Guns, Mental Illness, and Suicide: A Close Look

“Suicide is now the 10^th leading cause of death in the US, with over 40,000 people dying by suicide each year, at a cost of about $44B annually,” said Jose Maldonado MD, Stanford University, CA.

Maldonado’s presentation at the annual APA meeting in San Diego described factors linking suicide, mental illness, and firearms. In 2012, nearly two-thirds of all firearm deaths were suicides, meaning that Americans were far more likely to kill themselves with guns than each other.

Relating a key feature of firearms as they relate to suicide, Maldonado said, “Guns aren’t the most common way to attempt suicide, but they are the most lethal. About 90% of firearm suicide attempts are fatal versus less than 3% for the other commonly used methods.”

Maldonado detailed a few other methods. “Suicide attempts involving guns are 45 times more fatal than overdose, 30 times more fatal than self-cutting or stabbing, and even 3 times more fatal than jumping.” There are stark gender differences in suicide preferences, where guns are the overwhelming suicide method of choice for men — the extreme lethality of firearms skews the numbers to some extent.

Risk of firearm suicide varies greatly by age, sex, and race, increasing significantly with age, but is much more prevalent in men than in women at any age. While women attempt suicide up to 3 times more often than men, men are 4 times more likely to die by suicide than women.

Access to firearms is a key component of suicide rates. According to Maldonado, “The strongest single factor predictive of suicide is a prior history of attempted suicide, and the strongest predictor of how likely a person is to die from suicide is access to a gun.” It is the combination of lethality and accessibility that makes firearms the most common mode of suicide in the US.

“The presence of a gun in the home increases the likelihood of suicide, regardless of the method of storage, type of gun, or the number of guns in the home,” explained Maldonado. According to the data, if a gun is not available in the home, a gun is rarely used as the method of suicide.

Maldonado added that firearm suicide rate in states that do not require a waiting period for gun sales has been twice as high as the rate in states that do require a waiting period. Furthermore, while some suicide attempts are carefully planned, most are impulsive. Some studies of survivors of suicide have revealed that as many as two-thirds of the attempters did not plan their attempt, with about a quarter attempting suicide within 5 minutes of having suicidal thoughts, about half within 20 minutes, and nearly three-quarters within an hour of suicidal ideation.

Immediate stressors often trigger suicidal crises, with most survivors reported having made their attempt within 24 hours of a crisis. However, the urge to act is short-lived, typically lasting a few minutes to a few hours.

Maldonado said, “Intervention during the time of acute risk is key to saving lives. Most people who attempt suicide don’t really want to die, they are just so overwhelmed by their emotions that they feel unable to cope. A systematic review of 70 studies following patients after a non-fatal attempt found that on average only 7% eventually died by suicide, whereas 70% did not reattempt.”

Maldonado cautioned the assembled physicians that suicide rates are proportionately higher for medical doctors than for the general population. In terms of contributing causes, Maldonado said, “Physicians are often reluctant to seek help for illnesses that predispose to suicide. Burnout, alcohol/chemical dependency, depression, and other mental illnesses contribute to increased suicide risk in physicians.”

Also, Maldonado noted that self poisoning, not firearms, is the most common means of MD suicide, because physicians have greater knowledge of and access to lethal means. Additionally, gender differences are seen in this population, with a risk of completed suicide in female physicians about 60% higher than in males, when comparing age-matched controls.

In a final caution, Maldonado added, “Suicide is currently the most common cause of death among medical students.”