Gun Availability and Suicide – It Matters

A Strong Connection Exists between Gun Availability and Suicide

There is a strong connection between gun availability and suicide because guns are so much more lethal than other means and too easy to get in a crisis.

By Rebecca Martin

If one raises the issue of gun availability and suicide, a counter cry is immediately raised by gun advocates. However, gun availability and gun control are two distinctly separate topics. Gun availability embodies the issues of screening and background checks for gun accessibility. In contrast, gun control covers a much wider issue of constitutional rights and their interpretation in the courts and legislative bodies.  I preface this article with a clear statement of the topic, the issue of gun availability and suicide, as our focus is on those predisposition towards self-harm as a result of brain damage.

The high degree of connection between gun availability and suicide exists because a person acts before the fog of depression and desperation can clear.  Take handguns out of that equation and either the person becomes less desperate or chooses a method which is far less lethal. 

Even with that clarification, I want to address the objections which might arise with an article on this topic, which is specifically directed at potential or successful suicide rates in the US. I also want to further stress that my intention in undertaking  this article was to gain knowledge and understanding of a topic which we could all know more about.

23,000 Fire Arm Suicides

According to Everytown Research & Policy, a program of Everytown Gun Safety Support Fund[1], firearm suicide claims the lives of 23,000 Americans every year. An average of 4200 veterans die by firearm suicide annually, about 11 deaths a day.  In fact, nationwide, 53,230 military veterans died by gun suicide between 2005 and 2017. The rate of suicide by firearms has been rising steadily for the past decade.

One of the commonalities between those who have suffered a brain injury and those who have a military history is a decreased ability to cope with life after the event. Whether it be a brain injured person’s increased difficulty in navigating once familiar systems or a returning military personnel learning to cope after a tour of duty, the dynamics become very similar–inner disruptions occurring which are often invisible to other people. And when both of these events are experienced by one person, the impact can be elevated to levels which immediately become troublesome.

Why are we focusing on firearms when discussing suicide? Because, though many people attempt suicide by other means, firearms are the most lethal method of suicide. Suicide attempts by firearms have a 90% lethality rate.

Factors Connecting Gun Availability and Suicide

We determine lethality by examining several factors. One is Inherent Deadliness. There are multiple factors in the means which predict death after a suicide attempt. Though something might be determined to be lethal, the attempt may be carried out in a way that is not successful. The intent may be present but the means may be faulty.

Another factor is Ease of Use. In this category, the person making a suicide attempt is most likely to choose the easiest means possible rather than research the technical specifications needed by another method. And choosing something which requires some preparation is likely to give the person time to reconsider their actions.

Another factor is Accessibility. The most likely choice may be the method with the quickest access.

The fourth is Ability to Abort. The person may have a change of heart and there is a chance of medical intervention or rescue in many methods which is not  the case with firearms. The last factor we will consider is Acceptability. There are many ways to die but some methods are too gruesome to be considered by most contemplating ending their lives. These factors are identified by Harvard T.H. Chan, School of Public Health. See https://www.hsph.harvard.edu/means-matter/

Firearms embody all of the factors which can lead to a successful suicide. Readily accessible in many homes, easy to use, inherently deadly with very little successful intervention once used, and sadly, widely accepted as a means of suicide. When all of these factors are combined with a person undergoing a moment of extreme suicidal ideation, the act may be committed before the action is completely thought through.

Research Supports Connection between Gun Availability and Suicide

An article by E. Michael Lewiecki MD and Sara A. Miller, PhD, enunciates this point:

“Psychiatric disorders are present in at least 90% of suicide victims, but untreated in more than 80% of these at the time of death. Treatment of depression and other mood disorders is therefore a central component of suicide prevention.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518361/

Other factors can include physical illness, alcohol and drug use, access to lethal means and impulsivity. It is important to note that access and impulsivity may be present when we refer to the lethality of firearms. And when we are referring to firearms it is in general handguns which account for the majority of suicide by firearms.

