Suicide and Life-Threatening Behavior © 2017 The American Association of Suicidology DOI: 10.1111/sltb.12381
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Deadly Experience: The Association Between Firing a Gun and Various Aspects of Suicide Risk MICHAEL D. ANESTIS, PHD,
AND
DANIEL W. CAPRON, PHD
Firearms account for half of all U.S. suicide deaths, but research on mechanisms through which firearms confer risk is limited. Although research has indicated firearm ownership and the unsafe storage of firearms are associated with an elevated risk of suicide, such research cannot provide insight into the extent to which a history of using a gun plays a role. We recruited a community sample (N = 100; 76% female; 44% Black) oversampled for prior suicidal behavior in a high gun ownership state (Mississippi). Consistent with hypotheses, a greater number of lifetime experiences of firing a gun were associated with elements of the capability for suicide (fearlessness about death, pain tolerance, pain persistence) and lifetime suicide attempts, but not with suicide ideation or simple pain detection. These findings indicate that guns may confer risk of suicide in part through increased comfort and aptitude with the weapon, a notion consistent with the construct of practical capability. Furthermore, these findings are consistent with research indicating that guns do not cause healthy individuals to become suicidal, but rather increase risk among already suicidal individuals. Overall, our findings highlight the importance of considering practical experience with guns as well as simple ownership and storage methods. Regarding guns, Cobain initially thought they were barbaric and wanted nothing to do with them; later he agreed to go with his friend to shoot guns but would not get out of the car; on later excursions he got out of the car but would not touch the guns; and on still later trips, he agreed to let his friend show him how to aim and fire. Cobain died by a self-inflicted gunshot wound in 1994 at the age of twenty-seven. From Why People Die by Suicide (p.51) by Thomas Joiner Approximately half of all suicide deaths in the United States (U.S.) result from self-
MICHAEL D. ANESTIS and DANIEL W. CAPRON, University of Southern Mississippi, Hattiesburg, MS, USA. Address correspondence to Michael D. Anestis, Department of Psychology, University
inflicted gunshot wounds (Centers for Disease Control and Prevention, 2016). The prominence of guns in American suicide is largely a result of the uniquely high levels of gun ownership in the United States—with over 300 million privately owned firearms currently within the country (Krause, 2012)—as well as the extreme lethality of the method. Indeed, whereas 2% to 3% of intentional overdoses prove fatal, approximately 85% to 95% of all self-inflicted gunshot wounds result in death (Centers for Disease Control and Prevention, 2016; Chapdelaine, Samson, Kimberly, & Viau, 1991; Spicer & Miller, 2000).
of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS 39406; E-mail:
[email protected]
2 Much of the research on guns and suicide has focused on possession status and storage-related variables (e.g., loaded vs. unloaded, lock status) as a method of understanding risk. Across several decades, evidence has emerged demonstrating that gun ownership is associated with suicide death above and beyond an expansive list of potential confounds, including but not limited to demographics, religiosity, depression, antidepressant use, suicide ideation, and even prior suicidal behavior (Anestis & Houtsma, in press; Miller, Barber, White, & Azrael, 2013; Miller, Lippmann, Azrael, & Hemenway, 2007; Miller, Swanson, & Azrael, 2016; Miller, Warren, Hemenway, & Azrael, 2015; Opoliner, Azrael, Barber, Fitzmaurice, & Miller, 2014). Research has similarly shown that risk becomes even more pronounced when firearms are stored unsafely (e.g., loaded and in a nonsecure location such as a bedside table; Brent, 2001; Shenassa, Rogers, Spalding, & Roberts, 2004). Importantly, studies have repeatedly demonstrated that gun ownership is not associated with suicide ideation (Ilgen, Zivin, McCammon, & Valenstein, 2008; Khazem et al., 2016; Miller, Barber, Azrael, Hemenway, & Molnar, 2009), indicating that the mere possession of a firearm does not prompt an otherwise healthy individual to become suicidal. Instead, the risk appears to be that suicidal individuals with a gun are substantially more likely to die by suicide than are suicidal individuals without a gun. This point is supported by results indicating that gun owners with suicide ideation are significantly more likely to develop a suicide plan involving a gun than are nongun owners with suicide ideation (Betz, Barber, & Miller, 2011). The gun itself does not necessarily prompt suicidal thoughts, but it might shape them in a way that ultimately results in a greater likelihood of a suicidal individual enacting a suicide attempt with high odds of resulting in death. Indeed, Khazem et al. (2016) recently examined a sample of gun owning National Guard personnel and found that the relationship between suicide ideation and the
