Firearm Suicides in Minnesota

Key Facts:

• Firearm suicide is a public health crisis.¹ More than 24,000 individuals in the United States died by firearm suicide in 2018²; the rate of firearm suicide in the United States is 10 times higher than that of other high-income countries.^1,3 In Minnesota, there were 356 firearm suicides in 2018, or nearly one per day.⁴ This amounts to 82% of firearm deaths being attributable to suicide in Minnesota.² Firearm suicide rates have been increasing: between 2009 and 2018, the age- adjusted firearm suicide rate increased by 19% in the United States and by 24% in Minnesota.²
• White males are at increased risk of firearm suicide, both nationally⁵ and in our state.⁴ Thus, in 2018, 87% of firearm suicides in Minnesota were among non-Hispanic white males.² In the United States, firearm suicide rates among this demographic group increase with age starting in adolescence, with a particularly sharp rise after the age of 70.5 Likewise, in Minnesota among this demographic group, the highest firearm suicide rates are observed among those over the age of 75.²
• In the United States, the case-fatality rate of suicidal acts overall is less than 10%, whereas the case-fatality rate of suicidal acts with a firearm is nearly 90%.⁶ (Thus, firearms are used in less than 5% of all suicide attempts but in more than 50% of fatal suicide attempts.⁶ Suicidal crises are often self-limiting, suicide attempts are often impulsive acts, and the vast majority (90%) of those who survive a such an attempt do not subsequently die by suicide.^7,8 It thus stands to reason that reducing access to the most lethal method of self-injury among individuals in suicidal crisis is very likely to save lives.⁷ Indeed, the public health research bears this out: For example, in a summary analysis (meta-analysis) of 14 epidemiologic studies, the presence of guns in the home was found to be associated with a three-fold increase in the risk of suicide.⁹ Individuals living in US states with high gun ownership levels have a higher risk of suicide (and specifically firearm suicide) than those living in states with low gun ownership levels, even after controlling for other factors such as mental illness and drug and alcohol abuse.¹⁰
• All firearms within a home should be stored locked and unloaded, and ammunition should be stored and locked separately.^8,11 Studies indicate that these practices reduce the risk of firearm suicide.⁸ For Protect Minnesota 2020 Issue Summary individuals at increased risk of suicide, offsite storage of firearms may be the safest approach.¹¹ There are many resources available that present options for storage, both within and outside the home.¹¹
• Several types of gun policies can play an important role in reducing firearm suicide rates. Regarding criminal background check policy, implementation of a permit-to-purchase law in Connecticut was associated with a 15% reduction in firearm suicide rates, whereas repeal of Missouri’s permit-to-purchase law was associated with a 16% increase.¹² Extreme risk laws provide a mechanism for appropriate parties to petition a court to temporarily limit firearm access among individuals who pose a risk to themselves or others. Studies from Connecticut and Indiana suggest that extreme risk laws reduce firearm suicide rates.^13-15 Other gun policies that have been found to be associated with reductions in the risk of firearm suicide include waiting periods and child access prevention laws.¹⁶ It is essential that Minnesota pass measures such as the criminal background check bill and the extreme risk protection order bill.
• In addition to legislative approaches, other solutions are also worthy of consideration. One example is the Gun Shop Project that encourages gun shop and firing range owners to share suicide prevention information with customers and provides guidance as to how to avoid selling or renting guns to those who are potentially suicidal.¹⁷ The project started in New Hampshire, where half of gun shops there are now disseminating project materials.
• Additionally, it is important for health professionals such as primary care providers and emergency department physicians to educate patients about the connection between firearms and suicide and to screen for access to firearms in the home.⁸ Based on available data, such interventions are effective in terms of reducing access to firearms among those at risk.⁸ There are handouts and other resources available to help health professionals counsel their patients about firearms.¹⁸

If you or someone else is considering suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), which is free and confidential.

