1. 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

2.  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?

3. High Gun OwnershipLow gun Ownership  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  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 Miller, M, et al, Household Firearm Ownership and Rates of Suicide…, J of Trauma, 62(4), 1029-1035, 2007

4.  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

5.  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

6. VariableCasesControlsP value A gun in the home 72%50%.05 An unlocked gun 58%35%.05 > 1 gun56%28%.02 Conduct problem 64%25%<.01 Mental Health Rx 47%19%.01 Ever drank alcohol 54%34%<.01 Shah, et al, Adolescent suicide and household access to firearms…, J of Adolescent Health, 26 (3), 2000,157-163

7. VariableAdjusted Odds Ratio Conduct Disorder Related Behaviors 7.45 Past Mental Health Problem4.84 Household access to a gun3.91 Ever drank Alcohol1.86 Shah, et al, Adolescent suicide and household access to firearms…, J of Adolescent Health, 26 (3), 2000,157-163

8.  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

9. Type of Death #% Male Age <45 Firearm used Firearm in the Home Corrected Odds Ratio Suicide vs. Other Homicide vs. Other For gun in the home Suicide104981%50%68%72%Males 10.4** Females 2.3 Homi- cide 49063%73%68%42%1.9* Other53537%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)

10.  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

11. Storage Practice /Safety Device Cases N=106 Controls N=480 Gun loaded34%9% Gun unloaded66%91% Gun and Ammo stored separately 41%65% Both accessible56%28% Gun locked32%58% Ammunition locked24%48% Both locked17%35% Grossman et al, Gun Storage Practices…, JAMA,293,707-714, 2005

12. Storage PracticeOdds Ratio Gun and Ammunition Accessible1.0 Gun Accessible, Ammunition Not0.47 Ammunition Accessible, Gun Not0.34 Neither Accessible0.22 Grossman et al, Gun Storage Practices…, JAMA,293,707-714, 2005

13.  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

14.  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

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

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

17. MechanismWhite Males Black MalesWhite Females All Number Death Rate* Number Death Rate* Number Death Rate* Number (%) Firearms1688 12.71 99 8.14 234 1.66 2021 (60%) Suffocation607 4.49 35 2.70 90 0.65 732 (22%) Poisoning338 2.49 Too few for rate 261 1.87 599 (18%) All RATE 2633 19.7 134 10.8 585 4.18 3595 11.7 Table 4: Indiana Suicide Rates by Mechanism, Race and Gender, 2001- 2005 *Rates are per 100,000 population and are age-adjusted Indiana State Department of Health, Suicide Report, 2001-2005)

18.  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

19.  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.

20.  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%

21. YearGun in the HouseholdHandgun in the Household 200048.6%29.5% 200444.2%25.8% Indiana Partnership to Prevent Gun Violence, July,2004

22.  Suicide Rates for Youths and Young Adult Males 10-14 Year Olds 15-19 Year Olds 20-24 Year Olds Year Fire- arm OtherAllFire- arm OtherAllFire- arm OtherAll 1994 1.40.92.413.14.818.018.89.228.0 1999 0.8 1.98.44.713.012.88.020.9 2004 0.51.31.76.56.212.711.19.720.8 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

23.  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.