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belief that a suicide attempt is likely in the future increased in strength when guns were stored unsafely. In this sense, gun ownership and unsafe gun storage likely do not initiate risk, but may amplify existing risk. Such results highlight the importance of identifying high-risk gun owners and referring them to effective treatments. This notion is rendered more difficult, however, by the fact that the demographic groups most likely to use a gun in a suicide attempt —men, older adults, and soldiers, for instance—are often less likely to utilize mental health care resources or to openly endorse suicide ideation. The situation is further compounded by the fact that suicide decedents who died using a gun are less likely to have had a prior suicide attempt by any means than are suicide decedents who died using other methods (Anestis, 2016). In this sense, the prospective identification of suicide risk—a problem in suicide prevention in general (Franklin, Riberio, & Fox, 2016)—is particularly difficult for this specific subgroup of eventual suicide decedents. Progress in this area likely hinges on the development of a better understanding of the mechanisms through which guns bestow risk of suicide. Such clarity would allow for a more nuanced understanding of the relationship between guns and suicide and might enable more effective risk detection. To this end, Klonsky and May (2015) have proposed a specific role for firearms in the development of suicide risk through their Three-Step Theory (3ST) of suicide. Like the Interpersonal Theory of Suicide (ITS; Joiner, 2005), the 3ST notes that suicidal behavior is most likely to emerge when an individual possesses both the desire and capability for suicide. The 3ST divides the construct of capability for suicide into three components: dispositional, acquired, and practical capability. Dispositional capability involves a genetic predisposition to disinhibition, fearlessness about death, and pain tolerance. Acquired capability—similar to the ITS model—involves a habituation to pain and the fear of death and bodily harm through repeated exposure to painful
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and/or provocative experiences capable of impacting an individual’s fear and pain responses. And practical capability involves an individual’s comfort and familiarity with specific lethal means. The 3ST argues that, regardless of how fearless or pain tolerant an individual is, without sufficient access to and aptitude with specific lethal means, an individual is unlikely to implement a suicide attempt with a high likelihood of lethality. In their initial test of the 3ST, Klonsky and May (2015) found that all three components of the capability for suicide differentiated suicide attempters from those with only ideation; however, their assessment of practical capability lacked a specific measurement of the manner in which participants were familiar with the use of firearms. In an effort to build upon prior research and further our understanding of the manner in which guns contribute to suicide risk, we recruited a community sample of adults from a high gun ownership state (Mississippi) in part on the basis of prior suicidal behavior. Consistent with the 3ST, we anticipated that components of the capability for suicide would exhibit significant associations with one another. Specifically, we anticipated that the number of times an individual has fired a gun in their lifetime would be positively associated with self-reported fearlessness about death. Additionally, we anticipated that lifetime history of firing guns would be associated with higher laboratory assessed pain tolerance (i.e., the amount of pressure applied to a finger before an individual can no longer continue) and pain persistence (the amount of pressure an individual tolerated after the point at which they first identified the experience as painful). We did not, however, anticipate that firing a gun would be associated with pain threshold (the point at which the pressure is identified as painful), as neither the ITS nor the 3ST provide theoretical rationale for how such behavior would impact pain detection, whereas recent empirical work has highlighted the importance of the persistence through pain in the capability for suicide and actual suicidal
3 behavior (Anestis et al., 2014; Anestis & Capron, 2016). Further building off the 3ST model, we anticipated that, whereas lifetime history of firing a gun would be unrelated to suicide ideation, a more extensive history of firing guns would be associated with a greater number of lifetime suicide attempts. Lastly, we sought to determine the extent to which individuals with differing levels of prior suicidal behavior differed on their lifetime history of firing guns and anticipated that those with a prior attempt would have more experience firing guns than would those without any prior attempts, and those with multiple prior suicide attempts would have a more extensive history of firing a gun than would those with one or zero prior attempts. Results consistent with our hypotheses would have several implications. First, such results would provide support for the 3ST conceptualization of the capability for suicide as being comprised of characteristics related to fearlessness, pain response, and practical experience with high-lethality methods for suicide. Second, with respect to the risk of suicidal behavior, such results would highlight the relevance not only of possessing a gun, but also having experience using one. Experience using a gun speaks directly to an individual’s practical capability more so than proximity to a gun and, in this sense, may represent a more important path toward the capability for suicide. Furthermore, although the cross-sectional design would preclude temporal conclusions, results consistent with our model would provide additional evidence that, whereas guns are unlikely to prompt suicidal thoughts, they might play an important role in the development of suicidal behavior.
