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Thousands of Preventable Gun Suicides

A Collateral COVID-19 Public Health Crisis

6.10.2020
Two women cry and sit close together on a couch

The deep economic downturn caused by COVID-19, combined with the millions of guns already in homes and the millions more being purchased during each month of the pandemic, is a volatile mix that could exacerbate the risk of firearm suicide. Based on historic precedent, the US risks a 20 to 30 percent increase in firearm suicides, costing the nation an additional 5,000 to 7,000 lives—about 20 more per day—in 2020 alone.1This Everytown for Gun Safety Support Fund estimate calculates the rate of firearm suicide for working-age Americans 15 to 64 years of age (8.3 per 100,000 people) multiplied by the estimated additional number of unemployed (24 million) based on initial unemployment insurance claims from March through April 25, 2020 compared to 2018 unemployment multiplied by the relative risk of suicide within five years of unemployment compared to those who are employed (relative risk of 2.5). The firearm suicide rate source is the Centers for Disease Control and Prevention, National Center for Health Statistics, Wide-ranging Online Data for Epidemiologic Research (WONDER), Underlying Cause of Death, 2018. The additional unemployed population source is the “Unemployment Insurance Weekly Claims Data,” US Department of Labor, Employment and Training Administration, accessed April 30, 2020, https://bit.ly/3fkKeMb. The relative risk of suicide source is derived from: Allison Milner, Andrew Page, and Anthony D. LaMontagne, “Long-Term Unemployment and Suicide: A Systematic Review and Meta-Analysis,” PLoS ONE 8, no. 1 (2013), https://doi.org/10.1371/journal.pone.0051333. Per day calculations are based on 9 months from April 2020. These calculations include only the economic consequences of COVID-19 and do not take into account any increased firearm suicide risks from social isolation.

20-30%

Based on historic precedent, the US risks a 20 to 30 percent increase in firearm suicides.

The firearm suicide rate source is the Centers for Disease Control and Prevention, National Center for Health Statistics, Wide-ranging Online Data for Epidemiologic Research (WONDER), Underlying Cause of Death, 2018. The additional unemployed population source is the “Unemployment Insurance Weekly Claims Data,” US Department of Labor, Employment and Training Administration, accessed April 30, 2020, https://bit.ly/3fkKeMb. This Everytown for Gun Safety Support Fund estimate calculates the rate of firearm suicide for working-age Americans 15 to 64 years of age (8.3 per 100,000 people) multiplied by the estimated additional number of unemployed (24 million) based on initial unemployment insurance claims from March through April 25, 2020 compared to 2018 unemployment multiplied by the relative risk of suicide within five years of unemployment compared to those who are employed (relative risk of 2.5). The relative risk of suicide source is derived from: Allison Milner, Andrew Page, and Anthony D. LaMontagne, “Long-Term Unemployment and Suicide: A Systematic Review and Meta-Analysis,” PLoS ONE 8, no. 1 (2013), https://doi.org/10.1371/journal.pone.0051333. *Per day calculations are based on 9 months from April 2020. These calculations include only the economic consequences of COVID-19 and do not take into account any increased firearm suicide risks from social isolation.

These losses are collateral to COVID-19’s already considerable death toll, and would be in addition to the more than 23,000 lives taken by firearm suicide in an average year.2Centers for Disease Control and Prevention, National Centers 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 the most recent available data: 2014-2018. As with the virus, only swift and concerted intervention can reduce this projected loss and save lives.

Fear and anxiety during the COVID-19 pandemic has brought millions more guns into homes, increasing the risk for suicide.

2.5x

Unemployment is associated with a 2.5x increased risk of suicide.

