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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2003 Feb;57(2):120–124. doi: 10.1136/jech.57.2.120

Lethality of firearms relative to other suicide methods: a population based study

E Shenassa 1, S Catlin 1, S Buka 1
PMCID: PMC1732374  PMID: 12540687

Abstract

Objectives: (1) To quantify lethality of firearms relative to other suicide methods, (2) to quantify the extent to which suicide mortality may be reduced by limiting access to firearms.

Methods: Data on suicides and hospitalised para-suicides that occurred in the state of Illinois from 1990 to 1997 were combined. Total number of episodes for each suicide method was estimated as the sum of the number of suicides and the number of para-suicides for that method. Gender and suicide method were used as proxies for intention to die, and estimated lethality of suicide methods within method-gender groups (for example, male firearm users). Logistic regression was used to quantify the lethality of firearms relative to other suicide methods. Excess mortality associated with the use of firearms was estimated by conservatively assuming that in the absence of firearms the next most lethal suicide method would be used.

Results: From January 1990 to December 1997, among individuals 10 years or older in the state of Illinois, there were 37 352 hospital admissions for para-suicide and 10 287 completed suicides. Firearms are the most lethal suicide method. Episodes involving firearms are 2.6 times (95% CI 2.1 to 3.1) more lethal than those involving suffocation—the second most lethal suicide method. Preventing access to firearms can reduce the proportion of fatal firearms related suicides by 32% among minors, and 6.5% among adults.

Conclusions: Limiting access to firearms is a potentially effective means of reducing suicide mortality.

