A year later, I remain haunted by the death of a friend, 39 when he shot himself, because I’m pretty sure his life could have been saved.

Local police called his death a “suicide by gunshot” — one of more than 20,000 people a year who take their own lives with a firearm. Yes, it’s true: More people use guns to kill themselves than to kill others, according to 2012 statistics from the Centers for Disease Control and Prevention. Suicides may be the great untold story in the gun debate.

To those of us who knew him, my friend seemed the personification of wellness. A Duke grad and LGBT advocate, he’d become a personal trainer, and his lifestyle — from diet to workouts — defined “healthy.” At the time of his death he’d just won his first bodybuilding competition, and his many clients, including me, listened raptly to his fitness advice. But that image was clearly an illusion. (His family asked that his name not be used in this story.)

After his funeral, a mutual friend told me that our buddy had been suffering from major depression, a condition I know all too much from my own life. I reflected on all the conversations my friend and I had had about politics and religion, dating (his) and marriage (mine), and assorted minor ailments, but not one about depression (his or mine). While it may be magical thinking, I couldn’t help wondering whether, if I’d revealed my own depression, he might have confided in me and gotten help he needed.

But men often don’t like to acknowledge such “weaknesses,” said Andrew Solomon, author of “The Noonday Demon: An Atlas of Depression.” “Despite the enormous progress we’ve made in brain science and treatment, depression is still presumed a weakness. . . . Men feel they should be able to pull themselves together, to access their own bootstraps, and to cover up mood with militarism or athleticism.”

Still more was disclosed by friends at the funeral: About a year before his death, our friend had bought a pistol. Supposedly there was an “angry client,” and he was worried about his personal safety.

Would a watch list help?

Headlines about gun violence focus on terrorist attacks (San Bernardino), school shootings (Columbine, Sandy Hook), tragic accidents in which a child mistakenly kills a sibling, parent or friend — and, of course, shootings by or of police (Alton Sterling and Philando Castile, Dallas and Baton Rouge). Yet the suicide-by-gun toll is, for a variety of reasons, not really news.

When I asked the editor of my local paper whether it would be reporting on my friend’s death, he emailed back: “We don’t typically write about suicides in private places.” Without headlines, there’s a paucity of awareness of how prevalent this form of gun violence is.

More than 50 percent of all suicides are by gun, according to the CDC. In 2013, for example, 41,149 people took their own lives — 21,175 of them with a firearm. That’s about 58 suicides by gunshot a day.

Most people who try to kill themselves by overdosing, hanging or cutting their wrists don’t succeed, and a recent Harvard study found that about 90 percent of those people making initial attempts that way do not commit suicide later. Using a gun, though, flips those numbers: About 90 percent of suicide attempts using a firearm succeed. “You’re not given that second chance with a bullet,” said Dan Gross, president of the Brady Campaign, a nonprofit that advocates for gun control.

Then there’s the unsettling relationship between mental illness and suicide. “Epidemiologic studies show that the large majority of people with serious mental illnesses are never violent. However, mental illness is strongly associated with increased risk of suicide, which accounts for over half of U.S. firearms–related fatalities,” wrote researcher Jeffrey W. Swanson in the Annals of Epidemiology last year.

With that in mind, some have argued that laws must change to ensure that guns are kept out of the hands of those with mental illness. But how do we limit a mentally ill person’s access to firearms? Keep a national database? How many people would forgo much-needed help for depression or other mental illness if it meant going onto a watch list? Solomon, the noted expert on depression, agrees: “As soon as we start passing paternalistic laws like that, what happens is that people flee treatment and/or are secretive with their therapist. That doesn’t help anyone.”

With the anniversary of my friend’s death now just past, I am left wrestling with this question: How might he have been given a second chance? If he hadn’t had a gun at home, he may not have attempted suicide at all; his depression may have led him to try an overdose or another method that most people survive, and then reconsider his path. And if he’d been getting effective treatment, he might have been able to hold his suicidal thoughts at bay and never reached for his gun. It was the combination of untreated depression and a firearm at hand that proved deadly.

His friends and family will painfully ponder these “what ifs?” for a long time to come. But what about the 58 other people who will — today, tomorrow and every day — get their hands on a gun and kill themselves? What about their friends and relatives? Isn’t it time to break the silence about this hidden toll of the gun epidemic in the United States?

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