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Firearm Suicide in the United States

8.30.2019
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Mikey, a 13-year-old boy from upstate New York, was friendly and engaged. One day in January, he shot and killed himself with one of his father’s guns. Mikey’s suicide came as a shock. “He may have gotten angry for some reason. At that age you’re not thinking how final a gun is.”

–Alexandria Bodden, Mikey’s older sister and gun violence prevention advocate

Claiming the lives of 23,000 Americans every year, including 1,100 children and teens,1Centers for Disease Control and Prevention. National Center for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. A yearly average was developed using five years of most recent available data: 2014 to 2018. Children and teens defined as aged 0 to 19. firearm suicide is a significant public health crisis in the US.2Ibid. A yearly average was developed using five years of most recent available data: 2014 to 2018. Nearly two-thirds of all gun deaths in the US are suicides, resulting in an average of 63 deaths a day.3Ibid. Firearm suicide to total suicide ratio and daily average developed using five years of most recent available data: 2014 to 2018. And the problem is getting worse: Over the past decade, the US firearm suicide rate has increased by 19 percent.4Ibid. A percent change was developed using 2009 to 2018 age-adjusted rates for all ages.  This trend has been of particular concern for children and teens, whose firearm suicide rate has increased by 65 percent over the past 10 years;5Ibid. A percent change was developed using 2009 to 2018 crude rates for children and teens (0 to 19). and for veterans, who have a firearm suicide rate 1.5 times higher than non-veteran adults.6US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention. 2019 National Suicide Prevention Annual Report. https://bit.ly/2DCQeRB. September 2019.

2/3

Nearly 2/3 of all gun deaths in the US are suicides.

Centers for Disease Control and Prevention. National Center for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. https://bit.ly/3itntGu *A yearly average was developed using five years of most recent available data: 2014 to 2018. Children and teens defined as aged 0 to 19.

1/2

Firearm suicide makes up half of all suicides

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, 33, 393–408. (2012). https://bit.ly/2CjqAS3

In a recent poll, 16 percent of respondents—or roughly 40 million American adults—reported that someone they care for attempted or died by suicide with a gun.7SurveyUSA Market Research Study. Data collected from December 7, 2018 to December 11, 2018. https://bit.ly/2ExxpyZ. See question 36. Addressing firearm suicide is an essential element of any strategy to reduce 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.

Key Findings

Americans should be aware of the prevalence of firearm suicide, how having access to a gun increases the risk of suicide, and steps they can take to mitigate risk. Research shows 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 to everyone in the household.8Anglemyer 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. People who live in US states with high rates of household gun ownership are also almost four times more likely to die by gun suicide than those in states where fewer households have guns. This relationship remains strong even when controlling for other factors associated with suicide, like poverty, unemployment, serious mental illness, and substance abuse.9Miller M, Lippman SJ, Azrael D, and Hemenway D. Household firearm ownership and rates of suicide across the 50 United States. Journal of Trauma Injury, Infection, and Critical Care. 2007;62(4):1029–35.

Access to a gun robs a person in crisis from a second chance at life.

There is a popular misconception that suicide is inevitable, that suicidal ideation is a permanent condition. But most people who attempt suicide do not die—unless they use a gun. Across all suicide attempts not involving a firearm, 4 percent will result in death. But for gun suicide, those statistics are flipped: Approximately 90 percent of gun suicide attempts end in death.10Conner A, Azrael D, Miller M. Suicide Case-Fatality Rates in the United States, 2007 to 2014: A Nationwide Population-Based Study. Ann Intern Med. December 2019:885-895. And the vast majority of all those who survive a suicide attempt do not go on to die by suicide.11Owens 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.12Soffen 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.

Firearm suicides follow sharply divergent demographic patterns.

Men, white Americans, and those living in rural areas are disproportionately affected. Men represent 86 percent of firearm suicide victims; they are six times more likely than women to die by firearm suicide.13Centers for Disease Control and Prevention. National Center for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. Developed using five years of most recent available data: 2014 to 2018. For men, firearm suicide rates largely increase with age, and are especially high for males 65 and older.14Ibid. A yearly average was developed using five years of most recent available data: 2014 to 2018. For women, firearm suicide rates are highest in the 40-to-60 age range.15Ibid. A yearly average was developed using five years of most recent available data: 2014 to 2018.

