Research on gun suicides shows: The enemy is inside the house
On wednesday, Oct. 24, a white man walked into a supermarket on the outskirts of Louisville, Kentucky, pulled a gun and shot two black people, telling an armed man to stand down: “Whites don’t shoot whites.” Three days later, on Oct. 27, an American heir to Nazis entered the Tree of Life synagogue in Pittsburgh, shouting “all Jews must die” and killed 11 during Saturday services. That same day — if it was a typical one in the United States — another 60 or so Americans killed themselves with a gun.
Many Americans presume that those bent on inflicting violence upon others or themselves will go through with it, no matter what. We can never legislate the hate out of people’s hearts or deadly compulsions out of their heads. But is there nothing else we can do to keep our fellow citizens from becoming gunshot victims?
By keeping guns mostly out of the public square, many other nations have largely managed to prevent those consumed by bigotry and rage from doing the irreversible harm suffered by innocents in Louisville and Pittsburgh. But here, as we’ve seen after so many past massacres, the debate on gun regulation quickly devolves into political kabuki. For the last 40 years, the view that the Second Amendment guarantees an almost unlimited right to bear arms for personal protection has dominated. Yet a close reading of the data on who dies by the bullet reveals that, for all the talk of keeping malevolent intruders at bay, guns kill those closest to them: Two out of every three people who die by a bullet each year do so at their own hands — 22,938 of us in 2016, the most recent year for which statistics are available. In other words, those most likely to suffer gun violence are gun owners and those close to them.
Public-health researchers have studied suicides for decades, and they’ve learned something important: Many victims could be saved if it weren’t so easy to bring death upon themselves in their moments of greatest distress. If troubled people could just hold off until the psychological crisis abates, they might survive for years thereafter.
Some of these insights apply to homicide as well: It takes more than an eruption of despair or hate — directed at oneself or at others — to create a tragedy. The means must be at hand too, which is why the results of those working to reduce gun suicides may point a new way forward in what has been an intractable debate.
In our political rhetoric, the possibility that a given restriction won’t keep every last homicidal or suicidal person from obtaining a firearm ostensibly demonstrates that gun control is unworkable. But to public-health experts, a policy intervention that prevents a substantial fraction of needless deaths — even if not all of them — is a triumph.
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The story of suicide and guns starts with the numbers. On an average day, about 123 Americans kill themselves. That toll has been rising for years, up 35 percent since 2000. White males have the highest rates of suicide of any demographic group, 24.8 per 100,000, and white Americans overall kill themselves at a rate of 15.9 per 100,000. American Indians and Alaska Natives approach those levels, while black and Latino Americans have the lowest rates, just over one third of those worst hit. Suicide is the second leading cause of death for those between 10 and 34 years old, while those in middle age die at the highest rate of any age group, almost 20 per 100,000. Firearms account for just over half of all suicides, but the method skews by gender; 57 percent of men who kill themselves do so with a gun, compared with 32 percent of women.
The effort to fight suicide in America thus begins here, with the most common and — crucially — the most effective means people use to end their own lives.
A central question for public health researchers has been whether the availability of guns makes a difference to overall suicide rates. Do people use the means at hand and, if one method is unavailable, simply move on to another?
There is now a clear answer: no. The easier it is to find a gun, the more people will kill themselves. Fewer guns, or more restricted access to firearms, would save lives. Wyoming leads the nation in gun ownership and ranks first in gun suicides. Massachusetts residents come in 48th for gun ownership, and 48th in suicide rate. A county-by-county view produced by the Centers for Disease Control and Prevention makes the picture clear nationwide. There’s an ocean of deep blue, marking suicide rates of up to 72 per 100,000, that covers the Great Plains, the intermountain states, and across the rural areas of the Pacific Northwest. That’s the part of the country where — as Jerry Reed, director of suicide and violence programs at the Waltham-based Education Development Center, describes it — the deadly triad is most potent: “Loneliness, access to lethal means, and physical isolation leads to suicide. [The sociologist Emile] Durkheim said this in 1850,” Reed says. “It’s not rocket science.”
Two of Reed’s culprits are social: loneliness, often driven by the lack of friends or romantic rejection or the death of a spouse, and what researchers call “rurality” — living in places where there just aren’t very many people to encounter most days. Suicide prevention efforts can target both of those risk factors, but as the suicide rates in empty, firearms-friendly states like Wyoming, Montana and Utah suggest, when you add guns to that mix, the combination is fatal.
These are just correlations. But there have been a series of natural experiments that show the benefits of keeping deadly tools away from anguished people. Between 1970 and 2000, Denmark witnessed three key moves that made suicide more difficult: tighter controls on barbiturates and other medications, the elimination of carbon monoxide from household gas supplies, and a drastic reduction in the same deadly gas — thanks to catalytic converters — from car exhaust. These changes were accompanied by a major drop in suicide — by 40 percent for men and 25 percent for women.
Then there’s Sri Lanka. Between 1950 and 1995, suicide rates jumped 800 percent — topping out at 47 per 100,000, almost three times the proportion of Americans who kill themselves. About two-thirds of those who committed suicide poisoned themselves with pesticide. So, beginning in the 1980s, Sri Lankan authorities moved to get rid of the most lethal compounds. The result: suicide rates fell by half between 1996 and 2005, with 20,000 fewer deaths than the previous decade.
