University of Oklahoma Health Sciences Center

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Author/s:

Studdert, D.M., Zhang, Y., Swanson, S.A., Prince, L., Rodden J.A., Holsinger, E.E., Wintemute, G.J., Miller, M., Spittal, M.J.

Date Added:

June 4, 2020

Journal/Publication:

New England Journal of Medicine

Publication Date:

June 4, 2020

Volume:

382

Pages:

2220-2229

URL:

Handgun Ownership and Suicide in California

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMsa1916744

Keywords

gun ownership

depression

MeSH

Proportional Hazards Models

Ethnic Groups

RPR Commentary

I know it isn’t always easy to inquire about gun ownership in Oklahoma. However, if the goal is to prevent premature death, you should certainly ask patients who are depressed. James W. Mold, MD, MPH

Abstract

BACKGROUND

Research has consistently identified firearm availability as a risk factor for suicide. However, existing studies are relatively small in scale, estimates vary widely, and no study appears to have tracked risks from commencement of firearm ownership.

METHODS

We identified handgun acquisitions and deaths in a cohort of 26.3 million male and female residents of California, 21 years old or older, who had not previously acquired handguns. Cohort members were followed for up to 12 years 2 months (from October 18, 2004, to December 31, 2016). We used survival analysis to estimate the relationship between handgun ownership and both all-cause mortality and suicide (by firearm and by other methods) among men and women. The analysis allowed the baseline hazard to vary according to neighborhood and was adjusted for age, race and ethnic group, and ownership of long guns (i.e., rifles or shotguns).

RESULTS

A total of 676,425 cohort members acquired one or more handguns, and 1,457,981 died; 17,894 died by suicide, of which 6691 were suicides by firearm. Rates of suicide by any method were higher among handgun owners, with an adjusted hazard ratio of 3.34 for all male owners as compared with male nonowners (95% confidence interval [CI], 3.13 to 3.56) and 7.16 for female owners as compared with female nonowners (95% CI, 6.22 to 8.24). These rates were driven by much higher rates of suicide by firearm among both male and female handgun owners, with a hazard ratio of 7.82 for men (95% CI, 7.26 to 8.43) and 35.15 for women (95% CI, 29.56 to 41.79). Handgun owners did not have higher rates of suicide by other methods or higher all-cause mortality. The risk of suicide by firearm among handgun owners peaked immediately after the first acquisition, but 52% of all suicides by firearm among handgun owners occurred more than 1 year after acquisition.

CONCLUSIONS

Handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm. (Funded by the Fund for a Safer Future and others.)

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