Gun Suicide in Cities

Leer en Español

• Suicidio con armas de fuego en las ciudades: El lado menos conocido de la violencia con armas de fuego en las ciudades

Key Findings

Analysis from 750 cities of data available for the first times reveals that:

• The rate of people who died by gun suicide in cities increased 11 percent over the past decade, and now make up an average of over four in 10 city gun deaths.
• Cities in states with the strongest gun violence prevention laws have about half the rate of people who die by gun suicide as those in states with the weakest laws, demonstrating the importance of legislative action in preventing gun violence in cities.
• Cities with the most gun shops experience nearly four times higher rates of people who die by gun suicide than those with the fewest gun shops, signaling the importance of expanding cities’ focus beyond illegal guns.
• Smaller cities and those with fewer walkable neighborhoods (i.e., distance to local resources) experience higher rates of people who die by gun suicide, underscoring the importance of adequate access to resources and networks of social support that reduce risk factors like social isolation.
• Cities with the most parks have about half the rate of people who die by gun suicide as those with the least, suggesting that cleaning and greening efforts may offer benefits in reducing both gun homicides and suicides.

988 Suicide & Crisis Lifeline

The following material aims to increase your knowledge and understanding of firearm suicide in US cities. We understand that this content may be personal to you. If you or someone you know is in a time of emotional crisis or needs to talk to someone, please call or text the 988 Suicide & Crisis Lifeline at 988 for free from anywhere in the US. See additional resources at the end of the page.

Introduction

Gun violence often looks different in cities than it does in rural areas. In particular, gun homicides are notably high in cities, with a rate 80 percent above the national average, and 130 percent above rural counties.¹Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), WONDER Online Database, Underlying Cause of Death and Everytown analysis of CDC NVSS city firearm homicide data, 2016–2020. A yearly average was developed using five years of the most recent available data from 453 cities with populations of over 50,000. Firearm homicide rates were 8.4 per 100,000 people in cities, 4.7 nationally, and 3.7 in rural counties.  Today especially, the nation is rightfully focused on addressing the rise in gun homicides that has plagued cities across the country since the start of the COVID-19 pandemic. But the impact of gun violence on cities is larger than this narrow framing leads us to believe. Rates of people who die by gun suicide in cities are also on the rise, impacting far more diverse populations than ever before—but, until now, a dearth of city-level data on this topic leaves it often overlooked.²Everytown for Gun Safety, “The Rise of Firearm Suicides among Young Americans,” June 2, 2022,  https://everytownresearch.org/report/the-rise-of-firearm-suicide-among-young-americans/; Everytown for Gun Safety, “Gun Violence and COVID-19 in 2020: A Year of Colliding Crises,” May 7, 2021,  https://everytownresearch.org/report/gun-violence-and-covid-19-in-2020-a-year-of-colliding-crises/ 

The following analysis by Everytown for Gun Safety Support Fund (Everytown) and New York University Grossman School of Medicine (NYU), uses new city-level data compiled and made publicly available on NYU’s City Health Dashboard. While rural communities disproportionately experience high rates of people who die by gun suicide, this analysis unveils the unique and growing prevalence of gun suicides in cities and highlights the need to broaden the concept of city gun violence to recognize, prevent, and solve this pressing public health concern.

Firearm suicide rates in cities vary across the United States.

Source: Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020. Analysis features 752 cities.

In the United States overall, suicides account for nearly six out of 10 gun deaths (as compared to four out of 10 in the nation’s cities), resulting in more than 25,000 deaths per year.³Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using five years of the most recent available data: 2018 to 2022. At a national level, research indicates that gun suicides disproportionately impact white and American Indian and Alaskan Native people, older men, and veterans.⁴Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Underlying Cause of Death. A yearly average was developed using five years of the most recent available data: 2018 to 2022. Gun suicide rates increased across multiple racial groups during the COVID-19 pandemic,⁵ CDC, NCHS, WONDER Online Database, Underlying Cause of Death: 2016-2020. however, with particularly harmful impacts on young Black, Indigenous, and people of color (BIPOC).⁶Everytown for Gun Safety, “The Rise of Firearm Suicides among Young Americans.”  Lockdowns and school closures; lost jobs, housing, and social connections; deaths of loved ones; and pauses in necessary community services all hit BIPOC communities hardest, and introduced a multitude of suicide risk factors in the process—the effects of which are still being felt today.⁷Graham Rapier, “This Chart Shows Fewer Than Half of Black Americans Were Employed in April, Highlighting How Coronavirus Layoffs Have Disproportionately Affected Black Communities,” Business Insider, June 4, 2020, https://bit.ly/3cSop7p; Emma Dorn et al., “COVID-19 and Learning Loss: Disparities Grow and Students Need Help,” McKinsey & Company, December 8, 2020, https://www.mckinsey.com/industries/public-and-social-sector/our-insights/covid-19-and-learning-loss-disparities-grow-and-students-need-help; Megan Kuhfeld et al., “Learning during COVID-19: Initial Findings on Students’ Reading and Math Achievement and Growth,” NWEA, November 2020, https://www.nwea.org/research/publication/learning-during-covid-19-initial-findings-on-students-reading-and-math-achievement-and-growth/; Lindsay M. Monte and Daniel J. Perez-Lopez, “COVID-19 Pandemic High Black Households Harder Than White Households, Even When Pre-Pandemic Socio-Economic Disparities Are Taken into Account,” US Census Bureau, July 21, 2021, https://www.census.gov/library/stories/2021/07/how-pandemic-affected-black-and-white-households.html; Latoya Hill and Samantha Artiga, “COVID-19 Cases and Deaths by Race/Ethnicity: Current Data and Changes over Time,” KFF, February 22, 2022, https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-cases-and-deaths-by-race-ethnicity-current-data-and-changes-over-time/. Common across them all are the risks posed by gun access, which triples one’s risk of death by suicide.⁸Andrew Anglemyer, Tara Horvath, and George Rutherford, “The Accessibility of Firearms and Risk for Suicide and Homicide Victimization Among Household Members: A Systematic Review and Meta-Analysis,” Annals of Internal Medicine 160, no. 2 (2014): 101–10, https://doi.org/10.7326/M13-1301.