I think it is important to address the issue of impulsivity. Impulsive attempts at suicide often involve a trigger occurring when an individual is undergoing extreme changes in their psychological state. The trigger might seem insignificant from the outside but due to the psychological distress being experienced, it can lead to the impulsive, spur of the moment decision to end one’s life. Survivors of such attempts have been found to have entertained the thought of suicide roughly 5-10 minutes before making the attempt. In these cases, ease of access and ease of use are a deadly combination in many cases. Those who attempted suicide by firearms but were unsuccessful were reported to have contemplated their suicides for less than 24 hours prior to the event. This has been referred to in literature as an “accident of the mind”, a momentary lapse in judgement leading to an impulsive act which has not been thought through prior to the attempt.

It is generally acknowledged that a restriction of access is one way to combat these types of suicides. For instance, I reside in a state with a very stringent law regarding barbiturates and pain killers in order to combat the prescription drug addiction problem. This is legislation designed to protect the public from itself and though I have heard complaints about the limited access to pain killing drugs by legitimate patients, there has been no public outcry demanding freedom of access to these pharmaceuticals for all. We really need to delve deeper to discover why restriction of access to firearms is so vehemently opposed by so many and what has led to this almost immovable stance on the part of gun rights advocates.

Other Countries Reduce Suicide by Restricting Means

All over the world, countries have placed restrictions on certain devices or locations in an attempt to stop suicide attempts. We see fences erected at once common jump sites. The UK limits access to analgesics and coal gas.  All over the world legislative bodies have identified common means of suicide and enacted laws restricting access to those means for public safety.

Yet in the US, we have the highest number of firearms and the highest rate of suicide by firearms. In states which require waiting periods, safe storage requirements, and a minimum age of 21, we see lower numbers of deaths by firearms. In these states, there is a restriction of access which is working.

Can’t Presume Other Means

The argument always goes back to the point that if someone wants to commit suicide they will find a means to accomplish it. Then we return to the factors of accessibility, ease of use, and acceptability. And studies which conclude that those who act on impulse are working within a very narrow timeframe with thoughts of self-harm. Perhaps the argument of seeking different means might apply somewhat to those acting non-impulsively who may plot out their suicide attempt over a long period of time, but it seems the highest risk group involves those who act on impulse whether over several hours or minutes.

Stanford University has conducted one of the largest studies to date, following 25 million California residents over a 12-year period. The study was published in The New England Journal of Medicine. They agreed that suicide attempts are often impulsive acts.

“Suicide attempts are often impulsive acts, driven by transient life crises,” the authors write. “Most attempts are not fatal, and most people who attempt suicide do not go on to die in a future suicide. Whether a suicide attempt is fatal depends heavily on the lethality of the method used — and firearms are extremely lethal.” See https://www.nejm.org/doi/full/10.1056/NEJMsa1916744

Stanford found that people who owned handguns had suicide rates four times that of people who did not own handguns. In addition Stanford discovered a very high risk for female handgun owners. Women historically have been known to use less lethal methods when attempting suicide but this was not true when considering women handgun owners. Women have also been known to have a higher rate of suicide attempts so the introduction of an easily accessible firearm was a concern that had not been foreseen.

“Handgun ownership may pose an especially high risk of suicide for women because of the pairing of their higher propensity to attempt suicide with access to and familiarity with an extremely lethal method.”

One of the points of the study was to determine whether those purchasing a handgun already had thoughts of self-harm or whether the introduction of a handgun to their home created new risks. But it appeared that both were factors with some new gun owners at high risk for suicide immediately after their purchase and half of all the suicides by firearms occurring a year or more later. What was determined that gun access contributed to more successful suicide attempts. https://med.stanford.edu/news/all-news/2020/06/handgun-ownership-associated-with-much-higher-suicide-risk.html

It becomes clear that impulsivity coupled with ease of access can easily make gun availability and suicide a deadly combination. And it follows that this is a group of people which would benefit from restriction of access the most when discussing gun accessibility. They are the group more likely to act in a shorter period of time, least likely to seek out counseling or help and least likely to send out warning signals to family members and friends.  This then leads to the question of existing protocols and legislation and where it goes from here.

Veteran Suicide

The former secretary of Veterans Affairs, Robert Wilkie, held veteran suicide as a top priority. But he focused on the mental health component of suicide while refusing to address the gun issue. His presidentially commissioned group which he headed released a 65-page report regarding the subject of veteran suicide which did not mention the word “firearm” once.  The VA removed data sets on veteran suicide which were publicly available on its suicide prevention website at roughly the same time. In the 30 months, Wilkie oversaw the VA, approximately 10,000 veterans died by gun suicide. According to the Military Times it is hoped that Denis McDonough, President Biden’s newly appointed secretary of Veterans Affairs will again address the issue of suicide by firearms and discuss the role guns play.

