Injury Prevention Quarter

Reshaping the Discussion Surrounding Firearm-Related Injury and Deaths: The Truth About Guns, Homicide, and Suicide.

Omar K. Danner, MD, FACS

Morehouse School of Medicine

Department of Surgery

Grady Memorial Hospital Trauma Program, Atlanta, GA

Introduction

According to the 2014 National Vital Statistics, homicide by discharge of firearm was highest in non-Hispanic black males at 26.8 per 100,000 compared with 4.8 per 100,000 in Hispanic males and 2.0 per 100,000 in non-Hispanic whites. On the other hand, intentional self-harm by discharge of firearms was highest in non-Hispanic white males at 14.6 per 100,000 compared to 4.1 per 100,000 in Hispanic males and 5.3 per 100,000 in non-Hispanic black males.¹ Although a large degree of attention has, justifiably, been focused on gun-related aggravated assaults and homicide, suicide using a gun is actually the leading method of firearm-related death in the US, accounting for over half of all such deaths. In fact, approximately two-thirds of the annual gun-related fatalities in America are suicide-related, resulting in nearly 60 deaths per day. It is also significant to note that 85 percent of those who attempt firearm-related suicide do not survive but die via the self-harm incident.²

Discussion

Even though most suicidal ideations and impulses are intense, they are generally short lasting, which makes early intervention extremely important.³ This realization has presented a substantial problem and dilemma for the US healthcare service and public health system as reports have suggested that people who have access to weapons are more likely to complete suicide than those who live in homes without guns, particularly as it relates to the mentally ill. As Simon and colleagues have shown, suicide efforts may be impulsive; therefore, the lethality of the method chosen can be a critical determinant of whether an attempted suicide is fatal or nonfatal.³ Prior research indicates that the time between deciding on suicide and attempting suicide is often impulsive and can be as little as 10 minutes or less.^3,4 Therefore, as suicide attempts with firearms are usually fatal, limiting access to guns for individuals with known mental disorders makes sense, decreases the opportunity for self-harm, and should be seriously entertained and carefully enforced.⁵

To put things in perspective, other methods used in suicide attempts tend to have much lower case-fatality rates: cutting/piercing injuries, 0.7 percent; poisoning, 2.5 percent; and jumping/falling, 19.9 percent⁵ according to data from the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2005.⁶ Furthermore, some evidence by Drum et al. suggests more people start an attempt and then stop midway rather than carry it through to completion.⁷ Unlike firearms or jumping from a tall bridge or building, methods such as cutting, poisoning, and overdose provide an opening for an opportunity to rescue. Consequently, it is of vital importance to note that less than 10 percent of people who nonfatally attempt suicide go on to die by a self-inflicted injury.⁵ Prior research also indicates most people use the same highly lethal method of self-injury when using a firearm, and they do not deviate unless that approach is unavailable or too difficult to access.⁸

Consequently, the lethality of the mechanism available during an acute suicidal ideation and crisis can make an essential difference in the outcome. Therefore, as we continue to debate the issue of gun regulation and firearm-related harm in our society, we have to advance our understanding and embrace the full scope of the complexities surrounding firearm-related injury in our great nation. Multiple risk factors have been attributed to the prevalence of assault-related gun violence, including the spread of illicit drug abuse, gangs, the proliferation of firearms, and alterations in the family structure. ⁹ Enhancing our understanding of firearm-related violence as an Association and society could directly affect health care costs and decrease inequality, thereby potentially enhancing economic growth in this nation.

REFERENCES:

1. H Parks SE, Johnson LL, McDaniel DD, Gladden M. Surveillance for violent deaths – National Violent Death Reporting System: 16 States, 2010. Center for Disease Control and Prevention (CDC). MMWR Surveill Summ. 2014;63(1):1–33.
2. C Drapeau CW, McIntosh JL. U.S.A. Suicide 2015: Official Final Data. 2016. Available at: http://www.suicidology.org/portals/14/docs/resources/factsheets/2015/2015datapgsv1.pdf?ver=2017-01-02-220151-870. Accessed June 30, 2018.
3. A Simon OR¹, Swann AC, Powell KE, Potter LB, Kresnow MJ, O'Carroll PW. Characteristics of Impulsive Suicide Attempts and Attempters. Suicide Life Threat Behav.2001;32(1 Suppl):49–59.
4. B Deisenhammer EA, Ing CM, Strauss R, Kemmler G, Hinterhuber H, Weiss EM. The Duration of the Suicidal Process: How Much Time is Left for Intervention Between Consideration and Accomplishment of a Suicide Attempt? J Clin Psychiatry. 2009;70(1):19–24.
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6. D Miller M, Azrael D, Barber C. Suicide Mortality in the United States: The Importance of Attending to Method in Understanding Population-level Disparities in the Burden of Suicide. Annu Rev Public Health. 2012;33:393–408. doi: 10.1146/annurev-publhealth-031811-124636.
7. E Drum DJ, Brownson C, Denmark AB, Smith SE. New Sata on the Nature of Suicidal Crisis in College Students: Shifting the Paradigm. Prof Psychol: Res and Practice. 2009;40(3):213–22.
8. G Hawton K, Harriss L. Deliberate Self-harm in Young People: Characteristics and Subsequent Mortality in a 20-year Cohort of Patients Presenting to Hospital. J Clin Psychol. 2007;68(10):1574–83. http://psycnet.apa.org/doi/10.4088/JCP.v68n1017.
9. I Blumstein A, Wallman J. The Crime Drop in America. New York, NY: Cambridge University Press; 2000. https://doi.org/10.1017/CBO9780511616167.