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Analysis suggests risk-based gun removal laws to reduce violence, suicide

A significant proportion of individuals with serious mental illness who committed suicide by firearms were legally eligible to purchase and possess guns, according to recent findings.

“Our federal gun regulations pertaining to mental illness prohibit lots of people from accessing firearms who are not violent, and never will be,” Jeffrey W. Swanson, PhD, of Duke University School of Medicine, said in a press release. “At the same time, they fail to identify some people who will be violent or suicidal. With these data, we can improve criteria for restrictions that might actually reduce gun violence, but also carefully balance risk and rights.”

Jeffrey W. Swanson

To assess gun-related suicide and violence in individuals with mental illness and efficacy of legal restrictions on firearm sales, researchers analyzed administrative data from 2002 to 2011 for 81,704 adults diagnosed with schizophrenia, bipolar disorder or major depressive disorder who received services in public behavioral health systems of two large Florida metropolitan counties.

The average annual arrest rate for violent crime in the study population was 1,687.5 per 100,000, compared with 906.3 per 100,000 among the general adult population in the same area over the same time period.

The average annual arrest rate for gun-involved crime was 213.9 per 100,000 in the study population, compared with 217.4 per 100,000 among the general population.

Guns were involved in 13% of violent crime arrests among study participants, compared with 24% among the general population.

Death records indicated 254 study participants died by suicide and of these, 20% used a firearm. The average annual rate of suicide was 64.4 per 100,000 among the study population, compared with 17.7 per 100,000 among the general population. However, study participants were less likely to use firearms in suicide, compared with the general population (20% vs. 48%).

Thirty-eight percent of violent gun crime arrests and 72% of gun suicides involved individuals legally eligible to purchase and possess a firearm. However, 11% of arrests for violent gun crimes committed by gun-eligible individuals involved those with a record of short-term involuntary hold under the Florida Mental Health Act of 1971.

Approximately one-third of gun-eligible individuals who used a gun to complete suicide had an involuntary hold record. They represented 18% of all gun suicides.

After Florida’s National Instant Criminal Background Check System reporting policy went into effect, risk for violent crime arrest was significantly reduced among individuals with a gun-disqualifying mental health record (OR = 0.47; 95% CI, 0.38-0.58; P < .0001).

Regression analysis indicated male sex (OR = 1.77; P < .0001), young age (OR = 1.03; P < .0001), black ethnicity (OR = 1.44; P < .0001), diagnosis of bipolar disorder (OR = 1.22; P < .0001) and having a co-occurring substance use disorder (OR = 1.63; P < .0001) were clinical predictors of violent crime arrest.

Researchers did not find significant associations between legal disqualification of firearm possession and suicide risk. Twenty-eight percent of participants who died by suicide with a firearm were legally prohibited from possession but obtained a gun anyway or already had access.

“These individuals have already been identified during a previous mental health crisis. They haven’t been committed, but we know they’re at increased risk of harming themselves or others,” Swanson said in the release. “This is a lost public health opportunity in many states. States could say, let’s use these mental health records that already exist to separate that individual from guns, at least temporarily.” – by Amanda Oldt

Disclosure: Funding for this research was provided by the National Science Foundation, the Robert Wood Johnson Foundation program in Public Health Law Research, the Brain and Behavior Research Foundation, and the Elizabeth K. Dollard Charitable Trust.