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American Journal of Forensic Medicine & Pathology:
doi: 10.1097/PAF.0000000000000069
Original Articles

Evaluation of Shotgun Suicides in Konya, Turkey Between 2000 and 2007

Demirci, Serafettin MD*; Dogan, Kamil Hakan MD, PhD; Deniz, Idris MD; Erkol, Zerrin MD§

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From the *Department of Forensic Medicine, Meram Medical School, Necmettin Erbakan University; and †Department of Forensic Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey; ‡Department of Forensic Medicine, Burhan Nalbantoglu Hospital, Lefkosa, Nicosia, Cyprus; and §Department of Forensic Medicine, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.

Manuscript received December 19, 2012; accepted February 22, 2013.

The authors report no conflicts of interest.

Reprints: Kamil Hakan Dogan, MD, PhD, Department of Forensic Medicine, Faculty of Medicine, Selcuk University, Aleaddin Keykubat Campus, 42075 Selcuklu, Konya, Turkey. E-mail: drhakan2000@gmail.com.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site ( www.amjforensicmedicine.com).

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Abstract

The number of the suicides is increasing all around the world. In this study, the cases autopsied between 2000 and 2007 in The Konya Branch of Forensic Medicine Council were retrospectively investigated. Fifty-seven shotgun suicides were determined. The cases were evaluated in terms of their demographic characters, site of entrance wound, the type of the cartridge used, shooting distance, the place of incident, the place of death, motive for suicide, and the presence of previous suicide attempts. The most preferred site of entrance wound was the head with 34 cases (59.7%). Of 34 cases in which the entrance wound was on the head, there was indirect mandibular fracture in 16 cases (47.1%). In 11 cases (19.3%), there observed small ecchymosed abrasions on the finger surfaces, which are thought to have resulted from the trigger kicking back during triggering or the finger having been stuck between the trigger and the trigger guard. It is concluded that there is a need for a legal regulation that makes obtaining of shotguns more difficult and the people who have them are to be educated not to keep them in easily accessible places.

Shotguns have a long barrel with a smooth bore and are designed to fire a shell containing multiple lead pellets that, on exiting the barrel, spread out over a large area. This allows one to fire the weapon in the general direction of a target and have a better chance of hitting the target if it is small or moving.1

Hunting is a very old tradition in Turkey. Therefore, shotguns are very common in Turkey, especially in the countryside. Konya is the fourth largest city in Turkey, in which the study was carried out. It is located in the Middle Anatolia Region, and according to the census data for 2011, the total population is 2,038,555, of which 1,009,855 are male and 1,028,700 are female.2 As Konya province is one of the leading centers in shotgun production in Turkey, shotguns are very commonly used in this region. When shotguns are easily available to people through legal and illegal ways, other than their use in hunting, they are also used for protection and to commit suicide.

There is a relation between the availability of highly lethal suicide methods and rates of suicide.3,4 It is disappointing to note that studies specific to shotgun shooting cases are neither adequate nor comprehensive. It has been included either as a part of study of overall firearm cases or as a passing reference, with some emphasis to meet the requirement of a comparative analysis of cases involving different types of firearms. A few studies, which focused only to shotgun cases, have been devoted solely to injury aspects.5–7 This study aims to put the features of shotgun suicides forth.

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MATERIALS AND METHODS

In this study, the cases that were autopsied by forensic medicine experts at the Konya Branch of Forensic Medicine Council and in the districts of Konya between 2000 and 2007 were retrospectively investigated. Shotgun suicides were evaluated in terms of their demographic characters, location of entrance wound, indirect mandibular fracture in head injuries (which does not occur as a result of the missile hit), finger injuries during triggering, the type of cartridge used, shooting distance, the place of incident, the place of death, motive for suicide, and the presence of previous suicide attempts and suicide notes.

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RESULTS

In the 8-year period between 2000 and 2007, there were 3940 death examinations and autopsies performed, and 288 (7.3%) of them were committed with firearms. Of the firearm deaths, 141 of them (48.9%) were committed with shotguns. When the shotgun deaths are evaluated in terms of manner, 44.7% (n = 63) of the cases were homicide, 40.4% (n = 57) were suicide, and 14.9% (n = 21) were accident (Fig. 1). In this study, 57 suicides were included. These 57 cases comprised 14.9% of all suicide cases (n = 382), and 47.1% of all firearm suicides (n = 121) occurred in this period.

FIGURE 1
FIGURE 1
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The ages of the 57 subjects who committed shotgun suicides ranged between 13 and 75 years, the average being 34.0 ± 17.1 years. Twenty-seven (47.4%) of the cases were in 20- to 39-year age group (Fig. 2). Forty five of the cases (78.9%) were male, and 12 (21.1%) were female (Fig. 3). The male-to-female ratio was 3.7:1. Eighteen (31.6%) of the suicides occurred in summer, which was followed by autumn (n = 15, 26.3%) (Fig. 4).

