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Guns and Suicide in the United States
The New England Journal of Medicine ^ | September 4, 2008 | Matthew Miller, M.D., Sc.D., and David Hemenway, Ph.D.

Posted on 09/03/2008 6:58:42 PM PDT by neverdem

This past June, in a 5-to-4 decision in District of Columbia v. Heller, the Supreme Court struck down a ban on handgun ownership in the nation's capital and ruled that the District's law requiring all firearms in the home to be locked violated the Second Amendment. But the Supreme Court's finding of a Second Amendment right to have a handgun in the home does not mean that it is a wise decision to own a gun or to keep it easily accessible. Deciding whether to own a gun entails balancing potential benefits and risks. One of the risks for which the empirical evidence is strongest,1 and the risk whose death toll is greatest, is that of completed suicide.

In 2005, the most recent year for which mortality data are available, suicide was the second-leading cause of death among Americans 40 years of age or younger. Among Americans of all ages, more than half of all suicides are gun suicides. In 2005, an average of 46 Americans per day committed suicide with a firearm, accounting for 53% of all completed suicides. Gun suicide during this period accounted for 40% more deaths than gun homicide.

Why might the availability of firearms increase the risk of suicide in the United States? First, many suicidal acts — one third to four fifths of all suicide attempts, according to studies — are impulsive. Among people who made near-lethal suicide attempts, for example, 24% took less than 5 minutes between the decision to kill themselves and the actual attempt, and 70% took less than 1 hour.2

Second, many suicidal crises are self-limiting. Such crises are often caused by an immediate stressor, such as the breakup of a romantic relationship, the loss of a job, or a run-in with police. As the acute phase of the crisis passes, so does the urge to attempt suicide. The temporary nature and fleeting sway of many suicidal crises is evident in the fact that more than 90% of people who survive a suicide attempt, including attempts that were expected to be lethal (such as shooting oneself in the head or jumping in front of a train), do not go on to die by suicide. Indeed, recognizing the self-limiting nature of suicidal crises, penal and psychiatric institutions restrict access to lethal means for persons identified as potentially suicidal.

Third, guns are common in the United States (more than one third of U.S. households contain a firearm) and are lethal. A suicide attempt with a firearm rarely affords a second chance. Attempts involving drugs or cutting, which account for more than 90% of all suicidal acts, prove fatal far less often.

The empirical evidence linking suicide risk in the United States to the presence of firearms in the home is compelling.3 There are at least a dozen U.S. case–control studies in the peer-reviewed literature, all of which have found that a gun in the home is associated with an increased risk of suicide. The increase in risk is large, typically 2 to 10 times that in homes without guns, depending on the sample population (e.g., adolescents vs. older adults) and on the way in which the firearms were stored. The association between guns in the home and the risk of suicide is due entirely to a large increase in the risk of suicide by firearm that is not counterbalanced by a reduced risk of nonfirearm suicide. Moreover, the increased risk of suicide is not explained by increased psychopathologic characteristics, suicidal ideation, or suicide attempts among members of gun-owning households.

Three additional findings from the case–control studies are worth noting. The higher risk of suicide in homes with firearms applies not only to the gun owner but also to the gun owner's spouse and children. The presence of a gun in the home, no matter how the gun is stored, is a risk factor for completed suicide. And there is a hierarchy of suicide risk consistent with a dose–response relationship. How household guns are stored matters especially for young people — for example, one study found that adolescent suicide was four times as likely in homes with a loaded, unlocked firearm as in homes where guns were stored unloaded and locked.

Many ecologic studies covering multiple regions, states, or cities in the United States have also shown a strong association between rates of household gun ownership and rates of completed suicide — attributable, as found in the case–control studies, to the strong association between gun prevalence and gun suicide, without a counterbalancing association between gun-ownership levels and rates of nongun suicide. We recently examined the relationship between rates of household gun ownership and suicide in each of the 50 states for the period between 2000 and 2002.4 We used data on gun ownership from a large telephone survey (of more than 200,000 respondents) and controlled for rates of poverty, urbanization, unemployment, mental illness, and drug and alcohol dependence and abuse. Among men, among women, and in every age group (including children), states with higher rates of household gun ownership had higher rates of firearm suicide and overall suicides. There was no association between firearm-ownership rates and nonfirearm suicides. To illustrate the main findings, we presented data for the 15 states with the highest levels of household gun ownership matched with the six states with the lowest levels (using only six so that the populations in both groups of states would be approximately equal). In the table, the findings are updated for 2001 through 2005.

View this table:
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Data on Suicides in States with the Highest and Lowest Rates of Gun Ownership, 2001–2005.

