Running head: GUN RELATED SUICIDE 1

Culminating Experience: Reducing Gun Related Suicide Through Policy

Ashley Turner

Azusa Pacific University College

GUN RELATED SUICIDE 2

Abstract

Suicide remains a pressing public health issues that needs to be addressed. It remains one of the

leading causes of deaths among the general population both in the United States and across the

globe. While means of suicide differs from individual to individual, research has shown that

firearms have been the main method used to commit suicide. There is a current epidemic within

the United States concerning guns and gun-related violence. Specifically, this epidemic is rooted

in gun-related suicides. In all 50 states and the District of Columbia, guns are readily available

for purchase. Even with the implementation of some gun laws, suicide by self-inflicted gun

wounds still remains high. The lack of consistent gun laws throughout all 50 states and the

District of Columbia remain a challenge to the reduction of gun-related suicides. The purpose of

this research was to determine the role federal gun laws played in reducing gun related suicides

and whether states should be encouraged to implement such laws. Key informant interviews with

educators, students, and military members suggest different views on how gun-related suicides

should be dealt with. These interviews, graphic visuals, and the work of the Brady Campaign can

help develop successful policies to decrease gun-related suicides.

GUN RELATED SUICIDE 3

Culminating Experience: Reducing Gun Related Suicide Through Policy

Suicide is a public health issue within the United States. In 2017, approximately 47,000

individuals committed suicide. Out of these 47,000, 20,000 used guns (Brady, 2018). While

means of suicide tends to differ from individual to individual, the use of firearms to commit

suicide remains the most prominent means of suicide (Anestis & Anestis, 2015). Currently,

suicide is the tenth leading cause of death within the United States, constituting a public health

concern. When it comes to firearms and suicide, this method has the highest rate of completion

and is typically utilized impulsively. Regardless of means of suicide, policy measures are needed

in order to decrease the rates of suicide within the country.

Literature Review

Firearm ownership plays a role in the rate of gun-related suicides. In the United States

alone, 37% of Americans own a firearm (Butterworth et. al., 2017). Firearm ownership also

differs from region to region in the United States. The Southern region owns the highest amount

of firearms at 29% while the Northeast region owns the lowest amount at 17% (Butterworth et.

al., 2017). From a racial and gender perspective, 82% of all gun owners are Caucasian and men

are three times more likely than women to own a gun (Butterworth et. al., 2017).

Gun-related suicides account for the majority of suicides within the United States.

Approximately 51% of all suicides are a result of guns (Anestis & Anestis, 2015). Gun suicides

account for more deaths annually than all the fatal traffic accidents in this country (Anestis &

Anestis, 2015). On a global scale, the United States has the highest gun-related suicide rates out

of all Western countries, with rates of gun-related suicides declining in these other countries

(Ajdacic-Gross et. al., 2006). In the United States, gun-related suicides are said to increase

within the week a handgun has been purchased (Anestis et. al., 2015).
GUN RELATED SUICIDE 4

Three factors have been identified for the increase and decision to use firearms as a

means of suicide. Firearms are widely available within the United States both legally and

illegally (Brady, 2018). When firearms are readily available to access in the home, there is a

dramatic increase in the likelihood that a firearm will be used for suicide (Butterworth et. al.,

2017). Another factor to consider is the lethality of the means of suicide. Using a firearm means

that the individual is less likely to survive or be interrupted (Brady, 2018). In conjunction with

the second factor, the third factor – impulsivity – makes it extremely difficult for those using

firearms to commit suicide to change their mind (Brady, 2018).

Epidemiological Burden

Suicide can occur by any means, however, based on impulsivity, firearms are the favored

method. The percentage of suicide attempts by means other than firearm is 84% drowning, 82%

hanging, and poisoning with drugs accounting for 74% (Lewiecki & Miller, 2013). However,

only 14% of these suicide attempts result in fatalities (Lewiecki & Miller, 2013). When it comes

to gun-related suicides, fatalities result 85% of the time, showing just how lethal firearms can be

when compared to other methods (Brady, 2018).

