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Limiting firearm access of mentally ill does not reduce suicide deaths

Restricting access to firearms for individuals with an established mental health condition or those who have attempted suicide in the past did not reduce suicide deaths, indicating a need for broader restrictions to prevent suicide, according to findings published in Annals of Internal Medicine.

“Firearms account for one half of all suicide deaths in the United States, and reducing access to firearms among at-risk patients may reduce suicide mortality,” Jennifer M. Boggs, MSW, from Kaiser Permanente Colorado — Institute for Health Research, and colleagues wrote. “Attempts to reduce access to firearms have focused on persons with a mental health condition or a history of suicidal behavior.”

Boggs and colleagues conducted the Treatment Utilization Before Suicide (TUBS) study to determine if limiting firearm access for individuals with a mental health condition or a history of suicidal attempts prevented suicide deaths. They identified 2,674 adults and adolescents from eight integrated health systems who were continuously enrolled in the system for at least 10 months prior to suicide. The researchers separated participants into two groups based on medical records and claims information. The first group consisted of those who were diagnosed with any mental health or substance use condition in the year before death. The second group consisted of those who had made previous suicide attempts. The researchers noted that the groups were not mutually exclusive and that there was considerable overlap between individuals who had a mental health condition and whose who previously attempted suicide.

Researchers found that the majority of patients with a history of suicide attempts or mental health or substance abuse committed suicide through means other than firearms, while the majority of people who did commit suicide with a firearm did not have a previous diagnosis of mental health issues or suicide attempts. More than half of individuals who died by suicide (54.7%) had a mental health or substance use condition and among those, 42.8% used a firearm. Previous suicide attempts were documented in 10.9% of individuals who died by suicide and only 37.5% of those used a firearm. Approximately 4.1% of individuals who died by suicide with a firearm had previously attempted suicide, while 23.5% were diagnosed with a mental health or substance use condition.

“Our findings show that, even if successful, current efforts to limit firearm access only for persons with a mental health condition (including substance use disorders) or those who previously attempted suicide would prevent few suicide deaths by firearm,” Boggs and colleagues concluded. “We suggest that prevention of firearm suicide should be expanded beyond the current focus on these patients to include other persons at risk for suicide... Our findings also highlight the importance of expanding attention beyond an exclusive focus on firearms — especially for persons with mental health or substance use conditions — to include other common means of suicide, such as instruments used for suffocation (for example, rope for hanging) and poison (for example, medications, alcohol, and recreational drugs).”

They noted that there are suicide prevention resources available for PCPs to help in identifying at-risk patients, evaluating firearm access, engaging patients in treatment and transitioning patients to specialty care, as well as counseling patients and their families about restricting access to common means of suicide. – by Alaina Tedesco

Disclosure: Boggs reports receiving grants from the National Institute of Mental Health. Please see full study for complete list of all other authors’ relevant financial disclosures.