How Can Doctors Prevent Gun-Related Suicide?

In America, more than half of all suicides involve guns. Suicide is the second leading cause of death for those under age 40 years. About two-thirds of annual firearm-induced fatalities in the United States are by suicide. Every day, nearly 60 Americans kill themselves by gunshots. The rate of firearm suicide is nearly twice that of homicidal shootings. With more than one firearm for every person in the US, we experience the highest rate of gun suicide among developed countries. Firearms are the most lethal means of attempting suicide—death occurs in approximately 83% of all persons with a suicidal gunshot. Suicide attempts involving overdoses or lacerations are much more common but far less fatal.

Impulsivity is closely related to suicide. Among people who made an attempt with a gun, approximately 24% took only minutes between the decision to kill themselves and pulling the trigger; 70% did so in under an hour. Suicidal crises are often precipitated by an immediate stressor, such as the breakup of a romantic relationship, loss of a job, or a legal problem. As the acute phase of the crisis passes, the urge to kill oneself frequently dissipates. Approximately 90% of those who survive an attempt do not later die by suicide; even those who expected their actions to be lethal usually do not kill themselves later. The risk of suicide due to shootings in homes with a firearm is typically 2 to 10 times higher than in those without such a weapon; the risk of suicide in these homes applies not only to the owners but also to their significant others and children. There also is an increased risk of a firearm-suicide soon after a first-time handgun purchase, and it remains elevated for a long time thereafter.

The presence of such weapons in homes, no matter how they are stored, is a risk factor for premature death. States with more household gun ownership have higher rates of suicide. Youths living in homes in which all firearms are not stored securely are at a higher risk for suicide than those living in homes in which firearms are kept unloaded and locked. There is a powerful relationship between alcohol or other drug intoxications and shooting oneself and/or others. The strongest risk factor for attempting suicide is having a substance abuse or mental disorder. Despite knowing these associations with addictive or psychiatric illnesses, it is difficult to determine which individuals may actually kill themselves.

Since most suicidal impulses are intense but of short duration, prompt intervention is imperative. Many of the individuals contemplating suicide are indecisive about killing themselves, and thus the risk duration is often transient. Simply reducing gun availability might prevent a shooting tragedy. Although laws restrict firearm access for people with mental illness, these individuals rarely commit homicides. About 3% of violent acts are attributable to persons with serious psychopathology, and most of those behaviors do not involve guns. Actually, among psychiatric patients, only a small percentage have a condition that, with a background check, would limit firearm access.

The number one step in advocating gun safety is to ensure that guns are kept unloaded, locked, and away from children or anyone who is felt to be of suicidal risk or from persons with substance abuse. Restriction of access is a proven suicide prevention technique. Doctors focus on identifying and treating mental illness in suicidal individuals, but even those who care deeply about preventing such deaths may be less familiar with the evidence linking gun access and suicide.

In conclusion, physicians and their staffs should recommend that families remove firearm access from individuals with depression or suicidal thoughts, persons with a history of drug abuse or impulsivity, and/or those with psychiatric or neurologic conditions. All clinicians should discuss safe storage of firearms in the same way that they might recommend smoking cessation, exercise, and seatbelt use. Open discussion about guns in medical practices is a good strategy to improve patient care.

For more information, please see our Brief Report in The Primary Care Companion for CNS Disorders.

Financial disclosure:Drs Sarai, Abaid, and Lippmann have no relevant personal financial relationships to report.