hospital morgue from 1^st January 2023 to 31^st December 2024 have been taken into account considering both the inclusion and the exclusion criteria.

Data collection: Data was collected from:

• Hospital records.
• Police inquest and requisition related information.
• Medicolegal autopsy reports.

Data was then recorded in a validated pre-designed proforma.

Data analysis: All the data were plotted in excel sheet and the analysis was performed using the latest version of SPSS software (version 31). The results have been represented in the form of tables and charts.

Human subject protection: Approval from the esteemed Institutional Ethics Committee of IPGME&R and SSKM Hospital was obtained bearing the Memo no. IPGME&R/IEC/2025/0134 dated- 14/06/2025.

RESULTS

The results have been represented in the form of tables and charts as given below.

Out of 264 subjects, 186 (70 %) were males and 78 (30 %) were females, 166 were Hindus and 97 were Muslims, 194 subjects (73 %) resided in rural areas and 70 subjects (27 %) resided in urban areas, 205 subjects (78 %) received treatment and 59 subjects (22 %) did not receive any treatment. 85 subjects (32.2 %) received treatment for 1-7 days before death, 22 subjects (8.3 %) received treatment for less than 24 hours before death whereas 59 subjects (22.3 %) were brought dead to the hospital.

Out of 264 study subjects, 3 cases of homicide (1.1 %) were reported in males and 2 cases of homicide (0.8 %) were reported in females. Amongst suicidal deaths, the most common means adopted was poisoning which was seen in 19 male subjects (7.1 %) and 22 female subjects (8.3 %) followed by hanging which was seen in 7 male subjects (2.6 %) and 8 female subjects (3 %). Road traffic accidents were the most common cause of accidental deaths in males which was seen in 92 male subjects (34.8 %) followed by fall from height which was the second most common cause of accidental death in males and it was observed in 15 male subjects (5.7 %). Amongst females, burn injury was the most common cause of accidental death which was seen in 14 female subjects (5.3 %) followed by road traffic accident which was the second most common cause of accidental death in females and it was observed in 13 female subjects (5 %).

Tables and charts:

Chart 1: showing the distribution of the number of cases with respect to sex in the study population.

Chart 2: showing the distribution of the number of cases with respect to religion in the study population.

Chart 3: showing the distribution of the number of cases in the study population with respect to habitat.

Chart 4: showing the number of cases in the study population who received treatment and the number of cases who did not receive any treatment prior to death.

Table 1: showing the distribution of the number of cases in the study population with respect to the duration of treatment received prior to death.

Table 2: showing the distribution of the manner of death in the study population according to gender.

DISCUSSION

In a retrospective study by Santosh Kumar P et al. (2019) ^[5] undertaken in the Department of Forensic Medicine and Toxicology, Karnataka Institute of Medical Sciences, Hubballi, to determine the pattern of adolescent’s deaths (10-19 years) brought for autopsy during the period of January 2016 to December 2016 revealed that total 82 cases were studied and it was observed that the incidence rate of adolescent deaths was 6.49% among which 43 were males (52.43%) and 39 females (47.56%). Rural deaths were higher when compared to urban, accidental deaths were the highest and road traffic accidents followed by poisoning and burns were the commonest causes of deaths.

Lalchandra Verma et al ^[6] in a study seen that out of 1056 autopsies 94 victims were adolescents contributing 8.9% of total autopsies. Male deaths were more (about 60%) than female (about 40%) and all deaths increased with an increase in age. More than half of the total deaths (51%) were due to accidents, followed by suicides (43%). Females were prone to commit suicides. In suicidal deaths the most common cause was hanging following by poisoning.

Chakraborty P et al ^[7] in a study of medical college of West Bengal found majority (55.1%) of deceased were female; 35.71 percent belonged to younger adolescents (10-14 years). Average age was 16.03±2.49 years showing no variation across gender and castes. Majority (43 percent) of unnatural deaths was contributed by accidents including RTA, fall from height, snake bite, lightning, drowning. The accidents shared around half of total unnatural deaths. Poisoning, hanging including strangulation or throttling and thermal burns ranked next after accident contributing 22 percent, 19 percent and 10 percent, respectively. Accidental deaths were statistically higher in younger adolescents [71.43% vs 36.51%, χ 2=10.98, p=0.000 at df1, OR=4.35(1.63-11.80)] and males. Individuals of higher age were shown more prone to suicide [mean±sd=17.91±1.16 vs 14.32±2.17, t=9.825 & p=0.000 at df 93] than accidents. Females were found less vulnerable to accidents than suicide. Burns cases were found to survive significantly longer after the event.