METHOD
Participants Participants were 100 adults (76% female, mage = 23.63; age range = 18–60) recruited from a community in southern Mississippi. Recruitment efforts included
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fliers hung in public spaces and health care settings as well as advertisements placed in online forums. Several advertisements specifically indicated that the research team was seeking individuals with a history of at least one prior suicide attempt. This approach was taken in an effort to increase the base rate of suicide ideation and behavior within our community sample. Our sample was fairly diverse with respect to race, with 44% identifying as Black, 40% as White, 10% as Asian/Pacific Islander, and 6% as other. Most (62%) of the sample reported a total annual family income of less than $50,000. Measures Structured Interview. The presence and number of lifetime suicide attempts were assessed via the Lifetime Suicide Attempts Self-Injury Interview (L-SASI; Linehan & Comtois, 1996). The L-SASI is a semistructured interview that assesses both nonsuicidal self-injury and suicide attempts and inquires about the frequency, method, intent, and severity of such behaviors. Only behaviors that involved ambiguous or clear intent to die were coded as suicide attempts in these analyses. Pain Tolerance Task. Pain response was assessed through the use of a Wagner FPIX 25 (Wagner Instruments, Greenwich, CT, USA) pressure algometer. The algometer was placed just below the first knuckle on the second finger of each participant’s right hand. Care was taken to ensure that the algometer was applied on the bony portion of the finger. An initial pressure level of one pound of force was applied to the finger and with the administrator increasing the pressure by one pound of force every 5 seconds. Participants were asked to say “pain” when the sensation first became painful. At this point, the algometer was removed and the pressure level was recorded. This served as a measure of pain threshold. After a 90-second break, the algometer was reapplied to the same finger. Next, the participant was asked to say “stop” when the pain became too much to continue. The algometer was then removed, and the
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pressure level was recorded. This served as a measure of pain tolerance. This process was repeated such that each participant took part in five trials of both threshold and tolerance. The threshold and tolerance scores were calculated by averaging pressure levels across all five trials. A pain persistence variable was also computed by subtracting the threshold value from the tolerance value, thereby providing an index of how much pressure each participant was willing to endure after first identifying the sensation as painful. Self-report Questionnaires. Fearlessness about death was assessed using the Acquired Capability for Suicide Scale—Fearlessness About Death subscale (ACSS-FAD; Bender, Gordon, Bresin, & Joiner, 2011; Ribeiro et al., 2014). The ACSS is a 7-item self-report scale developed from items included in the original 20-item ACSS. Items are scored on a 0 (Not at all like me) to 4 (Very much like me) scale and assess the extent to which individuals are scared of dying. The alpha coefficient in this sample was .77. Suicide ideation was assessed using the Beck Scale for Suicidal Ideation (Beck & Steer, 1991). This scale consists of 21 items, with the first 19 items assessing suicidal thoughts during the most recent 2 weeks. Items are scored on a 0–3 scale and consist of statements involving increasing severity and frequency of suicidal thoughts. The alpha coefficient in this sample was .93. Lifetime frequency of firing a gun was assessed using item 11 of the Painful and Provocative Events Scale. The PPES is a 25item self-report scale that assesses the frequency with which individuals have encountered a range of experiences considered relevant to the fear of death and/or an individual’s pain response. The items are scored on a 1–5 scale, with answer choices that correspond to never, once, two or three times, four to twenty time, and more than twenty times. Item 11 asks “Have you ever shot a gun?” Procedure Participants presented in a laboratory setting and provided informed consent prior
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to participation. After providing consent, participants took part in a semistructured interview assessing their past history of suicidal behavior and nonsuicidal self-injury. Participants then completed a pain tolerance task. Upon completion of this task, participants then completed a battery of self-report questionnaires. The final component of the protocol was a behavioral paradigm unrelated to the current analyses. Participants were compensated with $20 gift cards for their participation. All procedures were approved by the relevant institutional review board. Data Analytic Plan To test our hypotheses regarding the association between lifetime history of firing a gun and a variety of continuous outcome variables, we utilized a series of hierarchical linear regressions. In each case, sex and age were entered as covariates in step 1 and lifetime history of firing a gun was entered in step 2. F-squared was utilized as an index of effect size. To test our hypothesis regarding the association between lifetime history of firing a gun and lifetime number of suicide attempts, we utilized a negative binomial regression to account for the use of a count variable with unequal variance and mean as
our dependent variable. To test our hypotheses regarding differences between individuals with varying levels of suicide attempt histories on their experience firing a gun, we ran a series of analyses of covariance (ANCOVAs). In each case, sex and age were entered as covariates. Partial eta-squared served as an index of effect size.
