Public Opinion About the Relationship Between Firearm Availability and Suicide: Results From a National Survey
Authors: Andrew Conner, Deborah Azrael, Matthew Miller
Journal: Annals of Internal Medicine (2017)

Letters16 January 2018Public Opinion About the Relationship Between Firearm Availability and Suicide: Results From a National SurveyFREEAndrew Conner, BS, Deborah Azrael, PhD, and Matthew Miller, MD, MPH, ScDAndrew Conner, BSHarvard School of Public Health, Boston, Massachusetts (A.C., D.A.), Deborah Azrael, PhDHarvard School of Public Health, Boston, Massachusetts (A.C., D.A.), and Matthew Miller, MD, MPH, ScDNortheastern University and Harvard School of Public Health, Boston, Massachusetts (M.M.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2348 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: In 2015, more than 44 000 persons in the United States died by suicide; one half of these persons used firearms (1). Considering and addressing beliefs about the relationship between firearms and suicide in this country are likely to improve prevention strategies that aim to lower suicide rates by reducing ready access to firearms, such as those endorsed by several medical societies (2). However, the extent to which persons in the United States understand that household firearms increase the risk for suicide is unknown.Objective: To use a nationally representative sample to describe public opinion about whether household firearms increase the risk for suicide.Methods and Findings: We used data from a 2015 Web-based survey conducted by Growth for Knowledge (3). Our primary outcome was the proportion of respondents who agreed with the statement, “Having a gun in the home increases the risk of suicide.” Response options were “strongly agree,” “agree,” “neither,” “disagree,” and “strongly disagree” and were categorized for analysis as agree, disagree, or neither. Other variables assessed included sociodemographic characteristics, opinions about firearm-related issues, prior firearm safety training, living in a home with firearms, and personal firearm ownership. We examined 2 items routinely collected from panel members: whether they had ever been diagnosed with a mental health condition and their occupation. Those who reported their occupation as “medical doctor (i.e. physician, surgeon, dentist, veterinarian)” or “other healthcare practitioner (i.e. nurse, pharmacist, chiropractor, dietician)” were grouped together as health care practitioners.Of the 7318 invited panel members, 3949 completed the survey (54.6% survey completion rate). Seventeen persons with missing responses to our key question about whether firearms increase suicide risk were excluded, resulting in a final sample of 3931 persons. A total of 15.4% (95% CI, 13.1% to 18.1%) of U.S. adults agreed that the presence of a firearm in the home increases the risk for suicide (6.3% [CI, 5.2% to 7.6%] of firearm owners, 8.9% [CI, 6.7% to 11.7%] of those who do not own a firearm but live with someone who does, and 19.8% [CI, 16.3% to 23.8%] of those who live in a home without firearms) (Table). Nearly 1 of 3 health care practitioners (30.2% [CI, 14.0% to 53.3%]) agreed that having a household firearm increases suicide risk; among health care practitioners who own firearms, 11.8% (CI, 4.5% to 27.3%) agreed with this statement. Fewer than 10% of gun owners with children (or gun owners who had received firearm training) agreed that household firearms increase suicide risk.Table. Proportion of Respondents Who Agreed That Having a Firearm in the Home Increases the Risk for Suicide, by Firearm Ownership Status and Selected Respondent Characteristics*Discussion: Our finding that most persons in the United States do not endorse the statement, “Having a gun in the home increases the risk of suicide,” may reflect broad skepticism about the effectiveness of preventing suicide by reducing access to means of suicide with high case fatality rates (that is, those likely to prove lethal). Consistent with this possibility, prior work has found that 75% of persons in the United States believe that few if any lives would be saved by erecting a wholly effective jumping barrier on the Golden Gate Bridge (4). In that study, gun owners were more likely than any other group to believe that persons who died by jumping from the bridge would have inevitably committed suicide using some other means.Our study has limitations, the most potentially consequential being that some respondents may have misinterpreted our key question as referring to suicidal ideation or nonlethal suicidal behavior rather than death by suicide. However, findings from prior studies of beliefs about suicide suggest that most respondents probably interpreted our key question as including death by suicide (4, 5). In addition to the results from the Golden Gate Bridge study, our finding that more than one half of health care practitioners actively disagree that a gun in the home increases the risk for suicide concurs with estimates derived from an emergency department survey that found that 67% of nurses and 44% of physicians believe that most persons who die of suicide by firearm would have found another way to die had the firearm not been available (5). Even if one half of respondents misinterpreted our question as excluding death by suicide, the conclusion remains that too many persons in the United States do not understand the empirical reality that a gun in the home substantially increases the risk for suicide. Moreover, given that health care providers can play a crucial role in identifying suicidality and intervening in ways to reduce risk for suicide, our finding that more than two thirds of providers are unaware of this increased risk is concerning.Despite these limitations, our findings suggest that medical and public health communities need to better educate at-risk patients and health care providers about how and why firearms increase the risk for suicide. Doing so will enable patients and their families to make more informed decisions about how to protect vulnerable members of their households. Health care providers can play an important role in communicating this message.References1. Centers for Disease Control and Prevention. Injury Prevention & Control: Data and Statistics. Web-based Injury Statistics Query and Reporting System (WISQARS). Accessed at www.cdc.gov/injury/wisqars/index.html on 2 February 2017. Google Scholar2. Weinberger SE, Hoyt DB, Lawrence HC 3rd, Levin S, Henley DE, Alden ER, et al. Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Ann Intern Med. 2015;162:513-6. [PMID: 25706470]. doi:10.7326/M15-0337 LinkGoogle Scholar3. Miller M, Hepburn L, Azrael D. Firearm acquisition without background checks: results of a national survey. Ann Intern Med. 2017;166:233-39. [PMID: 28055050]. doi:10.7326/M16-1590 LinkGoogle Scholar4. Miller M, Azrael D, Hemenway D. Belief in the inevitability of suicide: results from a national survey. Suicide Life Threat Behav. 2006;36:1-11. [PMID: 16676620] CrossrefMedlineGoogle Scholar5. Betz ME, Miller M, Barber C, Miller I, Sullivan AF, Camargo CA, et al; ED-SAFE Investigators. Lethal means restriction for suicide prevention: beliefs and behaviors of emergency department providers. Depress Anxiety. 2013;30:1013-20. [PMID: 23495002] doi:10.1002/da.22075 CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Harvard School of Public Health, Boston, Massachusetts (A.C., D.A.)Northeastern University and Harvard School of Public Health, Boston, Massachusetts (M.M.)Grant Support: By the Fund for a Safer Future and the Joyce Foundation.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2348.Reproducible Research Statement:Study protocol: See the Appendix of Betz ME, Azrael D, Barber C, Miller M. Public opinion regarding whether speaking with patients about firearms is appropriate: results of a national survey. Ann Intern Med. 2016;165:543-50. [PMID: 27455516] doi:10.7326/M16-0739. Statistical code: Available from Mr. Conner (e-mail, [email protected]harvard.edu). Data set: Not available.This article was published at Annals.org on 24 October 2017. 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