Kelley’s Story

My son Leslie was a very funny, smart, natural comedian who loved to make people laugh. He tapped into that as a baby—he was just nine or 10 months old when he realized he could make people laugh. Because he was such a happy kid, it was a shock that at 18, he took his life with a gun. It traumatized everyone who knew and loved him. In retrospect, it was a perfect storm of events and loss that took him to that place and was not just what seemed to be normal teen angst over ending a relationship. Although he knew about and grew up around guns, he chose to end his life at a moment when he was low, in grief, at a loss. It was an impulse that he did not have the maturity to overcome. There is so much ignorance about suicide, why a child would choose that route, and the importance guns play in vanquishing ‘second chances’ at life.

Read Kelley’s story on Moments that Survive.

The risk factors for gun homicides and gun suicides are quite different. Whereas gun homicides are closely tied to factors such as the spread of violence through social networks and historic racial segregation,⁹Daniel C. Semenza et al., “Firearm Availability, Homicide, and the Context of Structural Disadvantage,” Homicide Studies (September 2021): 1–21, https://doi.org/10.1177/10887679211043806; Aliza Aufrichtig et al., “Want to Fix Gun Violence in America? Go Local,” The Guardian, January 9, 2017, https://bit.ly/2i6kaKw; Ben Green et al., “Modeling Contagion through Social Networks to Explain and Predict Gunshot Violence in Chicago, 2006 to 2014,” JAMA Internal Medicine 177, no. 3 (2017): 326–33, http://dx.doi.org/10.1001/jamainternmed.2016.8245; Chaeyoung Cheon et al., “Neighborhood Racial Composition and Gun Homicides,” JAMA Network Open 3, no. 11 (November 30, 2020): e2027591, https://doi.org/10.1001/jamanetworkopen.2020.27591. the risk factors for gun suicides include serious mental illness, lack of access to health-care and social support, and stressful life events.¹⁰American Foundation for Suicide Prevention, “Risk Factors, Protective Factors, and Warning Signs,” accessed August 9, 2022, https://bit.ly/3LBpBuB; Camilla Haw et al., “Economic Recession and Suicidal Behaviour: Possible Mechanisms and Ameliorating Factors,” International Journal of Social Psychiatry 61, no. 1 (2015): 73–81, https://doi.org/10.1177/0020764014536545. Also differing across the two are common gun sources, as homicides often involve illegal guns, whereas suicides often involve legally purchased guns.¹¹Anthony Fabio et al., “Gaps Continue in Firearm Surveillance: Evidence from a Large U.S. City Bureau of Police,” Social Medicine 10, no. 1 (2016): 13–21, https://socialmedicine.info/index.php/socialmedicine/article/view/852; Semenza et al., “Firearm Availability, Homicide, and the Context of Structural Disadvantage;” Kevin M. Grassel et al., “Association between Handgun Purchase and Mortality from Firearm Injury,” Injury Prevention 9, no. 1 (2003): 48–52, https://doi.org/10.1136/ip.9.1.48; David M. Studdert et al., “Handgun Ownership and Suicide in California,” New England Journal of Medicine 382, no. 23 (2020): 2220–29, https://doi.org/10.1056/NEJMsa1916744; Likewise, the solutions to gun suicide prevention that are often emphasized in rural communities (e.g., secure firearm storage, extreme risk laws, and waiting periods) differ from the solutions to gun homicides that are emphasized in cities (e.g., street outreach, focused deterrence, and hot spots policing).¹²Everytown for Gun Safety, “City Gun Violence Reduction Insight Portal,” 2022, https://citygrip.org/.

This first-of-its-kind analysis unpacks the extent to which people die by gun suicide in cities. It explores associated factors and presents solutions to this significant but underrecognized component of city gun violence. 