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Selected References

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  1. Achté K. A., Stenbäck A., Teräväinen H. On suicides committed during treatment in psychiatric hospitals. Acta Psychiatr Scand. 1966;42(3):272–284. doi: 10.1111/j.1600-0447.1966.tb01932.x. [DOI] [PubMed] [Google Scholar]
  2. Bille-Brahe U., Jessen G. Suicide in Denmark, 1922-1991: the choice of method. Acta Psychiatr Scand. 1994 Aug;90(2):91–96. doi: 10.1111/j.1600-0447.1994.tb01561.x. [DOI] [PubMed] [Google Scholar]
  3. Boor M., Bair J. H. Suicide rates, handgun control laws, and sociodemographic variables. Psychol Rep. 1990 Jun;66(3 Pt 1):923–930. doi: 10.2466/pr0.1990.66.3.923. [DOI] [PubMed] [Google Scholar]
  4. Brent D. A., Perper J. A., Allman C. J., Moritz G. M., Wartella M. E., Zelenak J. P. The presence and accessibility of firearms in the homes of adolescent suicides. A case-control study. JAMA. 1991 Dec 4;266(21):2989–2995. [PubMed] [Google Scholar]
  5. Burvill P. W. The changing pattern of suicide by gassing in Australia, 1910-1987: the role of natural gas and motor vehicles. Acta Psychiatr Scand. 1990 Feb;81(2):178–184. doi: 10.1111/j.1600-0447.1990.tb06475.x. [DOI] [PubMed] [Google Scholar]
  6. Carlsten A., Allebeck P., Brandt L. Are suicide rates in Sweden associated with changes in the prescribing of medicines? Acta Psychiatr Scand. 1996 Aug;94(2):94–100. doi: 10.1111/j.1600-0447.1996.tb09831.x. [DOI] [PubMed] [Google Scholar]
  7. Clarke R. V., Lester D. Toxicity of car exhausts and opportunity for suicide: comparison between Britain and the United States. J Epidemiol Community Health. 1987 Jun;41(2):114–120. doi: 10.1136/jech.41.2.114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Comtois Katherine Anne. A review of interventions to reduce the prevalence of parasuicide. Psychiatr Serv. 2002 Sep;53(9):1138–1144. doi: 10.1176/appi.ps.53.9.1138. [DOI] [PubMed] [Google Scholar]
  9. Cummings P., Koepsell T. D., Grossman D. C., Savarino J., Thompson R. S. The association between the purchase of a handgun and homicide or suicide. Am J Public Health. 1997 Jun;87(6):974–978. doi: 10.2105/ajph.87.6.974. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Edwards J. G. Suicide and antidepressants. BMJ. 1995 Jan 28;310(6974):205–206. doi: 10.1136/bmj.310.6974.205. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Freed L. H., Vernick J. S., Hargarten S. W. Prevention of firearm-related injuries and deaths among youth. A product-oriented approach. Pediatr Clin North Am. 1998 Apr;45(2):427–438. doi: 10.1016/s0031-3955(05)70017-1. [DOI] [PubMed] [Google Scholar]
  12. Garland A. F., Zigler E. Adolescent suicide prevention. Current research and social policy implications. Am Psychol. 1993 Feb;48(2):169–182. doi: 10.1037//0003-066x.48.2.169. [DOI] [PubMed] [Google Scholar]
  13. Garland A., Shaffer D., Whittle B. A national survey of school-based, adolescent suicide prevention programs. J Am Acad Child Adolesc Psychiatry. 1989 Nov;28(6):931–934. doi: 10.1097/00004583-198911000-00019. [DOI] [PubMed] [Google Scholar]
  14. Gordon R. S., Jr An operational classification of disease prevention. Public Health Rep. 1983 Mar-Apr;98(2):107–109. [PMC free article] [PubMed] [Google Scholar]
  15. Harris E. C., Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997 Mar;170:205–228. doi: 10.1192/bjp.170.3.205. [DOI] [PubMed] [Google Scholar]
  16. Hawton K., Blackstock E. General practice aspects of self-poisoning and self-injury. Psychol Med. 1976 Nov;6(4):571–575. doi: 10.1017/s0033291700018195. [DOI] [PubMed] [Google Scholar]
  17. Hemenway D., Solnick S. J., Azrael D. R. Firearm training and storage. JAMA. 1995 Jan 4;273(1):46–50. [PubMed] [Google Scholar]
  18. Hlady W. G., Middaugh J. P. The underrecording of suicides in state and national records, Alaska, 1983-1984. Suicide Life Threat Behav. 1988 Fall;18(3):237–244. doi: 10.1111/j.1943-278x.1988.tb00159.x. [DOI] [PubMed] [Google Scholar]
  19. Isometsä E. T., Heikkinen M. E., Marttunen M. J., Henriksson M. M., Aro H. M., Lönnqvist J. K. The last appointment before suicide: is suicide intent communicated? Am J Psychiatry. 1995 Jun;152(6):919–922. doi: 10.1176/ajp.152.6.919. [DOI] [PubMed] [Google Scholar]
  20. Jacobs D. G. Depression screening as an intervention against suicide. J Clin Psychiatry. 1999;60 (Suppl 2):42-5; discussion 51-2, 113-6. [PubMed] [Google Scholar]
