Guns and Suicide

This is going to be about suicide. Please click here to be taken to something lighter if you don’t feel like reading this today. It will always be here for you to read. I won’t get offended if you go check out puppies.

I’m not really surprised when I hear that firearms are the preferred method of suicide in the United States. First, almost anyone can get a gun one way or another. They’re that ubiquitous. Need a gun and don’t have a criminal record or any other sort of restriction on buying one? Just drive down to a gun shop, fill out a form, maybe wait a little bit depending on where you live, and you’re good to go. You go home, load it up, pull the trigger.

Guns are so deadly that you pretty much are guaranteed to die if you use a firearm:

“Firearms make death a much more likely result for a suicide attempt: 85 to 91 percent of firearm suicide attempts are fatal compared with 3 percent or less for some of the other most commonly used methods, such as overdosing and wrist cutting.”

The evidence is really compelling that more guns equal more suicides, but there are still people who will fight the evidence (and the science behind that evidence). Lucky for us, the Harvard Injury Control Research Center has put together a great list of evidence that you can use to refute the non-believers.

That evidence refutes such gems like: “Yeah, more guns might mean more suicide, but it’s all about mental health, right?” Nope… #8 on the list from the center reads:

“8. Differences in mental health cannot explain the regional more guns = more suicide connection

We analyzed the relationship of gun availability and suicide among differing age groups across the 9 US regions. Levels of gun ownership are highly correlated with suicide rates across all age groups, even after controlling for lifetime major depression and serious suicidal thoughts.

Hemenway, David; Miller, Matthew. The association of rates of household handgun ownership, lifetime major depression and serious suicidal thoughts with rates of suicide across US census regions. Injury Prevention. 2002; 8:313-16.”

“Gun owners just have more mental health problems…” Nope… Look at #9 and #10:

“9. Gun owners do not have more mental health problems than non-owners

We added questions to, and analyzed data from the National Comorbidity Study.

Gun owning households do not have more mental health problems than non-gun owning households; differences in mental health do not explain why gun owners and their families are at higher risk for completed suicide than non-gun owning families.

Miller, Matthew; Molnar, Beth; Barber, Catherine; Hemenway, David; Azrael, Deborah. Recent psychopathology, suicidal thoughts and suicide attempts in households with vs. without firearms: findings from the National Comorbidity Study Replication. Injury Prevention. 2009; 15:183-87.

10. Gun owners are not more suicidal than non-owners

We analyzed data from the Second Injury Control and Risk Survey, a 2001-2003 representative telephone survey of U.S. households. Of over 9,000 respondents, 7% reported past-year suicidal thoughts, and 21% of these had a plan. Respondents with firearms in the home were no more likely to report suicidal thoughts, plans or attempts, but if they had a suicidal plan, it was much more likely to involve firearms. The higher rates of suicide among gun owners and their families cannot be explained by higher rates of suicidal behavior, but can be explained by easy access to a gun.

Betz, Marian E; Barber, Catherine; Miller, Matthew. Suicidal behavior and firearm access: results from the second injury control and risk survey (ICARIS-2). Suicide and Life Threatening Behaviors. 2011; 41:384-91.”

“Yeah, but if I teach my kids to respect guns, they’ll respect guns…” Then you better hope they don’t want to commit suicide too, because…

“11. Adolescents who commit suicide with a gun use the family gun

The vast majority of adolescent suicide guns come from parents or other family members.

Johnson, Rene M; Barber, Catherine; Azrael, Deborah; Clark, David E; Hemenway, David. Who are the owners of firearms used in adolescent suicides? Suicide and Life Threatening Behavior. 2010; 40:609-611.”

“Doctors need to stick to medicine. They shouldn’t ask if I have guns at home…” No, they should. Firearm violence is a public health threat, and healthcare providers are at the front lines of these threats.

“14. Physicians need to do more to help reduce access to lethal means

This commentary presents the overwhelming evidence that the availability of lethal means increases the suicide rate and argues that physicians need to take an active role in reducing access for potentially suicidal individuals.

Miller, Matthew; Hemenway, David. Guns and suicide in the United States. The New England Journal of Medicine. 2008; 359:989-991.”