The gun suicide data featured span 2010 to 2020 (the most recent available data) and 752 cities with populations of 50,000 or more spread across 49 states and Washington, DC. The dataset was obtained by special agreement from the Centers for Disease Control and Prevention’s (CDC) National Vital Statistics System.¹³Unless otherwise stated, five-year datasets (2016–2020) are utilized in this report’s analyses, to accommodate CDC National Vital Statistics System (NVSS) suppression of annual counts of fewer than 10. The number of cities featured in each analysis varies based on data availability. Note: The mortality data used in this analysis are not released as micro-level downloadable datasets from the NCHS  Research Data Center (RDC), but as aggregated data tables whose analyses were conducted per NCHS disclosure requirements in a secure environment and released as approved output. The findings and conclusions in this report are those of the author(s) and do not represent the views of the RDC, the NCHS, or the CDC. The NCHS does not recommend further analysis of this data because linking them to individually identifiable data from other NCHS or non-NCHS datasets could cause disclosure risks. If you believe a disclosure has occurred, please contact [email protected] and [email protected].

Results

Overview

Despite the common tendency to conflate city gun violence with gun homicides alone, over four in 10 gun deaths in cities are suicides,¹⁴Everytown analysis of CDC NVSS city firearm suicide and homicide data, 2016–2020. Analysis features 415 cities with data on homicides and suicides.  accounting for over 7,000 deaths a year—or nearly 20 suicides a day—in US cities.¹⁵Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020, and ATF FFL data, 2020. Analysis features 752 cities. Everytown analysis of CDC NVSS city firearm suicide and homicide data, 2016–2020. Analysis of the homicide-vs.-suicide proportions of firearm violence features 415 cities with populations over 50,000. Analysis of annual firearm suicides features 752 cities. This public health problem is growing as well: On par with national suicide trends, the rate of people who die by gun suicides in cities increased 11 percent over the last 10 years.¹⁶Everytown analysis of CDC NVSS city firearm suicide data, 2010–2020. Analysis features 751 cities with data in the 2010–2014 and 2016–2020 files. The average rate of firearm suicides in cities was 5.3 per 100,000 people in 2010–2014, and 5.9 in 2016–2020 (CDC, NCHS, WONDER Online Database, Underlying Cause of Death). A percentage change was developed using 2011 and 2020 data. The average national rate of firearm suicides increased 12 percent over the past 10 years [6.2 per 100,000 people in 2011, and 7.0 in 2020]). 

Nearly 20 people die by gun suicide a day in US cities.

Four in 10 gun deaths in US cities are suicides.

Source: Everytown analysis of CDC NVSS city firearm suicide and homicide data, 2016–2020. Analysis features 415 cities with data on homicides and suicides.

Beyond recognizing gun suicides as a public health problem in cities, understanding the types of cities and groups of people within them that are most affected is also essential for prevention efforts.

Gun Access and Policy Factors

Most people who attempt suicide do not die—unless they use a gun. Across all suicide attempts without a gun, 4 percent result in death, but when a gun is involved, that figure skyrockets to 90 percent.¹⁷Andrew Conner, Deborah Azrael, and Matthew Miller, “Suicide Case-Fatality Rates in the United States, 2007 to 2014: A Nationwide Population-Based Study,” Annals of Internal Medicine 171, no. 2 (2019): 885–95, https://doi.org/10.7326/M19-1324. Thus, addressing gun access is key to saving lives.

Fortunately, cities in states with stronger gun violence prevention laws experience lower rates of people who die by gun suicide. Analyses reveal that city gun suicide rates in states with the strongest gun laws are approximately 50 percent lower than cities in states with the weakest laws.¹⁸Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020, and Everytown Gun Law Rankings data, accessed June 2022. Analysis features 752 cities, in states whose gun law strength scores were separated into quartiles. See graph titled, “Cities in states with the strongest gun laws have approximately 50 percent lower rates of people who die by gun suicidethan cities in states with the weakest laws.” These city-level findings align with existing research on gun suicide prevention policies, and reinforce the need to supplement local initiatives with legislative efforts that have proven impacts on reducing gun suicides.¹⁹Everytown for Gun Safety, “Firearm Suicide in the United States,” December 28, 2021, https://everytownresearch.org/report/firearm-suicide-in-the-united-states/; Everytown for Gun Safety, “Gun Safety Policies Save Lives: Which States Have the Ideal Laws to Prevent Gun Violence?,” 2022, https://everytownresearch.org/rankings/; Everytown for Gun Safety, “Extreme Risk Laws Save Lives,” December 29, 2021, https://everytownresearch.org/report/extreme-risk-laws-save-lives/; Everytown for Gun Safety, “Unload, Lock, and Separate: Secure Storage Practices to Reduce Gun Violence,” November 2, 2021, https://everytownresearch.org/report/unload-lock-and-separate-secure-storage-practices-to-reduce-gun-violence/; Everytown for Gun Safety, “Update Background Check Laws,” June 22, 2021, https://everytownresearch.org/report/update-background-check-laws/; Deborah Stone et al., “Preventing Suicide: A Technical Package of Policies, Programs, and Practice,” Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, 2017, https://bit.ly/2FCaSmA.

Cities in states with the strongest gun laws have approximately 50 percent lower rates of people who die by gun suicide than cities in states with the weakest laws.

Source: Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020, and Everytown Gun Law Rankings data, accessed June 2022. Analysis features 752 cities.