86%

Men represent 86% of firearm suicide victims

CDC, NCIPC. Web-based Injury Statistics Query and Reporting System (WISQARS). (2012-2016). www.cdc.gov/injury/wisqar

White Americans represent 86 percent of all firearm suicide victims, and have the highest rate of firearm suicide by race.16Ibid. Racial and ethnic breakdowns developed using five years of most recent available data: 2014 to 2018. White defined as non-Hispanic white. American Indians/Alaska Natives also have a disproportionately high rate of firearm suicide, with the second-highest rate of firearm suicide among the country’s five major racial and ethnic groups.17Ibid. Racial and ethnic breakdowns developed using five years of most recent available data: 2014 to 2018.

Americans living in rural areas experience far higher rates of firearm suicide than those living in urban areas.18Centers for Disease Control and Prevention. National Center for Health Statistics, Wide-ranging Online Data for Epidemiologic Research (WONDER) Underlying Cause of Death. A yearly average of each CDC classified urbanization level was developed using five years of most recent available data: 2014 to 2018. The average firearm suicide rate increases as counties become more rural,19Ibid. A yearly average was developed using five years of most recent available data: 2014 to 2018. County urbanization levels given by CDC; Centers for Disease Control and Prevention. 2013 NCHS Urban-Rural Classification Scheme for Counties. April 2014.  and the rate of firearm suicide in the most rural counties is 2.5 times higher than in the most urban.20Centers for Disease Control and Prevention. National Center for Health Statistics, Wide-ranging ONline Data for Epidemiologic Research (WONDER) Underlying Cause of Death. A yearly average was developed using five years of most recent available data: 2014 to 2018.

Recommendations

Firearm suicide is preventable. Policies and practices that focus on disrupting access to firearms can reduce firearm suicides. Lawmakers and the public should:

Build public awareness about the suicide risk posed by firearm access.

Most gun-owning Americans think their firearms make them safer.21Igielnik 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.22Anglemyer 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. For example, through a program called the Gun Shop Project, dozens of gun shops nationwide have begun displaying and distributing materials with information about the risks of firearm access—particularly as it pertains to suicide.23Harvard T.H. Chan School of Public Health. Gun Shop Project. https://bit.ly/2c4QKah. Accessed August 27, 2019.

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.”24Counseling on Access to Lethal Means (CALM). Suicide Prevention Resource Center. https://bit.ly/2tmlUCr. Accessed June 20, 2018.

Limit 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.25Federal 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 20 states (and Washington, DC) 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.26Ibid. By contrast, when Missouri repealed its PTP law, the state experienced a 16 percent increase in the firearm suicide rate over the following five years.27Ibid.

80%

Over 80% of child firearm suicides involved a gun belonging to a family member

Johnson, R. M., Barber, C., Azrael, D., Clark, D. E., & Hemenway, D. (2010). Who are the owners of firearms used in adolescent suicides?. Suicide & life-threatening behavior, 40(6), 609–611. https://doi.org/10.1521/suli.2010.40.6.609

A mandatory waiting period may also help prevent firearm suicides. 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.28Luca 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.

Encourage the secure storage of firearms in the home to prevent access by children and other unauthorized users.

Secure firearm storage can help mitigate the risks of firearm suicide, especially for children.29Grossman DC, Mueller BA, Riedy C, et al. Gun storage practices and risk of youth suicide and unintentional firearm injuries. Journal of the American Medical Association. 2015;293(6):707–714. Approximately 4.6 million American children live in households with at least one loaded, unlocked firearm.30Azrael 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 under 18. When American children die by firearm suicide, over 80 percent use a gun belonging to a family member.31Johnson 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 under 18. One study found that households that locked both firearms and ammunition were associated with a 78 percent lower risk of self-inflicted firearm injuries and an 85 percent lower risk of unintentional firearm injuries among children, compared to those that locked neither.32Grossman DC, Mueller BA, Riedy C, et al. Gun storage practices and risk of youth suicide and unintentional firearm injuries. Journal of the American Medical Association. 2005;293(6):707–714. And researchers estimate that if half of households that store at least one unlocked gun moved to lock all of their guns, 251 youth fatalities from firearm suicide and unintentional shootings could be prevented in a single year. These lives saved would make up one-third of all preventable youth deaths from firearm suicide and unintentional shootings that year.33Monuteaux MC, Azrael D, Miller M. Association of increassed safe household firearm storage with firearm suicide and unintentional death among US youths. JAMA Pediatrics. 2019;173(7):657–662. 

