Stephen Dunlop, MD President Hoosiers Concerned About Gun Violence 3535 Kessler Blvd., North Drive Indianapolis, IN 46222 [email protected] Suicide Prevention,

Stephen Dunlop, MDPresidentHoosiers Concerned About Gun Violence3535 Kessler Blvd. , North DriveIndianapolis, IN [email protected]

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.