ORIGINAL ARTICLE
Evaluation of Shotgun Suicides in Konya, Turkey
Between 2000 and 2007
Serafettin Demirci, MD,* Kamil Hakan Dogan, MD, PhD,Þ Idris Deniz, MD,þ and Zerrin Erkol, MD§
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 in-
vestigated. 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 in-
cident, 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 fin-
ger 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 regu-
lation 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.
Key Words: suicide, shotgun, firearms, forensic
(Am J Forensic Med Pathol 2014;35: 45Y49)
S hotguns have a long barrel with a smooth bore and are de-
signed 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, shot-
guns 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 fe-
male.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
Manuscript received December 19, 2012; accepted February 22, 2013.
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.
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).
Copyright * 2014 by Lippincott Williams & Wilkins
ISSN: 0195-7910/14/3501Y0045
DOI: 10.1097/PAF.0000000000000069
Am J Forensic Med Pathol & Volume 35, Number 1, March 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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.5Y7 This study aims to put the features of
shotgun suicides forth.
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 eval-
uated in terms of their demographic characters, location of en-
trance wound, indirect mandibular fracture in head injuries
(which does not occur as a result of the missile hit), finger in-
juries 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 sui-
cide notes.
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.
The ages of the 57 subjects who committed shotgun sui-
cides ranged between 13 and 75 years, the average being 34.0 T
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).
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 com-
mon 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.
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 AYD).
www.amjforensicmedicine.com 45
Demirci et al
FIGURE 1. Distribution of manner of the shotgun deaths in
Konya, Turkey, between 2000 and 2007.
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.
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 at-
tempt history.
When the suicide motives that were based on the scene
investigation findings and/or on informant relatives were as-
sessed, 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.
FIGURE 2. Number of shotgun suicides by 20-year age group.
Figure 2 can be viewed online in color at
www.amjforensicmedicine.com.
46 www.amjforensicmedicine.com
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Am J Forensic Med Pathol & Volume 35, Number 1, March 2014
FIGURE 3. Distribution of sex of shotgun suicide cases. Figure 3
can be viewed online in color at www.amjforensicmedicine.com.
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
(1983Y1992), Karlsson12 reported 35% involvement of shot-
guns. 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 pro-
portion 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
FIGURE 4. Seasonal distribution of shotgun suicides. Figure 4
can be viewed online in color at www.amjforensicmedicine.com.
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Am J Forensic Med Pathol & Volume 35, Number 1, March 2014 Evaluation of Shotgun Suicides

TABLE 1. Distribution of Location of the Entrance Wound

n %
Head 34 59.7
Abdomen 9 15.8
Chest 7 12.3
Neck 4 7.0
Chest + abdomen* 2 3.5
Thigh 1 1.7
Total 57 100.0
*Two shots in 1 case.

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 in-
terests 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 se-
verity 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 re-
lieve the pressure produce is to shatter.20 In contrast to the head,
TABLE 2. Distribution of Location of the Entrance Wound on
the Head
n %
Under chin 19 55.9
Right temple 9 26.5
Forehead 3 8.8
Mouth 2 5.9
Left temple 1 2.9
Total 34 100.0
FIGURE 5. Indirect mandibular fracture occurring from a shot
under the chin. Figure 5 can be viewed online in color at
www.amjforensicmedicine.com.
contact shotgun wounds of the torso often have a fairly innoc-
uous appearance lightly related to the elastic nature of the tis-
sues 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 abdo-
men 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 aerody-
namic 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 in-
juries 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).

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Demirci et al Am J Forensic Med Pathol & Volume 35, Number 1, March 2014

FIGURE 6. Small ecchymosed abrasion on the finger that occurred during triggering. Figure 6 can be viewed online in color at
www.amjforensicmedicine.com.

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, represent-
ing 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 shot-
gun 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 sup-
ports 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 shot-
gun 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
TABLE 4. Motive of the Suicide

n %
TABLE 3. Distribution of the Incident Location Psychiatric illness 18 31.6
Relationship problems 14 24.5
n % Finance 12 21.1
Home 50 87.7 Chronic physical illness/disability 7 12.3
Field, garden 3 7.0 School failure 2 3.5
Office 2 3.5 Gossip about him/herself 2 3.5
Cemetery 2 1.8 Unknown 2 3.5
Total 57 100.0 Total 57 100.0

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Am J Forensic Med Pathol & Volume 35, Number 1, March 2014
at homes in TurkeyVespecially in the rural areasVmakes 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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