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Stephen Dunlop, MDPresidentHoosiers Concerned About Gun Violence3535 Kessler Blvd. , North DriveIndianapolis, IN 46222info@hcgv.org
Suicide Prevention, April 3, 2008
Does access to guns influence:◦ Risk of suicide in a community?◦ Risk of suicide in a home?◦ Risk of suicide among some individuals more than
others?◦ What does this mean for Indiana?
High Gun Ownership Low gun Ownership
15 States 116 million people 47% Gun Ownership Firearm Suicides 9749 Non Firearm suicides 5060
Total suicides 14,809
Firearm suicides per 100,000 8.4
6 States 119 million people 15% gun ownership Firearm Suicides 2606 Non-firearm Suicides
5446 Total Suicides
8052 Firearm suicides per
100,000 2.2
Miller, M, et al, Household Firearm Ownership and Rates of Suicide… , J of Trauma, 62(4), 1029-1035, 2007
Case Control studies are often used to determine whether a gun in the home increases the risk of suicide
These studies find a risk of 2.1 to 4.8 times greater for suicide when a gun is present
Shah and colleagues looked at adolescent suicides in Colorado from 1991 to 1993
36 of 54 suicides were committed with a gun
24 used a gun form home, 2 a non resident parent’s gun, 2 a relative’s, 4 a friend, neighbor or acquaintance, 4 unknown
42% used a handgun Only 25% of the guns were stored locked
Shah, et al , Adolescent suicide and household access to firearms…, J of Adolescent Health, 26 (3), 2000,157-163
Variable Cases Controls P value
A gun in the home
72% 50% .05
An unlocked gun
58% 35% .05
> 1 gun 56% 28% .02
Conduct problem
64% 25% <.01
Mental Health Rx
47% 19% .01
Ever drank alcohol
54% 34% <.01
Shah, et al , Adolescent suicide and household access to firearms…, J of Adolescent Health, 26 (3), 2000,157-163
Variable Adjusted Odds Ratio
Conduct Disorder Related Behaviors
7.45
Past Mental Health Problem 4.84
Household access to a gun 3.91
Ever drank Alcohol 1.86
Shah, et al , Adolescent suicide and household access to firearms…, J of Adolescent Health, 26 (3), 2000,157-163
Dahlberg and colleagues decided to look at a random national sample to get broader picture of the risks of guns in the home
They used data from the 1993 Mortality Followback Survey which collected data on a 10% sample of all deaths of persons 15 years or older
They focused on deaths by homicide, suicide, or accident that occurred in the home
Type of Death
# % Male
Age <45
Firearm used
Firearm in the Home
Corrected Odds RatioSuicide vs. OtherHomicide vs. OtherFor gun in the home
Suicide 1049 81% 50% 68% 72% Males 10.4**Females 2.3
Homi-cide
490 63% 73% 68% 42% 1.9*
Other 535 37% 22% 0% 32%** p<.01* p<.02
Dahlberg, LL, Ikeda, RM, Kresnow, M, Guns in the Home and Risk of a violent Death, Am J Epidemiology, 160 (10), 929-936)
Grossman et al studied 106 suicide and gun injury cases from Washington, Oregon and Missouri in individuals less than 20 years old
82 Suicide attempts, 95% fatal 24 unintentional injuries, 50% fatal Control gun owning households were found
by random telephone dialing and matched by age group of a household member and county
Storage Practice /Safety Device
CasesN=106
ControlsN=480
Gun loaded 34% 9%
Gun unloaded 66% 91%
Gun and Ammo stored separately
41% 65%
Both accessible 56% 28%
Gun locked 32% 58%
Ammunition locked 24% 48%
Both locked 17% 35%
Grossman et al, Gun Storage Practices…, JAMA,293,707-714, 2005
Storage Practice Odds Ratio
Gun and Ammunition Accessible 1.0
Gun Accessible, Ammunition Not 0.47
Ammunition Accessible, Gun Not 0.34
Neither Accessible 0.22
Grossman et al, Gun Storage Practices…, JAMA,293,707-714, 2005
All 1397 suicides in Finland in one year were studied
21% were by shooting This method was associated with male sex,
