Fall 2001; Volume 2, Number 2|
Feature: Violence and Healthcare
Firearm Prevalence and the Risk of Suicide: A ReviewContinued
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For youth, however, there does appear to be an international association between gun ownership levels and suicide. Among children aged 5-14, the U.S. suicide rate was, on average, twice as high as the suicide rate among other high-income countries. This two-fold increased risk of suicide among U.S. children was accounted for by a U.S. firearm suicide rate that was ten times higher than the firearm suicide rates in other high-income nations. There was no difference in the rate of non-firearm suicide (Table 2).9 In another study of 15-24 years olds among the 17 high-income countries for which data were available, the correlation between household gun ownership levels and suicide rates was .46 (p=.06).10
Table 2: Suicide rates among 5-14 year olds, early 1990s, U.S. versus 25 other richest nations. Source: Morbidity and Mortality Weekly Report, 1997 (February 7) 46:101-105.
In another study that benefited from careful collection of demographic data but involves only two countries, Sloan et al compared the suicide rates for the years 1985-1987 in Seattle, Washington to those in Vancouver, British Columbia.11 These large port cities in the Pacific Northwest have similar rates of unemployment, marriage, median income, and percentage of population earning below $10,000. Both communities have a substantial white majority (though Vancouver has a larger Asian population and Seattle a larger Black population). These two communities differ in that Vancouver has far more restrictive handgun laws, fewer handguns and fewer handgun owners. In the population as a whole, the higher rate of handgun suicide in Seattle (5.7 times higher) was completely offset by a 1.5 fold higher rate of suicide by other means in Vancouver. However, among young adults (15 -24 years of age), the overall suicide rate in Seattle was 38% higher than in Vancouver, with virtually all of this increased risk attributable to a nearly ten-fold greater risk of suicide by handguns.
(a) Individual LevelSeven case-control studies in the U.S. have found that a gun in the home is a substantial risk factor for suicide.12 Five studies by one research team focused on adolescent suicides in western Pennsylvania, comparing adolescents who killed themselves to other groups of adolescents from the same area. Controls included adolescents who were psychiatrically ill and had attempted suicide; who were psychiatrically ill and had not attempted suicide; who had a lifetime history of affective disorders; and who had no psychiatric history.
One of the studies compared 47 adolescent suicide completers from a community sample with two psychiatric inpatient control groups, 47 who had attempted suicide and 47 who had not. Guns were in the homes of 72% of the completers compared to 37% and 38% of the controls (Table 3).13
Another case-control study indicated that the danger of having a gun in the home applied to all adolescents in the community and not just to those with known psychiatric or drug abuse problems.14
Two large case-control studies included adults as well as adolescents. One study had 438 suicide cases that occurred in the homes of victims in two urban areasthe counties that include Memphis, TN and Seattle, WA. Controls were randomly drawn from the same neighborhoods. Sixty-five percent (65%) of victims had a firearm in the home, compared to 41% of controls (Table 4).15 In homes with firearms, 86% of suicides used a firearm; in homes without firearms, 6% of suicides used a firearm. After controlling for several variables including alcohol, illicit drug use and depression, the presence of a gun in the home was still associated with a large increased risk of suicide. Restricting the analysis to those suicides without a history of mental illness or depression revealed that a gun in the home was even more strongly associated with suicide.
A second large case-control study analyzed whether the purchase of a handgun from a licensed dealer was associated with an increased risk of suicide, whether or not the suicide took place in the home. Data on gun ownership came not from asking
people about the presence of a gun in their homes but rather from the states computerized database of all handguns purchased from a licensed dealer. Cases were 353 suicide victims who were members of a large HMO in Washington State; controls were members of the same HMO matched on age, gender and zip code. Over the 12-year study period, suicide was twice as likely among persons in families that had purchased a handgun, compared to rates in families that did not purchase a handgun.16
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