Can the National Call to Prevent Gun Violence Reduce Suicides?

The national attention currently focused on reducing gun violence provides an opportunity to consider how to use this momentum to make significant headway in preventing suicide. Year after year, about two-thirds of all firearm deaths are suicides (1). Evidence indicates that the availability of firearms is related to suicide rates. In regions that experience changes in levels of gun availability, suicide rates change in the same direction; people who buy firearms are more likely than otherwise similar peers to die by suicide; and people who die by suicide are more likely to live in homes with firearms compared with seemingly similar people who did not die, as well as those who died from other causes (1). There is evidence and a broad consensus among experts who favor both restrictive and permissive gun policies that not all individuals who are prevented from firearm suicide will die by another method of suicide (2).

These findings do not prove that guns cause people to end their own lives. Nevertheless, they suggest that limiting access to firearms by those at heightened risk of suicide may help reduce the nation’s increasing suicide rate. Policies have been enacted and clinical practices recommended that have attempted to do just that. The objectives of these efforts are to prevent persons at risk of using guns for suicide from acquiring them, require or convince persons at risk of using guns for suicide to forfeit (permanently or temporarily) the ones that they own, or require that guns be stored in a manner that prevents their access by those at risk of using them for suicide. We briefly review the evidence for each of these approaches in preventing suicide.

The Evidence

Preventing the acquisition of firearms by persons at risk of using them for suicide.

Several state and federal laws are designed to restrict access to firearms by those who may be at risk of using them for suicide. Such laws, for example, may require background checks or permits to own a firearm, prohibit persons with a history of some types of court-mandated mental health treatment from being gun owners, impose minimum age requirements for possessing or owning a gun, and mandate waiting periods before purchasing a gun. The 1994 Brady Act imposes federal background check requirements for guns purchased from licensed dealers, and some states have expanded this requirement to all firearm sales and transfers. The databases used by states to conduct background checks vary, and the empirical evidence linking these laws with reductions in suicide is limited. One of the more convincing studies found that states that enacted background checks that examined buyers’ histories of certain mental health–related incidents experienced an approximate 3% reduction in total suicides (3). On the basis of these results and evidence from one additional study, we concluded in a recent synthesis of available research that there is some, but limited, evidence that background checks reduce suicide rates (1). On the other hand, the evidence that permitting requirements, waiting periods, or similar policies led to reduced suicide rates either did not meet our criteria or was inconclusive.

Voluntary or involuntary forfeiture of guns by those at risk of using guns for suicide.

Policies are also used to force people at risk of using firearms for suicide to surrender their guns. Federal law establishes categories of people who are prohibited from possessing a firearm, and some states have laws requiring the forfeiture of firearms by gun owners who lose their right to possess a firearm, if, for instance, they are convicted of a felony. Several states have recently passed laws allowing police or family members to seek a court order to temporarily seize firearms from individuals deemed to be at imminent risk to themselves or others. Research is emerging that suggests that these laws may be associated with some reductions in suicides (4,5). However, skeptics believe these laws could allow abridgement of Second Amendment rights for misinformed or invalid reasons (6).

As many mental health professionals are aware, it is also possible to persuade gun owners to voluntarily remove guns from their homes when they or someone they live with is at risk of using them for suicide. Such conversations between providers and their patients have been recommended as a suicide prevention strategy, although the effects of these interventions are not well established. Although some states have proposed laws that restrict physicians from inquiring about gun ownership, these rules do not apply if the safety of the patient or others may be at stake (7). In some states, the temporary transfer of firearms from a suicidal individual to a private citizen may require a background check for the recipient, although gun retailers, local police departments, gun clubs, or pawn shops could also provide temporary storage options.

Secure storage of guns.

Child access prevention laws allow for the prosecution of adults who intentionally or through carelessness allow children to have unsupervised access to firearms. Such laws require gun owners to store their weapons with gun locks or in gun safes. Such laws reduce child self-injuries, including, but not limited to, suicide (1).

In addition to policies requiring safe storage, efforts to promote the safe storage of firearms include media campaigns designed to promote safe storage practices. Only one such media campaign has been rigorously evaluated, finding no statistically significant effects (8).

Just as they can encourage the temporary transfer of guns outside of the home, health care providers can also encourage the safe storage of firearms among their patients or patients’ families. Although rigorous evaluations have yet to be conducted among mental health professionals, interventions in which pediatricians and family physicians inquire about guns, counsel on safe storage, and provide free storage devices to patients improved their gun-owning patients’ storage practices (9). However, how these storage practices may translate into reductions in suicide has yet to be established.

Conclusions

Gun policy is a divisive issue in this country. A source of much of this divisiveness stems from disagreements about factual matters, such as the effects of various interventions (2). The research base on firearm policies and clinical guidelines on reducing suicide is thin, due in part to appropriations language that has been interpreted as limiting research funding by the Centers for Disease Control and Prevention and National Institutes of Health. Even when evidence is relatively strong, the possible consequences of such laws increase resistance to them and have not been studied. For example, what is the possible effect of child access prevention laws on the ability of gun owners to defend themselves in an emergency? The real tradeoff between the lives of children saved from death or injury and foregone self-defense opportunities is not currently known. These, and other recommended research priorities, are presented elsewhere (1).

As was true when the National Research Council called for improving the evidence base on firearms and suicide in 2004, insight into questions such as these will require significant increases in funding, given that the topic has suffered from years of underinvestment (1). However, this research will enable us to fill current knowledge gaps and move toward closing the chasm in factual matters that currently colors how policymakers and practitioners approach this important issue. By doing so, it will be possible to fashion gun policies and clinical practices that ultimately reduce the U.S. suicide rate.