15. Emergency department physicians and nurses rarely counsel about lethal means restriction

In one Boston emergency department (ED), ED physicians and nurses believe they should counsel suicidal patients on lethal means restriction, but they often don’t. Psychiatrists working at the ED were much more likely to ask about firearms.

Betz, Marian E; Barber, Catherine; Miller, Matthew. Lethal means restriction as suicide prevention: Variation in belief and practices among providers in an urban ED. Injury Prevention. 2010; 16:278-81.

16. Emergency department physicians and nurses do not believe lethal means restriction can prevent suicide

Physicians and nurses at 8 emergency departments (n = 631) were surveyed about their practices and beliefs concerning means restriction and whether they asked their patients about guns. The proportion of providers who reported that they “almost always” ask suicidal patients about firearm access varied across five patient scenarios: 64% would ask a suicidal patient whose suicide plan involved firearms and 21% would ask a suicidal patient who did not have a specific plan. Less than half believed that most suicides are preventable; two-thirds of nurses thought that most or all firearm suicide decedents would have died by another method if the firearm had not been available.

Many ED nurses and physicians do not understand the importance of the availability of lethal means in determining whether or not a suicide attempt ends in death. The Means Matter Campaign needs to continue educating these professionals.

Betz, Marian E; Miller, Matthew; Barber, Catherine et al. Lethal means restriction for suicide prevention: Beliefs and behaviors of emergency department providers. Depression and Anxiety. 2013; 10:2013-20.

17. Mental health providers can be trained to reduce the risk of gun suicide

The Counseling on Access to Lethal Means (CALM) workshops were effective in improving mental health care providers’ attitudes, beliefs and skills regarding lethal means counseling.

Johnson, Rene M; Frank, Elaine; Ciocca, Mark; Barber, Catherine. Training mental health providers to reduce at-risk patients’ access to lethal means of suicide: Evaluation of the CALM project. Archives of Suicide Research. 2011 15(3): 259-264.

“Is it mental health? Is it the economy? Culture? Something else. It can’t be the guns!” Nope, it’s the guns…

“31. Guns alone explain the gun-suicide connection

This article demonstrates that it is virtually impossible for unmeasured confounding to explain the association between firearms and suicide. The association is a real one.

Historically, the tobacco lobby claimed that the association between cigarettes and cancer could possibly be explained by some unknown risk factor for both. This assertion was finally refuted when scientists showed the absurd degree of association between both that such an unmeasured confounder would have to have. This article uses the same refutation for those who try to deny the causal association between guns and suicide.

Miller M, Swanson SA, Azrael D. Are we missing something pertinent? A bias analysis of unmeasured confounding in the firearm-suicide literature. Epidemiologic Reviews. 2016; 38(1):62-9.”

So what does this mean from a policy point of view? Get rid of guns?

In the United States, the ship has sailed on outright banning all firearms. It would be a logistical nightmare as well. Too many people have a ton of guns, and the gun lobby buys politicians with some very good money. Things are not going to change from a political perspective like that.

Instead, we change the attitude towards guns, like we did with seatbelts, airbags, and drunk driving into making cars safer. Or how we did with helmets and bicycle/motorcycle accidents. Or how we did it with smoking. We changed attitudes and cut the death rates from many things, and we can do it again.

We can make it a normal thing for a healthcare provider to ask about guns in the home during health consultations. If there are guns in the home, they can provide some education on safe storage. Mental health practitioners can partner with law enforcement to keep guns away from people in crisis.

Finally, we can de-program people from believing the lie that they must always be at code red when it comes to danger. No, there is not a constantly imminent threat that someone is going to break into your house or take you out on your way to work. You don’t need to carry a firearm everywhere.

Maybe we can someday convince people that it’s not the guns in the hands of the citizenry that protect Democracy. Instead, it’s an involved and active citizenry that holds its leaders accountable and strengthens the institutions of government that protect Democracy. Oh, and a healthy economy where everyone is benefited. Booming economies rarely become un-democratic, and people with jobs and a steady source of good income rarely want to go to war.

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