Personal protection is often cited as a motive for firearm ownership, but self-defense homicides accounted for far fewer firearm-related deaths than accidental deaths and suicides in Seattle’s King County, reports MedPage Today.

For each case of self-defense homicide in the home from 2011 to 2018, there were 44.1 suicides, 7.3 criminal homicides and 0.9 unintentional deaths, reported Dr. Elissa Butler of the University of Washington and colleagues in a research letter in JAMA Internal Medicine.

“This can encourage physicians to counsel their patients’ thinking about owning a firearm or already owning one that their firearms may not be keeping them safe,” Butler said. “They should be concerned it may actually increase their risk of suicide and homicide, and not actually protect them.”

The study did not include nonfatal firearm injuries or cases in which firearms were used as deterrents without being fired. In King County, about 340,000 adults reported a firearm in their home in 2015, with 150,000 reporting that the guns are stored unlocked.

The findings mirror a 1986 study from the same county that found the vast majority of firearm deaths involved suicides and homicides, whereas just 1.8 percent of firearm-related deaths were in self-defense.

This is “a sad commentary on the lack of progress,” commented Dr. Jerome Kassirer of Tufts University School of Medicine in an editorial.

Evidence shows that more comprehensive firearm legislation at the state level yields lower firearm-related injuries, he wrote, citing Massachusetts as a case in point. There, individuals must obtain a license to carry, pay a $100 fee, pass a background check and take a gun safety course.

Washington is an “open carry” state, but obtaining a firearm requires a license, background check, and proof that the purchaser has completed firearm safety training.