Claiming the lives of nearly 22,000 Americans every year, including over 950 children and teens,Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS). A yearly average was developed using five years of most recent available data: 2012-2016. Children and teens defined as 0 to 19. firearm suicide is a significant public health crisis in the U.S.Ibid. A yearly average was developed using five years of most recent available data: 2012-2016. Nearly two-thirds of all gun deaths in the U.S. are suicides: an average of 59 deaths a day.Ibid. Firearm suicide to total suicide ratio and daily average developed using five years of most recent available data: 2012-2016. And the problem is getting worse: over the past decade, the U.S. firearm suicide rate has increased by 19 percent.Ibid. A percent change was developed using 2007-2016 age-adjusted rates for all ages. This trend has been of particular concern for children and teens, with the rate of firearm suicide up by 61 percent in the past ten years.Ibid. A percent change was developed using 2007-2016 crude rates for children and teens (0 to 19). Addressing firearm suicide is an essential element of any strategy to reduce both suicide and gun violence in this country. Given the unique lethality of firearms as a means of suicide, policies and practices that limit or disrupt access to firearms have been shown to save lives.
While firearms are used in less than 6 percent of suicide attempts, over half of suicide deaths are with firearms.Miller M, Azrael D, Barber C. Suicide mortality in the United States: The importance of attending to method in understanding population-level disparities in the burden of suicide. Annual Review of Public Health. 2012; 33: 393-408.
- Of the most commonly used methods of self-harm, firearms are by far the most lethal, with a fatality rate of approximately 85 percent.Miller M, Azrael D, Hemenway D. The epidemiology of case fatality rates for suicide in the northeast. Annals of Emergency Medicine. 2004; 43(6): 723-30.,Miller M, Azrael D, Barber C. Suicide mortality in the United States: The importance of attending to method in understanding population-level disparities in the burden of suicide. Annual Review of Public Health. 2012; 33: 393-408. Conversely, less than 5 percent of people who attempt suicide using other methods will die,Vyrostek SB, Annest JL, Ryan GW. Surveillance for fatal and nonfatal injuries - United States, 2001. Morbidity and Mortality Weekly Report. Surveillance Summaries. 2004; 53(7): 1-57.,Miller M, Azrael D, Barber C. Suicide mortality in the United States: The importance of attending to method in understanding population-level disparities in the burden of suicide. Annual Review of Public Health. 2012; 33: 393-408. and the vast majority of all those who survive do not go on to die by suicide.Owens D, Horrocks J, House A. Fatal and non-fatal repetition of self-harm: Systematic review. British Journal of Psychiatry. 2002; 181: 193-199. This suggests that a reduction in suicide attempts by firearm would result in an overall decline in the suicide rate.Soffen K. To reduce suicides, look at guns. The Washington Post. July 13, 2016. https://wapo.st/2I7MCUx.,Yip PS, Caine E, Yousuf S, Chang SS, Wu KC, Chen YY. Means restriction for suicide prevention. The Lancet. 2012; 379(9834): 2393-2399.
- While there may be warning signs leading up to suicide attempts, almost half of all survivors report less than 10 minutes of deliberation between the thought of suicide and the actual attempt.Deisenhammer EA, Ing CM, Strauss R, Kemmler G, Hinterhuber H, Weiss EM. The duration of the suicidal process: How much time is left for intervention between consideration and accomplishment of a suicide attempt? The Journal of Clinical Psychology. 2007; 70(1): 19-24.,Simon TR, Swann AC, Powell KE, Potter LB, Kresnow M, O’Carroll PW. Characteristics of impulsive suicide attempts and attempters. Suicide and Life-Threatening Behavior. 2001; 32(supp): 49-59. Therefore, the method used in this moment of crisis can mean the difference between life and death, and firearms are an especially lethal means of self-harm.
Access to firearms—meaning personal or household gun ownership—is strongly associated with an increased risk of suicide.
- People who live in U.S. states with high rates of household gun ownership are almost four times more likely to die by gun suicide than in states where fewer households own guns. This relationship remains strong even when controlling for other factors associated with suicide, like poverty, unemployment, serious mental illness, and substance abuse.Miller M, Lippman SJ, Azrael D, and Hemenway D. Household firearm ownership and rates of suicide across the 50 United States. The Journal of Trauma Injury, Infection, and Critical Care. 2007; 62(4): 1029-35.
- A meta-analysis of 14 different scientific studies concluded that having access to a firearm triples one’s risk of death by suicide. This elevated risk applies not only to the gun owner, but everyone in the household.Anglemyer A, Horvath T, Rutherford G. The accessibility of firearms and risk for suicide and homicide victimization among household members: A systematic review and meta-analysis. Annals of Internal Medicine. 2014; 160: 101–110.
