Tom Gabor: Does Gun Availability Matter In Suicide?

Data from the CDC show that suicide rates in the US have increased by almost 30% since 1999.[1]  Nearly half of the suicides in the country are committed with guns and two-thirds of all gun deaths are suicides.  This last figure is often used by opponents of gun regulation to argue that America’s gun violence problem issue in the US has been overblown.  However, the World Health Organization defines suicide as a form of self-directed violence.[2]  In addition, isn’t it desirable to reduce firearm deaths and injuries, whether the harm prevented is directed toward another or self-directed and whether it is intentional or unintentional?   This said, preventive measures will obviously vary, depending on whether the harm being considered is a firearm-related homicide, suicide or accident.

suicide1Many people believe that suicide is the result of a long-standing mental illness and that the individual who takes his or her life has contemplated doing so for a long time.   When asked to estimate how many of the more than 1000 people who had jumped from the Golden Gate Bridge would have committed suicide some other way if an effective barrier had been installed on the bridge, over seven out of ten survey respondents answered that the suicide of all or most of the jumpers was inevitable and that limiting access to one suicide method was completely or most likely futile.[3]

According to this view, an individual, at some point, makes an irrevocable decision to end it all, selects a method, and takes the steps necessary to complete the act. If most suicides fit this profile of a rational act by a highly determined individual, it might be logical to argue that if guns were the chosen method, the lack of availability of a firearm would be irrelevant, as an alternative method would be selected with the same result.

In fact, an analysis of suicides over a 17-year period by researchers at the Centers for Disease Control and Prevention found that suicides often occur without warning and that, in over half the cases, there was no known mental health issue. More often, these individuals were experiencing relationship problems, substance abuse, physical health problems, financial problems, or crises of some other form.[4]

Keith Hawton, a psychiatrist who heads Oxford University’s Center for Suicide Research, has written the following in relation to the issue of planning versus impulsivity of this ultimate act of self-harm:

For most people who become suicidal, the period of real risk is relatively brief, lasting in some individuals for even just a few minutes or a few hours. In others it may last days, but rarely longer.  The concept of periods of risk is very important in…that if access to a dangerous means of suicide is restricted at such times, then survival until the end of these periods is more likely.[5]

In 1978, Richard Seiden, a researcher at the University of California at Berkeley, published a study in which he tracked over 500 people who were prevented from attempting suicide at the Golden Gate Bridge between 1937 and 1971.[6] An average of 26 years after the aborted attempt, 94 % of these individuals were either still alive or had died of natural causes. To Seiden, this finding supported the view that suicidal behavior is crisis oriented and acute in nature. He concluded that if suicidal people can get through this crisis, they would be unlikely to commit suicide later.

A Texas study in the 1980s showed that suicidal thinking can be transient. The study examined the cases of 30 people who were treated for gunshot wounds to the head, chest, or abdomen.[7]  Most, if not all, would have perished had a helicopter service and urban trauma center not been available. These were therefore very serious attempts. Interviews revealed that half of these patients had been drinking within 24 hours of the suicide attempt and 18 of the 30 had experienced a significant interpersonal conflict during that period. Most had no long-standing psychiatric disorders, only two had a history of suicides, and none of the 30 left a suicide note. Half the patients reported having suicidal thoughts for less than 24 hours. Many expected to die from their attempt, but indicated that they were glad to have survived. A follow-up two years later indicated that none had attempted suicide up to that point. This study showed that suicidal motivation can be fleeting but very serious at the same time.

Kay R. Jamison, a specialist in mood disorders at Johns Hopkins University, believes that, at most, 10–15 % of suicide cases are characterized by an unwavering determination to die on the part of the victim.[8] For other suicidal people, the risk is transient.

Research shows that availability is an important factor in the selection of a method by suicidal individuals.  In the above-mentioned Texas study of survivors of serious self-inflicted gunshot wounds, the answer most often given by the subjects for selecting a firearm was its availability in their homes.  Another indication of the importance of method availability is the fact that men are more likely to be gun owners and to select guns in suicide attempts than are women.  Yet another indication of the role played by availability of method, is that states with high levels of gun ownership have considerably higher rates of gun suicide than states with lower ownership levels.

Studies consistently show that firearms are the most lethal means of suicide.  Across four major studies I reviewed for my book Confronting Gun Violence in America, the percentage of suicide attempts with a firearm that proved fatal ranged between 83 and 92 %.  Next in line in terms of lethality were suffocation or hanging, with a lethality level ranging between 61 and 83 %, and drowning, ranging between 66 % and 80 %.   The least fatal methods were poisonings/overdoses and cutting/piercing at around 1–2 %. Thus, a suicide attempt involving firearms appears to be about 40 times as likely to end in a fatality as one involving a cutting instrument.

Research shows that we cannot assume that when a lethal suicide method becomes less available, people will simply switch to another method with the same result. If we believed that method substitution is inevitable, reducing access to lethal methods such as guns in order to prevent suicide would appear to be futile. However, a growing number of studies show that when lethal means are made less available or less deadly, suicide rates by that method decline and, often, suicide rates as a whole decline. In certain regions of Asia and the Pacific Islands, pesticides are among the most common suicide methods.   For example, in Sri Lanka, controlling the availability of highly lethal pesticides, such as paraquat, has brought about dramatic reductions in the overall suicide rate, indicating that large-scale substitution of other lethal methods did not occur.  The fatality rate of attempts using paraquat has been reported to be over 60 %, whereas it may be below 10 % for other pesticides that have replaced paraquat.

