Owning a gun greatly increases the risk that it will be used for suicide, according to a special report in The New England Journal of Medicine.
“In this study of firearm ownership and mortality in a cohort of 26.3 million adult residents of California, we found an elevated risk of suicide among a large sample of first-time handgun owners,” David M. Studdert, LLB, ScD, of the Stanford Law School and Stanford School of Medicine, and colleagues reported. “This risk was driven by a much higher rate of suicide by firearm — not by higher rates of suicide by other methods. Handgun owners’ risk of suicide by firearm peaked in the period immediately after their first handgun acquisition but remained relatively high 12 years later, and the long-term risk accounted for a majority of the excess suicides by firearm among owners.”
Studdert and colleagues noted that their study “bolsters and extends the message from previous research: ready access to firearms, particularly handguns, is a major risk factor for suicide.”
The authors pointed out that suicide attempts are often impulsive acts, and their lethality depend on the method used. The lethality of firearms “focus attention on firearm access as a risk factor for suicide, especially in the United States, which has a higher prevalence of civilian owned firearms than any other country and one of the highest rates of suicide by firearm,” they wrote.
In an editorial accompanying the study, Chana A. Sacks, MD, MPH, and Stephen J. Bartels, MD, of the Mongan Institute, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, wrote that while the finding of an association between handgun ownership and suicide is not surprising, the study has several implications for clinical care and suicide prevention.
For example, they wrote, assessments of suicide risk should look at recent handgun acquisitions. In addition, considering the high suicide by firearm rates among women, inquiries related to gun ownership should not be limited to men. They also noted that while this study focused on the gun owner, it may have underestimated the risk for other household members.
Finally, they pointed out that firearm-related violence remains a seriously underfunded research subject and asked how the recent surge of gun purchases with the onset of the coronavirus pandemic — 2 million guns purchased in the month of March alone — will affect firearm-related violence.
“With an additional 2 million guns now in households across the country at a time of widespread unemployment, social isolation, and acute national stress that is unprecedented in our lifetime, we urgently need to find out,” wrote Sacks and Bartels.
In their study, Studdert and colleagues tracked firearm ownership and mortality over a 12-year period in a cohort of about 26 million California residents, 21 years and older, who had previously not acquired handguns. Of those 26 million residents, 676,425 acquired their first handgun during the study period.
The authors used survival analysis to estimate the association between handgun ownership and both all-cause mortality and suicide by firearm and by other methods among men and women.
Studdert and colleagues found that handgun owners were younger than nonowners, and were more likely to be male (78.1% versus 44.2%), white (74.7% versus 60.7%), and reside outside an urban area (17.2% versus 9.6%).
A total of 1,457,981 persons in the study cohort died during the study period, 17,894 (70% male) of whom died by suicide. Of those persons who died by suicide, 6,691 (83% male) used a firearm. A firearm was used in 89% of suicides among handgun owners, but just 33% among nonowners.
The rate of suicide by any method among male handgun owners was more than 3 times as high as the rate among male nonowners (hazard ratio, 3.34; 95% confidence interval [CI], 3.13- 3.56), while the corresponding rate among female gun owners was 7 times as high as that of female nonowners (HR, 7.16; 95% CI, 6.22-8.24).
And these elevated suicide rates were most likely attributable to gun ownership. The suicide by firearm rate among male handgun owners was almost 8 times as high as the rate for male nonowners (HR, 7.82; 95% CI, 7.26-8.43), yet male gun owners had lower rates of suicide by other methods HR, 0.64; 95% CI, 0.55-0.76).
The same held true for female handgun owners, but with an even more extreme difference between gun owners and nonowners. The suicide by firearm rate among with female handgun owners was 35 times as high as that of female nonowners (HR, 35.15; 95% CI, 29.56-41.79). The rate of suicide by other means was comparable between the two groups of women.
The authors also found that while few suicides by firearm occurred on the day of gun acquisition (9), the risk of suicide by firearm peaked among gun owners in the 30 days immediately after acquiring a firearm (471 per 100,000 person years). However, the risk remained elevated with more than half (52%) of suicide by firearm occurring more than a year after acquisition.
The results of their study suggest health care providers and policymakers should be aware that ready access to firearms is a major risk factor for suicide, wrote Studdert and colleagues. “This information is also important for current and prospective firearm owners seeking to weigh the risks and perceived benefits of ownership.”
In speaking to limitations of their study, Studdert and colleagues noted that “unmeasured confounding is a threat to causal inference in observational studies,” and noted that it wasn’t possible to truly understand the trait that elevated this risk for suicide. They also explained that they were not able to account for mental illness, “although it is a major risk factor for suicide, it is unlikely to be a strong confounder.” Other limitations of the study include possible misclassification of some handgun owners as their guns may have been acquired illegally or prior to data on acquisition histories, and these findings may not be generalizable outside of California, which has strict run laws.
Gun ownership is associated with signficantly higher rates of suicide by firearm, both among women and men.
Rates of suicide by firearm among gun owners peak in the immediate period (30 days) after gun acquisition.
Michael Bassett, Contributing Writer, BreakingMED™
Supported by the Fund for a Safer Future, the Joyce Foundation, and internal funds from Stanford Law School and the Stanford University School of Medicine.
Studdert reported no financial interests to disclose.
Bartels has nothing to disclose.
Sacks is employed by the New England Journal of Medicine as Images Editor.
Cat ID: 254
Topic ID: 253,254,254,730,838,914,138,139,513,142,192,514,150,151,590,925