Analyses of newly released CDC data and Alcohol, Tobacco, and Firearms (ATF) data also reveal that the rate at which people die by gun suicide is nearly four times higher in cities with the most gun shops (also known as Federal Firearms Licensees [FFLs]) per 100,000 people than cities with the fewest gun shops per person.²⁰Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020, and Alcohol, Tobacco, and Firearms (ATF) FFL data, 2020. Analysis features 752 cities, whose rates of FFLs per 100,000 people were separated into quartiles. See graph titled, “Cities with the most gun shops per person have nearly four times higher rates of people who die by gun suicide than cities with the fewest.” Regression analyses further confirm that the relationship between the rate of city gun shops and people who die by gun suicide is strong and holds even after adjusting for other factors known to be associated with gun suicides, such as the percentages of white residents, veterans, adults 65 years and older, and economically disadvantaged residents.²¹Everytown analysis of CDC NVSS city firearm suicide and American Community Survey (ACS) data, 2016–2020, and Alcohol, Tobacco, and Firearms (ATF) FFL data, 2020. The following factors were included in linear regression analysis: percent white, percent veteran, percent 65 years or older, percent economically disadvantaged. Rate of gun shops per 100,000 people significantly predicted the city firearm suicide rate (b = 0.95, p < 0.01). Complete regression results are available in Appendix A. Further analyses of city gun suicide trends by race were not possible, due to the CDC’s practice of suppressing data when incidents are very few to protect confidentiality. Across the country as a whole, and as we now see in cities specifically, legally purchased guns are often used in suicides, signaling the importance of expanding city gun violence prevention efforts to include legal gun owners and local dealers.²²Grassel et al., “Association between Handgun Purchase and Mortality from Firearm Injury;” Apurva Bhatt et al., “Association of Changes in Missouri Firearm Laws with Adolescent and Young Adult Suicides by Firearms,” JAMA Network Open 3, no. 11 (November 4, 2020), https://doi.org/10.1001/jamanetworkopen.2020.24303; Paul S. Nestadt et al., “Prevalence of Long Gun Use in Maryland Firearm Suicides,” Injury Epidemiology 7, no. 4 (2020), https://doi.org/10.1186/s40621-019-0230-y; D. L. Steelesmith et al., “Contextual Factors Associated with County-Level Suicide Rates in the United States, 1999 to 2016,” JAMA Network Open 2, no. 9 (2019), https://doi.org/10.1001/jamanetworkopen.2019.10936; David M. Studdert et al., “Handgun Ownership and Suicide in California,” New England Journal of Medicine 382 (June 4, 2020): 2220–29, https://doi.org/10.1056/NEJMsa1916744. 

Cities with the most gun shops per person have nearly four times higher rates of people who die by gun suicide than cities with the fewest.

Source: Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020, and ATF FFL data, 2020. Analysis features 752 cities.

Environmental and Geographic Factors

Several geographic and environmental factors also contribute to the variations in gun suicide rates across cities. The rate of people who die by gun suicide in an average US city is 5.9 deaths per 100,000 people, but this ranges from 0.7 in New York City, New York to 34.5 in Bradenton, Florida, almost 50 times greater. In fact, of the 10 cities with the highest rates of people who die by gun suicide, four were in Florida (Sarasota, Fort Myers, and Ocala, in addition to Bradenton), and another four were in Mountain states (Cheyenne, WY; Grand Junction, CO; Idaho Falls, ID; Pocatello, ID).²³Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020. Analysis features 752 cities. CDC suppresses data for numerators under 10. Because all cities by definition have at least 50,000 people, the largest rate in any city with suppressed data could be 1.8 per 100,000. Thus, we computed conservative estimates for these cities, rather than excluding them from the analysis, by assigning them all nine gun suicides and using their existing population denominator to calculate the rate. Thus, rates for these cities are expressed as equal to or less than a certain value. All 10 cities with the highest rates of people who die by gun suicide were smaller cities with population sizes between 50,000 and 80,000. Users can interact with the dashboard below, which displays never-before-released CDC data, to learn how gun suicides impact people in their city specifically.

Cities with similar population sizes but very different rates of people who die by gun suicide

Sarasota, Florida’s rate of people who die by gun suicide is 21.7 per 100,000 people.

Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020. Analysis features 752 cities.

Palo Alto, California’s rate of people who die by gun suicide is 3.9 per 100,000 people.

Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020. Analysis features 752 cities.

How prevalent is gun suicide in your city? Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020. Analysis features 752 cities.

Source: Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020. Analysis features 752 cities.