In a study by Das R et al ^[8] at Kolkata showed that most affected age group is 15 to 19 years & victims are mainly students. RTA is the main cause of unnatural death. Burn injury was the commonest cause among the suicidal cases.

Incidentally a study in Izmir (Turkey) by Tatar G et al ^[9] showed that 75.4% of cases were males. The vast majority of deaths were related to external causes (91.8%), especially road traffic accidents and accidents at home, followed by suicides (24.6%) and homicides (13.4%). The majority of suicides were committed by hanging (59.6%) and most of the homicides by firearms (51.6%). Natural death accounted for only 7.3% of all deaths and 41.2% of them were related to acute myocardial infarction.

In a study done by Venkatesh R et al ^[10] out of 399 cases of unnatural deaths in adolescents, majority of the deceased were females falling in the late adolescent age group of 15-19 years. Majority of the unnatural deaths were suicidal in manner with hanging being the most common cause whereas most accidental deaths were caused by road traffic accidents. Homicidal deaths were seen in males only.

In another study done by Abderrahim SB et al ^[11] unnatural deaths were common amongst male adolescents. Accidental death is the most common manner of death (81.4 %). In cases of suicide, the highest risk profile was a female subject aged between 15 to 18 years. Hanging was the most common means of suicide. In cases of homicidal deaths, the most common means were stabbing and blunt injuries.

Peranantham S et al ^[12] conducted a study in which out of 1003 cases brought for autopsy, 753 subjects (75.1 %) died due to unnatural causes. Amongst 753 cases, 118 deaths (15.67 %) occurred in the age group of 15 to 24 years.

In this study, majority of the study subjects were males (186, 70 %) which is in agreement with the studies conducted by Santosh Kumar P et al. (2019) ^[5] in which majority of the study subjects 43 were males (52.43%), in the study of Lalchandra Verma et al ^[6] majority of the deaths were seen in male adolescents (about 60%) which is in congruence with the finding of our study. In the study of Tatar G et al ^[9] 75.4% cases of adolescent deaths were seen in males which agrees with the finding of our study and in another study done by Abderrahim SB et al ^[11], unnatural deaths were common amongst male adolescents which is in alignment with our finding.

Chakraborty P et al ^[7] in his study found that the majority (55.1%) of the deceased were females, in the study done by Venkatesh R et al ^[10] out of 399 cases of unnatural deaths in adolescents, majority of the deceased were females and both these studies are in disagreement with our study finding. The higher occurrence of adolescent deaths amongst male adolescents can be attributed to the fact that risk taking and impulsive behaviour along with interpersonal violence is more common amongst the male adolescents.

In our study, 194 subjects (73 %) resided in rural areas and 70 subjects (27 %) resided in urban areas. In the study of Santosh Kumar P et al. (2019) ^[5], majority of the adolescent deaths occurred in rural areas which is in agreement with our study finding. This can be explained by the fact that adolescents in rural areas have limited access to healthcare and safety, are exposed to environmental hazards and are prone to use unsafe roads. All these factors along with poverty and illiteracy contribute to higher adolescent deaths in rural areas.

  In our study, poisoning was the most common means of suicidal death seen in 19 male subjects (7.1 %) and 22 female subjects (8.3 %) followed by hanging which was seen in 7 male subjects (2.6 %) and 8 female subjects (3 %). This is in disagreement with the findings of the studies done by Lalchandra Verma et al ^[6], Tatar G et al ^[9], Venkatesh R et al ^[10] and Abderrahim SB et al ^[11] in which hanging was the most common means of suicide followed by poisoning and in another study done by Das R et al ^[8], burn was the commonest cause of suicide which is not in congruence with the finding of our study. Our finding can be explained by the fact that most of the adolescent unnatural deaths in our study were from rural areas and since there is widespread and easy availability of insecticides, weedicides and other poisonous substances in rural areas without any supervising regulations on their purchase so subjects residing in rural areas usually adopt poisoning as a means of suicide.