A demographic analysis of firearm suicide victims reveals several key patterns.
- Men represent 86 percent of firearm suicide victims, and are over six times more likely than women to die by firearm suicide.Centers for Disease Control and Prevention. National Centers for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS). Developed using five years of most recent available data: 2012-2016.
- For men, firearm suicide rates largely increase with age, and are especially high for male senior citizens (65 and older).Ibid. A yearly average was developed using five years of most recent available data: 2012-2016. For women, firearm suicide rates are highest in the 45 to 60 age range.Ibid. A yearly average was developed using five years of most recent available data: 2012-2016.
- White Americans represent 87 percent of all firearm suicide victims, and have the highest rate of firearm suicide by race.Ibid. Race and ethnicity developed using five years of most recent available data: 2012-2016. White defined as non-hispanic white. American Indians and Alaska Natives also have a disproportionately high rate of firearm suicide.Ibid. Race and ethnicity breakdowns developed using five years of most recent available data: 2012-2016.
- Americans living in rural areas experience higher rates of firearm suicide than those living in urban areas.Centers for Disease Control and Prevention. National Center for Health Statistics, Wide-ranging Online Data for Epidemiologic Research Tool (WONDER). A yearly average of each CDC classified urbanization level was developed using five years of most recent available data: 2012-2016. The average firearm suicide rate increases as counties become more rural,Ibid. A yearly average was developed using five years of most recent available data: 2012-2016. County urbanization levels given by CDC.,Centers for Disease Control and Prevention. 2013 NCHS Urban-Rural Classification Scheme for Counties. Published April 2014.and the rate of firearm suicide in the most rural counties is over two times higher than in the most urban.Centers for Disease Control and Prevention. National Center for Health Statistics, Wide-ranging Online Data for Epidemiologic Research Tool (WONDER). A yearly average was developed using five years of most recent available data: 2012-2016.
The U.S. firearm suicide rate is eight times that of other high-income countries.Grinshteyn E, Hemenway D. Violent death rates: The US Compared with other High-Income OECD Countries, 2010. The American Journal of Medicine. 2016; 129(3): 266-273. Americans should be educated on the prevalence of firearm suicide, how having access to a gun increases the risk of suicide, and steps they can take to mitigate risk.
Policies and practices that focus on disrupting access to firearms can reduce firearm suicides. These include:
Building public awareness about the suicide risk posed by firearm access.
- Most gun-owning Americans think their firearms make them safer.Igielnik R, Brown A. Key takeaways on Americans’ views of guns and gun ownership. Pew Research Center. June 22, 2017. https://pewrsr.ch/2sZzPjv. The reality is that access to a firearm increases the risk of suicide for all people in the household.Anglemyer A, Horvath T, Rutherford G. The accessibility of firearms and risk for suicide and homicide victimization among household members: A systematic review and meta-analysis. Annals of Internal Medicine. 2014; 160: 101–110.
- In the absence of public health campaigns led by the federal government, trusted experts like law enforcement, gun dealers, and medical professionals have all launched campaigns that help inform Americans about the risks of firearms in the home and how to mitigate those risks.
- Several law enforcement agencies run campaigns that provide new or prospective gun owners (or permit holders) with information about the risks of firearm access — particularly as it pertains to suicide.New York City firearm permit application “warning”. Email correspondence with New York Police Department.
- Physicians and other medical professionals are also crucial sources of information about the risk of firearm access. By asking their patients about firearm access and counseling about firearm suicide risk, medical professionals may help prevent these deaths. Counseling on Access to Lethal Means, or CALM., is one example of a program that trains medical professionals on how to explain the differing lethality of various suicide methods, and to “help clients at risk for suicide and their families reduce access to lethal means, particularly firearms.”CALM: Counseling on Access to Lethal Means. Suicide Prevention Resource Center Website. https://bit.ly/2OvUN1B.
Limiting the easy and immediate acquisition of firearms.
- Policies and practices that disrupt the easy and immediate acquisition of firearms have been shown to save lives.
- States with permit-to-purchase (PTP) laws, which require an individual to obtain a permit in addition to a background check when buying a handgun, see reductions in firearm suicide.Federal law requires criminal background checks for all guns purchased from a licensed firearms dealer, and does not cover any sales by unlicensed sellers. A total of twenty states (and Washington D.C.) have closed that critical gap for handguns, passing laws that require some form of a background check before a handgun purchase. Seven of those states require the check only pursuant to a purchase permitting process, nine require a background check only at the point of purchase, and four require background checks both in order to obtain a permit and also at the point of sale.,Crifasi CK, Meyers JS, Vernick JS, Webster DW. Effects of changes in permit-to-purchase handgun laws in Connecticut and Missouri on suicide rates. Preventive Medicine. 2015; 79: 43-49. Connecticut’s enactment of PTP and comprehensive point-of-sale background check laws were associated with a 15 percent decline in the firearm suicide rate over the following decade.Ibid. By contrast, when Missouri repealed its PTP law, this repeal was associated with a 16 percent increase in the firearm suicide rate over the following five years.Crifasi CK, Meyers JS, Vernick JS, Webster DW. Effects of changes in permit-to-purchase handgun laws in Connecticut and Missouri on suicide rates. Preventive Medicine. 2015; 79: 43-49.
