Suicides Greatest Cause of Gun Deaths in U.S.

This article originally appeared in The Chicago Sun-Times on May 28, 2014.

By Marie Crandall

It hit 85 degrees in Chicago last week. Police scanners were screaming, while headlines announced the tragedies of young people dying violent deaths.

Yet, as an academic trauma surgeon in Chicago, I know suicides, not unintentional shootings, mass shootings or even homicides, account for the bulk of gun deaths in the United States. Nearly two-thirds of the total firearm deaths in the U.S. are suicides.

Some 1 million people attempted suicide and 2 million reportedly considered it in the past year, according to the most recent report from the Centers for Disease Control and Prevention.

This month, 15-year-old Cora Delile of Pickerington, Ohio, hanged herself, while last week it was discovered that a JPMorgan executive had not fallen, but jumped, from a building. And 34 years ago this month, Ian Curtis, lead singer of the groundbreaking band Joy Division, killed himself, and in the years since lyrics of “Dead Souls” take on eerie prescience.

Of course, not all suicides use guns. However, access to firearms is a well-established risk factor for suicide completion, even when taking into consideration things like depression or substance abuse. This is all to say that firearms are at once devastatingly lethal, and quite user-friendly, which is a dangerous combination.

The dollar costs of suicide, between medical and work loss, is estimated at $34.6 billion per year. Impulsivity is known to be a factor in suicide attempts; in fact, the majority of suicide attempters who survive will not reattempt. With numbers as high as these, it makes sense to consider gun policy strategies that might impact the likelihood of successfully completing a suicide attempt, rather than focusing exclusively on mass shooting prevention.

Fortunately, at least one strategy has been shown to decrease the likelihood of firearm injuries and suicides, and that is Child Access Prevention Laws. These laws have been enacted by 28 states, including Illinois, and the District of Columbia, and while they differ somewhat by state, they impose criminal liability on adults who give children unsupervised access to firearms. Firearms stored safely in the home — unloaded and locked away — is associated with a lower risk of firearm injury and death. As the vast majority of childhood firearm-related suicides and unintentional deaths are caused by guns obtained from family or friends, the trend toward more states embracing Child Access Prevention laws is sensible.

Some gun measures that can prevent mass shootings can also curb suicide deaths. Australia’s aggressively instituted gun buyback program and uniform registry for firearm licensing after a 1996 mass shooting that killed 35 people has resulted in no mass shootings since then. Also, the firearm suicide rate dropped from 22 percent of all suicides to just 7 percent, and total suicides decreased at a faster rate than they were trending prior to the gun law changes. This suggests that people who wanted to commit suicide did not simply substitute another method if a firearm was not available, but that they likely didn’t attempt at all.

Unfortunately, similar programs have been hard to launch in the U.S. and those that have lack the effect of their Australian counterparts. The marked differences are likely due to geography — Australia is an isolated island, while small fractions of America’s vast continent could simply access firearms from other regions.

Suicide is always a tragic loss of life, but is particularly devastating when it affects young people. In fact, it’s the third-leading cause of death in America for individuals between the ages of 10 and 24, nearly 5,000 young people per year. Suicide contagion is much more common among young people; data from Australia found that 42 percent of young people who committed suicide had lost someone close to them due to suicide.

Knowing risk factors is important for suicide prevention; for instance depression and bereavement are profound risks for suicide attempts, as are gay, lesbian, and transgender youth, and young people who are suffering from bullying.

Organizational efforts are afoot to educate about suicide, but gun advocates are thwarting some of them. The American Psychiatric Association has published a fact sheet with evidence-based resources to prevent suicide; these methods rely on programs focused on identifying at-risk youth and connecting them with resources. The American Academy of Pediatrics has advocated for the understanding of this as a health issue affecting all children. However, the National Rifle Association sees this as a Second Amendment issue, and has sponsored legislation in at least six states — Florida, Alabama, North Carolina, West Virginia, Minnesota, and Oklahoma — to forbid pediatricians from asking about guns in the home.

Given the efficacy of Child Access Prevention Laws, the NRA’s stance seems counterproductive to child safety. In 2011, Florida Gov. Rick Scott signed this bill into law, though it was ultimately overturned by a federal judge. To counter the NRA, AAP members in some states have opted to work with gun owners. For example, Bulletproof Kids is a public service campaign advocating for the safe storage of firearms with the motto, “Owning a gun is a right. Protecting children is a responsibility.” Compromises may be more effective than the current all-or-nothing adversarial approach to firearm discussions.

Rather than focus on combating mass shootings by arming teachers or teaching drills to workers, we should focus on gun policy that would remove guns from the hands of those likely to commit suicide. We lose too many young people who just want their dreams to go away.

- Marie Crandall is an associate professor of medicine at Northwestern University.