The most common method of committing suicide in the United States is by shooting. Approximately 65% of men committing suicide use firearms, with the remainder of the deaths almost equally divided between drug overdoses and hanging. Traditionally, the preferred method used by women was an overdose of drugs. Since the mid-1980s, however, use of firearms has become the most popular method of suicide in women.1 In 1970, in the United States, 30% of women shot themselves and 48% took an overdose of drugs; by 1990, the percentages were 42% and 36%, respectively. In a study of 698 consecutive male suicides in San Antonio, Texas, 71.5% used a firearm, 13.8% hung themselves, 6.5% overdosed on drugs, and 8.2% used other means.2 Of 221 consecutive female suicides, 49.3% used firearms, 31.7% drugs, 10.4% hanging, and 8.6% other means.
In regard to choice of weapons, handguns are used more often than rifles or shotguns. There is a difference in firearm use based on sex as demonstrated by the San Antonio study where 73% of men used handguns, compared to 92% of women.
While most suicidal gunshot wounds are contact wounds, a small (1 to 3%) but significant number are of intermediate range (Figure 14.1). Occasionally, one encounters a distant wound. The latter situation was illustrated by an individual brought to the Bexar County Medical Examiner's Office with a self-inflicted intraoral gunshot wound. At autopsy, the bullet was seen to have entered the dorsal surface of the tongue, traveled straight backward into the vertebral column severing the cord. There was no soot, powder tattooing, or powder on the face, in the mouth, or on the posterior pharynx. Powder tattooing was present on the inner aspect of the wrists, however. The weapon was a 2 in. barrel .38 Special revolver. Testing of this weapon and the ammunition in it revealed that powder tattooing extended out to 12 to 18 inches. The deceased held the weapon at arms length, opened her mouth and discharged the weapon, firing a bullet into her mouth. The range was
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