Another example of what can be achieved when an accessible and highly lethal means of suicide is eliminated occurred when the domestic gas supply was changed in the UK. Before 1958, domestic gas was toxic, containing over 12 % carbon monoxide. People would commit suicide simply by putting their heads in the oven. In 1958, nontoxic natural gas was introduced region by region, and, by 1974, virtually all the gas supply in the UK was nontoxic.  Prior to the changeover, suicide by gas inhalation was the leading means of suicide in the UK.  Hawton of Oxford notes that as the carbon monoxide content of gas supplies decreased, there was a steady reduction in carbon monoxide suicides in England and Wales. While there was a modest increase in the use of other suicide methods, the overall suicide rate decreased by a third.  Thousands of lives were saved simply by detoxifying the domestic gas supply.

No society has a “built in” level of suicide.  Most people who commit suicide were not “destined” to do so but responded to personal crises and engaged in limited planning.  Suicidal people usually display impulsivity and ambivalence.  For these reasons, the availability of the most lethal methods when people are most at risk can be a critical factor in the outcome of attempts.  There are enormous differences in lethality of methods, with firearms consistently found to be the most lethal.

Gun policies that can prevent suicides include:

  1. Limiting the overall availability of firearms. One way to achieve this is through voluntary gun buybacks.  Research shows that lowering the number of homes with guns will reduce gun suicide by a substantial margin and will also reduce overall suicide as many without access to guns will not substitute some other method to commit suicide.[9]
  2. Imposing waiting periods for obtaining a firearm may prevent an individual from buying a firearm when he or she is most at risk of committing suicide.
  3. Red flag laws that allow families and law enforcement to petition a court to force the surrender of a firearm by someone at risk of self-harm can make a difference. Guns can be returned to these owners when they are no longer viewed as at elevated risk to harm themselves.
  4. Laws requiring safe storage can keep teenagers experiencing a crisis from gaining access to a gun and committing an impulsive suicide.

Thomas Gabor is a Florida-based criminologist and author of Confronting Gun Violence in America.

[1] Deborah Stone et al., Vital signs: Trends in states suicide rates—United States, 1999-2016 and circumstances contributing to suicide—27 states, 2015.  Morbidity and Mortality Weekly Report CDC (June 8, 2018).  Available at: https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a1.htm?s_cid=mm6722a1_w

[2] Linda Dahlberg, World Report on Violence and Health.  Geneva:  World Health Organization, 2002, Chapter 7.

[3] M. Miller, D. Azrael, and D. Hemenway, Belief in the inevitability of suicide: Results from a national survey.  Suicide and Life Threatening Behavior, 2006, 36: 1-11.

[4] CDC:  US suicide rates have climbed dramatically.  NPR (June 7, 2018).  Available at: https://www.npr.org/sections/health-shots/2018/06/07/617897261/cdc-u-s-suicide-rates-have-climbed-dramatically

[5] Hawton K. Restriction of access to methods of suicide as a means of suicide prevention. In: Hawton K, editor. Prevention and treatment of suicidal behavior: from science to practice. Oxford: Oxford University Press; 2005, P. 284.

[6] Seiden R. Where are they now: a follow up study of suicide attempters from the Golden Gate Bridge. Suicide Life Threat Behavior, 1978; 8(4): 203–216.

[7] Peterson L, Peterson M, O’Shanick G, Swann A. Self-inflicted gunshot wounds: lethality of method versus intent. American Journal of  Psychiatry, 1985; 142(2): 228–231.

[8] Jamison K. Night falls fast: Understanding suicide. New York: Knopf, 1999. P. 47.

[9] D. Wiebe, Homicide and suicide risks associated with firearms in the home: A national case control study.  Annals of Emergency Medicine, 2003, 41: 771-82.

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2 thoughts on “Tom Gabor: Does Gun Availability Matter In Suicide?

  1. Nicely done, Tom.

    One question right off. You say “No society has a “built in” level of suicide.” but if you look at suicide rates by nation, they vary by a lot. So I am not sure what you mean by “built in”.

    Presumably nations differ in suicide rate not just because there are differences in the availability of effective suicide methods, so there presumably are social overprints on suicide rates. For example, Japan has about twice the suicide rate as the UK.

    So I suspect all other things being equal, having a gazillion guns around means we in the US have a higher suicide rate than we would if there were very few guns. I suppose Japan might have a higher rate than it does if guns were ubiquitous. But I suspect there are social mores from nation to nation that affect people’s vulnerability to suicide, too.

    But this is your field, not mine. Comment?

    • Thanks Khal. Yes, social and cultural factors are impt. What I mean is that these unique societal factors do not produce a fixed rate of suicide because means and circumstances people face matter. Please examine my reference #9 to see how a gun in the home elevates the risk of suicide.

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