Methodology

An analysis of 2017 fatal injury reports was gathered using the Centers for Disease

Control and Prevention WONDER Online Database in order to study the trends in firearm

suicides throughout the United States. This information, in conjunction with information from

the Brady Campaign as well as information from key informant interviews allowed for the

recommendation of certain gun policies. Table A1 provides a visual of the population of each

state in 2017, the overall suicide rate, suicide rate by gun, and the rank of each state from highest

to lowest. The District of Columbia ranked 51 out of all states with no gun-related suicides while
GUN RELATED SUICIDE 5

Montana was ranked first with the highest number of gun-related suicides nationwide (Table

A1). Figure B1 provides a graphic visualization of the overall suicide rates compared to the

suicide rate by firearm.

At the federal level, there are multiple gun laws in place, however, not every state

imposes them. Table A2 provides a summary of six major federal gun laws that each state is

supposed to follow. Figure C3 provides a graphic of how many states implement these laws and

how many do not impose them on their population. Based on this information, Table A2 was

created to show the ten states with the lowest gun-related suicides as well as which laws are

implemented. States that implemented one of the federal laws was coded 1 for yes and those that

did not implement the laws were coded 0 for no. Figure B3 provides a graphic of this table,

indicating that states that implemented the background check law plus any of the other five laws

had low gun-related suicide rates.

Target Demographics

Three target demographics were discovered during this study. Each group provides its

own numbers regarding suicide rate by gun, however, the total suicide rate by gun was used to

provide a total overview of how pertinent this issue is to public health. The three groups –

adolescents, military service people, and men – illustrate the importance of comprehensive gun

policies that will not only decrease the overall suicide by firearm rate but will also provide

insight into how to help each target group on a micro scale.

Adolescents.

Easy access to firearms increases the risks of gun-related suicide by adolescents.

Approximately 4.6 million adolescents have access to unlocked and loaded guns in their homes,
GUN RELATED SUICIDE 6

with 57% of this group using a gun owned by a family member (Brady, 2018, Johnson et. al.,

2010). In many states there are laws requiring gun owners to lock their firearms and store

ammunition in separate areas to prevent child access. However, most states do not enforce this

law.

Military.

Military service people often times return from duty with some form of mental illness

that is often times left untreated. In 2012, the suicide rate in the military was 81.6% higher than

that of the general population (Anestis & Green, 2015). For this population, access to firearms is

extremely high and often times unpreventable. Even during service, military service people have

around the clock access to firearms as a part of their military duties (Anestis & Green, 2015).

Men.

Men are more likely to commit suicide regardless of the method. When looking at gun-

related suicides, 85% of victims are men (Brady, 2018). This group is also three times more

likely to own a firearm (Butterworth et. al., 2017). Elderly men are also more likely to commit

suicide by firearm than their female counterparts.

Conclusion and Recommendations

The Brady Campaign has worked with politicians and the general population to not only

bring about awareness to gun violence but to show the benefits of policy to reduce gun-related

suicides. Gun-related suicides continue to increase, triggering a nationwide public health

epidemic that needs to be swiftly addressed. From the data collected, it is evident that the current

federal laws do in fact work to reduce gun-related suicides. In the ten states with the lowest rate

of gun-related suicides, the law regarding background checks were implemented, with most

background checks taking an average of four days to complete. These ten states also
GUN RELATED SUICIDE 7

implemented at least two other federal laws along with background checks. This method used by

the states prevents quick and easy access to the purchasing of firearms. In respect to gun-related

suicide, this method by these states works as a deterrent, allowing suicidal individuals to seek

mental health assistance. Even when firearms were no longer available for suicide, research has

shown that there is no method substitution and the likelihood of a suicide attempt occurring is

decreased or will increase the likelihood of surviving a suicide attempt (Butterworth et. al., 2017,

Lewiecki & Miller, 2013).

