Guns and Suicide: Introduction In recent years, over 30,000 Americans die annually from fatal gunshot injuries. The majority of those killed are not victims of criminal attacks or the result of accidental shootings, but are instead the gun owners themselves and their family members who intentionally take their own lives using a gun. In 2010, the last year for which complete data are available, over 19,000 Americans used a gun to kill themselves. Yet with an average of 50 people using a gun to kill themselves every day, the issue of gun suicide receives hardly any attention in the press, from pundits, in congress, from think tanks, or from the gun industry. There exists a deep and abiding stigma surrounding suicide in our country, resulting in a profound silence on the subject. Many Americans cherish their self-sufficiency and hold guns as an archetypal symbol of our collective bravery and self-reliance. It is difficult to confront the fact that guns may be useful tools but are also now used more often in an act of suicidal desperation or rage than in an act of freedom or self-defense. To some it is akin to pooping in the punch-bowl: no one wants to do that. Most of the time we instinctively want to respect the deceased. Many of us were taught that respect after death includes not speaking ill of the dead. And so we as a nation respond with silence as 19,000+ Americans are lost every year to a preventable death of gun suicide. Currently, there are a large number peer-reviewed published research studies that demonstrate a 2 – 10 fold increase in the risk of suicide in households where a gun is stored - the elevated risk varies by the people studied, and by the way the gun is stored. There are NO studies that show any reduction in the risk of suicide in homes where a gun is stored. The evidence is very telling: the increased risk of suicide from having a gun in the home is not explained by increases in suicide attempts among gun-owning households; it is not explained by increases in suicidal ideation (thoughts about suicide) among the members of gun-owning households; nor is it explained by increases in mental illness in gun-owning households. Moreover, the higher risk of suicide in homes with firearms includes not only the gun-owners themselves, but also their wives, partners, children, and relatives residing in the household. The increased risk of suicide remains even when the guns are stored locked and unloaded – the risk of suicide is reduced, but not eliminated. There are a number of reasons why a gun is frequently used in a completed suicide (a suicide act that results in death). Guns are designed to maim and kill, and so are highly lethal. Guns are very easy to use: simply point and shoot - sadly, even children can (and do) accomplish this. The lethal effect of guns is instantaneous – no waiting required. And guns are plentiful in this country and easily available for anyone contemplating suicide. Medical science recognizes two ways to reduce the incidence of suicide: a) reduce the number of suicide attempts by identifying and treating those people contemplating suicide; and b) reduce the possibility that a suicide attempt is lethal, by removing lethal means from people thinking about suicide. Most doctors and public health officials focus too much on the first approach, and overlook the second. Yet research studies have shown that restricting the access to lethal means is a highly effective strategy for preventing suicide acts and reducing deaths from suicidal behaviors. There are a variety of way in which our gun laws and national policies regarding guns can influence the incidence of gun suicides. Washington DC has arguably the most strict gun laws in the nation. It also has the lowest rate of firearm suicide in the country. In 2008, the Supreme Court issued it's ruling in the case of District of Columbia vs. Heller, striking down the Washington DC ban on handgun ownership in the nation's capital. According to the Washington Post, over 1400 handguns were registered with the Washington DC police between 2008 and 2011, after the Heller decision. Given what we know of the linkage of gun ownership and the risk for gun suicide, this increase in gun ownership in all likelihood also represents an increase in the incidence of suicide by gun in the city. In 2011, Florida signed into law the Firearm Owner's Privacy Act. The law prohibits “inquiries regarding firearm ownership or possession…by licensed health care practitioners”. While the Firearm Owner's Privacy Act was later ruled to be unconstitutional by a federal court, a similar law is currently being considered by the Kansas state legislature. And as of Oct 1, 2013, a new law has gone into effect in the state of Montana (HB 459) that prohibits doctors from "inquir(ing) about a person’s ownership, possession, or use of firearms as a condition of receiving health care." Preventing doctors from discussing gun ownership and use with their potentially suicidal patients takes away an effective tool in preventing gun suicides. In order to better understand these issues, the Firearm Law and Policy Group is launching a series on the topic of guns and gun suicide. We owe it to ourselves and to our neighbors to address the stigma and silence surrounding gun suicides, and we hope this series will help do that. We will take a closer look at the nature of suicidal behavior, research studies that address guns and suicide, disparities in the incidence of suicide and homicide, factors that influence the incidence of gun suicide, and how laws effect gun violence in general and gun suicide in particular. We welcome your comments, thoughts, experiences, and questions on this difficult issue. Further reading: Miller M, Hemenway D. Guns and Suicide in America. New England Journal of Medicine. 2008; 359:989-991