 

The recent Supreme Court decision may lead to higher rates of gun ownership. Such an outcome would increase the incidence of suicide. Two complementary approaches are available to physicians to help counter this possibility: to try to reduce the number of suicide attempts (e.g., by recognizing and treating mental illness) and to try to reduce the probability that suicide attempts will prove fatal (e.g., by reducing access to lethal means). Many U.S. physicians, from primary care practitioners to psychiatrists, focus exclusively on the first approach. Yet international experts have concluded that restriction of access to lethal means is one of the few suicide-prevention policies with proven effectiveness.5

In our experience, many clinicians who care deeply about preventing suicide are unfamiliar with the evidence linking guns to suicide. Too many seem to believe that anyone who is serious enough about suicide to use a gun would find an equally effective means if a gun were not available. This belief is invalid.

Physicians and other health care providers who care for suicidal patients should be able to assess whether people at risk for suicide have access to a firearm or other lethal means and to work with patients and their families to limit access to those means until suicidal feelings have passed. A Web site of the Harvard Injury Control Research Center can help physicians and others in this effort (www.hsph.harvard.edu/means-matter). Effective suicide prevention should focus not only on a patient's psychological condition but also on the availability of lethal means — which can make the difference between life and death.

No potential conflict of interest relevant to this article was reported.


Source Information

Dr. Miller is the associate director and Dr. Hemenway the director of the Harvard Injury Control Research Center, Harvard School of Public Health, Boston.

References

  1. Hemenway D. Private guns, public health. Ann Arbor: University of Michigan Press, 2004. 
  2. Simon OR, Swann AC, Powell KE, Potter LB, Kresnow MJ, O'Carroll PW. Characteristics of impulsive suicide attempts and attempters. Suicide Life Threat Behav 2001;32:Suppl:49-59. [CrossRef][ISI][Medline]
  3. Miller M, Hemenway D. The relationship between firearms and suicide: a review of the literature. Aggress Violent Behav 1999;4:59-75.
  4. Miller M, Lippmann SJ, Azrael D, Hemenway D. Household firearm ownership and rates of suicide across the 50 United States. J Trauma 2007;62:1029-1035. [Medline]
  5. Mann JJ, Apter A, Bertolote J, et al. Suicide prevention strategies: a systematic review. JAMA 2005;294:2064-2074. [Free Full Text]




TOPICS: Culture/Society; Editorial; News/Current Events; Politics/Elections
KEYWORDS: banglist; heller; suicide
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To: neverdem

More commit suicide from drugs they’ve been prescribed by doctors.


41 posted on 09/03/2008 10:57:57 PM PDT by mabelkitty (Why does Obama hate pregnant women so much?)
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To: Brad from Tennessee
I agree with you. He wasn't in his right mind, and today the meds are so much better.
42 posted on 09/04/2008 4:55:35 AM PDT by JimC214
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To: harpseal; TexasCowboy; nunya bidness; AAABEST; Travis McGee; Squantos; Shooter 2.5; wku man; SLB; ..
Enemy Action Ping: The latest psuedo-science "study" by the New England Journal of Medicine.

Click the Gadsden flag for pro-gun resources!

For the FreeRepublic "banglist", please click HERE .

43 posted on 09/04/2008 5:34:26 AM PDT by Joe Brower (Sheep have three speeds: "graze", "stampede" and "cower".)
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To: neverdem

Morons. Guns no more cause suicides than pencils cause misspelled words.


44 posted on 09/04/2008 5:41:44 AM PDT by Blood of Tyrants (G-d is not a Republican. But Satan is definitely a Democrat.)
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To: neverdem
Attempts involving drugs or cutting, which account for more than 90% of all suicidal acts, prove fatal far less often.

So we are going to affect the lower 10% by attacking your guns.

What idiots.

45 posted on 09/04/2008 6:06:13 AM PDT by Pistolshot (Palin has run a state, city, and a business. NObama has only run his mouth.)
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To: RicocheT
The gun store I frequent has had a lot of new customers come in for a hand gun. Many say it’s because they aren’t sure the next president will allow such purchases. They want one now while the purchase is still allowed.

I hear the same things every weekend in the shop. People are scarfing up the sunset-'black guns' as fast as they can. The fear is that NObama will reinstate the AWB no matter what Heller says in the interest of 'public safety'.

Even the post-ban guns are getting purchased, which is unusual. Heller was definitive, but a few doors opened up for 'some controls', which will be interpreted liberally by the anti-gunners, and narrowly by the pro-gun crowd.

46 posted on 09/04/2008 6:17:18 AM PDT by Pistolshot (Palin has run a state, city, and a business. NObama has only run his mouth.)
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To: Pistolshot

I think they were referring to attempted suicides, not successful suicides.