In line with the trend that rates of people who die by gun suicide are highest in rural communities, small cities also experience higher rates than medium-size to large cities. We found that rates of people who die by gun suicide in cities with at least 500,000 people (such as New York, Los Angeles, and Dallas) are 35 percent lower than in cities with fewer than 500,000 people.²⁴Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020. Analysis features 752 cities. Cities with over 500,000 people had a firearm suicide rate of 4.4 per 100,000 people, and cities with under 100,000 people had a firearm suicide rate of 6.8 per 100,000. Notably, suicide risk factors such as changing economic markets and limited access to mental health care²⁵American Foundation for Suicide Prevention, “Risk Factors, Protective Factors, and Warning Signs,” accessed August 9, 2022, https://bit.ly/3LBpBuB; are more prominent in smaller cities,²⁶C. Holly A. Andrilla et al., “Geographic Variation in the Supply of Selected Behavioral Health Providers,” American Journal of Preventive Medicine 54, no. 6, supplement 3 (June 2018): S199–S207,  https://www.sciencedirect.com/science/article/pii/S0749379718300059; Shannon M. Monnat et al., Washington Center for Equitable Growth, “Gaps in U.S. Rural and Urban Economic Growth Widened in the Post–Great Recession Economy, with Implications amid the Coronavirus Recession,” August 6, 2020, https://equitablegrowth.org/gaps-in-u-s-rural-and-urban-economic-growth-widened-in-the-post-great-recession-economy-with-implications-amid-the-coronavirus-recession/; Anne Case and Angus Deaton, Deaths of Despair and the Future of Capitalism (Princeton, NJ: Princeton University Press, 2020); Bindu Kalesan et al., “Intersections of Firearm Suicide, Drug-Related Mortality, and Economic Dependency in Rural America,” Journal of Surgical Research 256 (December 1, 2020): 96–102, https://doi.org/10.1016/j.jss.2020.06.011. likely contributing to this trend, as extensive research shows they do in rural communities as well.²⁷Everytown for Gun Safety, “Firearm Suicide in the United States”; Everytown for Gun Safety, “Firearm Suicide by Congressional District: How Does Your District Stack Up?,” October 2, 2020, https://everytownresearch.org/report/firearm-suicide-by-congressional-district/; Jameson K. Hirsch and Kelly C. Cukrowicz, “Suicide in Rural Areas: An Updated Review of the Literature,” Journal of Rural Mental Health 38, no. 2 (2014): 65–78, https://bit.ly/2FGqrJT; Bindu Kalesan et al., “Intersections of Firearm Suicide, Drug-Related Mortality, and Economic Dependency in Rural America,” Journal of Surgical Research 256 (December 1, 2020): 96–102 https://bit.ly/2FCWmel.

Rates of people who die by gun suicide in large cities are 35 percent lower than in cities with fewer than 500,000 people.

Source: Everytown analysis of CDC NVSS city firearm suicide and ACS data, 2016–2020. Analysis features 752 cities.

Similarly, analyses show that cities in the South experience four times higher rates of people who die by gun suicide than cities in the Northeast.²⁸Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020. Analysis features 752 cities. Notably, there are higher rates of gun ownership in the South, and stronger gun violence prevention policies in place in the Northeast, likely contributing to variations in city gun suicide rates that largely align with these facts.²⁹RAND Corporation, “Gun Ownership in America,” accessed August 22, 2022,   https://www.rand.org/research/gun-policy/gun-ownership.html; Everytown for Gun Safety, “Firearm Suicide in the United States.”  

Rates of people who die by gun suicide are highest in the South and lowest in the Northeast.

Source: Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020. Analysis features 752 cities.

In terms of protective factors, analyses reveal that cities with the most walkable neighborhoods and/or parks have approximately half the rate of people who die by gun suicide than cities with the least.³⁰Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020, and NYU City Health Dashboard data on Walkability, 2019, and Park Access, 2018. Analysis features 750 cities for the parks analysis and 749 for the walkability analysis, whose percentage of residents with park access and residents living in walkable neighborhoods was divided into quantiles (see graph titled “Cities with the most parks and/or walkable neighborhoods have approximately half the rate of people who die by gun suicide than cities with the least”). Walkable neighborhoods provide residents with close proximity to doctors’ offices, pharmacies, grocery stores, schools, social groups, and other resources and advantages, which may help to counter suicide risk factors such as social isolation and limited access to mental health services.³¹Dustin T. Duncan et al., “Validation of Walk Score for Estimating Neighborhood Walkability: An Analysis of Four US Metropolitan Areas,” International Journal of Environmental Research and Public Health 8, no. 11 (November 2011): 4160–79, https://doi.org/10.3390/ijerph8114160; Andrilla et al., “Geographic Variation in the Supply of Selected Behavioral Health Providers;” Raffaella Calati et al., “Suicidal Thoughts and Behaviors and Social Isolation,” Journal of Affective Disorders 245 (February 15, 2019): 653–67,  https://www.sciencedirect.com/science/article/abs/pii/S016503271831694X; Daniel D. L. Coppersmith et al., “The Dynamics of Social Support among Suicide Attempters: A Smartphone-Based Daily Diary Study,” Behaviour Research and Therapy 120 (September 2019): 103348, https://www.sciencedirect.com/science/article/abs/pii/S0005796718301979#!. Well-maintained parks and green spaces have been shown to reduce suicides in cities, as they offer opportunities for social gatherings, nature exploration, exercise, fresh air, and a sense of community.³²Marco Helbich et al., “Natural Environments and Suicide Mortality in the Netherlands: A Cross-Sectional, Ecological Study,” The Lancet Planetary Health 2, no. 3 (March 2018): e134–e139,  https://www.sciencedirect.com/science/article/pii/S2542519618300330; Yu-Sheng Shen et al., “Exploring Multiple Pathways and Mediation Effects of Urban Environmental Factors for Suicide Prevention,” Environmental Pollution 294 (February 1, 2022): 118642, https://www.sciencedirect.com/science/article/abs/pii/S0269749121022247; Lisa Wood et al., “Public Green Spaces and Positive Mental Health: Investigating the Relationship between Access, Quantity and Types of Parks and Mental Wellbeing,” Health & Place 48 (November 2017): 63–71,  https://www.sciencedirect.com/science/article/abs/pii/S1353829216303689#!. Investments in “cleaning and greening” physical spaces such as parks and vacant lots and additional lighting—a common, evidence-based, and cost-effective strategy for reducing gun homicides and shootings in cities³³Charles C. Branas et al., “Urban Blight Remediation as a Cost-Beneficial Solution to Firearm Violence,” American Journal of Public Health 106, no. 12 (October 13, 2016): 2158–64, https://doi.org/10.2105/AJPH.2016.303434; Charles C. Branas et al., “Citywide Cluster Randomized Trial to Restore Blighted Vacant Land and Its Effects on Violence, Crime, and Fear,” Proceedings of the National Academy of Sciences 115, no. 12 (March 20, 2018): 2946–51, https://doi.org/10.1073/pnas.1718503115.—may also be beneficial for reducing gun suicides.

