Elderly suicides in Denizli, Turkey: a retrospective study from 2011 to 2020

Background Although suicide rates and methods used may vary according to society, gender, and age there are epidemiological studies reporting that suicide rates increase with advanced age in all societies, particularly accelerating after the age of 65 years. This study aimed to investigate the demographic data and suicide characteristics—such as the location and method, among others—of the elderly suicide deaths among forensic deaths between 2011 and 2020 in Denizli, Turkey. Results It was determined that elderly suicides constituted 13.8% of all suicides and increased gradually over the years during the 10-year period. The vast majority of cases were male (82%). It has been observed that hanging is the most frequently used method. It is also noteworthy that although firearm suicide among men was the second most common method, women do not choose this method at all. The majority of elderly suicides (88.5%) in Denizli occurred in the home and its annexes. Conclusions Suicide prevention programmes should promote the elderly to benefit widely from social and health services. Therefore, there is a need to include widespread home care services and firearms regulations in prevention programmes.

Handgun purchasing characteristics and firearm suicide risk: a nested case–control study

Background Firearms are the most lethal method of suicide and account for approximately half of all suicide deaths nationwide. We describe associations between firearm purchasing characteristics and firearm suicide. Methods Data on all legal handgun transactions in California from 1996 to 2015 were obtained from the California Department of Justice Dealer’s Record of Sale database. Handgun purchasers were linked to mortality data to identify those who died between 1996 and 2015. To account for variation in timing and duration of observation time, analyses were stratified by birth cohort. The primary analysis focused on those aged 21–25 in 1996. A secondary analysis tested associations among those aged 50–54 in 1996. Using incidence density sampling, purchasers who died by firearm suicide (cases) were each gender-matched to 5 purchasers (controls) who remained at risk at the case’s time of death. We examined the characteristics of purchasers and transactions, focusing on the transaction closest in time to the case’s death. Data were analyzed with conditional logistic regression. Results There were 390 firearm suicides among the younger cohort and 512 firearm suicides among the older cohort. Across both cohorts, older age at first purchase and the purchase of a revolver were associated with greater risk of firearm suicide. For example, among the younger cohort, those who purchased a revolver versus semiautomatic pistol had 1.78 times the risk of firearm suicide (95% CI 1.32, 2.40) in multivariable models. Other associations varied across cohorts, suggesting cohort or age effects in purchasing patterns. Conclusions Findings add to the evidence on firearm suicide risk and may help inform prevention strategies and future research.

Clinical strategies for reducing firearm suicide

Suicide is complex, with psychiatric, cultural, and socioeconomic roots. Though mental illnesses like depression contribute to risk for suicide, access to lethal means such as firearms is considered a key risk factor for suicide, and half of suicides in the USA are by firearm. When a person at risk of suicide has access to firearms, clinicians have a range of options for intervention. Depending on the patient, the situation, and the access to firearms, counseling on storage practices, temporary transfer of firearms, or further intervention may be appropriate. In the USA, ownership of and access to firearms are common and discussing added risk of access to firearms for those at risk of suicide is not universally practiced. Given the burden of suicide (particularly by firearm) in the USA, the prevalence of firearm access, and the lethality of suicide attempts with firearms, we present the existing evidence on the burden of firearm suicide and what clinicians can do to reduce their patients’ risk. Specifically, we review firearm ownership in the USA, firearm injury epidemiology, risk factors for firearm-related harm, and available interventions to reduce patients’ risk of firearm injury and death.

Seat Belts and Second Chances

This chapter argues for a potentially high-impact but underutilized strategy: restricting or limiting access to highly lethal methods for suicide, especially firearms. It begins by describing the role of seatbelts in traffic fatality prevention. Prevention through design assumes that injuries, illnesses, and fatalities can be most effectively reduced or controlled by designing and building systems that eliminate or remove potential hazards from the very beginning, before they can cause any harm. If we shifted our mindset surrounding suicide prevention in a way that better aligned with the prevention through design approach underlying traffic fatality prevention, we might reconsider the considerable time, effort, and resources being devoted to the development and implementation of suicide risk identification and detection methods, and consider instead the potential impact of redirecting these efforts toward environmentally focused strategies that are more likely to reduce suicide rates. The chapter then considers the life-saving effects of laws and policies designed to reduce access to firearms, discussing firearm suicide in the United States.

“Rust stain”: a rare mark in firearm suicide—a case report and review of the literature

Rust stains are marks left by firearms in case of prolonged contact with the cutaneous surfaces. These peculiar signs along with other well-documented findings can guide the medical examiner in the determination of the manner of death, especially in case of firearm suicide. This paper presents the case of a 33-year-old male soldier who committed suicide by using a short-barreled weapon, whose trigger remained in contact with the first finger of his right hand, leading to the formation of a rust stain that perfectly reproduced its design. The forensic examination of the scene, the external cadaveric inspection, and the autopsy are described. For the evaluation of the histological findings typical of rust spots, the authors decided to replicate the phenomenon in an experimental setting using porcine skin. In order to provide an exhaustive overview on the formation and the features of rust stains, a review of the forensic literature concerning this rare mark was performed.

Gun availability and gun control in suicide prevention

Suicide by firearm is the most lethal method of suicide and is executed much more frequently by men than by women. In comparison with other suicide methods, pre-existing psychiatric conditions are found less often and medical comorbidities more often. Suicide by firearm is carried out impulsively, frequently following a relationship crisis. Firearm suicide is mainly found in high- and middle-income countries. There is a close correlation between the frequency of firearm ownership and the frequency of this suicide method. People living in households with a gun generally seem to be at a higher risk of suicide. Several changes of legislation that lead to a decreased availability of guns have proven to be effective. However, legislation changes regarding firearms often lead to resistance by gun lobbies. Which intervention can be successfully implemented, mostly depends on country-specific circumstances.