In 2022, the number of US gun suicides reached an all-time high: 73 people dying by gun suicide every day, or a total of nearly 27,000 deaths that year.
Despite years of intense debate over gun violence in the US, this central fact still receives little attention: the majority of the country’s gun deaths are suicides, not homicides.
Experts say stigma and misinformation are still getting in the way of preventing more of these deaths. Paul Nestadt, an assistant professor of psychiatry at Johns Hopkins University, spoke to the Guardian about the country’s rising number of suicides, the role of guns and mental health – and what works to save lives. The conversation has been lightly edited for length and clarity.
More than half of this country’s 50,000 suicides per year are committed with guns. What are some misconceptions about guns and suicide?
There’s this myth that suicide is this carefully considered thing. But there’s been studies that look at the time between decision and action, through interviews with suicide survivors. It’s impulsive. The vast majority of people came to their decision about suicide, and attempted it the same day. For three-quarters of people, it’s within an hour. A quarter of them within five minutes. People use what they have available. Lying in bed at two in the morning, you reach for what you have in your bedside drawer. If that’s a bottle of Tylenol, the survival rate is 98%, and the people who survive keep on surviving.
Firearms, however, have a 90% fatality rate. There’s not going to be a chance to get help, get better, which is what most people do. That’s why having a firearm in the house triples the risk of suicide. There’s even more of a correlation in the case of young people. Kids don’t have as many other options.
When it comes to guns and suicide, a lot of Americans believe that if someone wants to die by suicide, they will find a way to do it, so there’s no point in trying to restrict access to firearms when people are at risk. Is that true?
A survey asked Americans: “If somebody was going to jump off the Golden Gate Bridge and they were prevented, do you think they would find some other way to do it?” About three-quarters said that most or all of the people who were thwarted would find some other way. It’s a common belief. But it isn’t true.
There was a large study of people who did try to jump off the Golden Gate Bridge. Researchers were able to find 515 people who either survived the fall, or who were physically pulled off the ledge. The researchers followed up with them for 26 years. Only 4.9% of those people went on to die by suicide. Ninety-five percent – the vast majority – kept surviving. This speaks to the impulsivity of suicide.
People who have survived the Golden Gate Bridge fall and now talk about it, like Kevin Hines, capture what it’s like: when you’re in the midst of that fall, metaphorically or in reality, all of the problems you’re dealing with stop seeming so important. That’s why it’s so important that the method people use on the first suicide attempt isn’t so terribly lethal.
What are some ways to approach suicide prevention with firearms, given that estimates show a quarter to a third of Americans own guns?
If someone in the house is experiencing depression or has a substance use issue, the gun might temporarily be stored outside the house. Firearm ranges, gun shops and police stations – lots of people will let you temporarily store a gun with them. In Maryland, they have a map you can find on a government website, of people who have agreed to hold your gun for you in a crisis. Those safe-storage maps are a great tool.
If there’s a kid in the house, and there must be a gun, it really needs to be stored safely, locking it up with ammunition stored separately.
There are also red-flag laws, or extreme-risk protection orders. If you’re worried about a family member or somebody who might be at risk who has access to a firearm, depending on your state, a family member, the police or clinicians can petition for the guns to be temporarily removed.
Is there evidence that any of these gun-suicide prevention strategies work?
Just about any law that reduces firearm access tends to demonstrate a reduction in firearm suicide. One study from 2004 found that just passing child-access prevention laws – which say that if there’s a kid in the house, you need to keep any guns locked up – reduced suicide rates among teenagers by 8%.
There was a really good study in 2017, looking at Connecticut’s extreme-risk protection law, and it found that for every 10 or 11 guns seized by a risk warrant, there was one life saved from firearm suicide. Another study found that Indiana’s extreme-risk protection law reduced firearm suicide by 7.5% over 10 years, without any increase in other means of suicide.
That’s pretty good. You wouldn’t want to use these laws if you didn’t have evidence they worked, because you’re impacting someone’s constitutional right.
It was really after the 2018 Parkland school shooting that many other states started passing these laws, and the intent for most of the legislators was to prevent mass shootings. There’s also been evidence that these laws work to prevent mass shootings, but it’s in suicide that we really see their effects, because the majority of gun deaths are suicides.
The suicide rate in the US has risen in recent years. Are the demographics of who is at risk changing?
White Americans have had about twice the rate of suicide of Black, Latino or Asian populations. Indigenous people also have a really high suicide rate. In 2021, we saw the largest single-year increase in suicide in the general population since the year 2000. And there was a 16% increase in Black suicide, by far the largest increase in Black suicide we’ve ever seen. In particular, firearm suicide in Black Americans skyrocketed. That’s what drove the entire increase.
What do we know about what might be driving the increase in gun suicide?
I think the simplest answer is: there are more guns in this country now. There was a dramatic increase in firearm purchasing in 2020, starting in March, with the pandemic. Firearm sales were record-breaking all through 2020 and 2021.
We’ve seen spikes in gun purchasing in the past, like when Barack Obama was elected, but those had tended to be people who already owned guns who were buying their 12th or 13th gun. The gun purchasers in 2020 and 2021 were much more new gun owners. They were much more in blue states than in red states. Studies found that more of these gun owners were Black, and more were living in urban settings. It was a different kind of gun owner. And those were exactly the populations that saw an increase in firearm suicide.
How significant a role does mental health play in gun suicide, versus gun homicide?
Even if we were to remove all firearm homicides that involve mental illness, that would barely make a dent in firearm homicides in this country.
Most gun deaths are actually suicides. And about 90% of people who die by suicide have some form of mental illness that contributed to their suicide deaths.
About 1% to 5% of people with depression per year will die by suicide. That’s approximately 1% to 3% of the US population.
Substance dependance adds a lot of risk. Ten percent of people with schizophrenia will die by suicide, which is a lot. Also, people with anorexia or other eating disorders have a very high suicide rate. People don’t often think of this, but people with dementia and Parkinson’s have tremendously high suicide rates, especially early in the diagnosis. It’s really something we have to pay attention to.
Mass shootings and other interpersonal violence are incredibly tragic, and very much need to be focused on. But the things that we can to do prevent suicide deaths with guns will potentially save the most lives.
This is part of an ongoing interview series on the connections between mental health and gun violence. Read the first installment on why it’s “misleading and counterproductive” to blame mass shootings on mental health here.
• In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org or text HOME to 741741 to connect with a crisis counselor. In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
