Death By Suicide and Russian Roulette: Using National Registry Data to Inform Public Policy and Social Work Practice Among Young Adults

Background and Purpose

Increasingly, Russian Roulette (RR) has garnered the attention of social workers, because it is actively promoted on social media with fatal consequences. There is limited epidemiological research on this phenomenon, and it is rarely acknowledged or treated in clinical or forensic settings. Administrative data provide a comprehensive understanding of demographic, psychological, and social factors that can inform public policy and social work interventions for RR. Previous research in the US showed that RR was associated with being male, under 30, and using substances. However, this research was not nationally representative and had small sample sizes. Our current study uses a large, nationally collected dataset of all officially recorded deaths by suicide over two decades to: 1) examine the demographic characteristics of individuals who die by RR; 2) explore differences in RR deaths versus other revolver deaths by suicide; 3) investigate factors and precipitating events contributing to RR deaths, and 4) differentiate RR deaths that appear to be largely impulsive risk-taking acts from those similar to other deaths by suicide.

Methods

This study used data from the National Violent Death Reporting System’s Restricted Access Datafile from January 1, 2003, to December 31, 2022. A text string search of coroner/medical examiner and law enforcement reports was used to identify RR deaths. Identified cases were screened by two researchers to confirm engagement in RR at time of death. Bivariate associations (Chi-square, ANOVA, t-tests) assessed differences between RR and non-RR revolver deaths by suicide across demographics (e.g., race/ethnicity, sex, age), specific case characteristics, and precipitating events, such as financial crises, relationship problems, and criminal activity. In-depth narrative analyses distinguished RR deaths that appeared to be spontaneous, risk-taking acts, from those similar to other revolver deaths by suicide.

Results

Results identified 534 cases of RR out of 45,388 revolver deaths by suicide. Rates of RR were significantly higher among people who were younger (mean age=28.49 vs. 59.02; p<.001), less educated (Χ²=198.388, p<.001), and Black, American Indian/Alaskan Native, and/or Hispanic (Χ²=576.896, p<.001). Almost all RR cases were men (98.3%). Mental health issues (Χ²=84.243, p< .001) and common precipitating factors for death by suicide were significantly lower, while positive toxicology for alcohol (Χ²=115.672, p< .001), amphetamines (Χ²=110.919, p< .001), cocaine (Χ²=58.108, p< .001), and marijuana (Χ²=148.151, p< .001) were significantly higher among individuals who died by RR. Narrative analyses found a substantial proportion of people who died by RR did not display active suicidality, and rather appeared to be engaging in impulsive, ego-based risk taking.

Conclusions and Implications

The current study shows that administrative datasets can be used to identify risk factors that contribute to RR. Given the popularity of social media and its ties to risky or self-injurious behaviors (e.g., TikTok Challenges), social work researchers should consider using these datasets to inform targeted prevention and intervention efforts. The findings also suggest that social workers need specialized training in recognizing that risk-taking behaviors may include lethal activities such as RR, which can inform standards and advocacy with young adults, their families, and communities.