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Contact Us Fall 2001; Volume 2, Number 2
Feature: Violence and Healthcare

Firearm Prevalence and the Risk of Suicide: A Review

Matthew Miller, MD, MPH, Sc.D.David Hemenway, Ph.D.

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In the United States, more people kill themselves with guns than by all other methods combined (Table 1). In 1998, the last year for which complete data are available, there were approximately 30,000 suicide deaths among Americans, of which 57% were caused by guns.1 The number of suicides (30,558) exceeded the number of homicides (17,894), and the number of gun suicides (17,420) exceeded the number of gun homicides (12,078). One really cannot discuss suicide in the United States without examining the role of firearms. The age-adjusted suicide rate in the U.S. (11 per 100,000) slightly exceeds the death rate from leukemia (10 per 100,000) and pancreatic cancer (9 per 100,000), but is far less than the mortality rate from heart disease (270 per 100,000) or from cancer over all (204 per 100,000). Although the risk of suicide increases with age, relative to most life threatening diseases, suicide disproportionately affects younger people. For 10-24 year olds, suicides account for 13% of all deaths, third only to motor vehicle crashes (43%) and homicides (17%) - exceeding the number of deaths due to all cancers (6%) and heart disease (4%) combined.2 Suicide also disproportionately affects men, despite suicide attempts being 4 times as common among women. This is largely explained by the fact that when men attempt suicide, they are far more likely to use a gun. Guns account for more completed suicides than any other means, not only among men but among women and children as well.3 This should not be surprising since, compared to other methods commonly used in suicides, firearms are among the most lethal. For example, a study in Canada found that 92% of gun attempts resulted in death compared to 78% of attempts using carbon monoxide or hanging, 67% of drowning attempts, and 23% of intentional drug overdoses.4

  Number of Suicides % Firearm
Males 24,538 52%
Females 6,037 38%
Total 30,575 57%
Males Under 18 Yrs 1,293 52%
Females Under 18 Yrs 304 49%

Table 1: Gun Deaths in the United States, 1998
Source: Centers for Disease Control, WISQUARS Website, 2001

This article reviews the empirical literature on the relationship between gun ownership levels and suicide rates. Throughout the literature an implicit question motivates research: are suicides largely determined by the strength of intent alone or does ready availability of lethal means increase the likelihood that susceptible individuals will take their own lives?

Expert opinion and related evidence support the idea that both intent and instrumentality matter, and that individuals who commit suicide often do so when confronting a severe but temporary crisis.5 For example, in one study of 18 men who survived a self-inflicted intentional gunshot wound to the face, subsequent suicide attempts were uncommon.6 In another study of self-inflicted gunshot wounds that would have proven fatal without emergency treatment, none of the 30 attempters had written a suicide note, and more than half reported suicidal thoughts for less than 24 hours. After two years, none of the 30 people attempted suicide again.

International Studies Developed Nations

A problem with international studies is the difficulty in fully accounting for the disparate cultural factors that may influence the incidence and method of suicide. Additional problems with these studies are that data on suicides may not be completely comparable across nations, and data on gun availability are not routinely collected. On the other hand, a virtue of international comparisons is that gun availability and suicide levels are often so variable that it is possible to spot significant differences even when the sample size is small.

The few international studies that address the gun-suicide question suggest that firearm availability affects the method of suicide and may have an influence on the total level of suicides, especially among youth. The evidence, however, is far from convincing that gun ownership levels are related to overall suicide rates for all age groups. The U.S., for example, has the highest levels of gun ownership, but its overall suicide rate is only 16th out of 26 high-income countries. One study found a statistically significant relationship between gun ownership levels and suicide rate across 14 developed nations (e.g. where survey data on gun ownership levels were available), but the association lost its statistical significance when additional countries were included.7,8

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