Example

By the Numbers

More than half of completed suicides in the U.S. are by firearm, despite the fact that only 6% of attempts are made with a gun.²

Suicide is the tenth leading cause of death in the United States, and the third leading cause among adolescents and young adults.¹

Suicide rates in the United States rose steadily from 1999 to 2016, and that trend appears to be continuing.¹ More than half of completed suicides in the U.S. are by firearm, despite the fact that only 6% of attempts are made with a gun.² This is because firearms are by far the most lethal method of suicide, with less than a 15% survival rate.³ Research indicates that just having a firearm in the home increases a household member’s risk of suicide by more than three times.⁴ Over 80% of adolescents who complete suicide use a family member’s gun.⁵

Examples of escalating risk and interventions

Using a harm reduction approach

Mental Illness

It is unknown exactly how much mental illness contributes to the suicide rates, but research has estimated about half of suicide decedents meet criteria for a mental illness at the time of their death.⁷ Major depressive disorder is one of the diagnoses most commonly associated with suicide (lifetime risk 3.4%) because of the relatively large number of people who have it.⁸ While fewer people are diagnosed with schizophrenia or bipolar disorder, the risk of suicide with those disorders is higher, approximately 5% and up to 20% respectively.^9,10 While many firearm prohibitions are targeted at people with mental illness, these are not sensitive enough to be effective at preventing suicide, as most people with serious mental illness who completed suicide with a firearm are legally allowed to own a gun at the time of their deaths.¹¹

Other Factors

Other medical illnesses also contribute to the burden of suicide in the United States. Patients who suffer from chronic medical disorders, particularly chronic pain, are at elevated risk.¹² Alcohol use disorder is also associated with an increase in suicide risk. 41% of suicide decedents in one study were intoxicated at the time of their death, and that number was higher for those who used firearms.¹³

Clinicians of various specialties are in a unique position to counsel patients at risk for firearm suicide, but though many believe it to be within their purview, few actually do it. One study of Emergency Medicine physician documentation found that for patient encounters in which suicidal ideation was the chief complaint, only 3% documented access to firearms in the chart.¹⁴ Another study looking at the practice and perceptions on guidance of firearms by psychiatrists found only 27% of psychiatrists had a routine system for asking patients if they owned firearms.¹⁵ Providers cite lack of time, uncertainty about how to have these conversations, and lack of knowledge about how to intervene appropriately.

What You Can Do

Putting time and space between a suicidal patient and their firearm can be the difference between life and death. Waiting periods and permit to purchase processes have both been shown to decrease suicide rates, presumably because may people’s suicidality will subside in the intervening time period.^16,17 The majority of near lethal suicide attempts are impulsive, and only 10% of people who survive one attempt die by a subsequent one.^18,19 This means that if an attempt can be aborted or survived because the means used are of low lethality, the person’s life may be saved. Firearms are lethal in over 90% of the attempts in which they are used.²

Depending on the acuity of the patient’s suicidality and their willingness to collaborate on lethal means safety, a variety of options are available to the clinician. If the suicidality is not imminent but poses a continued sub-acute or intermittent threat, safe storage counseling or temporary transfer may be viable options. If the person is at imminent risk of self-harm and needs mental health treatment, an involuntary psychiatric hold may be indicated. If criteria are not met for a mental health hold, and the patient is not willing to relinquish their firearm, a gun violence restraining order poses an option for temporary, civil removal of guns involuntarily.

Crisis Services

For emergency medical attention, dial 911.

• 24/7 Crisis Hotline: National Suicide Prevention Lifeline Network
  1-800-273-TALK (8255) (Veterans, press 1)
• Find your crisis center: https://suicidepreventionlifeline.org/our-crisis-centers/#section-4
• Crisis Text Line
  Text TALK to 741-741 to text with a trained crisis counselor from the Crisis Text Line for free, 24/7
• Veterans Crisis Line
  HYPERLINK “tel:+1-800-273-8255”1-800-273-TALK (8255) (Veterans, press 1) 
• Send a text to 838255
• Support for deaf and hard of hearing individuals is available.