Gun Violence in Indiana Focus on Suicide Stephen

Gun Violence in Indiana Focus on Suicide Stephen Dunlop, MD President Hoosiers Concerned About Gun Violence 3535 Kessler Blvd. , North Drive Indianapolis, IN 46222 info@hcgv. org Suicide Prevention, April 3, 2008

Guns and Suicide � Does access to guns influence: ◦ Risk of suicide in a community? ◦ Risk of suicide in a home? ◦ Risk of suicide among some individuals more than others? ◦ What does this mean for Indiana?

Guns and Suicide, 2000 -2002 15 States 116 million people 47% Gun Ownership Firearm Suicides 9749 Non Firearm suicides 5060 Total suicides 14, 809 Firearm suicides per 100, 000 8. 4 High Gun Ownership 6 States 119 million people 15% gun ownership Firearm Suicides 2606 Non-firearm Suicides 5446 Total Suicides 8052 Firearm suicides per 100, 000 2. 2 Low gun Ownership Miller, M, et al, Household Firearm Ownership and Rates of Suicide… , J of Trauma, 62(4), 1029 -1035, 2007

Risk of Suicide in a Home � Case Control studies are often used to determine whether a gun in the home increases the risk of suicide � These studies find a risk of 2. 1 to 4. 8 times greater for suicide when a gun is present � Shah and colleagues looked at adolescent suicides in Colorado from 1991 to 1993

Adolescent Suicide in Colorado 1991 -1993 � 36 of 54 suicides were committed with a gun � 24 used a gun form home, 2 a non resident parent’s gun, 2 a relative’s, 4 a friend, neighbor or acquaintance, 4 unknown � 42% used a handgun � Only 25% of the guns were stored locked Shah, et al , Adolescent suicide and household access to firearms…, J of Adolescent Health, 26 (3), 2000, 157 -163

Adolescent Suicide in Colorado 1991 -1993 Variable Cases Controls P value A gun in the home 72% 50% . 05 An unlocked gun 58% 35% . 05 > 1 gun 56% 28% . 02 Conduct problem 64% 25% <. 01 Mental Health Rx 47% 19% . 01 Ever drank alcohol 34% <. 01 54% Shah, et al , Adolescent suicide and household access to firearms…, J of Adolescent Health, 26 (3), 2000, 157 -163

Independent Factors predicting the risk of suicide in adolescents Variable Adjusted Odds Ratio Conduct Disorder Related Behaviors 7. 45 Past Mental Health Problem 4. 84 Household access to a gun 3. 91 Ever drank Alcohol 1. 86 Shah, et al , Adolescent suicide and household access to firearms…, J of Adolescent Health, 26 (3), 2000, 157 -163

Guns in the Home � Dahlberg and colleagues decided to look at a random national sample to get broader picture of the risks of guns in the home � They used data from the 1993 Mortality Followback Survey which collected data on a 10% sample of all deaths of persons 15 years or older � They focused on deaths by homicide, suicide, or accident that occurred in the home

National Followback Study Type of Death # % Age Firearm Male <45 used Firearm in the Home Corrected Odds Ratio Suicide vs. Other Homicide vs. Other For gun in the home Suicide 1049 81% 50% 68% 72% Males 10. 4** Females 2. 3 Homicide 490 63% 73% 68% 42% 1. 9* Other 535 37% 22% 0% 32% ** p<. 01 * p<. 02 Dahlberg, LL, Ikeda, RM, Kresnow, M, Guns in the Home and Risk of a violent Death, Am J Epidemiology, 160 (10), 929 -936)

Does Storage Matter? � Grossman et al studied 106 suicide and gun injury cases from Washington, Oregon and Missouri in individuals less than 20 years old � 82 Suicide attempts, 95% fatal � 24 unintentional injuries, 50% fatal � Control gun owning households were found by random telephone dialing and matched by age group of a household member and county

Does Storage Matter? Storage Practice /Safety Device Cases N=106 Controls N=480 Gun loaded 34% 9% Gun unloaded 66% 91% Gun and Ammo stored separately 41% 65% Both accessible 56% 28% Gun locked 32% 58% Ammunition locked 24% 48% Both locked 17% 35% Grossman et al, Gun Storage Practices…, JAMA, 293, 707 -714, 2005