- A mandatory waiting period may also help prevent firearm suicides by inserting a buffer between impulse and action. A waiting period law requires a certain number of days to elapse between the purchase of a firearm and when the purchaser can actually take possession of that firearm. Policies that create this buffer are associated with reduced rates of firearm suicide.Luca M, Malhotra D, Poliquin C. Handgun waiting periods reduce gun deaths. Proceedings of the National Academy of Sciences of the United States of America. 2017; 114(46): 12162-12165. ,Anestis MD, Anestis JC, Butterworth SE. Handgun legislation and changes in statewide overall suicide rates. American Journal of Public Health. 2017; 107(4): 579-581.
Encouraging the responsible storage of firearms in the home to prevent access by children and other unauthorized users.
- Responsible firearm storage can help mitigate the risks of firearm suicide, especially for children.Grossman DC, Mueller BA, Riedy C, et al. Gun storage practices and risk of youth suicide and unintentional firearm injuries. JAMA. 2015; 293(6): 707-714.
- 4.6 million American children live in households with at least one loaded, unlocked firearm.Azrael D, Cohen J, Salhi C, Miller M. Firearm storage in gun-owning households with children: Results of a 2015 national survey. Journal of Urban Health. 2018; 95(3): 295-304. Study defined children as age under the age of 18. When American children die by firearm suicide, over 80 percent use a gun belonging to a family member.Johnson RM, Barber C, Azrael D, Clark DE, Hemenway D. Who are the owners of firearms used in adolescent suicides? Suicide and Life-Threatening Behavior. 2010; 40(6): 609-611. Study defined children as age under the age of 18.
- Storing household guns locked, unloaded, or separate from the ammunition is associated with reductions in the risk of self-inflicted and unintentional firearm injuries among children and teens — up to 85 percent depending on the type of storage practice.Grossman DC, Mueller BA, Riedy C, et al. Gun storage practices and risk of youth suicide and unintentional injuries. JAMA. 2005; 293(6): 707-714. Study found households that locked both firearms and ammunition had an 85 percent lower risk of unintentional firearm deaths than those that locked neither.
- Many cities and states have laws that require or encourage responsible storage. Four states and the District of Columbia have passed laws mandating that owners responsibly store their firearms. And 14 states have passed Child Access Prevention (CAP) laws, which impose criminal penalties on adults when a child gains unsupervised access to their firearms. States with safe storage or CAP laws have seen reductions in firearm suicide rates for children.Gius M. The impact of minimum age and child access prevention laws on firearm-related youth suicides and unintentional deaths. The Social Science Journal. 2015; 52(2): 168-175.,Webster DW, Vernick JS, Zeoli AM, Manganello JA. Association between youth-focused firearm laws and youth suicides. JAMA. 2004; 292(5): 594-601.,Grossman DC, Mueller BA, Riedy C, et al. Gun storage practices and risk of youth suicide and unintentional injuries. JAMA: The Journal of the American Medical Association. 2005; 293(6): 707-714.
Creating mechanisms to temporarily remove firearms from individuals in moments of crisis.
- To protect individuals in crisis, several states have passed Red Flag Laws as a way to temporarily remove firearm access. These laws — which establish emergency risk protection orders (ERPOs), or gun violence restraining orders (GVROs) — allow immediate family members and/or law enforcement officers to petition a court to temporarily block gun possession by individuals who have exhibited behavior suggesting they are a risk to themselves or others. At the time of publication, 13 states have Red Flag Laws in place.
- In the ten years after Indiana passed its Red Flag Law, the state’s firearm suicide rate decreased by 7.5 percent.Kivisto AJ, Phalen PL. Effects of risk-based firearm seizure laws in Connecticut and Indiana on Suicide Rates, 1981-2015. Psychiatric Services. 2018; 69(8): 855-862. In Connecticut, the Red Flag Law was associated with a 14 percent reduction in firearm suicide rate once enforcement of the law increased significantly in 2007.Ibid. Another study in Connecticut found that approximately one suicide was averted for approximately every 11 gun removals carried out under the law.Swanson JW, Norko M, Lin H, et al. Implementation and effectiveness of Connecticut's risk-based gun removal law: Does it prevent suicides? Law and Contemporary Problems. 2017; 80: 179-208.