REFERENCES

1. Firearm suicide in the United States. Everytown for Gun Safety Support Fund website. https://everytownresearch.org/firearm-suicide/. Published August 30, 2019. Accessed April 27, 2020.
2. Underlying cause of death 1999-2018 on CDC WONDER Online Database,released in 2020. Centers for Disease Control and Prevention, National Center for Health Statistics website. http://wonder.cdc.gov/ucd-icd10.html. Accessed April 27, 2020.
3. Grinshteyn E, Hemenway D. Violent death rates in the US compared to those of the other high-income countries. Prev Med. 2019;123:20-26.doi:10.1016/j.ypmed.2019.02.026.
4. Prevent firearm suicide. Educational Fund to Stop Gun Violence website. https://preventfirearmsuicide.efsgv.org/states/minnesota/. Accessed April 27, 2020.
5. Wintemute GJ. The epidemiology of firearm violence in the twenty-first century United States. Annu Rev Public Health. 2015;36:5-19. doi:10.1146/annurev-publhealth-031914-122535.
6. Connor A, Azrael D, Miller M. Suicide case-fatality rates in the United States, 2007 to 2014: a nationwide population-based study. Ann Intern Med.2019;171:885-895. doi:10.7326/M19-1324.
7. Miller M, Azrael D, Barber C. Suicide mortality in the United States: the importance of attending to method in understanding population-level disparities in the burden of suicide. Annu Rev Public Health. 2012;33:393-408. doi:10.1146/annurev-publhealth-031811-124636.
8. Reducing suicides by firearms. American Public Health Association website. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/28/reducing-suicides-by-firearms. Published November 13, 2018. Accessed April 27, 2020.
9. Anglemyer A, Horvath T, Rutherford G. The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis. Ann Intern Med. 2014;160:101-110. doi:10.7326/M13-1301.
10. Firearm access is a risk factor for suicide. Harvard T.H. Chan School of Public Health website. https://www.hsph.harvard.edu/means-matter/means-matter/risk/. Accessed April 27, 2020.
11. Prevent firearm suicide. Educational Fund to Stop Gun Violence website. https://preventfirearmsuicide.efsgv.org/interventions/individual/. Accessed May 2, 2020.
12. Crifasi CK, Meyers JS, Vernick JS, Webster DW. Effects of changes in permit-to-purchase handgun laws in Connecticut and Missouri on suicide rates. Prev Med. 2015;79:43-49. doi:10.1016/j.ypmed.2015.07.013.
13. Kivisto AJ, Phalen PL. Effects of risk-based firearm seizure laws in Connecticut and Indiana on suicide rates, 1981-2015. Psychiatric Services. 2018;69:855-862. doi:10.1176/appi.ps.201700250.
14. Swanson JW, Easter MM, Alanis-Hirsch K, et al. Criminal justice and suicide outcomes with Indiana’s risk-based gun seizure law. Journal of the American Academy of Psychiatry and the Law Online. 2019;47:188-197. doi:10.29158/JAAPL.003835-19.
15. Swanson JW, Norko MA, Lin H-J, et al. Implementation and Effectiveness of Connecticut’s Risk-Based Gun Removal Law: Does it Prevent Suicides? Law and Contemporary Problems. 2017;80:179-208. http://scholarship.law.duke.edu/lcp/vol80/iss2/8/. Accessed January 26, 2020.
16. Crifasi C. How do gun laws affect suicide rates? Johns Hopkins Bloomberg School of Public Health, Bloomberg American Health Initiative website. https://americanhealth.jhu.edu/article/how-do-gun-laws-affect-suicide-rates. Accessed April 28, 2020.
17. Gun shop project. Harvard T.H. Chan School of Public Health website. https://www.hsph.harvard.edu/means-matter/gun-shop-project/. Accessed April 28, 2020.
18. Firearm injury prevention: resources for health care providers. UC Davis Health website. https://health.ucdavis.edu/what-you-can-do/. Accessed April 28, 2020.