Does Storage Matter? Storage Practice Odds Ratio Gun and Ammunition Accessible 1. 0 Gun Accessible, Ammunition Not 0. 47 Ammunition Accessible, Gun Not 0. 34 Neither Accessible 0. 22 Grossman et al, Gun Storage Practices…, JAMA, 293, 707 -714, 2005

Do Means Matter? � All 1397 suicides in Finland in one year were studied � 21% were by shooting � This method was associated with male sex, living with a partner, lack of previous psychiatric treatment or suicide attempts � About 25% of Finnish households own fire arms Pirkola S, et al, Do Means matter? Differences in Characteristics of Finnish Suicides… J Nervous and Mental Disorders, 2003; 191: 745 -750

Do Means Matter ? � In Switzerland, men must keep a weapon at home during compulsory military service � Suicides in Basel from 1992 -1996 were examined � Firearms accounted for 30%, 11% were with military weapons � Military firearm suicides were younger, more likely to have white collar jobs, less likely to have a psychiatric diagnosis, a prior attempt, or be single than those using other methods Frei, A, et al, Use of Armay Weapons and Firearms for Suicide and Homicide, Crisis, 27(3), 140 -145, 2006

Figure 8: Indiana Suicide Rates by Race and Age, 2001 -2005 Indiana State Department of Health, Suicide Report, 2001 -2005)

Figure 7: Indiana Suicide Deaths by Gender and Age, 2001 -2005 Indiana State Department of Health, Suicide Report, 2001 -2005)

Table 4: Indiana Suicide Rates by Mechanism, Race and Gender, 20012005 Mechanism White Males Number Death Rate* Firearms 1688 12. 71 Suffocation 607 4. 49 Poisoning 338 2. 49 All 2633 RATE 19. 7 Black Males Number Death Rate* 99 8. 14 35 2. 70 Too few for rate 134 10. 8 White Females Number Death Rate* 234 1. 66 90 0. 65 261 1. 87 585 4. 18 All Number (%) 2021 (60%) 732 (22%) 599 (18%) 3595 11. 7 *Rates are per 100, 000 population and are age-adjusted Indiana State Department of Health, Suicide Report, 2001 -2005)

Indiana Gun Ownership �In Indiana � 44. 2% of families reported owning a gun* � 25. 8% reported owning a handgun* � 9. 6% store guns loaded** � 6% store guns loaded and unlocked** *Indiana Firearm Survey, 2004**Miller, M, Firearm Storage, Accident Analysis and Prevention (2005), 37, 661 -667

Guns and Suicide, Answers � This is a problem usually involving legal guns accessed by people at risk from personality disorders, mental illness, substance abuse, physical illness, old age, etc. � Simply removing guns from the community on a large scale is the simplest and would probably be the most effective measure. � Regulation of gun storage could limit the risk. � Enforced waiting periods under Brady led to a decrease in suicide. � Educational campaigns may be helpful.

Measures Favored By a Majority of Hoosiers, 2004 � Background checks at gun shows 87% � Wiating period to buy a handgun 85% � Raise age to 21 for purchase of a long gun 63% � Storage requirements for guns 73% � Child Access Prevention Law 73% � Safety Training for New Owners 83% � Recognition device for new handguns 75%

Some Good News In Indiana Year Gun in the Household Handgun in the Household 2000 48. 6% 29. 5% 2004 44. 2% 25. 8% Indiana Partnership to Prevent Gun Violence, July, 2004

Guns and Suicide � Suicide Rates for Youths and Young Adult Males 10 -14 Year Olds 20 -24 Year Olds 15 -19 Year Olds Year Firearm Other All 1994 1. 4 0. 9 2. 4 13. 1 4. 8 18. 0 18. 8 9. 2 28. 0 1999 0. 8 1. 9 8. 4 4. 7 13. 0 12. 8 8. 0 20. 9 2004 0. 5 1. 3 1. 7 6. 5 6. 2 12. 7 11. 1 9. 7 20. 8 Change 94 -04 -0. 9 +. 4 -0. 7 -6. 6 +1. 4 -5. 3 -7. 7 +0. 5 -7. 2 MMWR 9/7/ 2007, CDC, DHHS, rates per 100, 000 in the age and gender group

Finally � If Indiana were to somehow become a low gun ownership state, we might expect little change in non gun suicides but gun suicides to go from 60% to 33% of all suicides � For an average year this would decrease the number of suicides from about 700 to about 420. The decrease would come preferentially from suicides in younger males.