The firearms tragedy we forget about

Missouri Republican dead after apparent suicide
Missouri Republican dead after apparent suicide

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    Missouri Republican dead after apparent suicide

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Missouri Republican dead after apparent suicide 01:07

Story highlights

  • In 2013, there were 21,175 suicides committed with a firearm, the CDC says
  • Kimberly Yonkers: Guns are a particularly effective way to commit suicide

Kimberly Yonkers is a clinician and researcher at the Yale School of Medicine and a professor in the departments of psychiatry and epidemiology and public health. She is also an Op-ed Project Public Voices Fellow. The views expressed are her own.

(CNN)Could the mental health system have saved the life of Missouri gubernatorial candidate Tom Schweich? His tragic death last month was apparently the result of a single self-administered gunshot wound to the head. He left behind a grieving family and friends, as well as members of the media, who have speculated about what may have driven him to suicide. Was it the result of bullying? Was he a martyr in a fight against anti-Semitism or dirty politics?

We don't have definitive answers to these questions, and maybe we never will. What we know for certain is that Tom Schweich, like dozens of people in America each day, was a victim of gun violence. If he and 10% of others who attempt suicide by a firearm instead attempted it by taking an overdose of pills, we would have 1,900 fewer suicide fatalities each year.
When we think about gun violence, we don't think of suicide as readily as homicide. But in 2013, more than 20,000 people died from a self-inflicted firearm injury, compared to 11,000 who died from firearm-related homicide.
    The idea of suicide conjures up thoughts of mental health problems such as major depressive disorder or substance use problems. This is reasonable, because between 60% and 90% of individuals worldwide who succeed in their suicide attempt are thought to have a psychiatric disorder; major depression, bipolar disorder and substance abuse are the leading conditions associated with suicide.
    However, simply focusing on mental illness ignores other contextual issues that connect the thought of suicide to its completion. As many as 40% of people who attempt suicide do so impulsively, research shows. But while many individuals who attempt suicide have a discernible psychiatric condition, some, particularly those engaged in an impulsive suicide attempt, do not. Instead, it is typical that they have been subjected to high levels of stress before the suicide event: intense emotional states that may have been brought about by interpersonal conflict.
    Importantly, thoughts of suicide in people with impulsive suicide events occur rapidly; less than five minutes may elapse between the thought of ending one's life and the actual attempt. When thoughts turn into actions so rapidly, the means by which a person acts to take his or her own life becomes critical.
    And guns are a particularly effective way to commit suicide. Ingesting pills or poison are, perhaps unsurprisingly, the most common method for attempting suicide, accounting for about 75% of all suicide attempts, but these methods result in death only 6% of the time. Yet while firearms are the means used in only 10% of suicide attempts, they are fatal more than 95% of the time.
    A number of risk factors have been associated with suicide, with firearms among the riskiest. The presence of a firearm in the home increases the likelihood of suicide by 300%, while the likelihood is even greater if the firearm is loaded and unlocked. Indeed, even after taking into account mental health problems, the presence of a firearm in the home increases the chances of suicide by a factor of three.
    Meanwhile, the risk of suicide with a handgun is elevated during the first year after its purchase, but remains elevated for five years after its purchase. Simply put, a gun makes for an effective and permanent means to complete what may have been a fleeting thought in an emotionally distraught person.
    Some may argue that if a gun was not available, another means of suicide would be used. However, as shown by events in Australia, for example, this is not necessarily the case. In 1996, in response to a mass shooting in Tasmania in which 35 people were killed, the Australian government responded by banning rapid-fire long guns, engineering gun buy-backs, tightening licensing policies, and enhancing restrictions to gun ownership. Gun-related homicide and suicide rates have declined sharply. Suicide by a firearm decreased to nearly half the 1996 rate by 2003. However, the rate of nonfirearm suicides did not increase during this interval, in this case debunking the idea that there would be a simple substitution of one suicide method with another.
    We will never know if Schweich's life could have been saved if he saw a psychiatrist or a counselor in the days before he died. However, based upon available research, we can infer that his chances of survival after a suicide attempt would have been higher if he did not have a gun in the home. He was a dedicated and effective politician who focused on corruption and government waste, yet it is likely that a few brief moments of severe emotional distress and the availability of a gun has left Missouri and his family to wonder what additional achievements he might have had.
    Tragically, the pain of such thoughts is sickeningly familiar to us by now, because it is pain shared by family and friends of the 20,000 other people in our nation who suffered a similar fate in the last year alone. Federal support for research on gun violence was essentially banned for over 15 years. While the debate about the precipitants and prevention of gun violence continues, we can all agree that we need research on problems such as suicide -- and how best to help prevent suicides committed with a firearm.