Road traffic accidents were the most common cause of accidental deaths in males which was seen in 92 male subjects (34.8 %) followed by fall from height which was the second most common cause of accidental death in males and it was observed in 15 male subjects (5.7 %). Amongst females, burn injury was the most common cause of accidental death which was seen in 14 female subjects (5.3 %) followed by road traffic accident which was the second most common cause of accidental death in females and it was observed in 13 female subjects (5 %). This finding is in congruence with the studies conducted by Santosh Kumar P et al. (2019) ^[5], Chakraborty P et al ^[7], Das R et al ^[8], Tatar G et al ^[9] and Venkatesh R et al ^[10] in which road traffic accident was the commonest cause of accidental death in adolescents.

Conclusion and recommendations: Unnatural deaths in adolescents constitute a significant public health issue, reflecting a multifactorial aetiology that includes psychosocial stressors, risk-taking behaviours, and inadequate preventive measures. The high burden of mortality from accidents, suicides, and other external causes underscores the vulnerability of this age group during a critical developmental period. Prevention requires a multidimensional strategy incorporating mental health promotion, early detection of psychological distress, stringent enforcement of safety regulations, and targeted awareness programs. Strengthening school and community-based interventions, along with accessible counselling and support systems, is essential to mitigate risk factors. A coordinated approach involving healthcare providers, educators, policymakers, and families is imperative to reduce preventable mortality and safeguard the well-being of adolescents.

Limitations of the study: 1. The same study could have been done on a larger sample size which would have helped us in arriving at better precise results regarding the trend of unnatural death in adolescents.

2. The present study was conducted over a duration of two years. The same study could have been conducted over a longer duration of time to increase the validity of the results.

Source of funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflict of interest: None declared.

Acknowledgement: I would like to express my heartfelt gratitude to Dr Biswanath Saren and Dr Rohit Sarkar for their contributions and work in completing this research and thereby writing this article.

REFERENCES

1. Aryappan A, Jayadev CJ. Society in India. Social Science Publication;1985 accessed on 5th November 2018.
2. Sivagurunathan C, Umadevi R, Rama R, Gopalkrishanan S. Adolescent Health: present status and its related programmes in India. Are we in right direction? J Clin Diagn Res. 2015; 9(3):1-6.
3. Rao VSK, Rao PCS. An Analytical study of teenage deaths in and around Guntur, Andhra Pradesh, South India. Int J Contemp Med Res. 2018; 5(8):115-9.
4. National Adolescent health information centre. Fact sheet on Mortality: Adolescents and young adults. 2006: 1-4.
5. Santosh Kumar P, Nayak Gajanan H, Karlawad Mahalaxmi B. A Study on Pattern of Adolescent Deaths- A Retrospective Study. Medico-legal Update, January-June 2019; 19(1): 47-51.
6. Verma L, Garg V K, Meena S K. Analysis of medico legal deaths in adolescence: An Autopsy based study at coaching city, Kota. J Indian Acad Forensic Med. 2021 Apr-Jun; 43(2): 126-9.
7. Chakrabarty P, Saren A B, Tudu N K, Dwari AK, Haldar D, Mitra S. Spectrum of Unnatural Deaths among the Adolescents: An Autopsy Based Study. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) April 2015; 14(4): 18-24.
8. Das R, Bhattacharya P, Das S. A Socio-Demographic Review on Adolescent Deaths in West Bengal. J. Evolution Med. Dent. Sci. November 2012; 7 (46): 4990-93.
9. Tatar G, Ulucay T, Asirdizer M, Yavuz M S, Zeyfeoglu Y, Dalgic M, Koker M. The analysis of medico-legal deaths in adolescents and teenagers in Izmir (Turkey). Ege Journal of Medicine 2014;53(1):25-32.
10. Venkatesh R, Kumar P, Mahesh C, Udaya Shankar BS. Pattern of unnatural deaths amongst adolescents autopsied at Bengaluru. International Journal of Medicine and Public Health 2025; 15 (2): 1422-26.
11. Abderrahim SB, Belhaj A, Bellali M, Hmandi O, Gharbaoui M, Harzallah H, Naceur Y, Khelil MB, Allouche M. Patterns of Unnatural Deaths Among Children and Adolescents: Autopsy Study (2011-2018). Pediatr Dev Pathol 2022 Nov-Dec; 25 (6): 635-44.
12. Peranantham S, Gerard PD, Janani S. Autopsy Study of Unnatural Deaths among Youth Population Conducted at Government Thoothukudi Medical College and Hospital 2024. SSR Inst Int J Life Sci, 2024; 10 (6): 6508-12.