Many cities and states have laws that require or encourage secure storage. Six states and the District of Columbia have passed laws mandating that owners securely store their firearms.34California (Cal. Penal Code §§ 25000-25110), Massachusetts (ALM GL ch. 140, section 131L), Minnesota (Minn. Stat. § 609.666), Nevada (Nev. Rev. Stat. § 202.300), New York (NY CLS Penal §§ 265.45, 265.50), Virginia (Va. Code Ann. § 18.2-56.2); District of Columbia (DC Code §§ 7-2507.02). And 14 states have passed Child Access Prevention (CAP) laws, which impose criminal penalties when a person fails to securely store a firearm and a child gains unauthorized access to it.35Connecticut (Conn. Gen. Stat. §§ 29-37i, 53a-217a), Delaware (11 Del. C. § 1456, 11 Del. C. § 603), Florida (Fla Stat §§ 790.174, 790.175, 784.05), Hawaii (HRS §§ 134-10.5, 707-714.5), Illinois (720 ILCS § 5/24-9), Iowa (Iowa Code § 724.22(7)), Maryland (Md. Crim. Law Code Ann. § 4-104), New Hampshire (RSA § 650-C:1), New Jersey (N.J. Stat. § 2C:58-15), North Carolina (N.C. Gen. Stat. § 14-315.1), Rhode Island (RI Gen Laws § 11-47-60.1), Texas (Tex. Penal Code § 46.13), Washington (ARCW 9.41.360), Wisconsin (Wis. Stat. § 948.55). States with laws mandating secure storage or with CAP laws saw an 8 percent decrease in overall suicide rates and an 11 percent decrease in firearm suicide rates among adolescents aged 14 to 17.36Webster DW, Vernick JS, Zeoli AM, Manganello JA. Association between youth-focused firearm laws and youth suicides. Journal of the American Medical Association. 2004;292(5):594–601.

Create mechanisms to temporarily remove firearms from individuals in moments of crisis.

To protect individuals in crisis, several states have passed Extreme Risk laws as a way to temporarily remove firearm access. Extreme Risk laws give family members and law enforcement a way to intervene before warning signs escalate into tragedies. These laws permit immediate family members and law enforcement to petition a court for an order to temporarily remove guns from dangerous situations. If a court finds that a person poses a serious risk of injuring themselves or others with a firearm, that person is temporarily prohibited from purchasing and possessing guns, and any guns they already own are held by law enforcement or another authorized party while the order is in effect. At the time of publication, 17 states and DC have Extreme Risk laws in place.37Cal. Penal Code § 18125; Cal. Penal Code § 18150; Cal. Penal Code § 18175; CO HB 1177 (2019); Conn. Gen. Stat. § 29-38c; 10 Del. C. 7701, et seq.; 2018 D.C. Act 22-629; Fla. Stat. § 790.401; 430 ILCS 67/1, et seq.; HI SB 1466 (2019); Ind. Code § 35-47-14-1; Ind. Code § 35-47-14-2; Ind. Code § 35-47-14-5; Ind. Code § 35-47-14-6; Ind. Code § 35-47-14-8; Md Public Safety Code 5-601, et seq; Mass. Gen. Laws ch. 140, § 121; Mass. Gen. Laws ch. 140, § 129B(C); Mass. Gen. Laws ch. 140, § 131(C); Mass. Gen. Laws ch. 140, §131R-Z; Nev. AB 291 (2019); NY SB 2451 (2019); NJ A 1217 (2018); ORS 166.525, et seq.; 13 VSA 4051, et seq.; RI Gen Laws 8-8.3-1, et seq.; Wash. Rev. Code § 7.94.030; Wash. Rev. Code § 7.94.040; Wash. Rev. Code § 7.94.050; Wash. Rev. Code § 7.94.080.


If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or text HOME to 741741 to reach the Crisis Text Line for free from anywhere in the US.


For more information on secure storage of firearms and how you can help others improve their storage practices, visit besmartforkids.org.

Everytown Research & Policy is a program of Everytown for Gun Safety Support Fund, an independent, non-partisan organization dedicated to understanding and reducing gun violence. Everytown Research & Policy works to do so by conducting methodologically rigorous research, supporting evidence-based policies, and communicating this knowledge to the American public.

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