J. W. Swanson
Psychiatric Services
Volume 72, Issue 2
February 01, 2021, 174-179
Abstract
The U.S. suicide rate continues to increase, despite federal investment in developing preventive behavioral health care interventions. Important determinants of suicide—social, economic, and circumstantial—have little or no connection to psychopathology. Firearm injuries account for over half of suicides, and firearm access is perhaps the most important modifiable determinant. Thus gun safety policy deserves special attention as a pathway to suicide prevention. This article summarizes arguments for several recommended statutory modifications to firearm restrictions at the state level. The policy challenge is to develop and implement evidence-based strategies to keep guns out of the hands of people at highest risk of suicide, without unduly infringing the rights of a large number of gun owners who are unlikely to harm anyone. Recommendations for states include expansion and refinement of legal criteria prohibiting firearm purchase, possession, or access to better align with suicide risk, including prohibition for persons with brief involuntary psychiatric holds or repeated alcohol-impaired driving convictions; enactment of extreme risk protection order laws, which allow temporary removal of firearms from persons who are behaving dangerously, and entering purchase prohibition data for these persons in the FBI’s background-check database; and adoption of an innovative policy known as precommitment against suicide as well as voluntary self-enrollment in the FBI’s background-check database.
Highlights
- Suicide is caused by many factors in addition to mental illness and often cannot be prevented by mental health treatment alone.
- Access to firearms is one of the most important modifiable determinants of suicide mortality in the United States.
- Evidence-based firearm restrictions and policies that limit gun access to people who pose a clear risk of intentional self-harm could prevent many suicides without infringing the rights of lawful gun owners.
Important data points
Overall, 60% of males who died by suicide had no known mental health conditions. Across all age groups, firearm suicides were more common among males without known mental health conditions compared with males who had known mental health conditions. Between 32% and 40% of all young and middle-aged adults in the study had a history of problematic substance use. Between 43% and 48% of all young and middle-aged adults tested positive for alcohol at the time of their death.