Berk, M., & Christensen, L. (2013). Faculty Opinions recommendation of Long-term unemployment and suicide: A systematic review and meta-analysis. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature. https://doi.org/10.1371/journal.pone.0051333

The COVID-19 pandemic has led to never-before-seen spikes in gun purchases, with an estimated 1.9 million additional guns sold during March and April 2020 compared to the same time period last year.3Everytown for Gun Safety Support Fund, “Estimated Number of Guns Sold by State Between 2019-2020,” May 2020, https://everytownresearch.org/covid-gun-sales. Many of these “panic buyers” may assume this new purchase will make them and their families safer. In reality, access to a firearm in the home triples the risk of death by suicide.4Andrew 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. Firearm suicide is uniquely lethal, with 90 percent of suicide attempts using a gun resulting in death. By comparison, only 4 percent of suicide attempts by other means are fatal.5Andrew 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. 12 (2019): 885–95, https://doi.org/10.7326/M19-1324.

Past economic downturns suggest a suicide crisis is looming ahead.

During the Great Depression of the 1930s and the Great Recession that ended in 2010, the US experienced a tragic rise in suicide rates as unemployment increased and the economy contracted.6Feijun Luo et al., “Impact of Business Cycles on US Suicide Rates, 1928–2007,” American Journal of Public Health 101, no. 6 (2011): 1139–46, https://doi.org/10.2105/AJPH.2010.300010; Aaron Reeves et al., “Increase in State Suicide Rates in the USA during Economic Recession,” The Lancet 380, no. 9856 (2012): 1813–14, https://doi.org/10.1016/S0140-6736(12)61910-2. Fast forward to today, when 30 million Americans have filed for unemployment insurance in just six weeks (March 14 to April 25, 2020) amidst the COVID-19 pandemic, and there is reason for deep concern.7“Unemployment Insurance Weekly Claims Data,” US Department of Labor, Employment and Training Administration Unemployment at these levels (currently nearly 15 percent) has not been experienced since the Great Depression—the period with the highest documented rate of suicide our country has ever faced.8Luo et al., “Business Cycles on Suicide Rates”; “Current Population Survey, Unemployment Rate (LNS14000000),” US Bureau of Labor Statistics Data, accessed May 8, 2020, https://bit.ly/35DFXyS.

4,750

The Great Recession led to an estimated 4,750 additional suicide deaths.

Reeves, A., Stuckler, D., Mckee, M., Gunnell, D., Chang, S., & Basu, S. (2012). Increase in state suicide rates in the USA during economic recession. The Lancet, 380(9856), 1813-1814. https://doi.org/10.1016/S0140-6736(12)61910-2

Job loss, particularly when sustained, can bring with it eviction, foreclosure, increased debt, and other economic fallout. These extreme economic stressors can lead to a host of outcomes, from a sense of hopelessness to depression, strained relationships, and mental health conditions, all of which can manifest in suicidal behaviors.9Camilla Haw et al., “Economic Recession and Suicidal Behaviour: Possible Mechanisms and Ameliorating Factors,” The International Journal of Social Psychiatry 61, no. 1 (2015): 73–81, https://doi.org/10.1177/0020764014536545. At the end of March 2020, more than four in 10 Americans reported that their mental health has been negatively impacted as a result of COVID-19-related stress and anxiety.10Ashley Kirzinger et al., “KFF Health Tracking Poll – Early April 2020: The Impact of Coronavirus on Life in America,” Kaiser Family Foundation, April 2, 2020, https://bit.ly/3bH67D0. It is unsurprising, therefore, to see a nearly 900 percent increase in calls to the federal Disaster Distress Helpline in March 2020 compared to the same month last year.11Amanda Jackson, “A Crisis Mental-Health Hotline Has Seen an 891% Spike in Calls,” CNN, April 10, 2020, https://cnn.it/3dkTcHc. In addition to personal financial distress, other suicide risk factors associated with today’s unprecedented pandemic—such as social isolation caused by lockdowns, unparalleled anxiety about health and finances, increased alcohol use, and the introduction of millions more guns into American homes—are cause for even greater alarm.12Tara Nurin, “During Self-Isolation, More People Show Online Interest In Alcohol than Healthcare,” Forbes, April 11, 2020, https://bit.ly/2VJgEb9; Carrie Henning-Smith, “COVID-19 Poses an Unequal Risk of Isolation and Loneliness,” The Hill, March 18, 2020, https://bit.ly/2yymDHa; Kirzinger et al., “KFF Health Tracking Poll – Early April 2020.”