47 posted on 09/04/2008 6:22:23 AM PDT by B4Ranch ("Don't pick a fight with an old man. If he is too old to fight, he'll just kill you"--John Steinbeck)
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To: DBrow
Speaking of which, I heard that a "popular" means of suicide in Japan these days is asphxiation. The person shuts themselves up in a small space, maybe even a car, and simply burns a couple of charcoal briquets in an hibachi.

Sad but true.

48 posted on 09/04/2008 6:27:36 AM PDT by OKSooner
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To: neverdem
How many people acquired the weapon for the purpose of commiting suicide and how many owned them for more than a year prior to the event? How many of those people would have commited suicide by another means if a weapon was unavailable?

What brand of firearm "causes" the most suicides?

How many of the suicide victims consulted a doctor within a month before the attempt?

Does this means that doctors cause suicides?

49 posted on 09/04/2008 6:30:30 AM PDT by mbynack (Retired USAF SMSgt)
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To: neverdem

Because these guys want to make sure only doctor-assisted suicide is legal.


50 posted on 09/04/2008 6:34:39 AM PDT by <1/1,000,000th%
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To: OKSooner
This happens here too. A Delaware kid killed himself in a camping tent with a charcoal burner. He had used salvia within the last month, so his mom got active to make yet another plant illegal, salvia’s illegal now in Delaware and a few other states.

As a method to go, it's more peaceful than running an auto in the garage and certainly cheaper and less messy than a .357.

51 posted on 09/04/2008 6:44:09 AM PDT by DBrow
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To: neverdem
The nanny staters have a brush with the truth, in that the urge to commit suicide is a transient one in most instances, with the intensity of the crisis which provokes it.

Why is suicide becoming more common?

I think the answer is cultural, not technical.

Our culture, especially youth culture, is focused on the present and living in the moment, instead of taking a longer view which would add perspective. The intensity of the present becomes overwhelming easily to someone who cannot or will not envision a future beyond the moment of crisis. A breakup/divorce or other event becomes world-ending, not a gateway to the future, and the good that can arise from a difficult moment is overshadowed by the immediacy of a short-term worldview.

The same phenomenon is visible in the way many handle (or don't) their finances, and trade instantaneous gratification for what would be a better deal over the long term.

The absence of God, the idea of eternity (to place the hour/week/month/year in perspective), and the lack of philosophical depth to see the potential benefits inherent in even a negative circumstance contribute as well.

If people had to beat themselves to death with a stick, at some point the lights would go on and they might decide this isn't such a good idea.

But if someone is bound and determined to end their life, they will find a way, and all that will change is the means, not the outcome.

Then, too, weren't some in the medical community pushing for doping up the depressed to the point where they were purt'near catatonic and letting them die?

I guess they figured it is OK if the doctor kills you, that way they can send the relatives a bill.

52 posted on 09/04/2008 6:55:23 AM PDT by Smokin' Joe (How often God must weep at humans' folly.)
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To: umgud

A friend hung himself in his garage. I don’t have any problem with that except that he was married and had three small kids. Why did he take the chance that one of the kids would be the first to find him if he was pissed at his wife?

I suppose when things get that bad you aren’t thinking too straight anymore.


53 posted on 09/04/2008 6:55:30 AM PDT by B4Ranch ("Don't pick a fight with an old man. If he is too old to fight, he'll just kill you"--John Steinbeck)
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To: neverdem

Another amateurish, flawed paper.

The paper fails to mention any benefits from owning firearms. Yes, some people use them to commit suicide just as others use them for crimes. However, the number of defensive uses is two orders of magnitude greater than the number of criminal or suicidal uses. The paper also fails to address the issue of substitution. If a suicidal person is denied access to a gun, their suicidal impulses do not magically disappear. They substitute another method of self destruction. Furthermore, the paper relies of unverifiable phone data. It’s a known fact that gun owners lie to strangers asking about their guns over the phone. Thus the rate of gun ownership is likely higher in the states they identify as “high gun ownership states” and the rate of suicide per firearm is lower.

If only they would show the same level of concern about real threats to health; like 5-gallon buckets.


54 posted on 09/04/2008 7:32:26 AM PDT by Redcloak ("Yes, I have been drinking. Why do you ask?" #1 on the list of "Things heard from McCain voters")
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To: neverdem

In 2005, an average of 46 Americans per day committed suicide with a firearm, accounting for 53% of all completed suicides.


I suppose they’d rather these folks jumped outta windows?


55 posted on 09/04/2008 9:48:54 AM PDT by Atlas Sneezed (Guns don't kill people, criminals and the governments that create them do.)
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To: DBrow
Canada and New Zealand where gun ownership is highly restricted have higher rates than the USA.