Current policies are beneficial both in the short and long term. In the short term,

encouraging and providing access to mental health treatment would reduce the likelihood of

suicides. According to Brady (2018), 45% of people who committed suicide by firearm had

contact with a primary care physician a month before their death. Policies that provide

continuing education training to physicians would help encourage discussion about suicide

ideation as well as firearms with patients. In the long term, federal laws and policies must be

implemented in each state. Currently, even though there are federal gun laws in place, not every

state acknowledges them. In order to reduce gun-related suicides in the long term, policymakers

need to ensure that all federal laws are implemented by each state.

The purpose of this research was to determine if gun-related suicides could in fact be

reduced by policies. Based on the data collected, it is clear that the implementation of current

firearm legislation has in fact reduced this public health epidemic in ten states. Data also

provides insight into ways in which policy and the Second Amendment can coexist while

reaching the goal of decreasing gun-related suicides. The actions of the Brady Campaign and

public health ambassadors exemplifies the need to educate and address the needs of target

populations by using successful policies already at work.

GUN RELATED SUICIDE 8

References

Ajdacic-Gross, V., Killias, M., Hepp, U., Gadola, E., Bopp, M., Lauber, C., . . . Rössler,, W.

(2006). Changing Times: A Longitudinal Analysis of International Firearm Suicide

Data. American Journal of Public Health,96, 1752-1755.

Anestis, M. D., & Anestis, J. C. (2015). Suicide Rates and State Laws Regulating Access and

Exposure to Handguns. American Journal of Public Health,105(10), 2049-2058.

Anestis, M. D., & Green, B. A. (2015). The Impact of Varying Levels of Confidentiality on

Disclosure of Suicidal Thoughts in a Sample of United States National Guard

Personnel. Journal of Clinical Psychology,71(10), 1023-1030.

Anestis, M. D., Khazem, L. R., Law, K. C., Houtsma, C., Letard, R., Moberg, F., & Martin, R.

(2015). The Association Between State Laws Regulating Handgun Ownership and

Statewide Suicide Rates. American Journal of Public Health,105(10), 2059-2067.

Anestis, M. D., Selby, E. A., & Butterworth, S. E. (2017). Rising longitudinal trajectories in

suicide rates: The role of firearm suicide rates and firearm legislation. Preventive

Medicine,100, 159-166.

Brady. (2018). The truth about suicide and guns. Retrieved from https://brady-

static.s3.amazonaws.com/Brady-Report-Suicide-and-Guns.pdf

Butterworth, S. E., Houtsma, C., Anestis, J. C., & Anestis, M. D. (2017). Investigating the

Relationship Between Social and Economic Policy Views, Firearm Ownership, and

Death by Firearm in a Sample of Suicide Decedents. Archives of Suicide Research,22(3),

420-431.

Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying

Cause of Death 1999-2017 on CDC WONDER Online Database, released December,

GUN RELATED SUICIDE 9

2018. Data are from the Multiple Cause of Death Files, 1999-2017, as compiled from

data provided by the 57 vital statistics jurisdictions through the Vital Statistics

Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html

Johnson, R. M., Barber, C., Azrael, D., Clark, D. E., & Hemenway, D. (2010). Who are the

Owners of Firearms Used in Adolescent Suicides? Suicide and Life-Threatening

Behavior,40(6), 609-611.

Lewiecki, M., & Miller, S. (2013). Suicide, Guns, and Public Policy. American Journal of Public

Health,103.

NRA. (2014). NRA-ILA. Retrieved from https://www.nraila.org/

Runyan, C. W., Brown, T. L., & Brooks-Russell, A. (2015). Preventing the invisible plague of

firearm suicide. American Journal of Orthopsychiatry,85(3), 221-224.