However, McDonough is backing the Hannan Act which seeks to bolster the VA’s mental health workforce, increase rural veteran’s access to care, expand veterans’ access to alternative and local treatment options, increase coordination with the Department of Defense and conduct veteran suicide prevention research and oversight. But according to Moms Demand Action, For Gun Sets in America: https://momsdemandaction.org/everytown-applauds-confirmation-of-va-secretary-denis-mcdonough/

“Secretary McDonough has long been a gun sense champion. During his time as White House chief of staff, the Obama administration twice (2013, 2016) signed executive actions to address our nation’s gun violence crisis, and pushed vehemently for the passage of the Machin-Toomey background checks proposal –– legislation to strengthen America’s background check system. Secretary McDonough was also chief of staff for the administration’s 2014 suite of executive actions to fulfill “our promises to service members, veterans and their families,” which included a good first step of encouraging firearm safety as part of the plan to address suicide among veterans.”

We will see which stance McDonough takes in regard to veteran suicide in the coming months.

According to the American Public Health Association suicidality is transitory. If a person makes it through the initial impulse to commit suicide, the prognosis is often good. As a result removal of lethal means from someone with a past history of suicide attempts, a history of depression or other mental illness, alcohol or drug abuse, a family history of suicide or violence or a feeling of isolation, is the single best preventive measure that can be taken.

This can be accomplished several ways, according to the APHA.

(1) relocation of household firearms away from the home when a family member is at risk for suicide, (2) safe storage at home if relocation is not possible, (3) working with leaders in the gun community to develop and implement messaging about the preceding two strategies that will be favorable to most gun owners, and (4) increasing screening for access to firearms by health professionals and other gatekeepers.

The APHA also repeats that impulsivity is a very common factor in firearm suicide. That suicide is pre-meditated in most cases is simply not backed up by research. Most people who attempt suicide and fail do not go on to attempt another suicide according to studies. And this is tied to the fact that most people who fail did not use the most lethal means available on their first attempt. In fact most people who succeed at suicide made their first attempt by lethal means and that means that suicide by firearms is the most frequent method to result a fatal outcome.

There are also other methods which can work to diminish the danger from firearms in these cases. Proposals have been made to adopt gun violence restraining orders which could be exercised by partners or law enforcement personnel to limit access for someone threatening harm himself/herself or others. Smart gun technology could be used to allow only the gun owner to have access to a gun in their possession and thus limiting access.

However it is agreed that access to mental health help, education about gun storage and access to temporary offsite gun storage, and further research into the issue of gun accessibility are all steps towards creating a safer environment for those at risk.

State laws regarding offsite gun storage vary. You can contact your local police or search gun storage nearby. It is different in each state. Sticking it in your garage or a storage unit is not an option. It is illegal to store firearms in a storage unit.  If you are storing a gun with a friend, there are forms which must be completed for the registry of ownership. I did a simple google search and came up with many approved options in my state. If you feel someone in your home might be at risk, this may be the safest option until mental health issues can be addressed

Keep in mind it is never ok to store a loaded gun anywhere. Not even in your house. Guns should be loaded when in use only. Some states have laws prohibiting keeping a loaded gun in your home, or safe. My state requires a gun be stored separate from ammunition. Check your state for gun regulations.

We have often heard people say, after the fact, that they had no idea someone was about to end their life. And I hope I have clearly addressed why that is. The vast majority of successful suicide attempts were initiated after only a short period of time and were only successful due to accessibility and ease of use. There are some high risk factors but not everyone who suffers from depression or suffers from addiction is going to make an attempt on their life. What our concern is here is how to diminish the risk for those that are high risk. Especially in regard to those who have suffered some life altering experience such as a brain injury or a tour of duty in a war zone. And that is something a family can educate itself about and become aware of how the cycle of depression can spiral out of control if it goes unchecked.

It is time to stop ignoring the issue of Gun Availability and Suicide. Gun deaths in the United States are more likely suicide than murder.

National Suicide Prevention Lifeline

Hours: Available 24 hours. Languages: English, Spanish. Learn more

800-273-8255

[1] a non-partisan organization dedicated to understanding and reducing gun violence.