Background

Suicide is the tenth leading cause of death in the United States, with over half of cases involving firearms (WISQARS 2020). Survivors who discover the body of a suicide decedent or witness the suicide may be at increased risk of mental health diagnoses and suicide from trauma in addition to grief (Tal Young et al. 2012; Pitman et al. 2014). First responders and health care professionals are also at increased risk of suicide themselves due to their occupational exposure to suicide (Lyra et al. 2021). Despite the well-documented deleterious effects of suicide exposure, there is a paucity of data to indicate who typically finds the body of the suicide decedent.

Objective

To describe (1) differences between firearm and non-firearm suicides and (2) circumstances regarding who discovered the body of firearm and non-firearm suicide decedents.

Methods and findings

Data on all suicide decedents in 2018–2019 were abstracted from the El Paso County Coroner’s Office, including police and coroner reports. Authors (LB, CL, JL, EW) abstracted data detailing who discovered the decedent, circumstances of the scene and known suicide risk factors. A 15% random sample of firearm decedents (n = 28) was double-coded with an inter-rater reliability of 94.0%. Analyses were performed using R Statistical Software (version 3.6.2; R Foundation for Statistical Computing, Vienna, Austria).

Of the 332 people who died by suicide, 182 (55%) used a firearm (Table 1). Those who died by firearm suicide and non-firearm suicide had similar distributions of age, race, and ethnicity. Similar to extant research (WISQARS 2020), a higher proportion of individuals dying by firearm suicide was male (83.5% vs. 67.3%), have military affiliation (39.0% vs. 19.3%), and were less likely to have a known mental health diagnosis (47.3% vs. 64.7%) compared to those who died from other means (Table 1). A higher proportion of individuals dying by firearm suicide was male (83.5% vs. 67.3%), had military affiliation (39.0% vs. 19.3%). Those dying by firearm suicide was less likely to have a known mental health diagnosis (47.3% vs. 64.7%) compared to those who died from other means (Table 1). Among those who died by firearm suicide, 85.2% used a handgun (Table 1) and 89.0% suffered a gunshot wound to the head/neck (Table 2).

Table 1 Demographic information in all suicide decedents in El Paso from 2018 to 2019
Full size table
Table 2 Circumstances surrounding suicide decedent, stratified by firearm and non-firearm suicide
Full size table

Most suicide decedents died in their home (71.4%) and were found by a family member or friend of the decedent (60.2%). Of these, 90 (49.5%) were current or former intimate partners, 74 (40.7%) were 1st degree relatives, 39 (21.4%) were other relatives and friends. The remainder were found by a stranger/acquaintance (20.0%) or a first responder (22.4%).

Most (73.2%) suicide decedents were already deceased when found; however, more non-firearm suicide decedents were already deceased when found compared to firearm suicide decedents (81.3% vs. 66.5%). Significantly more firearm suicide events included forced witnessing compared to non-firearm suicide decedents (25.8% vs. 10.3%); (Table 2). Both who discovered the decedent and the decedent's location were similar between firearm and non-firearm suicide events.

Discussion

In this analysis of 332 suicide decedents in El Paso County, Colorado from 2018 to 2019, over two-thirds of suicide decedents died in their home and more than half were discovered by a family member or friend. The remaining 43% of suicide decedents were discovered by strangers/acquaintances or first responders. Little is known about the bereavement and trauma-related outcomes among people who discover a suicide decedent. Given that first-degree relatives of suicide decedents are at increased risk of suicide themselves, interventions targeting survivor-victims who discover the suicide decedent may be warranted to address trauma and mental health effects (Harvard Womens Health Watch 2009). The disfigurement associated with violent methods of suicide (especially firearm suicide to the head/neck) may be an important factor when understanding these traumatic impacts. Additionally, suicides that involve forced witnessing (e.g. shooting oneself in the midst of an argument with an intimate partner or jumping in front of a moving vehicle) and discovering the victim while still alive and being unable to save them are also important factors to consider in terms of the vicarious trauma for the suicide discoverer. Data included in this report are limited to that collected by the coroner’s office and police reports in suicide death investigations in one county. Though there may be some differences, our comparative data appear similar to other firearm vs. non-firearm suicide data at the national level (WISQARS 2020). Contagion effects of suicide have been studied, particularly among adolescents and the impact of media reports reporting suicides and resulting clusters (Gould and Davidson 1988). Future research may evaluate contagion effects of suicide stratified by who discovers the suicide decedent. Lastly, further studies exploring who discovers suicide decedents and how this impacts their mental health may be important to develop-targeted postvention strategies for supporting impacted family, friends, first responders, and strangers.