Suicides per 100,000 people per year[1]

Country  ↓ Males  ↓ Females  ↓ Total  ↓ Year  ↓
Flag of Lithuania Lithuania 70.1 14.0 40.2 2004
Flag of Belarus Belarus 63.3 10.3 35.1 2003
Flag of Russia Russia 61.6 10.7 34.3 2004
Flag of South Africa South Africa[2] N/A N/A 30.0 2004
Flag of Kazakhstan Kazakhstan 51.0 8.9 29.2 2003
Flag of Hungary Hungary 44.9 12.0 27.7 2003
Flag of Guyana Guyana 42.5 12.1 27.2 2003
Flag of South Korea South Korea[3][4] N/A N/A 26.1 2005
Flag of Slovenia Slovenia 37.9 13.9 25.6 2004
Flag of Latvia Latvia 42.9 8.5 24.3 2004
Flag of Japan Japan[5] 35.6 12.8 24.2 2005
Flag of Ukraine Ukraine 43.0 7.3 23.8 2004
Flag of the People's Republic of China People's Republic of China (selected areas) 13.0 14.8 13.9 1999
Flag of Sri Lanka Sri Lanka N/A N/A 21.6 1996
Flag of Belgium Belgium 31.2 11.4 21.1 1997
Flag of Estonia Estonia 35.5 7.3 20.3 2005
Flag of Finland Finland 31.7 9.4 20.3 2004
Flag of Croatia Croatia 30.2 9.8 19.6 2004
Flag of Serbia and Montenegro Serbia and Montenegro 28.8 10.4 19.3 2002
Flag of Hong Kong Hong Kong 25.2 12.4 18.6 2004
Flag of France France 27.5 9.1 18.0 2003
Flag of Switzerland Switzerland 23.7 11.3 17.4 2004
Flag of Austria Austria 26.1 8.2 16.9 2005
Flag of Moldova Moldova 29.3 5.2 16.7 2004
Flag of Poland Poland 27.9 4.6 15.9 2004
Flag of the Czech Republic Czech Republic 25.9 5.7 15.5 2004
Flag of Uruguay Uruguay 24.5 6.4 15.1 2001
Flag of Luxembourg Luxembourg 21.9 7.4 14.6 2004
Flag of the People's Republic of China People's Republic of China[6] 13.0 14.8 13.9 1999
Flag of Denmark Denmark 19.2 8.1 13.6 2001
Flag of Cuba Cuba 20.3 6.6 13.5 2004
Flag of Slovakia Slovakia 23.6 3.6 13.3 2002
Flag of the Seychelles Seychelles N/A N/A 13.2 1998
Flag of Sweden Sweden 19.5 7.1 13.2 2002
Flag of Bulgaria Bulgaria 19.7 6.7 13.0 2004
Flag of Germany Germany 19.7 6.6 13.0 2004
Flag of Trinidad and Tobago Trinidad and Tobago 20.9 4.9 12.8 2000
Flag of Romania Romania 21.5 4.0 12.5 2004
Flag of Suriname Suriname 17.8 6.4 12.1 2000
Flag of Iceland Iceland 17.7 6.2 12.0 2004
Flag of New Zealand New Zealand 19.8 4.2 11.9 2000
Flag of Bosnia and Herzegovina Bosnia and Herzegovina 20.3 3.3 11.8 1991
Flag of Canada Canada 18.3 5.0 11.6 2002
Flag of Norway Norway 15.8 7.3 11.5 2004
Flag of Portugal Portugal 17.5 4.9 11.0 2003
Flag of the United States United States 17.9 4.2 11.0 2002

56 posted on 09/04/2008 10:10:34 AM PDT by CholeraJoe (Hey Biden! Saracuda's gonna give you a major wedgie in the VP debates!)
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To: txroadkill

You need to get your facts about suicide right
first suicide has changed over the past 50 years. The increase in black men killing themselves has increased 10 fold. Teenage suicides have had a slight decrease.
Men who complete suicide are more likely to use a gun
Women are more likely to attempt and they use pills
Places where gun ownership is high in this country are higher than places that do not have high gun ownership rates
More suicides used to happen in urban areas 20 years ago, today it’s higher in rural areas


57 posted on 09/04/2008 2:49:01 PM PDT by PRC
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To: PRC

Source?


58 posted on 09/04/2008 2:57:35 PM PDT by txroadkill (Sarah Palin-- Vote for her?!? Hell, I want to marry her!)
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To: txroadkill

Multiple sources
start with the CDC
I am an expert on this subject and have been a national speaker for over 25 years on preventing suicide


59 posted on 09/09/2008 11:25:21 AM PDT by PRC
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To: Skibane
In gun-free Japan, the per-capita suicide rate is several times that of America.

You got it. It's pretty bad when even the New England Journal of Medicine is doing political advocacy.
60 posted on 09/09/2008 11:28:58 AM PDT by Antoninus (McCain/Palin -- The winning ticket!)
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