FIGURE 2
FIGURE 2
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FIGURE 3
FIGURE 3
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FIGURE 4
FIGURE 4
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The shooting distance was contact/near contact in 55 cases (96.5%), and in 2 cases (3.5%) it was close. The most preferred site of entrance wound for shotgun suicides was the head with 34 cases (59.7%). This was followed by abdomen with 9 cases (15.8%), and by chest region with 7 cases (12.3%) (Table 1). Analysis of the specific head locations revealed the most common location to be under the chin with 19 cases (55.9%), followed by right temple with 9 cases (26.5%) (Table 2). In all of the 34 shoots to the head region, the skulls were burst.

TABLE 1
TABLE 1
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TABLE 2
TABLE 2
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Of 34 cases in which the entrance wound was on the head, there was indirect mandibular fracture in 16 cases (47.1%) (Fig. 5). In 11 cases (19.3%), small ecchymosed abrasions were observed on the finger surfaces, which are thought to have resulted from the trigger kicking back during triggering or the finger having been stuck between the trigger and the trigger guard (Figs. 6 A–D).

FIGURE 5
FIGURE 5
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FIGURE 6
FIGURE 6
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In 54 of the cases (94.7%), there was only 1 shot, in 2 cases (3.5%) there were 2 shots, and in 1 case there were 3 shots. In 50 cases (87.7%), the event occurred at home (Table 3). Fifty-two (91.2%) of the shotguns were 12-gauge; the others were 16-gauge. Forty-nine of the cartridges (86.0%) used in the event contained birdshot pellets, which was followed by 4 buckshot pellets (7.0%) and 4 rifled slugs (7.0%). Whereas 51 cases (89.5%) died at the incident scene, 6 cases (10.5%) died in hospital.

TABLE 3
TABLE 3
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In all the cases who died at the incident scene, the scene was investigated, and blood and/or tissue parts on the shotgun and/or in the barrel were found. Suicide notes were found in 13 cases (22.8%). In 10 cases (17.5%), there was suicide attempt history.

When the suicide motives that were based on the scene investigation findings and/or on informant relatives were assessed, 18 (31.6%) of the victims with psychiatric illness were the largest group, which was followed by 12 cases (21.1%) with economic problems, and 7 cases (12.3%) had chronic physical illness/disability (Table 4). Forty-eight victims (84.2%) were living in slums of the city or in towns or villages.

TABLE 4
TABLE 4
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DISCUSSION

Suicide is the eighth leading cause of death in the United States.8 In 2011, 2677 people committed suicide in Turkey, a rate of 3.62 per 100,000 population,9 and suicides are in the 13th position among all deaths.10

Gunshot injuries are a major problem worldwide from the human, medical, and economic perspectives. The number and characteristics of gunshot fatalities have been observed to vary significantly between countries. The types of weapon used to commit suicide vary by country. In an investigation of the patterns of firearm fatalities, Thomsen and Albrektsen11 from East Denmark reported 50% suicides and 28% homicide cases of shotgun. In a study of 335 suicide cases in Stockholm (1983–1992), Karlsson12 reported 35% involvement of shotguns. Druid,13 on site of entrance wound, also revealed similar statistics. He pointed out that shotguns were the most frequent weapons used in all age groups, being responsible for about half of both suicidal and homicidal wounds. A similar proportion has been reported by Chapman and Milroy14 in their study on firearm deaths in Yorkshire and Humberside. On suicidal gunshot wound, Avis15 also reported that shotguns were most frequently used weapons (60.9%). In 57% of firearm fatalities in Denmark, a shotgun was used, with rifles and handguns accounting for 20%, in 18%, respectively.16 In the studies carried out in Turkey, Azmak et al17 reported that shotgun deaths were 34.1% of all firearm deaths; Goren et al18 noted that shotgun deaths were 23.3% of firearm suicides. In this study, shotguns were used in 47.1% of all firearm suicides and 48.9% of all shotgun deaths. These rates in this study seem to be very high compared with those of the other studies in Turkey. This difference can be attributed to the common possession of guns at homes especially in the countryside.

Azmak et al17 reported that 54% of firearm deaths occur in the 20- to 40-year age group. In a study on firearm suicides, the average age was found to be 36.9 years.19 In this study, the average age was 34 years, which was similar to those of the studies on firearm deaths, and 47.4% of the cases were between 20 and 39 years old.

Firearm deaths are reported more commonly in males.17,18,20 In this study, males comprised 78.9% of the cases, and male-to-female ratio was 3.7:1. This can be stemming from men’s interests to guns since childhood and from their being more eager to possess guns.

Goren et al18 reported that firearm deaths mostly occur in summer with 30.4% of the cases happening in summer. In this study, 18 (31.6%) of the cases committed suicide in summer.

Shotgun wounds impart a large amount of energy to the tissues, particularly if fired at contact or close range.1 The severity of the injuries in contact wounds of the head is due to 2 factors: the charge of shot entering the skull and the gas from combustion of the propellant. The shot directly fractures the skull and shreds the brain while producing pressure waves that increase the severity of these injuries as well as ejecting the brain tissue. The gas entering the closed chamber of the head expends rapidly, adding to the pressure waves acting on the bony framework of the skull. The only way for the skull to relieve the pressure produce is to shatter.20 In contrast to the head, contact shotgun wounds of the torso often have a fairly innocuous appearance lightly related to the elastic nature of the tissues of the body walls and the ability of the chest or abdominal cavities to be able to accommodate a large amount of expelled gas.1 The most preferred site of entrance wound for shotgun suicides was the head with 34 cases (59.7%) in this study, and all of them were burst. The shooting distance was contact/near contact in 55 cases (96.5%), and in 2 cases (3.5%) it was close.

