Harvard study finds a gun in the home increases risk of suicide
A semi-automatic handgun and a holster are displayed at a North Little Rock, Ark., gun shop. AP Photo/Danny Johnston
By Carolyn Y. Johnson / Globe Staff 09/06/2013 | 2:19 PM
In the late 1950s in England and Wales, people began switching from heating their stoves with a gas containing carbon monoxide to one that didn’t. Over the next two decades, the suicide rate dropped—a decline attributed in a landmark study to the decline in death by carbon monoxide poisoning [ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC478945/?page=1 ]. Forty years later, the Sri Lankan government began to restrict the use of extremely toxic pesticides that had been commonly ingested to commit suicide. The suicide rate in that country dropped by half [ http://davideharrington.com/wp-content/uploads/2013/02/sri-lanka-suicides.pdf ]. In the United States, gun ownership dropped over a 22-year period ending in 2002, and the suicide rate declined, too [ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563517/ ].
When people talk about preventing suicide, the conversation usually centers on detecting and treating suicidal behavior, but a growing body of evidence points to a far simpler and more effective way to save thousands of lives: simply remove the means by which people commit suicide. In the United States, that means firearms; half of all suicides are committed with a gun.
But despite dovetailing streams of evidence from history and public health research that removing guns from the houses of people at risk of suicide could save thousands of lives, some critics have been unpersuaded. Skeptics argue that perhaps gun owners, and the people who live with them, are just more suicidal than the regular population.
A new study [ http://aje.oxfordjournals.org/content/178/6/946 ] published by Dr. Matthew Miller, associate professor of health policy at the Harvard School of Public Health, offers powerful evidence to the contrary, showing that while rates of suicide attempts are virtually identical in states with high and low gun ownership, the number of gun deaths from suicide are four times higher in states with high gun ownership [ http://aje.oxfordjournals.org/content/early/2013/08/22/aje.kwt197.abstract ], where about half the people live in homes with guns. Overall suicide rates are also higher, but the rate of suicides that did not use guns was not.
“If you look back to cigarette smoking and lung cancer and the history of the resistance that was put up and the uncertainty that was manufactured by the cigarette industry, it is almost like a blueprint for many of the arguments that pro-gun forces have made in the US,” Miller said. “But the evidence has really gotten over the last 10 years or so to be overwhelming.”
Suicide comes with a stigma that means it rarely gets the attention it deserves, as the 10th most common cause of death in the United States and the second most common cause of death of people under age 40. My colleague, Leon Neyfakh, wrote an important story earlier this year calling attention to the remarkable fact that there are nearly twice as many gun deaths by suicide than by homicide [ http://www.bostonglobe.com/ideas/2013/01/20/the-gun-toll-ignoring-suicide/xeWBHDHEvvagfkRlU3CfZJ/story.html ], and three out of every five people who are killed by a gun are dying by their own hand.
Far from advocating for the abolition of gun ownership or even gun control, researchers such as Miller argue that lives could be saved by removing guns from the home when a family member is depressed or angry or at risk of self-harm. That’s because suicide attempts with other means are often unsuccessful.
In the new study, published in August in the American Journal of Epidemiology, he and colleagues point out a striking statistic. In 2010, 22,000 people attempted suicide with a gun, and all but 2,000 were successful. If one out of every 10 of those people used something other than a gun, about 1,900 additional people would have lived.
“This is not about legislating our way out of it,” Miller said. “If I have a kid who is moody and having problems or a husband or wife who just lost a job and is being issued divorce papers, or just going through a rough time, the best thing I can do to reduce that person’s immediate risk of death from suicide” is to take guns out of the house.
What’s needed now, Miller said, is more research on suicide and guns. President Obama called for $10 million be spent on public health firearm research in the wake of the Newtown school shooting [ http://www.nbcnews.com/health/obama-plan-eases-freeze-cdc-gun-violence-research-1B7999574 ], and Miller thinks it is important that the brunt of the public health burden, suicide, receives a good share of that funding.
“My feeling is the stigma that attaches itself to suicide is something that has kept us from speaking more objectively and commonly about the ways to prevent it,” Miller said. “The idea that you can prevent it is now seen as entirely within the mental health arena, and that’s problematic, because there are many good reasons to try to prevent mental illness and treat it, including reducing suicidal behavior. But we haven’t really been very good at doing that.”