GUN RELATED SUICIDE 10

Appendix A

Table A1

Suicide in the United States: Overall Rate vs. Rate by Gun (CDC, 2017)

State 2017 Suicide Rate 2017 Suicide Rate by Gun Rank

Alabama 16.6 11.75 24
Alaska 27 16.09 2
Arizona 18.2 11.29 20
Arkansas 20.8 13.05 9
California 10.5 4.07 45
Colorado 20.3 10.56 10
Connecticut 10.5 3.04 46
Delaware 11.6 5.2 43
District of Columbia 6.9 0 51
Florida 14 8.21 37
Georgia 13.6 8.71 39
Hawaii 15.2 2.1 28
Idaho 23.2 14.21 5
Illinois 11.2 4.51 44
Indiana 16.3 9.06 25
Iowa 15 7.06 30
Kansas 19.1 10.85 13
Kentucky 16.9 10.55 21
Louisiana 15.2 9.48 29
Maine 18.9 11.3 16
Maryland 9.8 4.48 47
Massachusetts 9.5 2.22 48
Michigan 14.1 6.85 36
Minnesota 13.8 6.55 38
Mississippi 15 9.89 31
Missouri 18.5 11.47 18
Montana 28.9 20.28 1
Nebraska 14.7 6.56 34
Nevada 20.3 10.97 11
New Hampshire 18.9 9.83 17
New Jersey 8.3 2.27 49
GUN RELATED SUICIDE 11

New Mexico 23.3 12.5 4

New York 8.1 2.18 50
North Carolina 14.3 8.18 35
North Dakota 20.1 12.31 12
Ohio 14.8 7.87 33
Oklahoma 19.1 11.17 14
Oregon 19 10.6 15
Pennsylvania 15 7.75 32
Rhode Island 11.8 3.11 42
South Carolina 16.3 10.57 26
South Dakota 22.5 9.54 7
Tennessee 16.8 10.59 23
Texas 13.4 7.62 40
Utah 22.7 11.09 6
Vermont 18.3 9.94 19
Virginia 13.4 7.93 41
Washington 16.9 8.63 22
West Virginia 21.2 14.7 8
Wisconsin 15.4 7.51 27
Wyoming 26.9 17.09 3
GUN RELATED SUICIDE 12

Table A2

States with 6 Federal Gun Laws in Place (NRA, 2014)