Head and chest are reported as the 2 most common entry wound sites for firearm injuries.21 It was reported that the head was the most common location, followed by chest, then abdomen in shotgun suicides.15,22,23 Karlsson12 and Karger et al24 both showed that head wounds were the most common, followed by chest wounds. Abdomen with 9 cases (15.8%) and chest region with 7 cases (12.3%) followed head wounds in this study.

Analysis of the specific head locations reveals the most common location to be under the chin with 19 cases (55.9%), followed by right temple with 9 cases (26.5%). However, some authors found that the most common location on the head to be intraoral.12,22,23 Cina et al25 found that wounds to the side of head were more common than intraoral wounds.

In a study by Kolusayin,26 in which he investigated 222 firearm cases with skull injuries, it was reported that 31 cases had their skull burst, among them 5 (3 shotguns, 1 handgun, and 1 military rifle) had indirect mandibular corpus fracture and that these fractures occurred as bending or tightening because of the force pushing the condyle outward. In this study, in 4 of the 13 cases in which shots were done to the forehead or temporal region, the fractures are thought to have occurred with the same mechanism Kolusayin26 put forward. However, in 12 cases of the 19 cases in which the shots were done to under the chin, indirect mandibular fractures are to have resulted from aerodynamic effect, that is, the gas pressure that comes out when the shot is done. In firearm injuries, although the shot distance and the type of the gun used can be identified easily in fresh corpses, this information can hardly be obtained from mortified corpses. Therefore, the indirect mandibular fractures found in shotgun injuries are considered to be useful findings in determining the manner of death and shooting distance.

In a study about shotgun wounds, it is reported that, given a shotgun wound to the head, it is 7.6 times more likely that the wound is a result of a suicide than a homicide. The same can be said for an intraoral wound (20.8 times more likely a suicide) and a submental wound (9.8 times more likely a suicide). However, for several wounds, the reverse is true. Given multiple wound locations, the wounds are 85.6 times more likely to be the result of a homicide than a suicide. The same is true for wounds to the face (88.5 times more likely a homicide) and a wound to the back of the head (25 times more likely a homicide).22

A contact/near-contact shot is generally assessed as a finding that increases the possibility of suicide. It is interesting to note that, although uncommon, multiple shots do occur in suicides.22 In this study, whereas 54 of the cases (94.7%) made 1 shot, 2 cases (3.5%) made 2, and 1 case (1.8%) made 3 shots.

It was reported that 12.4% of the houses had firearms, and only 25% of them kept them in a safe place in a study carried out in Turkey. It was also determined that in less than one third of the houses with guns, the bullets and shells are kept in a separate place.27 In this study, the place of the incident was house in 50 cases (87.7%).

Harruff28 evaluated 89 contact shotgun wounds of the head. Twelve-gauge shotguns were the most common, accounting for 69% of the cases, followed by 20-gauge (18%). Kohlmeier et al29 reported that the most common gauge was 12-gauge, representing 57.3% of 157 cases. Whereas 52 (91.2%) of the shotguns were 12-gauge, the others were 16-gauge in this study. This is related with the common availability of 12-gauge shotguns in our region.

One point that should be taken into consideration in shotgun injuries is the examination of the hands and fingers. In 11 cases of this study, small ecchymosed abrasions on the finger surfaces were observed, which are thought to have resulted from the trigger kicking back during triggering or the finger having been stuck between the trigger and the trigger guard. This finding indicates that the trigger is pulled by the victim himself and supports suicide.

In this study, it was determined that 89.5% of the cases died at the spot. This is important as it points out the severity of shotgun injuries. In shotgun injuries, scene investigation would be very useful in determining the manner of death and enlightening the event. Especially, in head region injuries, the tissue parts strewed to the place, the shotguns being very close to the person, the existence of blood and tissue parts on the gun and/or in the barrel (especially in shots to under the chin and neck), and a suicide note are the findings that make us consider suicide.

As a result, shotgun deaths and shotgun suicides make up an important place in firearm deaths. Our region has an important place in shotgun production. The prevalent availability of shotguns at homes in Turkey—especially in the rural areas—makes these guns easily accessible. Therefore, we think that there is a need for a legal regulation that makes the obtaining of shotguns more difficult; the people who have them are to be educated not to keep them in easily accessible places, and the awareness of the society about the use of shotguns is to be raised. Besides, in addition to a detailed scene investigation in shotguns deaths, the investigation of indirect mandibular fractures in head injuries and the determination of skin abrasions on the finger that pulled the trigger are considered to be useful in the determination of the manner of death.

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REFERENCES

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Keywords:

suicide; shotgun; firearms; forensic

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