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Harvard Public Health Review/Summer 2002


Mortal Allies: Guns and Suicide

In the United States, suicides outnumber homicides and firearm suicides outnumber firearm homicides. In 1999, over 29,000 Americans committed suicide (approximately 17,000 with guns), while some 17,000 were murdered (almost 11,000 with guns). Guns are the most common method used in fatal suicide attempts, not only by men, but by women and children as well. In a nation where over 200 million guns are in civilian hands and where approximately 25 percent of households have handguns, one cannot discuss suicide without talking about guns.

A central question regarding the relationship between firearms and suicide is whether the ready availability of firearms increases the overall number of suicides, rather than merely the proportion of suicides from guns. Some have claimed that only intent matters--that anyone serious enough about suicide to use a gun would, if guns were less available, substitute equally lethal means. On the other hand, if some individuals substitute less lethal means (or do not attempt at all), the overall number of suicides might decrease.

A growing body of evidence indicates that the means at hand matter: where there are more guns, more people are taking their own lives. For example, American case-control studies all find that a gun in the home is a strong risk factor for suicide, not only for the gun owner, but for other household members as well. The risk of suicide associated with the presence of a firearm in the home is large (an increase of two- to five-fold in most studies), especially when the gun is a handgun or is stored loaded or unlocked.

A consistent finding across several different types of studies is that the risk of suicide associated with firearms is especially high for adolescents and young adults. For example, although the suicide rate among adult Americans is similar to that among adults in other developed countries, American children are twice as likely as are their counterparts to commit suicide--a result entirely due to a firearm suicide rate that is ten times higher. Within the US as well, more children commit suicide where there are more guns. A recent study from the Harvard Injury Control Research Center found that the suicide rate is twice as high for 5-14-year-olds living in the five US states with the highest (compared with the lowest) gun ownership rates. The excess suicides were due to differences in suicides from firearms (approximately ten times as many children killed themselves with guns in the high gun states) and could not be explained by differences in rates of poverty, education, or urbanization.

We do not have to accept the current toll as an American norm. In conjunction with more general suicide prevention strategies, firearm-related policies and practices, supported by a majority of Americans, can help us better protect our children and, probably, many older Americans as well. For example, guns can be redesigned so that they can only be fired by the the authorized owner. Health professionals can better educate patients (or patients' guardians) about the suicide risk associated with keeping a gun in the home. States can enact safe storage requirements (which are mandatory in many other developed nations), close loopholes in secondary markets (so that acquiring a gun requires the same scrutiny no matter where it is purchased), and computerize data on serious mental health problems (so that background checks can be done quickly and more thoroughly).

These policies and practices aim to save lives by making it harder for youth and individuals with mental illness to gain access to firearms, a strategy based on four well-established facts. First, guns are far more lethal than most other popular methods of suicide. Second, suicide crises are often temporary. Third, suicide attempts are often impulsive--according to psychiatric authorities, half or more of suicides and non-fatal violent attempts may be impulsive. (In one study of near-lethal suicide attempts, 24 percent of the subjects spent less than five minutes between the decision to attempt suicide and the actual attempt.) And fourth, the long-term suicide rate for survivors of near fatal attempts is strikingly low. (In one study, survivors of near-fatal firearm suicide attempts were followed for two years and, although most intended to kill themselves in their attempts, most were glad to have survived. Indeed, despite persistent medical, social and psychological problems, none of 30 subjects attempted suicide again.)

To dismiss the possibility that the ready availability of firearms increases the overall rate of suicide in the US, especially among children and young adults, is to betray a way of thinking that is contrary to the vast majority of empirical evidence and dismissive of the complexity of human behavior. We are none of us always good or evil, completely rational or irrational, immutably condemned to despair or protected from destructive impulse. It is precisely because our lives have dimension and our actions range, that the mantra 'guns don't kill people, people kill people,' is properly seen as a reason to thoughtfully reduce, not reflexively ease, ready access to guns, especially for those who are at particularly high risk to use a gun to harm themselves or others.

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