RESULTS
Descriptive statistics and correlations between variables of interest are shown in Table 1. Both suicide ideation and lifetime suicide attempts were skewed (skews > 3.29) and kurtotic (kurtoses > 10.23) and, as such, we utilized a rank transformation using Blom’s formula on these variables to better approximate a normal distribution (posttransformation: skews < 1.39, kurtoses < 0.70). For ease of interpretation, nontransformed descriptives are presented in Table 1; however, all relevant analyses utilized the transformed variables. The transformed suicide attempt variable was only used in the correlation table, as the negative binomial regression approach used in our primary analyses does not require a normally distributed dependent variable.
TABLE 1
Intercorrelations and Descriptive Statistics for the Primary Variables of Interest
1. Firing a gun 2. Fearlessness about death 3. Pain tolerance 4. Pain threshold 5. Pain persistence 6. Suicide ideation 7. Lifetime suicide attempts Mean SD Minimum Maximum
1
2
3
4
5
6
7
– .26** .22* .01 .27** .12 .28** 2.36 1.51 1 5
– .29** .27** .05 .17 .22* 13.98 6.42 0.00 28.00
– .67** .50** .01 .06 17.92 6.15 3.62 30.36
– .31** .02 .08 11.39 5.61 2.39 25.00
– .05 .16 6.53 4.78 1.19 20.53
– .45** 1.49 4.09 0.00 28.00
– 2.01 5.11 0.00 23.16
Note. Three univariate outliers were noted in participant suicide attempt histories. The outliers were adjusted to three SD above the original mean. *Significant at the p < .05 level; **Significant at the p < .01 level.
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Approximately one-third (35%) of our sample reported at least one prior suicide attempt, with 10 reporting only one attempt and 25 reporting multiple prior suicide attempts. Additionally, 29% of our sample reported current suicide ideation. Primary Analyses Our initial set of analyses examined the association between lifetime history of firing a gun and a range of variables related to the capability for suicide as conceptualized by the 3ST. Results indicated that lifetime history of firing a gun was significantly and positively associated with fearlessness about death (b = .28; p = .008; f2 = .08). Lifetime history of firing a gun was also significantly and positively associated with both pain TABLE 2
Lifetime History of Firing a Gun Predicting Fearlessness about Death and Pain Response R2
DR2
Fearlessness about death .065 Sex Age .136 .071 Firing a gun Pain tolerance .073 Sex Age .140 .067 Firing a gun Pain threshold .138 Sex Age .138 .000 Firing a gun Pain persistence .012 Sex Age .110 .098 Firing a gun
b
p
.25 .02
.020 .886
.28
.008
.28 .10
.008 .320
.27
.008
f2
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tolerance (b = .27; p = .008; f2 = .09) and pain persistence (b = .33; p = .002; f2 = .11), but was not associated with pain threshold b =.02; p = .859; f2 = .00; see Table 2). Our second set of analyses examined the association between lifetime history of firing a gun and both suicide ideation and lifetime suicide attempts. Results indicated that, whereas lifetime history of firing a gun was not significantly associated with suicide ideation (b = .08; p = .460; f2 = .00), there was a significant and positive association between lifetime history of firing a gun and lifetime history of suicide attempts (b = .40; SE = .10; Wald v2 = 15.23; p < .001; see Table 3). Our third set of analyses examined between-group differences in lifetime history of firing a gun across individuals with varying levels of suicide attempt history. Results indicated that those with a prior history of at least one suicide attempt (n = 35) reported a higher mean level of lifetime history of firing a gun than did individuals with no prior history of suicidal behavior (n = 63; F = 5.28; p = .024; pg2 = .053). Similarly, individuals with two or more prior suicide attempts (n = 25) reported a higher mean level of lifetime history of firing a gun than did individuals with zero or one prior suicide attempt (n = 73; F = 5.89; p = .017; pg2 = .059). Lastly, when TABLE 3
.38 .08
.000 .423
.02
.859
.10 .04
.369 .720
.33
.002
.08
Lifetime History of Firing a Gun Predicting Suicide Ideation and lifetime Suicide Attempts Suicide Ideation DR2
R2 .09
p
.03 .18
.800 .084
.08
.460
f2
.031 Sex Age .037
.006
Firing a gun .00
.11
b
.00
Lifetime Suicide Attempts
Sex Age Firing a gun
b
SE
Wald v2
p
.89 .01 .40
.39 .02 .10
5.14 .22 15.23
.023 .638 .000
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TABLE 4
Differences on Lifetime History of Firing a Gun Between Individuals with Varying Histories of Prior Suicide Attempts Mean
SD
F
p
2 pg