  21. Kaplan M. S., Geling O. Firearm suicides and homicides in the United States: regional variations and patterns of gun ownership. Soc Sci Med. 1998 May;46(9):1227–1233. doi: 10.1016/s0277-9536(97)10051-x. [DOI] [PubMed] [Google Scholar]
  22. Lester D., Leenaars A. Suicide rates in Canada before and after tightening firearm control laws. Psychol Rep. 1993 Jun;72(3 Pt 1):787–790. doi: 10.2466/pr0.1993.72.3.787. [DOI] [PubMed] [Google Scholar]
  23. Lester D. Substitution of method in suicide and homicide: a regional analysis. Psychol Rep. 1987 Feb;60(1):278–278. doi: 10.2466/pr0.1987.60.1.278. [DOI] [PubMed] [Google Scholar]
  24. Lester D. The availability of firearms and the use of firearms for suicide: a study of 20 countries. Acta Psychiatr Scand. 1990 Feb;81(2):146–147. doi: 10.1111/j.1600-0447.1990.tb06468.x. [DOI] [PubMed] [Google Scholar]
  25. Li G., Ling J., DiScala C., Nordenholz K., Sterling S., Baker S. P. Characteristics and outcomes of self inflicted pediatric injuries: the role of method of suicide attempt. Inj Prev. 1997 Jun;3(2):115–119. doi: 10.1136/ip.3.2.115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Marzuk P. M., Leon A. C., Tardiff K., Morgan E. B., Stajic M., Mann J. J. The effect of access to lethal methods of injury on suicide rates. Arch Gen Psychiatry. 1992 Jun;49(6):451–458. doi: 10.1001/archpsyc.1992.01820060031005. [DOI] [PubMed] [Google Scholar]
  27. Melander A., Henricson K., Stenberg P., Löwenhielm P., Malmvik J., Sternebring B., Kaij L., Bergdahl U. Anxiolytic-hypnotic drugs: relationships between prescribing, abuse and suicide. Eur J Clin Pharmacol. 1991;41(6):525–529. doi: 10.1007/BF00314979. [DOI] [PubMed] [Google Scholar]
  28. Mohler B., Earls F. Trends in adolescent suicide: misclassification bias? Am J Public Health. 2001 Jan;91(1):150–153. doi: 10.2105/ajph.91.1.150. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Ohberg A., Vuori E., Ojanperä I., Lonngvist J. Alcohol and drugs in suicides. Br J Psychiatry. 1996 Jul;169(1):75–80. doi: 10.1192/bjp.169.1.75. [DOI] [PubMed] [Google Scholar]
  30. Peterson L. G., Peterson M., O'Shanick G. J., Swann A. Self-inflicted gunshot wounds: lethality of method versus intent. Am J Psychiatry. 1985 Feb;142(2):228–231. doi: 10.1176/ajp.142.2.228. [DOI] [PubMed] [Google Scholar]
  31. Petrie K. Recent general practice contacts of hospitalised suicide attempters. N Z Med J. 1989 Mar 22;102(864):130–131. [PubMed] [Google Scholar]
  32. Proulx F., Lesage A. D., Grunberg F. One hundred in-patient suicides. Br J Psychiatry. 1997 Sep;171:247–250. doi: 10.1192/bjp.171.3.247. [DOI] [PubMed] [Google Scholar]
  33. Rose G. Sick individuals and sick populations. Int J Epidemiol. 1985 Mar;14(1):32–38. doi: 10.1093/ije/14.1.32. [DOI] [PubMed] [Google Scholar]
  34. Schuster M. A., Franke T. M., Bastian A. M., Sor S., Halfon N. Firearm storage patterns in US homes with children. Am J Public Health. 2000 Apr;90(4):588–594. doi: 10.2105/ajph.90.4.588. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Shaffer D., Craft L. Methods of adolescent suicide prevention. J Clin Psychiatry. 1999;60 (Suppl 2):70-4; discussion 75-6, 113-6. [PubMed] [Google Scholar]
  36. Shah A. K., Ganesvaran T. Inpatient suicides in an Australian mental hospital. Aust N Z J Psychiatry. 1997 Apr;31(2):291–298. doi: 10.3109/00048679709073834. [DOI] [PubMed] [Google Scholar]
  37. Shenassa E. D. Society, physical health and modern epidemiology. Epidemiology. 2001 Jul;12(4):467–470. doi: 10.1097/00001648-200107000-00018. [DOI] [PubMed] [Google Scholar]
  38. Sloan J. H., Rivara F. P., Reay D. T., Ferris J. A., Kellermann A. L. Firearm regulations and rates of suicide. A comparison of two metropolitan areas. N Engl J Med. 1990 Feb 8;322(6):369–373. doi: 10.1056/NEJM199002083220605. [DOI] [PubMed] [Google Scholar]
  39. Turner R. M. Parasuicide in an urban general practice, 1970-1979. J R Coll Gen Pract. 1982 May;32(238):273–281. [PMC free article] [PubMed] [Google Scholar]
  40. Vieland V., Whittle B., Garland A., Hicks R., Shaffer D. The impact of curriculum-based suicide prevention programs for teenagers: an 18-month follow-up. J Am Acad Child Adolesc Psychiatry. 1991 Sep;30(5):811–815. [PubMed] [Google Scholar]

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