Cities with the most parks and/or walkable neighborhoods have approximately half the rate of people who die by gun suicide than cities with the least.³⁴Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020, and NYU City Health Dashboard data on Walkability, 2019, and Park Access, 2018. Analysis features 750 cities for the parks analysis and 749 for the walkability analysis, whose percent of residents with park access and residents living in walkable neighborhoods was divided into quantiles.

Source: Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020, and NYU City Health Dashboard data on Walkability, 2019. Analysis features 749 cities.

Source: Everytown analysis of CDC NVSS city firearm suicide data, 2016–2020, and NYU City Health Dashboard data on Park Access, 2018. Analysis features 750 cities.

Recommendations

By limiting discussions of city gun violence strictly to homicides, local governments hinder their ability to spot key drivers of and solutions to nearly half of the gun deaths that occur in their cities. While factors such as illegal guns, the spread of violence through social networks, and historic neighborhood segregation are associated with city gun homicides,³⁵Anthony Fabio et al., “Gaps Continue in Firearm Surveillance: Evidence from a Large U.S. City Bureau of Police,” Social Medicine 10, no. 1 (2016): 13–21, https://socialmedicine.info/index.php/socialmedicine/article/view/852; Daniel C. Semenza et al., “Firearm Availability, Homicide, and the Context of Structural Disadvantage,” Homicide Studies (September 2021): 1–21, https://doi.org/10.1177/10887679211043806; Chaeyoung Cheon et al., “Neighborhood Racial Composition and Gun Homicides,” JAMA Network Open 3, no. 11 (November 30, 2020): e2027591, https://doi.org/10.1001/jamanetworkopen.2020.27591; Ben Green et al., “Modeling Contagion through Social Networks to Explain and Predict Gunshot Violence in Chicago, 2006 to 2014,” JAMA Internal Medicine 177, no. 3 (2017): 326–33, http://dx.doi.org/10.1001/jamainternmed.2016.8245. Everytown and NYU’s new analysis suggests that weaker gun laws, more gun shops, and fewer parks and walkable neighborhoods are just some of the factors uniquely associated with higher rates of people who die by gun suicides in cities. City governments should consider all of these factors in taking action to reduce gun violence in their communities.

Research shows that several policies, practices, educational campaigns, and resources can significantly reduce the risk of gun suicide.³⁶Everytown for Gun Safety, “Firearm Suicide in the United States”; Everytown for Gun Safety, “Firearm Suicide by Congressional District: How Does Your District Stack Up?,” October 2, 2020, https://everytownresearch.org/report/firearm-suicide-by-congressional-district/. Implementation of these strategies in cities should take into account each city’s unique needs, resources, and priorities—many of which differ from those of the rural communities where gun suicide prevention efforts are more commonly focused.

At the policy level, extreme risk laws, waiting periods, background checks, secure storage, and voluntary do-not-buy lists save lives by limiting the ease and immediacy of acquiring firearms, especially during vulnerable times. Likewise, to comprehensively address all aspects of gun violence, cities must complement local gun homicide prevention programs with legislative efforts that have been proven effective at reducing gun suicides as well.

Secure firearms storage practices, including unloading, locking, and separating guns from ammunition when not in use, and storing guns temporarily away from home in times of crisis, are also evidence-based strategies for preventing people from dying by gun suicide. Secure gun storage is particularly important for preventing suicides and unintentional gun deaths among children and teens,³⁷Michael C. Monuteaux, Deborah Azrael, and Matthew Miller, “Association of Increased Safe Household Firearm Storage with Firearm Suicide and Unintentional Death among US Youths,” JAMA Pediatrics 173, no. 7 (2019): 657–62, https://doi.org/10.1001/jamapediatrics.2019.1078; David C. Grossman et al., “Gun Storage Practices and Risk of Youth Suicide and Unintentional Firearm Injuries,” JAMA 293, no. 6 (2005): 707–14, https://doi.org/10.1001/jama.293.6.707. and therefore must be addressed in cities, where more people tend to live in intergenerational homes. Educational campaigns, such as Be SMART, work to raise awareness of the fact that secure storage practices can save children’s lives. Trained volunteers can access tools for educating their communities in best practices that are responsive to their specific safety goals and resources. City officials, police,³⁸“Woodland Park Police Department, Gun Range Support Be SMART Safety Initiative,” Tap into Passaic Valley, March 22, 2021, https://bit.ly/3hvT9gJ; Multnomah County Health Department, “Is Your Safety On? Firearms and Suicide,” accessed August 22, 2022, https://bit.ly/2lwa7h4; Everytown for Gun Safety, “Be SMART Partners with Local Law Enforcement to Hold Nearly 100 ‘National Night Out’ Events across the Country to Promote Secure Firearm Storage,” press release, August 3, 2022, https://www.everytown.org/press/be-smart-partners-with-local-law-enforcement-to-hold-nearly-100-national-night-out-events-across-the-country-to-promote-secure-firearm-storage/. and educators³⁹Students Demand Action for Gunsense in America, “Urge Your School Board to Act on School Safety,” January 26, 2022, https://studentsdemandaction.org/report/urge-your-school-board-to-act-on-school-safety/. can also play a role in urgently distributing this lifesaving information.