Finally, work in Israel showed that restricting access to lethal methods of self-harm works when the means involved are guns themselves. The Israeli Defense Force used to allow its soldiers — most between 18 and 21 years old — to take their service weapons home with them on weekends. In 2006, the defense force changed its policy and sent troops home unarmed. Suicide rates in Israel for this age group fell immediately by about 40 percent.
Over and over again, around the world, putting the deadliest threats out of reach — including, of course, guns — was followed directly by fewer lives lost.
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On one level it’s not surprising that restricting access to the most dangerous methods reduces the number of people who kill themselves. But there is a deeper explanation for these results: Most who attempt suicide do not have a settled intention to die. “It’s documented in the literature,” Reed says. “Most people make the decision to end their life between five minutes and an hour before the attempt.”
The statistics back up Reed’s observation: Most who survive their time of crisis survive, period. That’s been confirmed repeatedly, most dramatically in a study that tracked those who survived one of the most lethal means of suicide, one that suggests real determination to die at the moment of the attempt: those who leapt in front of trains on the London Underground. Over a three-year period in the 1970s, 94 people lived through as unequivocal a decision to die as there is. Ten years later, only seven of those people had completed a suicide, with two more deaths recorded as accidental. That is: Nine out of every 10 who had chosen one of the most lethal means available did not, once they survived, find themselves in that extremity again. That means, as Reed says, “if you can get time and space between thought and action you can save a life.”
That realization is what animates some of the most promising public health responses to the increasing weight of suicide in America. A Harvard School of Public Health team led by Catherine Barber has been working in Utah in collaboration with pro-gun advocates to test a variety of approaches to getting guns out of the hands of those at risk for suicide.
Utah is fifth in suicides per capita in the United States, and it tracks the national average with about half coming by firearms. As they attempt to mitigate that harm, the Harvard researchers recognize what’s nonnegotiable in a state where half the households own a gun — more than two-thirds in rural areas — and gun rights are treasured. So Barber and her team don’t push for gun control, in the form of any legislative attempts to remove firearms from daily life. Rather, as she told one Utah legislator, between the pro-gun side and those who want to get rid of guns there’s “a little oval, where both sides agree. That’s the culture of safety.”
Framing their efforts as gun safety instead of gun control has led to several interventions developed by the Harvard team and others. Together with the New Hampshire Firearm Safety Coalition, the Harvard team piloted The Gun Shop Project, which helps those in the gun business — shop owners and staff, range operators and instructors — avoid selling a gun to someone at risk for suicide. Utah gun advocates working with suicide prevention researchers have come up with public service announcements that encourage people to send their guns out of the house temporarily when the walls close in. And in July, the Utah legislature began to debate legislation that would require trigger locks or secure storage of guns. The committee debate, dominated by Republicans, centered on the measure’s potential to prevent suicides. Gun safety is, as Barber argues, a way to enlist the pro-gun community in a conversation about the right way to accommodate firearms in American public life.
Such approaches are rigorous, data-driven, and — proponents believe — radical acts of kindness. Enlisting gun advocates in a gun safety paradigm aimed at preventing suicides has saved lives and will save more. And if our gun culture can evolve in ways that prevent sales to people who might harm themselves, perhaps it can do the same to those who might harm others.
Just as in studies of suicide, population-level research has shown that homicide rates, including the murder of police officers, tracks the amount of guns available in a given region. And as with suicide, it’s clear how dangerous it is to have lethal means close at hand in a crisis: For 2017, the FBI reports that about 20 percent of all homicide victims were friends, family members, or romantic partners of their murderers, and research into domestic violence has found that just as in incidents of self-harm, the presence of a gun in the household hugely increases the risk that a violent situation ends in death. In other words, getting guns out of volatile settings reduces the risk for everyone near any given firearm.
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Gun-rights activists in the United States didn’t always take as maximalist a view as they do now. The view, now strenuously held, that guns belong essentially everywhere in everyday life — in homes, in cars, on college campuses, in restaurants and stores, out in the open on the street — is historically anomalous and, as such, may be subject to change in the future. At a recent lunch with a number of suicide-prevention scholars, one noted that it wasn’t that long ago that drinking and driving was regarded as a minor sin.
Now, after years of work led by Mothers Against Drunk Driving and others, driving after drinks is broadly unacceptable. This doesn’t mean it doesn’t happen — obviously it does — but as a society we’ve agreed that it shouldn’t. With the evolution of legal penalties and behavioral norms, drunk-driving deaths have fallen by about half in the last 40 years.
In America in 2018, easy access to guns empowers those who hate enough to slaughter innocents. Many elected leaders have tuned out that argument, insisting instead on the benefits of still more guns. But the story of suicide in America directly confronts the myth that guns protect their owners and those whom they love. The old line about the phone call coming from within the house is doubly true here: A gun bought to ward off the dangers of the world outside brings those dangers right into the home.
Thomas Levenson is a professor of science writing at MIT and an Ideas columnist. His latest book is “The Hunt for Vulcan.”