BACKGROUND: Complex suicide, whether planned or unplanned, presents significant challenges for forensic specialists and judicial authorities. Although rare, each case requires a thorough examination of both the body and the scene of death. This study aims to analyze the pattern of complex suicide victims in northern Tunisia, comparing them with simple suicide cases. METHODS: This was a retrospective observational study with retrospective data collection. We included all cases of simple and complex suicides, autopsied at the Department of Legal Medicine of Tunis, from 2005 to 2021. RESULTS: In total, 72 complex suicides (3.3 % of 2153 suicide fatalities) were identified, with 35 planned and 37 unplanned complex suicides. Males represented 77.8 % of the cases and their mean age was 42.2 ± 15 years. A history of mental illness was reported in 31.9 %. Two suicide methods were used in 93.1 % of cases. The most frequent combination was poisoning and hanging (29.2 %), followed by drowning and falling from a height (12.5 %). The most common single methods were hanging (48.6 %), poisoning (55.6 %), sharp force (31.9 %), and fall from a height (25.0 %). The latter three methods were significantly higher than simple suicides (p <
0.002). CONCLUSIONS: Complex suicide is infrequent and presents significant investigative challenges. A detailed analysis of the victim's background, an on-site inspection of the scene, reconstruction of the events, and a complete autopsy are essential to determine the cause and manner of death.