New Study: Gun Ownership, Not Suicidal Behavior, Is Strongest Predictor of Death by Suicide
Posted by Goldy on Wed, Sep 4, 2013 at 9:46 AM
State by state data has long shown a strong correlation between rates of gun ownership and rates of suicide [ http://www.hsph.harvard.edu/news/magazine/spr08gunprevalence/ ], but whether there is a causal relationship, well, that has been harder to discern. A variety of factors influence suicide rates, including poverty, population density, and crime. For example, I'd probably kill myself were I forced to live in Wyoming, even if the state didn't rank tops in gun prevalence.
But now a new study [ http://aje.oxfordjournals.org/content/178/6/946 ] conducted by researchers at the Harvard School of Public Health, and published in the American Journal of Epidemiology, concludes that, controlling for other factors, the strongest predictor of how likely a person is to die from suicide within a given state, is in fact, whether they have a gun in the home:
[S]uicide attempt rates were not significantly related to gun ownership levels. These findings suggest that firearm ownership rates, independent of underlying rates of suicidal behavior, largely determine variations in suicide mortality across the 50 states. Our results support the hypothesis that firearms in the home impose suicide risk above and beyond the baseline risk and help explain why, year after year, several thousand more Americans die by suicide in states with higher than average household firearm ownership compared with states with lower than average firearm ownership.
The full text of the paper is behind a firewall, but you can hear an interview with Dr. Matthew Miller, its lead author, on this week's edition of Science Friday [ http://www.sciencefriday.com/segment/08/30/2013/diagnosing-self-destruction.html ]. Dr. Miller makes the point that rates of suicide mortality are not much related to rates of major depression, rates of substance abuse, or even rates of suicide attempts. Statistically, the impulsive and fleeting nature of suicide—a quarter of all attempts occur within five minutes of the initial impulse, about half within the first 20 minutes—combines with the lethality of guns to overwhelm all other factors.
To be clear, easy access to firearms within the home does not increase one's risk of attempting suicide, the study found. It merely increases one's risk of succeeding. Dramatically. Victims who attempt suicide using pills or cutting are 100 times more likely to survive, says Miller, whereas "you don't get a second chance when you use a gun."
And since less than ten percent of suicide survivors go on to make a second attempt, it is easy access to firearms within the home, at that fleeting moment of impulse, that ends up having the single largest impact on suicide mortality rates.
Suicide Risk Linked to Rates of Gun Ownership, Political Conservatism
UCR study links risk of suicide with rate of gun ownership and political conservatism at the state level. (Credit: Image courtesy of University of California, Riverside)
by Bettye Miller Apr. 5, 2013
Residents of states with the highest rates of gun ownership and political conservatism are at greater risk of suicide than those in states with less gun ownership and less politically conservative leanings, according to a study by University of California, Riverside sociology professor Augustine J. Kposowa.
The study, "Association of suicide rates, gun ownership, conservatism and individual suicide risk," was published online in the journal Social Psychiatry & Psychiatric Epidemiology in February.
Suicide was the 11th leading cause of death for all ages in the United States in 2007, the most recent year for which complete mortality data was available at the time of the study. It was the seventh leading cause of death for males and the 15th leading cause of death for females. Firearms are the most commonly used method of suicide by males and poisoning the most common among females.
Kposowa, who has studied suicide and its causes for two decades, analyzed mortality data from the U.S. Multiple Cause of Death Files for 2000 through 2004 and combined individual-level data with state-level information. Firearm ownership, conservatism (measured by percentage voting for former President George W. Bush in the 2000 election), suicide rate, church adherence, and the immigration rate were measured at the state level. He analyzed data relating to 131,636 individual suicides, which were then compared to deaths from natural causes (excluding homicides and accidents).
"Many studies show that of all suicide methods, firearms have the highest case fatality, implying that an individual who selects this technique has a very low chance of survival," Kposowa said. Guns are simply the most efficient method of suicide, he added.
With few exceptions, states with the highest rates of gun ownership -- for example, Alaska, Montana, Wyoming, Idaho, Alabama, and West Virginia -- also tended to have the highest suicide rates. These states were also carried overwhelmingly by George Bush in the 2000 presidential election.