Long after the last COVID-19 patient’s fever subsides, there will remain real potential for a coronavirus-adjacent public health crisis: firearm suicide. Based on Everytown’s research of the impacts of unemployment on suicide from past recessions, we estimate that the economic downturn caused by COVID-19 could lead to a 20 to 30 percent increase in the number of lives lost to firearm suicide in the US in 2020, with the potential for 9,000 to 15,000 additional firearm suicide deaths to take place over the next 3 years.13This Everytown for Gun Safety Support Fund estimate calculates the rate of firearm suicide for working-age Americans 15 to 64 years of age (8.3 per 100,000 people) multiplied by the estimated additional number of unemployed (24 million) based on initial unemployment insurance claims from March through April 25, 2020 compared to 2018 unemployment multiplied by the relative risk of suicide within five years of unemployment compared to those who are employed (relative risk of 2.5). The firearm suicide rate source is the Centers for Disease Control and Prevention, National Center for Health Statistics, Wide-ranging Online Data for Epidemiologic Research (WONDER), Underlying Cause of Death, 2018. The additional unemployed population source is the “Unemployment Insurance Weekly Claims Data,” US Department of Labor, Employment and Training Administration, accessed April 30, 2020, https://bit.ly/3fkKeMb. The relative risk of suicide source is derived from: Allison Milner, Andrew Page, and Anthony D. LaMontagne, “Long-Term Unemployment and Suicide: A Systematic Review and Meta-Analysis,” PLoS ONE 8, no. 1 (2013), https://doi.org/10.1371/journal.pone.0051333. Per day calculations are based on 9 months from April 2020. These calculations include only the economic consequences of COVID-19 and do not take into account any increased firearm suicide risks from social isolation.

Actual and Projected Firearm Suicide Deaths Per Year, 2010-2022

Line graph representing Actual and Projected Firearm Suicide Deaths Per Year, 2010-2022. From 2010 to 2019, you see a steady increase. There is a spike projected in 2020 due to firearm suicides as a result of the COVID-19 economic crisis.

Without urgent action, there is the potential for 9,000 to 15,000 additional firearm suicide deaths to take place over the next 3 years.14Milner, Page, and LaMontagne, “Long-Term Unemployment and Suicide.” Everytown’s calculations use CDC WONDER reported firearm suicide rate for persons 15–64 years of age for 2018 of 8.3 suicides per 100,000 people and RR 2.5 from meta-analysis by Milner et al., multiplied by the estimated additional unemployment compared to the 2018 firearm suicide deaths of 24,432. Our calculations include only the economic consequences of COVID-19 and do not take into account any increased firearm suicide risks from social isolation.

What can leaders do to prevent a post-COVID-19 firearm suicide crisis?

The hopeful news is that there are proven policies with respect to gun access that can save lives and important mental health actions and economic supports that experts agree could prevent the COVID-19 pandemic from exacerbating a secondary firearm suicide epidemic.

Limit the easy and immediate acquisition of firearms.

Limiting access to firearms among those at risk for suicide saves lives. The vast majority of people who survive a suicide attempt do not go on to die by suicide.15David Owens, Judith Horrocks, and Allan House, “Fatal and Non-Fatal Repetition of Self-Harm: Systematic Review,” British Journal of Psychiatry 181, no. 3 (2002): 193–99, https://doi.org/10.1192/bjp.181.3.193. Policies for limiting the easy and immediate access to firearms such as extreme risk and waiting period laws, background checks on all gun sales, and secure storage practices have all been proven to reduce suicide rates and save lives.

Build public awareness of the link between firearms and suicide and how to access support resources.

For many years, trusted messengers like medical professionalsgun dealerslaw enforcement, and others have engaged in campaigns that help inform gun owners about the risks of firearms in the home and how to mitigate those risks for themselves and their families. These efforts, in addition to public outreach to gun owners and non-gun owners about secure firearm storage and the availability of crisis support resources (e.g., suicide crisis lines, alcohol and substance use treatment, and mental health treatment), should be continued and expanded.