Waiting Background Locking Permit to Registration of License

State Period Check Device Purchase Handgun to Own

Alabama No No No No No No

Alaska No No No No No No

Arizona No No No No No No

Arkansas No No No No No No

California Yes Yes Yes Yes Yes No

Colorado No Yes No No No No

Connecticut Yes Yes Yes Yes Yes Yes

Delaware No Yes No No No No

District of

Columbia Yes Yes Yes No Yes No

Florida Yes No No No No No

Georgia No No No No No No

Hawaii Yes Yes No Yes Yes No

Idaho No No No No No No

Illinois Yes Yes Yes Yes No Yes

Indiana No No No No No No
GUN RELATED SUICIDE 13

Iowa Yes No No Yes No No

Kansas No No No No No No

Kentucky No No No No No No

Louisiana No No No No No No

Maine No No No No No No

Maryland Yes Yes Yes Yes Yes Yes

Massachusetts No Yes Yes Yes No Yes

Michigan No Yes Yes Yes Yes No

Minnesota Yes Yes No Yes No No

Mississippi No No No No No No

Missouri No Yes No No No No

Montana No No No No No No

Nebraska No Yes No Yes No No

Nevada No No No No No No

New Hampshire No No No No No No

New Jersey Yes Yes Yes Yes No Yes

New Mexico No No No No No No

New York No Yes Yes Yes Yes Yes

North Carolina No No No Yes No No

North Dakota No No No No No No
GUN RELATED SUICIDE 14

Ohio No No Yes No No No

Oklahoma No No No No No No

Oregon No Yes No No No No

Pennsylvania No Yes Yes No No No

Rhode Island Yes Yes Yes No No No

South Carolina No No No No No No

South Dakota No No No No No No

Tennessee No Yes No No No No

Texas No No No No No No

Utah No Yes No No No No

Vermont No Yes No No No No

Virginia No Yes No No No No

Washington No Yes No No No No

West Virginia No No No No No No

Wisconsin No Yes No No No No

Wyoming No No No No No No
GUN RELATED SUICIDE 15

Table A3

10 Lowest Gun-Related Suicides with 6 Federal Laws in Place

Permit to Registration of License Waiting Background Locking

State Purchase Handgun to Own Period Check Device
District of
Columbia 0 1 0 1 1 1
Hawaii 1 1 0 1 1 0
Massachusetts 1 0 1 0 1 1
New York 1 1 1 0 1 1
New Jersey 1 0 1 1 1 1
Connecticut 1 1 1 1 1 1
Rhode Island 0 0 0 1 1 1
California 1 1 0 1 1 1
Illinois 1 0 1 1 1 1
Maryland 1 1 1 1 1 1
*1= yes the law is implemented; 0= no the law is not implemented
GUN RELATED SUICIDE 16

Appendix B

2017 Suicide Rate Suicide Rate by Gun

60

50

40

30

20

10

Figure B1: 2017 Overall Suicide Rates vs. Suicide Rate by Gun
GUN RELATED SUICIDE 17

4
Locking Device
Background Check
3
Waiting Period
License to Own
2
Registration of Handgun
Permit to Purchase
1

Figure B2: 10 States with Lowest Rates of Suicide by Firearm and 6 Federal Laws in Place
GUN RELATED SUICIDE 18

Figure B3: 6 Federal Laws in the United States

GUN RELATED SUICIDE 19

Appendix C

Interview C1

Name: James Huerta

1. How long have you worked in education?

-This is my 11th year of teaching

2. Have you ever come into contact with guns? In what capacity?

- I have come into contact with guns. But not as a teacher. - while a teen I was hanging

out the house of an acquaintance and someone pulled a gun on another person.

3. During your time in education, how many times if any have you dealt with or heard of

gun related violence among students?

- I have not heard of many cases of gun related violence among my students. While in

Mexico a student of mine was kidnapped at gunpoint. But other than that -that is all i can

remember.

4. What is your view on gun violence?

- Gun violence is a result of a really American mentality. We all have this Wild West

mentality and feel we have to defend ourselves against some outside invasion.

5. Have you known any students who were victims of gun related violence?

- I have not known of any of my students being victims of gun related violence.

6. Do you know someone (personally or indirectly) who has committed suicide? Was it gun

related? Were they considered youth?

- Yes. A cousin on my mother’s side committed suicide by shooting himself. But not

considered youth.
GUN RELATED SUICIDE 20

7. Based on your time as an educator, do you think there is an issue with gun related

suicides among youth? If so, in what capacity? If not, why do you think gun related

suicides among youth are low? How do you think schools could reduce gun related suicides

among youth?

- I have not seen much gun related violence. But I think that is more the result of the

places I’ve worked and maybe not the majority. I believe one of the leading causes of

death for adolescent boys is suicide.

8. What recommendations would you give for reducing gun related suicides?

- Need more school psychologists. Need more mental health services within schools.

Need to consider better academic routes for students to avoid stress.

GUN RELATED SUICIDE 21

Interview C2

Name: Christine Para

1. How long have you been a student?

- Cumulative 9 years (6 years undergrad & 3 years associates)

A. Degrees?

- Bachelor of Science in Business Administration concentration Cybersecurity /

Associates of Applied Sciences in Nursing

2. Have you ever come into contact with guns?

-Yes

A. In what capacity?

- In the home, practice in shooting range. My boyfriend is a police officer and we have

firearms in the home.

3. What is your view on gun violence?

- I feel that it’s unfortunate and wish we never had them in the first place. I see gun

violence as a symptom of a disease in society and individually in a person.