Lifetime suicide attempts Yes (n = 35) 2.94 1.51 5.28 .024 .053 No (n = 63) 2.02 1.41 Multiple suicide attempt status 2+ Attempts 3.16 1.49 5.89 .017 .059 (n = 25) 2.07 1.42 0 or 1 Attempts (n = 73) Multiple, single, or no suicide attempt status 2+ Attempts 3.16a 1.49 3.17 .047 .064 (n = 25) 1 Attempt 2.40a,b 1.51 (n = 10) 1.41 0 Attempts 2.02b (n = 63) Lifetime firing of a gun is scored along the following scale: 1 = Never. 2 = Once. 3 = 2 or 3 times. 4 = 4–20 times. 4 = 20+ times; rows that do not share superscripts differ at the p < .05 level.
comparing three distinct groups of individuals based on suicide attempt history (those with no prior attempts, those with one prior attempt, those with two or more prior attempts), the overall model was significant (F = 3.17; p = .047; pg2 = .064), with individuals with two or more prior suicide attempts differing from those with no prior suicide attempts. These results are presented in Table 4.
DISCUSSION
The first set of results indicated that lifetime history of firing a gun was significantly and positively associated with fearlessness about death, pain tolerance, and pain persistence. Conceptually, these results are compatible with the construct of capability proposed by Joiner (2005) and also included in the 3ST (Klonsky & May, 2015), which posit provocative experiences (e.g., firing a gun) will lead to greater
fearlessness about death and increased pain tolerance and pain persistence. However, a distinct possibility is that individuals with a dispositional capability (i.e., high in disinhibition and sensation seeking) seek out provocative experiences (Klonsky & May, 2015) and the experiences themselves may just be a proxy. In support of this idea, Bryan, Sinclair, and Heron (2016) found stable capability scores over a 2-year period covering predeployment to postdeployment in 168 military personnel deployed to Iraq. Significant associations between capability and combat exposure were comparable both before and after deployment, strongly suggesting that capability was not acquired. Therefore, we believe the greatest contribution of this finding is the support of a practical capability as proposed in the 3ST. For at least some people (i.e., high dispositional capability), firing the gun might not make them more capable with respect to fearlessness, but it does elevate their practical capability by increasing their aptitude with a particularly lethal means. This idea is consistent with the finding that self-reported fearlessness prospectively predicted combat exposure, but combat exposure did not predict increases in fearlessness in two military samples (Bryan, Hernandez, Allison, & Clemans, 2013). Lastly, lifetime history of firing a gun was not associated with pain threshold; however, that was predicted as the point at which pain is detected is posited by these models as a dispositional trait. We also examined the association between lifetime history of firing a gun and both suicide ideation and lifetime suicide attempts. As predicted, lifetime history of firing a gun was not significantly associated with suicide ideation, but was associated with lifetime history of suicide attempts. Although our findings were cross-sectional and thus did not demonstrate the prediction of future thoughts or behaviors, this pattern of results is nonetheless consistent with an emerging literature suggesting that guns do not make otherwise healthy individuals become suicidal, but drastically increase the risk of death among already suicidal individuals. For
8 example, several studies have reported nonsignificant associations between gun ownership and thoughts of suicide, both in civilian and military samples (Ilgen et al., 2008; Khazem et al., 2016; Miller et al., 2009). In contrast, a study of 70,000 suicide decedents found those individuals who used a gun for suicide were significantly less likely to have a prior suicide attempt than were suicide decedents who died by other means. Such results indicate that firearm suicide decedents are more likely than others to die during their first suicide attempt (Anestis, 2016). Furthermore, Betz et al. (2011) reported that, although gun owners were no more likely to think about suicide than were nongun owners, they were more than seven times as likely to develop a suicide plan involving a gun. Again, the gun did not prompt suicidal thinking; but it facilitated the planning of a high-lethality suicide attempt, an important step in the transition from ideation to action. Further, there appears to be a linear relationship between suicide attempt history and lifetime history of firing a gun. Individuals with two or more past attempts had higher mean levels of