This week a major group of researchers on complicated subjects related to society issues, from California, Australia, and Boston published findings on examining the experiences of over 26 million people living in California, in relation to the question of owning a gun and succumbing to suicide.   https://www.nejm.org/doi/full/10.1056/NEJMsa1916744

The Two Stances

There has long been no doubt that homes that have a handgun also have more suicide.   But two sides have taken positions on whether this true observation is a coincidence, or a cause and effect phenomenon.   Those who celebrate and promote owning handguns are convinced that owning a handgun has nothing to do with suicide.  From their perspective, if we got rid of all handguns, there would be the same number of suicides.  The will to kill oneself leads to suicide they say, and having a gun makes no real difference.

Those who are convinced that owning a gun increases the chance of suicide have a different understanding.  They are confident that if you buy a handgun and have one in your home, you greatly increase the chance that an occasional thought of suicide will result in death, since guns are highly effective machines to end life.

The United States has been deeply split across these two stances, and so this study is an important contribution.

The Study

The authors looked at much of the adult population of California, using voter registration data to locate 61% of the adults in this very large state.

The study also traced the purchase, gifting, transfer of every known handgun transaction in the state of California.

And thirdly, the authors studied every death occurring in the state of California during the period of the study.

What they ended up with was examining the fate of those adults in California who obtained a gun, soon after their purchase and up to nearly 7 years after.

The study examined over 26 million adults and found that over nearly 7 years, over 675,000 obtained a handgun (2.6% of adults studied).

Comparing those who got a handgun to those who did not, gun obtainers were more likely to be younger (41 v 43 y/o), male (78% v 44%), white (74% v. 60%), and rural (17% v 10%).

During the nearly 7 year period of study, 1.5 million adults tracked in this study in California died.  Of these deaths about 18,000 died by suicide, with 6,700 of the suicides by gun (83%).

Of those who died by suicide, 70% were men.

Of all those who died by suicide, if they owned a handgun their suicide was done by gun 89% of the time.  If they did not own a gun that proportion was 33%.

The Risk of Dying by Suicide in Relation to Owning a Handgun

The study found the following on this question:

• If you obtained and owned a hand-gun, your risk of suicide by any methodincreased, dramatically.  For men threefold, for women sevenfold.
• If you obtained and owned a hand-gun, your risk of suicide by gunincreased, even more dramatically.  For men 8 fold, for women 35 fold!
• In California, to obtain a handgun you must first wait 10 days, and so the period of 11-30 days after obtaining the handgun looked at the risk of dying by suicide compared to those who did not obtain a handgun.   The chance of dying by suicide in the 11-30 days period rose 100 fold!
• Even long after obtaining a handgun, the risk of suicide continued to be higher than in those who owned no gun.  About 52% of suicides by handgun happened over a year after getting one.

Do People who Get a Handgun have More Mental Health Problems?

The authors review the literature on this point and find the answer is no.

Compare people who own a handgun and those who do not, and you will find each group has very similar rates of depression, suicidal thinking, and suicide attempting.

BOTTOM LINES

1. This study of 26 million adults in California proves that buying or receiving a handgun is associated with a powerful spike in the chance you will die of suicide.
2. The real question is:  If people did not own handguns would suicide become less frequent?  This and no other study has tested this question, it would be hard to actually perform such a study.
3. It is very much like the situation with tobacco and lung cancer.  No one has actually proven that it causes lung cancer.  But the more people smoke tobacco, the more they get lung cancer.  This association is strong enough to let people know that if they smoke they greatly increase their chance of dying by cancer.
4. And now, so it is with handguns.  The ability to prove a cause is so hard, but once evidence in the association becomes too overwhelming to ignore, it might be time to be thinking, maybe owning a handgun raises the chance of me or someone I love dying by suicide.
5. These data make this point blazingly clear.   Think about it, looking at most of the adults in the massive state of California, those who bought a handgun jumped their chances of dying by suicide 100 times in the first month, and over a nearly 7 year period, men suffered a jump in their chance of dying by suicide by 8 and for women 35 times!
6. And these enormous jumps in suicide happened without there being too much difference in depression, thinking about suicide or making a suicidal act between those who got a handgun and those that did not.

Advanced Pediatrics will also note that having a gun in the home has long been known to dramatically increase the chance of a child dying by gun.

At some level there is no surprise to learn any machine makes what it does easier to do.    A handgun is a machine with only two purposes, target practice and killing people.  Like all effective machines, it is very good at both tasks, and does indeed allow anyone to do either far better than without one.

These findings demonstrate that owning a handgun, making killing a person so much more easy and effective, succeeds in doing so via suicide, and dramatically.

We strongly urge all families to be aware of this risk.  Just as we advise against the use of tobacco because of the risk of dying by cancer, we advise against owning a handgun because of the risk of dying by suicide.

If a home has a gun, it should be stored in a lock-box, a device endorsed by gun manufacturers.  And we look forward to the day when more secure safety devices will be widely available.

With the onset of the world’s COVID-19 pandemic, an extra 2 million guns were obtained by Americans, just this year.  So the danger has increased, not just of the virus, but the gun.

And so, now more than ever, these data are very good to know and we hope you can put them to use to protect you and your family.

To your health,
Dr. Arthur Lavin