Suicide

Guns, Suicide, and the American Psyche

12.2 years of research on 26.3 million defines the gun-suicide connection.

Posted Jun 11, 2020

America has a complex, conflicted, and unresolved relationship with guns. If we measured the nation’s psychological attachment style with firearms, it would surely be a disorganized attachment, characterized by preoccupation and dismissal, anxiety and withdrawal, needy dependency, and frank hatred. The dominant narratives about guns in the U.S. are competing narratives.

In spite of chronic mass casualty events, the U.S. cannot walk a path to gun violence mitigation. We have a deadly love affair with guns which overshadows any healthy relationship.

We the People

Only subgroups, sub-identities, have a coherent stance toward guns, generally either strongly pro or con. There is no dialogue, no "alliance of moderates." At best, we are talking past each other, a situation which can easily devolve into mindless aggression—though heartening cultivation of constructive conversation is happening, notably Harvard School of Public Health's "Gun Shop Project" to prevent suicide.

Guns arguably represent the basic right to protect oneself from abusive authority. The Second Amendment legislates the hard-won knowledge that citizens are needed to check centralized government. We are a democracy, not an autocracy.

Because of our dis-integrated relationship with guns, and general fragmented character as a nation, gun issues are more a matter of belief than science.

Toy Guns?

Owning a gun is a great responsibility. In the right hands, for many reasons guns are understandably items to own and use for recreation, sport, and personal protection. In the wrong hands, guns are the most dangerous tool we have ever devised, one best left on the drawing board. 

Guns are so much a part of the culture and a part of our play. There's myriad different types of toy guns more and less realistic. Nerf guns that shoot foam bullets, guns that shoot water, guns that shoot marshmallows, and guns that shoot foam balls and anything you can imagine.

The allure of projectile weapons is undeniable. Childhood games use pretend gun play and teach social divisions. Movies, video games, and other media amplify these messages. These experiences are for many thrilling, exhilarating, and intensely pleasurable. "Happiness," as the sardonic Beatles song goes, "is a warm gun."

The gritty independence, use of violence, and struggle between right and wrong as depicted in classic Western films is, for example, a clear signal of American identity. There's no ambiguity who the bad guys are, when the capacity for ambiguity is what we most need to deal with key problems confronting our culture, including racism, gender bias, and many other deeply rooted problems.

The divisiveness and inability to hold ambiguity makes a discussion of suicide prevention, from the point of view of access to firearms, incendiary. Every psychiatrist knows that assessing suicide risk requires a deep understanding of access to the means of taking one’s life.

Studies definitively show that preventing access to suicide methods saves lives. Suicide prevention nets around bridges work as detailed in the white paper Suicide Prevention on Bridges: The National Suicide Prevention Lifeline Position (2017) by John Draper, Ph.D., Director.

Large-Scale Research on Guns and Suicide

In Handgun Ownership and Suicide in California, published in the New England Journal of Medicine (2020), a team of researchers analyzed data from a cohort of 26.3 million adults for over 12 years, starting in October of 2004.

Using a statistical approach called “survival analysis,” they looked at various outcomes over the course of time to determine relationships with gun ownership and mortality, looking at all causes of death including suicide by firearm and other means. They correlated mortality data with various factors such as age, neighborhood, gender and other demographics.

Of the 26.3 million, 676,425 acquired at least one handgun, and 1,457,981 total died during the study period of any cause. Suicide risk by any method was higher for gun owners—3.34-fold for men and 7.16 for women—compared with people who did not own a gun.

Rates of firearm suicide were 7.82-fold higher for male owners and 35.15-fold higher for female gun owners. Men accounted for 70 percent of the suicides overall and 83 percent of suicides by firearm. Neither men nor women had increased risk for suicide by other methods or increased all-cause mortality. This does not mean that gun ownership protected against other causes of death, but rather they died from suicide beforehand.

Critically, there was a strong uptick in firearm suicide shortly after gun acquisition, in spite of waiting periods. Gun suicide between the first day of eligibility to get a gun and 30 days later accounted for 14 percent of all such suicides. Nearly 50 percent of suicides took place within a year of getting a gun, and the rest (52 percent) happened in the years following, as shown in this survival plot:

Stoddert et al., 2020
Suicide following Gun Acquisition
Source: Stoddert et al., 2020

Handgun owners on average were a couple of years younger than non-owners (41 vs. 43 years old) and over three-quarters were male. They were 1.8 times more likely to live outside of a major city. Analysis of other risk factors to determine if the association between gun acquisition and suicide might be due to non-gun-related factors showed a high likelihood that gun acquisition was the key precipitant for those already at risk.

Priorities

While a small percentage of the total group acquired guns and died by suicide, for those at risk, acquiring a gun is an ominous sign and a dangerous permissive factor, associated with striking increases in risk for both men and women, in spite of waiting periods. Suicide risk remains elevated for years after gun acquisition, negating the possibility of a safe period. 

Firearms are a common cause of suicide and of noteworthy concern because they are highly lethal, relatively easy to acquire, require little planning or preparation, and with only a moment of thought irrevocably change countless lives in one of the most tragic ways imaginable.

Most gun owners are not at risk for suicide, but for those with risk factors including depression, prior suicide attempts, history of maltreatment, substance and alcohol use, and others, limiting access to guns is likely to save many lives, particularly as the waiting period does not effectively prevent suicide as do suicide nets around bridges.

Waiting periods are more akin to suicide hotlines on bridges—they prevent some suicides, but are not a definitive solution. Keeping people at risk for suicide from accessing firearms is almost certain to save countless lives, the equivalent of a safety net for firearms, as a large number of people who are prevented from carrying out suicide plans do not end up pursuing other means. Working out how to protect the right to life and the right to bear arms is a challenge we have yet to effectively engage. 

Resources

CDC: Suicide Risk and Prevention Factors

Harvard TH Chan School of Public Health Gun Shop Projection

The National Suicide Prevention Lifeline

References

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