Given the connection between gun shops and higher rates of people dying by gun suicide in cities, gun dealers also have several roles to play in preventing suicides, including educational campaigns to make purchasers aware of the risks and responsibilities associated with firearm ownership,⁴⁰New Hampshire Firearm Coalition, “Suicide Prevention: A Role for Gun Dealers and Ranges,” accessed August 8, 2022, https://theconnectprogram.org/resources/nh-firearm-safety-coalition/; Means Matter, “Gun Shop Project,” accessed August 8, 2022, https://www.hsph.harvard.edu/means-matter/gun-shop-project/. offering options for gun owners experiencing crises to temporarily store their guns out of their homes, and recognizing purchasers who appear in distress. Some jurisdictions have passed legislation requiring gun dealers and ranges to post warning signs about the risks associated with firearms.⁴¹King County, Rule & Regulation BOH 18-04, Relating to disclosure of information on health risks related to firearms: https://bit.ly/3kqMpzj; Massachusetts, MGL ch. 140, §123, requiring that information on suicide prevention is posted and presented: https://bit.ly/32EI4Th; Everytown for Gun Safety, “Following Tireless Advocacy from Volunteers, Westchester County Passes Gun Ordinance Requiring Gun Dealers to Post Informational Warning Signs for Customers,” press release, May 24, 2022, https://bit.ly/3dqXMcp. Firearm storage maps have been developed to help community members find third-party storage options in several states, including Colorado, Maryland, Mississippi, New Jersey, New York, and Washington. 

Roughly two in three Americans who attempt suicide visit a health-care professional in the month before the attempt.⁴²Brian K. Ahmedani et al., “Racial/Ethnic Differences in Health Care Visits Made before Suicide Attempt across the United States,” Medical Care 53, no. 5 (May 2015): 430–35, https://doi.org/10.1097/MLR.0000000000000335. City-based doctors and mental health providers must also be educated on the prevalence of gun suicides in their communities, so that they can work to both recognize and educate patients about these risks and connect them to care.⁴³Leslie Cantu, “Pediatricians Ask Parents to ‘Be SMART’ about Storing Guns Safely,” Medical University of South Carolina Catalyst News, October 28, 2020, https://bit.ly/3d8u5u6; Suicide Prevention Resource Center, “CALM: Counseling on Access to Lethal Means,” 2009, https://bit.ly/2OvUN1B; Marian Betz et al., “Lock to Live: Development of a Firearm Storage Decision Aid to Enhance Lethal Means Counselling and Prevent Suicide,” Injury Prevention 25, no. 1 (2019): i18–i24, https://doi.org/10.1136/injuryprev-2018-042944. 

Street outreach workers—who mediate conflicts as a means of preventing gun homicides and assaults—may also be well positioned to connect with hard-to-reach populations like the young men and BIPOC youth whose suicide rates have increased in recent years. However, in order to ensure outreach workers’ credibility, ability to identify those at risk, and access to suicide-relevant wraparound services, mental health training for frontline workers and funding for programmatic expansion would be necessary. BIPOC community leaders such as barbers, hair stylists, and nail technicians, may also be well positioned to recognize those at risk for suicide and connect them with support systems—in fact, many people in these roles have been doing this for decades. State certification programs or mental health first-aid trainings could work to legitimize this type of program and enhance its effectiveness.⁴⁴Amy J. Morgan et al., “Systematic Review and Meta-Analysis of Mental Health First Aid Training: Effects on Knowledge, Stigma, and Helping Behaviour,” PLoS ONE 13, no. 5 (2018): e0197102, https://doi.org/10.1371/journal.pone.0197102. These community leaders may also be well positioned to post warning signs about the risks associated with guns in their businesses and organizations, to help increase awareness. 

