Understanding Risk and Implementing Data-Driven Solutions for Firearm Suicide

Published date01 November 2022
AuthorMichael D. Anestis,Allison E. Bond,Shelby L. Bandel
Date01 November 2022
Subject MatterThe Efficacy of Interventions
204 ANNALS, AAPSS, 704, November 2022
DOI: 10.1177/00027162231173321
Risk and
Solutions for
Firearm Suicide
Each year, firearms account for half of all the suicide
deaths in the U.S. Research has shown that, worldwide,
the most effective way to prevent suicide is so-called
means safety: making the tools and methods of suicide
less accessible and less lethal. In the U.S., research has
shown, time and again, that access to firearms increases
the risk for suicide death, particularly when firearms
are not stored safely. Means safety, therefore, could be
a powerful tool in reducing suicide deaths in America,
where firearms are highly lethal, widely available, and
frequently used within a specific geographic area. For
this nation to sustainably lower its suicide rate, the issue
of access to firearms is pivotal. We argue for a public
health approach to suicide prevention: one that would
improve data linkage; promote the effective upstream
use of interventions like lethal means counseling and
safe firearm storage messaging; and deploy more sys-
tematic efforts to identify and understand subcommu-
nities of firearm owners, including those who obtained
their firearms illegally.
Keywords: suicide; means safety; firearms; secure
storage; means restriction
Of the 45,979 individuals who died by sui-
cide in the U.S. in 2020, 24,292 (52.8
Correspondence: mda141@sph.rutgers.edu
Michael D. Anestis is the executive director of the New
Jersey Gun Violence Research Center and an associate
professor in the Department of Urban-Global Public
Health at Rutgers. His research interests include fire-
arm suicide prevention within both military and civil-
ian populations.
Allison E. Bond is a clinical psychology PhD student at
Rutgers University and is a graduate research assistant
at the New Jersey Gun Violence Research Center. Her
research interests include firearm suicide prevention,
with a particular focus on effective messaging to pro-
mote secure firearm storage.
Shelby L. Bandel is a clinical psychology PhD student
at Rutgers University and is a graduate research assis-
tant at the New Jersey Gun Violence Research Center.
Her research interests include firearm suicide preven-
tion as well as societal and demographic factors associ-
ated with secure firearm storage.
percent) died as the result of self-inflicted gunshot wounds (Centers for Disease
Control and Prevention [CDC] 2022)—this, despite the fact that firearms are
used in fewer than 5 percent of all suicide attempts nationwide (CDC 2022).
That is, when individuals attempt suicide in the U.S., they rarely opt to use a
firearm; yet, when an individual dies by suicide, more often than not a firearm is
the cause of death. This disparity in frequency of use and proportion of deaths
accounted for can be explained in large part by the uniquely high fatality rate of
firearms, which is estimated at 85 to 95 percent, as compared to fewer than 5
percent for all other methods combined (e.g., Spicer and Miller 2000).
As with other forms of gun violence, our ability to effectively address the issue
of firearm suicide has been hindered by a lack of federal research funding, which
severely limited scientific investigations until funding lines began emerging only
in recent years. Despite this substantial obstacle, a growing body of research has
helped clarify the ways in which firearms contribute to suicide risk in specific
communities and has indicated steps that can be taken to mitigate that risk. In
this article, we outline the nature of firearm suicide risk and the existing tools that
have proven useful in preventing firearm suicide. Further, we outline and argue
for a public health approach centered on more robust data and effective messag-
ing as a path towards making substantially more progress in preventing firearm
The Magnitude of the Problem of Firearm Suicide
Although often overlooked in conversations about gun violence, firearm suicide
accounted for a nearly identical number of deaths as homicide by all methods
combined in 2020 (24,292 vs. 24,576) and represented a death count 25.3 per-
cent higher than that of the 19,384 firearm homicide deaths that year (CDC
2022). The sheer number of deaths highlights that firearm suicide is a profound
public health concern in need of greater attention nationwide.
The age-adjusted firearm suicide rate in 2020—6.93 per 100,000—represents
a 17.9 percent increase over the rate 20 years earlier, and a recent plateau in the
national firearm suicide rate marks a modest shift from a trend of annual
increases that began around the turn of the twenty-first century. Throughout this
time, firearms have consistently accounted for approximately half of all U.S. sui-
cide deaths. Moreover, firearm suicides have accounted for nearly two-thirds of
all U.S. firearm deaths. Table 1 shows shifts in the age-adjusted firearm suicide
rate by sex and age cohort between 2000 and 2020 and highlights stark increases
for several groups over this time period.
The disproportionate role of firearms in U.S. suicides can be explained largely
by this method’s uniquely high case fatality rate. Using the National Vital
Statistics System, Conner, Azrael, and Miller (2019) examined records from
309,377 U.S. suicide decedents and found that firearms have an 89.6 percent
case fatality rate, as compared to 56.4 percent for drowning, 52.7 percent for
hanging, 30.5 percent for gas, 27.9 percent for jumping, and only 1.9 percent for

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