Increase access to mental health and medical services.

4/10

4 in 10 Americans reported that their mental health has been negatively impacted as a result of COVID-19-related stress and anxiety, at the end of March 2020.

Kirzinger, A., Kearney, A., Hamel, L., & Brodie, M. (2020, April 20). KFF Health Tracking Poll – Early April 2020: The Impact Of Coronavirus On Life In America. Retrieved from https://bit.ly/3fhOnz0

Medical professionals have an important role to play in discussing behavioral risks with their patients. Roughly two in three Americans who attempt suicide will visit a health care professional in the month before the attempt.16Brian K. Ahmedani et al., “Racial/Ethnic Differences in Healthcare Visits Made Prior to Suicide Attempt Across the United States,” Medical Care 53, no. 5 (2015): 430–35, https://doi.org/10.1097/MLR.0000000000000335. Increased access to mental health and medical services, including strengthened access to suicide prevention services, can help prevent a rise in suicide deaths. In a system in which health care coverage is often tied to employment, losing a job can also mean losing access to mental health services at a time when they are most needed. To expand access to mental health and medical services and prevent suicides, the Centers for Disease Control and Prevention (CDC) recommends providing medical benefits, ensuring coverage of mental health and substance use treatment in health insurance policies, increasing the number of medical and mental health providers in underserved areas, and providing lethal means counseling in health care settings.17Deborah 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://doi.org/10.15620/cdc.44275.

Expand access to economic support to mitigate suicide risk.

Studies have found that US states that offer higher-than-average unemployment benefits over time offset the impact of unemployment on suicide.18Jonathan Cylus, M. Maria Glymour, and Mauricio Avendano, “Do Generous Unemployment Benefit Programs Reduce Suicide Rates? A State Fixed-Effect Analysis Covering 1968–2008,” American Journal of Epidemiology 180, no. 1 (2014): 45–52, https://doi.org/10.1093/aje/kwu106. The CDC’s recommendations for suicide prevention also highlight economic support programs and policies that mitigate suicide risk factors by reducing the strain of paying for food, medical care, housing, and other basic expenses on families. The CDC provides evidence of the effectiveness of higher spending on such programs as unemployment insurance, household subsidies to reduce eviction and foreclosure, Temporary Assistance for Needy Families, and public assistance for medical benefits on lowering suicide rates.19Stone et al., “Preventing Suicide.” Other high-income countries that have funded workforce programs, job-search training, and other economic supports during recessions have mitigated the risk of suicide compared to those that cut programs intended to buffer a recession’s impacts on households.20Haw et al., “Economic Recession and Suicidal Behaviour.”

Conclusion

The CDC’s recommendations for suicide prevention also highlight economic support programs and policies that mitigate suicide risk factors.21Stone et al., “Preventing Suicide.”

COVID-19 has suddenly pervaded every aspect of our lives and deeply unsettled our country. The pandemic has had far-reaching impacts on our social, psychological, and economic well-being and decisions. And, while some of this “new normal” is temporary, we have less control over the duration and timing of other changes. Though we can look forward to eventually emerging from self-isolation and spending time with family and friends, in the next few months, the country has seen a massive economic setback that will require a long road to recovery. The steps outlined above can go a long way to avoiding a collateral public health crisis of firearm suicide and help smooth the path ahead.

Resources for those in crisis

If you or someone you know is in crisis, please contact the National Suicide Prevention Lifeline, a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24/7. 1-800-273-TALK (8255) suicidepreventionlifeline.org

You may also contact the Crisis Text Line, which provides trained crisis counseling services over text 24/7. Text HOME to 741741 from anywhere in the US crisistextline.org.

Free and confidential mental health, suicide prevention, and crisis intervention services and resources are also available to people in-need of help, loved ones of those in-need, and frontline workers through the Pandemic Crisis Services Response Coalition at covidmentalhealthsupport.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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