When One’s Not Enough

Self-inflicted gunshot wounds are a common modality of suicide. Cases with multiple gunshot wounds are rare. Problems with determining manner may arise when there is a lack of understanding of how and why they occur. Demographic data has seldom been explored in these cases. Gunshot wound suicides from the years 2015 to 2023 were reviewed at the Hillsborough County Medical Examiner's Office. Nineteen cases with multiple gunshot wounds were found. The multi-GSW cases, compared to the single-GSW cases, had a significantly increased proportion of revolvers (57.9% vs. 29.8%, P =0.008), lower muzzle energy handguns (86.7% vs. 39.6%, P <0.001), and shots to the torso (70.6% vs. 9.0%, P <0.001). Multi-GSW case decedents were significantly older than the single-GSW suicide average (16.2 y, P <0.001). There were also significant age differences between decedents who used the following: (Revolvers vs. semi-automatic pistols, 16.2 y, P <0.001; muzzle energy <400 vs. >400 J, 15.8 y, P <0.001; and shots to the torso vs. head, 8.4 y, P =0.002). In our population, older age was associated with factors that might necessitate multiple gunshot wounds in a suicide.