Why Reducing Access to Firearms Can Prevent Veteran Suicide

The BulletPoints Project November 9, 2022

 

 

Meredith Sears, PhD 

Psychologist, San Francisco VA Healthcare System 

 

Addressing firearm access is critical to suicide prevention efforts in the military veteran population. In 2020, nearly 46,000 Americans died by suicide, making suicide the 12th most common cause of death in the US.1 That year, the veteran suicide rate was 57.3% higher than that of non-veteran adults in the US.2  

While veterans are more likely than non-veteran adults to experience certain risk factors for suicide such as depression and post-traumatic stress disorder, substance misuse, exposure to suicide, traumatic brain injury, and unaddressed chronic health conditions related to their military service, firearm access is a major contributor to the higher rates of suicide among veterans than non-veterans. Public health efforts to educate gun owners about the increased risk of suicide that comes with access to firearms, and counseling by healthcare professionals when veterans are at increased risk for suicide, can play an important role in reducing suicide death. 

Firearms and veteran suicide 

In 2020, 71% of veteran suicide deaths were by firearm, compared with 50.3% of non-veteran adult suicides.2 This gap has been increasing over the last two decades: while the percentage of suicide deaths that resulted from firearm injury decreased 2.3% from 2001 to 2020 in the general US adult population, there was a 4.5% increase in the percentage of veteran suicide deaths that occurred by firearm.2 

 What factors may be responsible for the higher rates of suicide by firearm among veterans? 

  1. Veterans are more likely to have access to firearms. Nearly half (44.9%) of all veterans report owning a firearm,3 compared with approximately 30% of the general US population.4 
  2. Multiple theories of suicide posit that suicide is more likely in people who have an acquired capability or capacity to place their lives at risk and experience pain.5,6 Veterans are more likely to have experienced threats to their lives (e.g., by exposure to combat) and to be familiar and comfortable with firearm use.  
  3. The majority of veteran gun owners cite protection as their primary reason for owning firearms,3 and one third store at least one firearm unlocked and loaded.7 Owning firearms for protection, and the perception that firearm access is not associated with suicide risk, have both been shown to reduce the likelihood that gun owners will store their firearms safely (i.e., unloaded and/or locked).7,8 

Reducing firearm access reduces suicide rates 

Reducing access to lethal means in an at-risk population has been found to be one of the most effective interventions to drive down suicide rates.9 

In 2006, the Israeli Defense Force implemented a policy requiring all military servicemembers to leave their firearms on base when they left on weekend leave. This simple policy change—which only reduced servicemember access to firearms on weekends, not weekdays, and did not address access to any other lethal means—resulted in a 40% decrease in suicides.10   

Why might reducing access to firearms decrease suicide rates? 

  1. Suicidal crises are often brief. One study showed that for nearly half of people who had made serious suicide attempts, less than 10 minutes elapsed between their first current thought of suicide and the attempt itself.11 
  2. Firearms are highly lethal. The vast majority (96.5%, per one study) of self-inflicted firearm injuries result in a fatality, in comparison with 6.5% of suicide attempts by poisoning/overdose.12  
  3. Firearm injury is immediate. There is no opportunity for a change-of-heart by the individual or a rescue by a loved one or emergency services.  

These factors help us explain why living in a household with a firearm greatly increases the risk of suicide.13 Easy access to lethal means during what may be a brief window of intense pain and suicidal urges may determine whether an attempt takes place, and how lethal that attempt is.  

What can we do? 

Actions for veterans and their families, household members, and friends: 

  1. Keep your firearms safely stored, especially when a member of your household is struggling with mental health concerns. 
  2. If you know someone in your life is struggling with suicidal thoughts and owns a firearm, tell them you’re worried, and problem-solve with them about how they can reduce access to their guns. This can include temporarily loaning the firearm to another person, storing the gun outside the home, or finding other ways to increase the time it would take to access a loaded weapon in a crisis. 

Actions for clinicians and other professionals: 

  1. Safety plans written out in advance of a crisis can remind those who struggle with suicidal thoughts to reduce access to firearms and use their coping strategies when times get tough. 
  2. Health care providers can ask individuals who are at higher risk of suicide—especially veterans—if they have access to firearms at home and talk to them about safe storage methods.14 For example, all healthcare providers at Veterans Administration hospitals receive routine training in lethal means safety counseling, and veteran patients receive annual suicide risk screening to facilitate these important conversations. 
  3. Public health campaigns like the American Foundation for Suicide Prevention’s “Project 2025,” and collaborations between firearm advocates and suicide prevention organizations can educate gun owners about suicide risks. Over time, this may increase safe storage practices among gun owners at a population level.

 

Clinical tools for preventing firearm injury

Click to view references

  1. Curtin, S.C., Hedegaard, H., Ahmad, F.B. (2021). Provisional numbers and rates of suicide by month and demographic characteristics: United States, 2020. Vital Statistics Rapid Release; no 16. Hyattsville, MD: National Center for Health Statistics.
  2. U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention. (2022). 2022 National Veteran Suicide Prevention Annual Report.
  3. Cleveland, E.C., Azrael, D., Simonetti, J.A., & Miller, M. (2017). Firearm ownership among American veterans: findings from the 2015 National Firearm Survey. Inj Epidemiol, 4(1), 33.
  4. Pew Research Center. (2014). “Wide differences on most gun policies between gun owners and non-owners, but also some agreement,”
  5. Joiner, T.E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
  6. Klonsky, E.D. & May, A.M. (2015). The Three-Step Theory (3ST): A New Theory of Suicide Rooted in the “Ideation-to-Action” Framework. International Journal of Cognitive Therapy, 8, 114-129.
  7. Simonetti, J.A., Azrael, D., Rowhani-Rahbar, A., & Miller, M. (2018). Firearm Storage Practices Among American Veterans. American Journal of Preventive Medicine, 55(4), 445–454.
  8. Anestis, M.D., Butterworth, S.E., Houtsma, C. (2017). Perceptions of firearms and suicide: the role of misinformation in storage practices and openness to means safety measures. J Affect Disord, 227, 530–535.
  9. Daigle, M.S. (2005). Suicide prevention through means restriction: Assessing the risk of substitution: A critical review and synthesis. Accident Analysis & Prevention, 37(4), 625-632.
  10. Lubin, G., Werbeloff, N., Halperin, D., Shmushkevitch, M., Weiser, M., & Knobler, H. Y. (2010). Decrease in suicide rates after a change of policy reducing access to firearms in adolescents: a naturalistic epidemiological study. Suicide and Life‐Threatening Behavior, 40(5), 421-424.
  11. Deisenhammer, E. A., Ing, C. M., Strauss, R., Kemmler, G., Hinterhuber, H., & Weiss, E. M. (2009). The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt? Journal of Clinical Psychiatry, 70(1), 19-24.
  12. Shenassa, E. D., Catlin, S. N., & Buka, S. L. (2003). Lethality of firearms relative to other suicide methods: a population based study. Journal of Epidemiology & Community Health, 57(2), 120-124.
  13. Miller, M.J., Barber, C.W., White, R.A., & Azrael, D. (2013). Firearms and Suicide in the United States: Is Risk Independent of Underlying Suicidal Behavior? American Journal of Epidemiology, 178(6), 946–955.
  14. Barber, C.W., & Miller, M.J. (2014). Reducing a suicidal person’s access to lethal means of suicide: a research agenda. American Journal of Preventive Medicine, 47(3), S264-S272.
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