Nov. 17, 1999 (Cleveland) -- The purchase of a handgun is associated with an increased risk for suicide by any method, but when a woman purchases a handgun it is tantamount to stepping before a firing squad, says Garen J. Wintemute, MD, MPH. Wintemute's study of the impact of firearm purchase on mortality appears in Thursday's issue of TheNew England Journal of Medicine.
"We were astonished to see an almost 40-fold increase in the risk for gun suicide in the first year after [women] buy a gun," Wintemute tells WebMD. "The increase lasted for the 6 years of the study. And a woman's risk of homicide from a gun was doubled, suggesting for me that women who may be under threat or stress from partner abuse are purchasing a gun for self-protection ... but the purchase adds to the threat."
Wintemute, a professor of epidemiology and preventive medicine and the director of the violence prevention program at the University of California, Davis, and his team conducted a study of mortality among more than 230,000 people in California who purchased a handgun in 1991. In California, the state requires a 15-day waiting period for handgun purchases, so the observation period began when the buyer took possession of the gun and continued through Dec. 31, 1996.
Wintemute says that during the first year of handgun ownership, "suicide was the leading cause of death for the buyers, accounting for 24.5% of all deaths and 52% of deaths among women aged 21 to 44." In the first week after buying a gun, the rate of suicide among new gun owners was 57 times as high as the adjusted rate in the general population. Compared to the general population, handgun purchasers continued to be at higher risk for suicide by a handgun during the 6 years of the study.
According to Wintemute, the greatly increased risk of gun suicide following purchase might lead some to suggest the use of a screening tool to identify suicidal ideation or intent. "But," he says. "even if the screening test were 99% sensitive and 99% specific -- and there is no such test -- only 7% of the people who committed suicide would have been identified. For every person correctly labeled, 13 would be falsely identified. That's a screening that just won't fly."
A better approach to reducing handgun suicide, says Wintemute, is to reduce the availability of the means to commit suicide rather than focusing on high risk people. "A good example is coal-heating gas in England. There were many suicides by coal gas because there was easy access and it was simple. When it was replaced by a less lethal gas, suicides by gassing went down and suicides by other means didn't increase."
He says that similar examples can be seen in New York, where handguns have always been tightly controlled and where handgun suicides are low, or in Washington, D.C., where handgun controls were instituted in the 1970s. "Gun suicide went down 25% and suicide by other methods didn't go up," he says.
Wintemute also says other suicide methods are unlikely to replace gun suicide because "guns are easier than other methods. It is easier to get a gun than it is to get pharmaceuticals in lethal quantities. ... It takes skill to hang one's self, using a gun is over quicker, a jumper may have time to contemplate. The fact is that about 10% of suicide attempts with pharmaceuticals are fatal; when you use a firearm more than 90% are fatal. It just reverses the ratio."
In an editorial accompanying the article, Mark L. Rosenberg MD, MPP, of the Collaborative Center for Child Well-being in Decatur, Georgia; James A. Mercy, PhD, of the Medical College of Wisconsin at Milwaukee; and Lloyd B. Potter, PhD, MPH, of the CDC, write that it is "no longer a question of whether we should apply science to the problem of firearm-related injuries, but how we should do so in the effort to prevent such injuries."
Robert K. Musil, PhD, executive director of Physician for Social Responsibility (PSR), says PSR has "known for a long time that in terms of gun violence the largest number of deaths are from suicide by firearm, not homicide." Musil tells WebMD that even in 1993, when death from guns used in crime hit an all time high, the number of deaths from gun suicide were higher.
PSR is supporting a new national gun buy back bill scheduled expected to be introduced Wednesday by Illinois Democratic Sen. Richard Durbin.
Musil says that PSR wants "the gun debate framed as a public health issue, not as a crime issue. In our view, keeping guns out of homes is a key element in reducing the risk of gun death or injury."
PSR recently supported a gun buy back program in Washington, D.C., that Musil says resulted in 3,000 guns being turned in. "We hope to replicate this program nationally." He says that guns acquired in the PSR-sponsored buy back were destroyed and persons who turned in guns were given coupons for services, not money. "An early criticism of gun buy backs was that the money was used to buy new weapons."
- In terms of gun violence, suicide, not homicide, is the leading cause of death.
- During the first year of handgun ownership, suicide is the leading cause of death, an association that is even more pronounced in women.