4. Have you known anyone who was a victim to gun related violence?

-Yes

5. Do you know someone (personally or indirectly) who has committed suicide?

-Yes indirectly

A. Was is gun related?

- Boyfriends friend committed suicide by gunshot

6. Based on your role as a student, how do you perceive the issue of gun related suicides?
GUN RELATED SUICIDE 22

- I’m currently a nursing student, so I have a clinical rotation completed in a psych unit. I

feel that some gun related suicides are somewhat preventable, in that if we treat issue, we

can prevent that outcome. Depression, Psychosis, or an underlying mental illness can lead

to suicidal ideations. Unfortunately, medications that also treat mental issues can also

cause suicide ideations on their own. I think the United States especially pressures the

availability of guns and gun rights but is in denial of mental illness, or even just the

mental wellbeing of the everyday person. We’re pressured to work hard at a job,

essentially breaking down our bodies and minds for someone else’s overall gain.

7. What recommendations would you give for reducing gun related suicides?

- Funding for psych health, shorter workweeks, and bringing focus to the self. Treat the

root of suicide and also the root of gun violence. Promote tolerance of others and

celebrate differences. Raise awareness to warning signs and promote the idea of

“community” and communication. Restrict lenient gun sale rules at events such as at gun

shows.
GUN RELATED SUICIDE 23

Interview C3

Name: Caroline Sweeney

1. How long have you worked in education?

-19 years

2. Have you ever come into contact with guns?

-yes

A. In what capacity?

-at work, not including police officers

3. During your time in education, how many times if any have you dealt with or heard of

gun related violence among students?

-50 instances but not necessarily while they were still my student but were in the

description of the incident; most past students

4. What is your view on gun violence?

-preventable, but how preventable I don’t know. Not guns received legally. Received

legally is preventable part. Society flush with weapons and not difficult to get a gun

which is a problem.

5. Have you known any students who were victims of gun related violence?

-yes multiple, 5 deaths in last year

6. Do you know someone (personally or indirectly) who has committed suicide?

-yes

A. Was it gun related?

-no

B. Were they considered youth?

GUN RELATED SUICIDE 24

-three were

7. Based on your time as an educator, do you think there is an issue with gun related

suicides among youth?

-no

A. If so, in what capacity?

B. If not, why do you think gun related suicides among youth are low?

-I associate guns with violent acts like homicide and robbery, not to say suicide isn’t a

violent act, but when I think of guns I think about guns pointed at others. All suicides that

I have been acquainted with have been based on other means like hangings or jumping.

C. How do you think schools could reduce gun related suicides among youth?

-limit access, no child should have access to guns/gun safe

8. What recommendations would you give for reducing gun related suicides?

-prevent access to guns by children. No one under the age of 21 should have access.
GUN RELATED SUICIDE 25

Name: Shanowa De La Cruz

1. What is/was your rank and how long did you serve?

-Sergeant E5 and I served for 9 years

2. How often did you work with guns?

A. In what capacity?

-I worked with weapons weekly. We would have ranges throughout the month and on my

own personal time I would go to the local range and target practice along with safety

measures. Assembling and disassembling my weapon

-Mostly with the Army and when I had time on my own.

3. How often did you come into contact with guns outside of work?

A. In what capacity?

- Daily we had to inventory weapons that we had in our Armory

4. What is your view on gun violence?

- I don't believe that it is a Gun issue more of a people one. I had able Men and women

handle weapons of almost every caliber. I never had an incident. Now do I believe that

guns in the wrong hands are dangerous of course. But so are any object used to inflict

harm.

5. Do you know someone through work who was involved in any form of gun violence?

- I have never come in contact or know anyone who has been harmed by a gun

6. Do you know someone (personally or indirectly) who has committed suicide?

A. Was it gun related?

- Yes I know quite a few men and women who have attempted or successfully committed

suicide. One suicide was gun related others were by over dosing and bleeding out.
GUN RELATED SUICIDE 26

7. How do you perceive the issue of gun related suicides given your time in the military?

-A person who is mentally ill enough to commit suicide will do so no matter what the

weapon. Mental health should be the focus for this country especially those Hero's who

have come home with PTSD. Help should be available with no Reprisals

8. What recommendations would you give for reducing gun related suicides in the military?

- Again mental health programs. Ones that won't label a Soldier. But will help with the

PTSD from war, from the home front. Whatever it maybe