A recent article from the The American Journal of Forensic Medicine and Pathology has a 10-year case review covering 24 deaths (wow) from the US state of Kentucky alone and serves as a summary of the research into this fate-tempting and most suicidal of games.
It’s a curious set of studies for which the most reliable finding is that people who die by Russian roulette are mostly young men who were drunk or had taken drugs.
On the more unusual side, one study found a link between participation in Russian roulette and “the types and number of tattoos and body piercing”.
The article also briefly describes a number of previous case reports from the literature, including this one which is remarkable for both mathematical and ultimately tragic reasons:
Playing a variation of traditional Russian roulette with his brother and 2 friends, the victim placed 5 live rounds in the cylinder, leaving one empty chamber, of a .357 Traus revolver. He spun the cylinder, put the gun to his right temple, and pulled the trigger. Postmortem blood toxicology revealed an ethanol level of 0.01% and the presence of diazepam and nordiazepam. The decedent had played Russian roulette on 2 occasions in the previous several weeks, each time placing only one live round in the cylinder.