Gun Violence in Indiana Focus on Suicide

Gun Violence in IndianaFocus on Suicide Stephen Dunlop, MD President Hoosiers Concerned About Gun Violence 3535 Kessler Blvd. , North Drive Indianapolis, IN 46222 info@hcgv.org Suicide Prevention, April 3, 2008

Guns and Suicide • 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?

Guns and Suicide, 2000-2002 • 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 High Gun Ownership Low gun Ownership Miller, M, et al, Household Firearm Ownership and Rates of Suicide… , J of Trauma, 62(4), 1029-1035, 2007

Risk of Suicide in a Home • 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

Adolescent Suicide in Colorado 1991-1993 • 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

Adolescent Suicide in Colorado 1991-1993 Shah, et al , Adolescent suicide and household access to firearms…, J of Adolescent Health, 26 (3), 2000,157-163

Independent Factors predicting the risk of suicide in adolescents Shah, et al , Adolescent suicide and household access to firearms…, J of Adolescent Health, 26 (3), 2000,157-163

Guns in the Home • 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

National Followback Study Dahlberg, LL, Ikeda, RM, Kresnow, M, Guns in the Home and Risk of a violent Death, Am J Epidemiology, 160 (10), 929-936)

Does Storage Matter? • 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

Does Storage Matter? Grossman et al, Gun Storage Practices…, JAMA,293,707-714, 2005

Do Means Matter? • 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

Do Means Matter ? • 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 methods Frei,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 Indiana State Department of Health, Suicide Report, 2001-2005)

Figure 7: Indiana Suicide Deaths by Gender and Age, 2001-2005 Indiana State Department of Health, Suicide Report, 2001-2005)

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)

Indiana Gun Ownership • In Indiana • 44.2% 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

Guns and Suicide, Answers • 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.

Measures Favored By a Majority of Hoosiers, 2004 • 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%

Some Good News In Indiana Indiana Partnership to Prevent Gun Violence, July,2004

Guns and Suicide • Suicide Rates for Youths and Young Adult Males MMWR 9/7/ 2007, CDC, DHHS, rates per 100,000 in the age and gender group

Finally • 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.

Gun Violence in Indiana Focus on Suicide