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Abstract
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The United States (US) has seen a continuous rise in suicide rates since 2005, a trend that suggests a general failure of traditional interventions alone. With the dawn of a new decade - and with a global pandemic raising concerns about an impending spike in suicide rates (Gunnell et al., 2020) - comes an opportunity to reflect on past strategies and adjust future directions. Specifically, additional attention to environmental approaches may help reverse the trend of rising rates. Environmental approaches, typically referred to as "means safety," involve making a specific method ("means") for suicide less deadly or less available. In the US, any such approach must focus primarily on firearms, which have the highest case-fatality rate and account for approximately half of all suicide deaths (Conner et al., 2019). Countless questions remain about firearm-focused means safety interventions, including how, where, and with whom to design and implement them (Allchin et al., 2019).
Some answers may come from international experiences in reducing suicide by pesticide ingestion. While suicide rates were increasing in the US, an opposite trend emerged in parts of Asia where pesticide ingestion was a major cause of suicide. Success on this front was achieved largely through bans of several particularly lethal pesticides (Gunnell et al., 2017), highlighting the importance of high-level policy change in effecting widespread change. Yet there were also studies on the effectiveness of safer household pesticide storage, including through provision of lockable storage boxes. Unfortunately - and importantly for the firearm suicide field - randomized controlled trials have not found evidence that these storage interventions reduced pesticide-related suicide rates (Pearson et al., 2017). A 2019 systematic review on pesticide suicide prevention concluded efforts focused on in-home storage should end, with energy instead shifted to community-based, centralized storage options (Reifels et al., 2019). Notably, this systematic review was funded by the pesticide industry and, while methodologically sound, overstated the promise of community-based programming (Knipe and Eddleston, 2019).
The experience from pesticides - that banning certain types had the biggest impact on suicide prevention - might suggest the parallel action of banning certain types of firearms in the US. But such bans are, in 2020, politically unrealistic on a national level and typically only have support in states with low firearm ownership rates (Mann and Michel, 2016). Although public support for certain types of firearm legislation (e.g., banning assault-style weapons or high-capacity magazines) has increased in recent years (Pew Research Center, 2019), persistent political divides are a significant obstacle to implementation (Winker et al., 2020). In the US, there are other types of firearm legislation (e.g. extreme risk protection orders, firearm licensing) that might impact suicide rates (Swanson et al., 2017); however, current political reality renders federal implementation of such laws unlikely...
Language: en |