City governments can also address gun suicides by expanding the resources allocated to prevent them, including funding for mental health care, more parks and green spaces, and greater data availability. Evidence suggests that suicides can be prevented through early and consistent mental health care.⁴⁵Pablo Mendez-Bustos et al., “Effectiveness of Psychotherapy on Suicidal Risk: A Systematic Review of Observational Studies,” Frontiers in Psychology 10 (2019): 277,  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389707/. Beyond ensuring adequate funding for these services, cities should work to remove common barriers to health care, including language barriers, immigration status, cultural competencies in therapists, and stigmas (especially among gun-owning and/or BIPOC men).⁴⁶Deborah Stone et al., “Preventing Suicide: A Technical Package of Policies, Programs, and Practice,” Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, 2017, https://bit.ly/2FCaSmA. Cleaning and greening of communities represents another cost-effective, evidence-based gun homicide prevention strategy,⁴⁷Branas et al., “Citywide Cluster Randomized Trial to Restore Blighted Vacant Land and Its Effects on Violence, Crime, and Fear;” Branas et al., “Urban Blight Remediation as a Cost-Beneficial Solution to Firearm Violence;” Alan Mallach, Ken Steif, and Kim Graziani, “The Reimagining Cleveland Vacant Lot Greening Program,” December 2016, https://www.communityprogress.net/filebin/Cleveland_Economic_Impact_Report_12.21.2016_FINAL.pdf; Michelle Kondo et al., “Effects of Greening and Community Reuse of Vacant Lots on Crime,” Urban Studies 53, no. 15 (November 1, 2016): 3279–95, https://doi.org/10.1177/0042098015608058. with promise in preventing people from dying by gun suicide too, as parks can provide opportunities for community gatherings, exercise, and self-reflection or rest. Finally, police departments should expand their gun violence data collection and reporting practices to include both gun homicides and suicides, to provide communities with more holistic information on the scope of this public health crisis.

Kelley’s Story

When people came for his funeral, I said I can’t even think about cooking—it felt so monumental. So I dialed one of the numbers on the list Leslie had put together, thinking I was calling Domino’s, and they say, ‘Compassionate friends.’ I said, ‘I’m so sorry, I am trying to dial a restaurant,’ and she said, ‘We work with parents who have lost their children.’ Leslie had accidentally transposed the numbers, and it was a sign that I needed help. So I reached out. I found a grief counselor and I got in the next day. I was not aware of resources at the time—now I know there are many. The body of knowledge that these agencies have now is so different from what we had 33 years ago when this happened.

Read Kelley’s story on Moments that Survive.

By expanding the narrative of city gun violence to recognize the role of gun suicides in addition to homicides, mayors, community leaders, and legislators can broaden the scope of solutions and resources available to save lives.

Acknowledgement

Everytown for Gun Safety Support Fund would like to gratefully acknowledge Amelia Lehto of the American Association of Suicidology for sharing her expertise during the development and drafting of this report.

Further Resources

Free and Confidential Crisis Lines

• 988 Suicide & Crisis Lifeline, previously known as the National Suicide Prevention Lifeline, provides free and confidential support for people in distress or suicidal crisis. Call or text 988 to talk with a counselor or visit 988lifeline.org/chat/ to chat online with one. Call, text, and chat lines are available 24 hours a day, 7 days a week.
• Crisis Text Line provides free live texting with a trained crisis counselor. Text HOME to 741741 from anywhere in the US 24/7.
• Teen Line connects teens who need someone to talk to with other trained teens who can listen and present available options. Call 1-800-852-8336 or text TEEN to 839863 from 6 to 9 pm, Pacific Time.
• The Trevor Project provides crisis intervention and suicide prevention services to LGBTQ+ people under age 25. Call 1-866-488-7386, text START to 678-678, or chat online with a counselor 24/7.
• Trans Lifeline Hotline provides support services by trans people, for trans and questioning callers in crisis 24/7. Call 1-877-565-8860.
• Veterans Crisis Line provides confidential support to anyone, regardless of Veterans Affairs status. Call 988 and press 1, text 838255, or chat online 24/7.
• Your Life Your Voice connects teens in need of help with crisis counselors 24/7. Call 1-800-448-3000 or text VOICE to 20121.

Suicide Prevention and Mental Health Organizations

• American Foundation for Suicide Prevention is a voluntary health organization that gives those affected by suicide a nationwide community empowered by research, education and advocacy to take action against this leading cause of death.
• Active Minds has chapters on more than 800 college campuses that work to empower students to talk openly about their mental health so that no one struggles alone.
• Asian Mental Health Collective provides a list of culturally competent therapists for the Asian and Pacific Islander community and works to raise awareness about the importance of mental health care and challenging the stigma surrounding it.
• Black Mental Health Alliance aims to develop and promote culturally relevant trainings and services to support the health of Black people and other communities in the US.
• Center for Native American Youth of the Aspen Institute works to improve the health and safety of Native American youth through research, advocacy, and policy change.
• Loveland Foundation provides financial assistance to Black women and girls nationwide seeking therapy, with the goal of prioritizing opportunity, access, validation, and healing.
• National Alliance for Hispanic Health is a science-based and community-driven organization that focuses on improving the health and well-being of Hispanic people and providing quality care to all.
• American Association of Suicidology’s National Center for the Prevention of Youth Suicide works to identify youth at risk, develop strategies to move prevention upstream, and engage and empower youth to be partners in their suicide prevention efforts.
• Society for the Prevention of Teen Suicide, founded by two dads who lost teenage children to suicide, encourages public awareness of teen suicide through the development and promotion of educational training programs.
• You Matter, administered by the 988 Suicide & Crisis Lifeline, creates a safe space for youth to share their stories about mental health.

Appendix

OLS Regression Results for Firearm Suicide Rates per 100,000 People⁴⁸Everytown analysis of CDC NVSS city firearm suicide and ACS data, 2016–2020, and ATF FFL data, 2020.