Effective suicide prevention should focus not only on a patient's psychological condition but also on the availability of lethal means — which can make the difference between life and death. [Miller & Hemenway, The New England Journal of Medicine 2008]
In my efforts to understand our national gun culture from other points of view I keep finding myself drawn back to some of the 70 amicus briefs filed in the Heller case and articles such as the perspective from The New England Journal of Medicine, (below the fold) and other evidence. Justice Breyer's minority opinion in Heller includes a detailed analysis of the 1970s crime problem that the Washington DC city council intended to address. Washington DC is unique; it is the only totally urban jurisdiction in the country. Even after Heller their gun laws remain arguably the most strict in the nation. All guns must be registered, a license to keep a gun in your home or business requires training, magazines are limited to ten rounds, and assault weapons remain banned.
Consider this scatter plot of Gun Ownership vs. Suicide Rates published earlier this year in The Washington Post (March 22, 2013). The data is from 2008-2010.
When I look at this plot I notice that gun ownership is plotted on the X-axis as the independent variable and the suicide rate is plotted on the Y-axis as the dependent variable. The data is very noisy with a couple of overlapping blobs in the middle and a few clustered outliers in the lower left and the upper right corners. It appears that Alaska, Montana, and Wyoming have something in common. They are clustered together in the upper right corner. They all have the highest gun ownership and the highest suicide rates. But the relationship is not that simple, since both South Dakota and West Virginia also have very high gun ownership but have significantly lower suicide rates. If start at West Virginia and look along that horizontal line, at other states that have the same gun suicide rate, we see that Florida has only half the gun ownership rate but the same suicide rate as West Virginia. Clearly there is something more underneath the suicide rates than a simple gun/suicide correlation.
Moving down and to the left, we see a cluster of states that strictly regulate gun ownership, California, Illinois, Maryland, Connecticut, New York, Rhode Island, Massachusetts, and New Jersey.
And then there is a true outlier down there in the lower left corner. Washington D.C. has by far the lowest gun ownership and the lowest suicide rate. It is a true outlier. Bear in mind that our eyes and brain evolved to recognize patterns, and because of those outliers on both corners this plot may look like a rough linear correlation. I'm not a statistician, but I'll venture that a statistician would say this is not a strong linear correlation. A plot like this only shows that there is some relationship. Remember an apparent correlation can't by itself establish cause and effect, but it can suggest areas for further study.
Even if legal gun ownership in DC is low, about 4%, we know there are plenty of guns in the district; DC gets a lot of press about the high crime and high gun homicide rate. What I find compelling about that plot is that there is something unique and notable about DC's very low suicide rate. On prevention of gun suicides, an important goal of public health policy, DC appears to be doing something right. We should carefully consider what factors are working for them and why.
Join us below the fold. This is an Open Thread.
|
The Daily Kos Firearms Law and Policy group studies actions for reducing firearm deaths and injuries in a manner that is consistent with the current Supreme Court interpretation of the Second Amendment. To see our list of original and republished diaries, go to the Firearms Law and Policy diary list. Click on the ♥ or the word "Follow" next to our group name to add our posts to your stream, and use the link next to the heart to send a message to the group if you have a question or would like to join. |
|
Perspective: Guns and Suicide in the United States
Matthew Miller, M.D., Sc.D., and David Hemenway, Ph.D.
September 4, 2008 in The New England Journal of Medicine
The empirical evidence linking suicide risk in the United States to the presence of firearms in the home is compelling.3 There are at least a dozen U.S. case–control studies in the peer-reviewed literature, all of which have found that a gun in the home is associated with an increased risk of suicide. The increase in risk is large, typically 2 to 10 times that in homes without guns, depending on the sample population (e.g., adolescents vs. older adults) and on the way in which the firearms were stored. The association between guns in the home and the risk of suicide is due entirely to a large increase in the risk of suicide by firearm that is not counterbalanced by a reduced risk of nonfirearm suicide. Moreover, the increased risk of suicide is not explained by increased psychopathologic characteristics, suicidal ideation, or suicide attempts among members of gun-owning households.
Three additional findings from the case–control studies are worth noting. The higher risk of suicide in homes with firearms applies not only to the gun owner but also to the gun owner's spouse and children. The presence of a gun in the home, no matter how the gun is stored, is a risk factor for completed suicide. And there is a hierarchy of suicide risk consistent with a dose–response relationship. How household guns are stored matters especially for young people — for example, one study found that adolescent suicide was four times as likely in homes with a loaded, unlocked firearm as in homes where guns were stored unloaded and locked.
[…]
Physicians and other health care providers who care for suicidal patients should be able to assess whether people at risk for suicide have access to a firearm or other lethal means and to work with patients and their families to limit access to those means until suicidal feelings have passed. A Web site of the Harvard Injury Control Research Center can help physicians and others in this effort (www.hsph.harvard.edu/means-matter). Effective suicide prevention should focus not only on a patient's psychological condition but also on the availability of lethal means — which can make the difference between life and death.
…Continue reading Perspective: Guns and Suicide in the United States
Source Information
Dr. Miller is the associate director and Dr. Hemenway the director of the Harvard Injury Control Research Center, Harvard School of Public Health, Boston.
Citation: N Engl J Med 2008; 359:989-991 September 4, 2008 | DOI: 10.1056/NEJMp0805923
Coming up in Firearms Law and Policy
Guns and Suicide
Hugh Jim Bissell will publish another diary in his ongoing series
Guns and Suicide. Previous installments of the series can be found
here, and
here.
AndyT will be joining us to discuss his personal diary from November 2010,
I can't own a gun.
Has nothing to do with the law, I've got a clean record. I can afford a gun, so that is not it. I've been to shooting ranges on several occasions and apparently I'm a decent shot. I have friends who love their guns and would probably really enjoy if I joined them going shooting. [...] But people who advocate for the Right to Keep and Bear Arms (RKBA) never have good answers or suggestions for people in my situation. I don't think they much like discussing it at all.
...Continue reading I can't own a gun.
Oral Arguments at SCOTUS in Rosemond v. US
On Tuesday this courtroom was full.
TRPChicago will report on the oral arguments heard by the Supreme Court last Tuesday.
For decades, state and Federal criminal laws have imposed heavier penalties on crimes where a firearm is in play. What about accomplices who may not have had anything to do with the gun? What does a prosecutor have to show to prove a perp is guilty of the armed offense? This was the question argued before the Court in Rosemond v. US last Tuesday.
TRPChicago previewed the case
here.