living with a partner, lack of previous psychiatric treatment or suicide attempts
About 25% of Finnish households own fire arms
Pirkola S, et al, Do Means matter? Differences in Characteristics of Finnish Suicides…J Nervous and Mental Disorders, 2003;191:745-750
In Switzerland, men must keep a weapon at home during compulsory military service
Suicides in Basel from 1992-1996 were examined
Firearms accounted for 30%, 11% were with military weapons
Military firearm suicides were younger, more likely to have white collar jobs, less likely to have a psychiatric diagnosis, a prior attempt, or be single than those using other methodsFrei,A, et al, Use of Armay Weapons and
Firearms for Suicide and Homicide, Crisis, 27(3), 140-145, 2006
Figure 8: Indiana Suicide Rates by Race and Age, 2001-2005
0
5
10
15
20
25
30
35
Age
Ag
e-A
dju
ste
d R
ate
pe
r 1
00
,00
0
White Males 1.57 14.11 21.3 25.66 27.79 29.14 22.39 31.48
Black Males 1.56 4.41 27.89 24.07 17.62 13.16 12.83 7.97
White Females 0.73 3.07 3.2 5.57 7.97 7.63 6.23 2.85
10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+
Indiana State Department of Health, Suicide Report, 2001-2005)
Figure 7: Indiana Suicide Deaths by Gender and Age, 2001-2005
0
100
200
300
400
500
600
700
Ages
De
ath
s
White Males
Black Males
White Females
Black Females
Indiana State Department of Health, Suicide Report, 2001-2005)
Mechanism White Males
Black Males White Females
All
NumberDeath Rate*
Number Death Rate*
Number Death Rate*
Number (%)
Firearms 168812.71
998.14
2341.66
2021(60%)
Suffocation 6074.49
352.70
900.65
732(22%)
Poisoning 3382.49
Too few for rate
2611.87
599(18%)
AllRATE
263319.7
13410.8
5854.18
359511.7
Table 4: Indiana Suicide Rates by Mechanism, Race and Gender, 2001-2005
*Rates are per 100,000 population and are age-adjusted Indiana State Department of Health, Suicide Report, 2001-2005)
In Indiana44.2% of families reported owning a gun*
25.8% reported owning a handgun*
9.6% store guns loaded**6% store guns loaded and unlocked**
*Indiana Firearm Survey, 2004**Miller, M, Firearm Storage, Accident Analysis and Prevention (2005), 37, 661-667
This is a problem usually involving legal guns accessed by people at risk from personality disorders, mental illness, substance abuse, physical illness, old age, etc.
Simply removing guns from the community on a large scale is the simplest and would probably be the most effective measure.
Regulation of gun storage could limit the risk.
Enforced waiting periods under Brady led to a decrease in suicide.
Educational campaigns may be helpful.
Background checks at gun shows 87% Wiating period to buy a handgun 85% Raise age to 21 for purchase of a long gun
63% Storage requirements for guns 73% Child Access Prevention Law 73% Safety Training for New Owners 83% Recognition device for new handguns 75%
Year Gun in the Household
Handgun in the Household
2000 48.6% 29.5%
2004 44.2% 25.8%
Indiana Partnership to Prevent Gun Violence, July,2004
Suicide Rates for Youths and Young Adult Males
10-14 Year Olds
15-19 Year Olds
20-24 Year Olds
Year Fire-arm
Other All Fire-arm
Other All Fire-arm
Other All
1994 1.4 0.9 2.4 13.1 4.8 18.0 18.8 9.2 28.0
1999 0.8 0.8 1.9 8.4 4.7 13.0 12.8 8.0 20.9
2004 0.5 1.3 1.7 6.5 6.2 12.7 11.1 9.7 20.8
Change 94-04
-0.9 +.4 -0.7 -6.6 +1.4 -5.3 -7.7 +0.5 -7.2
MMWR 9/7/ 2007, CDC, DHHS, rates per 100,000 in the age and gender group
If Indiana were to somehow become a low gun ownership state, we might expect little change in non gun suicides but gun suicides to go from 60% to 33% of all suicides
For an average year this would decrease the number of suicides from about 700 to about 420. The decrease would come preferentially from suicides in younger males.
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