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Abstract
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Suicide is a leading cause of death in the US, with rising rates in recent decades despite declines in other preventable injury-related deaths, such as motor vehicle crashes. From 2010-2020, among all firearm deaths (n = 45 222 in 2020), 60% were due to suicide, and among all suicides (n = 45 979 in 2020), 51% were due to firearm injury, based on data from the Centers for Disease Control and Prevention (CDC). Also based on CDC data, among youth aged 10 to 19 years who died by suicide (n = 2797 in 2020), 42% used a firearm, almost always one that belonged to a family member.1
Studies have consistently shown that firearm availability increases the risk of suicide, which in part explains why US firearm suicide rates are highest among populations with high ownership rates, including veterans and middle-aged and older white men. Recent changes in US gun purchasing--with increasing ownership among women and Asian, Black, and Hispanic populations2--raise concern about changing suicide risk in these populations.3
Inspired by the success in reducing motor vehicle deaths in the past 3 decades, a similar "public health" approach has been suggested for reducing firearm-related violence, including firearm suicide. Such an approach would be comprehensive and data-informed, and it would include culturally informed interventions that engage health care systems and the firearms community in reducing firearm suicide risk among firearm-exposed communities across a range of suicide risk.
Like other types of gun violence, firearm suicide is preventable. Fewer than 1 in 10 individuals who present to health care services for deliberate self-harm later die by suicide,4 meaning that suicide death among those with elevated risk is not inevitable.
Lethal means safety (LMS)--in which access to firearms and other lethal methods is reduced--is an evidence-based approach to reducing suicide risk.5 For firearms, this means removing firearms from the home or changing home storage so the individual with suicide risk does not have access to these weapons. Ideally, such reductions are voluntary and engage the at-risk person in short-term changes, which allows for the individual at risk to take ownership of their own health while still reducing risk. In this model, LMS is analogous to the concept of a "designated driver" to prevent motor vehicle injuries during a period when a driver is at increased risk of crash. LMS does not negate the need for other aspects of suicide prevention, such as assessment and mitigation of other physical health, mental health, or social risk factors. Rather, it reduces the odds that someone with suicidal intent or in crisis can lethally harm themself.
In clinical settings, LMS is an essential element of evidence-based suicide prevention programs because (1) clinicians are already charged with assessing and mitigating suicide risk across varied patient populations and settings; (2) an estimated 80% of individuals who die by suicide engage with the health care system in the year prior to death6; and (3) clinician-delivered interventions are effective in motivating secure firearm storage practices...
Language: en |