The study also found that:
• The odds of committing suicide were 2.9 times higher among men than women
• Non-Hispanic whites were nearly four times as likely to kill themselves as Non-Hispanic African Americans
• The odds of suicide among Hispanics were 2.3 times higher than the odds among Non-Hispanic African Americans
• Divorced and separated individuals were 38 percent more likely to kill themselves than those who were married
• A higher percentage of church-goers at the state level reduced individual suicide risk.
"Church adherence may promote church attendance, which exposes an individual to religious beliefs, for example, about an afterlife. Suicide is proscribed in the three monotheistic religions: Judaism, Christianity and Islam," Kposowa noted in explaining the finding that church membership at the state level reduces individual risk of suicide. "In states with a higher percentage of the population that belong to a church, it is plausible that religious views and doctrine about suicide are well-known through sacred texts, theology or sermons, and adherents may be less likely to commit suicide."
Kposowa is the first to use a nationally representative sample to examine the effect of firearm availability on suicide odds. Previous studies that associated firearm availability to suicide were limited to one or two counties. His study also demonstrates that individual behavior is influenced not only by personal characteristics, but by social structural or contextual attributes. That is, what happens at the state level can influence the personal actions of those living within that state.
The sociologist said that although policies aimed at seriously regulating firearm ownership would reduce individual suicides, such policies are likely to fail not because they do not work, but because many Americans remain opposed to meaningful gun control, arguing that they have a constitutional right to bear arms.
"Even modest efforts to reform gun laws are typically met with vehement opposition. There are also millions of Americans who continue to believe that keeping a gun at home protects them against intruders, even though research shows that when a gun is used in the home, it is often against household members in the commission of homicides or suicides," Kposowa said.
"Adding to the widespread misinformation about guns is that powerful pro-gun lobby groups, especially the National Rifle Association, seem to have a stranglehold on legislators and U.S. policy, and a politician who calls for gun control may be targeted for removal from office in a future election by a gun lobby," he added.
Although total suicide rates in the U.S. are not much higher than in other Western countries, without changes in gun-ownership policies "the United States is poised to remain a very armed and potentially dangerous nation for its inhabitants for years to come."
Story Source: The above story is based on materials provided by University of California, Riverside. http://www.ucr.edu/
Matthew Miller, M.D., Sc.D., and David Hemenway, Ph.D. N Engl J Med 2008; 359:989-991 September 4, 2008 DOI: 10.1056/NEJMp0805923
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.
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.
In the United States, suicides outnumber homicides almost two to one. Perhaps the real tragedy behind suicide deaths—about 30,000 a year, one for every 45 attempts—is that so many could be prevented. Research shows that whether attempters live or die depends in large part on the ready availability of highly lethal means, especially firearms.
A study by the Harvard School of Public Health of all 50 U.S. states reveals a powerful link between rates of firearm ownership and suicides. Based on a survey of American households conducted in 2002, HSPH Assistant Professor of Health Policy and Management [ http://www.hsph.harvard.edu/departments/health-policy-and-management/ ] Matthew Miller [ http://www.hsph.harvard.edu/faculty/matthew-miller ], Research Associate Deborah Azrael, and colleagues at the School’s Injury Control Research Center [ http://www.hsph.harvard.edu/research/hicrc/ ] (ICRC), found that in states where guns were prevalent—as in Wyoming, where 63 percent of households reported owning guns—rates of suicide were higher. The inverse was also true: where gun ownership was less common, suicide rates were also lower.
The lesson? Many lives would likely be saved if people disposed of their firearms, kept them locked away, or stored them outside the home. Says HSPH Professor of Health Policy David Hemenway [ http://www.hsph.harvard.edu/faculty/david-hemenway ], the ICRC’s director: “Studies show that most attempters act on impulse, in moments of panic or despair. Once the acute feelings ease, 90 percent do not go on to die by suicide.”
But few can survive a gun blast. That’s why the ICRC’s Catherine Barber has launched Means Matter, a campaign that asks the public to help prevent suicide deaths by adopting practices and policies that keep guns out of the hands of vulnerable adults and children. For details, http://visit www.meansmatter.org .
Barber, who co-directed the National Violent Injury Statistics System, has also developed free, self-paced, online workshops to help public officials, mental health service providers, and community groups put together suicide prevention programs and policies. To take advantage of this joint effort by HSPH and the Suicide Prevention Resource Center, visit http://training.sprc.org .
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