history of firing a gun than those with one attempt and those with one past attempt had higher mean levels of firing a gun than those with no past attempts. These results are consistent with the initial test of practical capability (Klonsky & May, 2015). This is an important corroboration of the practical capability construct given that the initial empirical support is based on two self-report questions in a sample with low-suicide attempt history (10%; Klonsky & May, 2015). The current results add to the literature on practical capability by examining the self-report of a specific behavior used frequently to die by suicide (i.e., firing a gun) in a relatively severe community sample within a high gun ownership state. An important clinical implication is the responsibility of health care providers in assessing the patient’s risk of violence due to guns. As with most issues related to suicide and firearms, there is confusion and
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misunderstanding relating to a doctor’s right to ask patients about gun ownership. Many doctors believe they are not able to ask about gun ownership due to a widely reported 2011 Florida law that reads, “health practitioners ‘should refrain’ from asking about firearms and ‘may not intentionally enter’ firearm information into medical records.” However, in a recent review of this topic, Wintemute, Betz, and Ranney (2016) found that no laws prevent doctors from asking patients whether they have guns in their home. Unfortunately, this same report found that doctors ask infrequently about firearms and rarely counsel patients due to such barriers as lack of knowledge about firearm ownership, worry about damaging the patient relationship, and doubts about the efficacy of firearm counseling (Wintemute et al., 2016). The results of the present study suggest that doctors should not only be asking about gun ownership but also more specific behaviors such as firing a gun. Among gun owners, those who own a gun but have less experience using the weapon may be at somewhat lower risk than those who have an extensive history of discharging it. In addition, individuals that do not own a gun but who are firing a friend’s gun during target practice or renting a gun at a shooting range may also be increasing their risk of suicidal behavior. Given physician doubts about firearm intervention, it is worth discussing whether the gun itself is a worthy intervention target. Critics of focusing on suicide method argue that the underlying psychopathology or issue driving suicidal desire remains unresolved. The data suggest, however, that demographic groups most vulnerable to dying by suicide using a gun (e.g., men in general, soldiers) never come in for treatment or do not talk about their ideation (Anestis & Green, 2015). Therefore, intervening directly on means (e.g., guns) creates a greater opportunity to decrease the chance of unreported suicide ideation resulting in attempt or death (i.e., by reducing capability) and increases the time and thus the opportunity for individuals to be identified as high risk before they die. Another concern about gun
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interventions is the idea of means substitution (i.e., a suicidal individual will kill themselves using a different method if their preferred method is successfully prevented). In reality, means substitution lacks any consistent empirical support (Daigle, 2005). Therefore, preventing an individual from utilizing a gun means on a particular occasion will often result in keeping that individual from ever dying by suicide. One limitation of the current study is that we could not assess the temporal relationship between suicide attempt and firearm variables given the cross-sectional design of the study. However, previous research highlights that those with either a past suicide attempt or multiple suicide attempts have categorically higher risk of future suicide attempt (Joiner, Walker, Rudd, & Jobes, 1999). Suicide attempt has an extremely low base rate in the population, even among those with suicidal thoughts (Joiner, 2010). Therefore, knowing the relations between the variables in this study (i.e., history of firing a gun, fearlessness about death, suicide attempt history) is potentially useful for predicting who will make a future suicide attempt. In their current form, our findings are supportive of the role of practical
9 capability, but also require replication with a longitudinal design. There are several notable characteristics we would like to highlight. First, to our knowledge, this is the first study to support the role of practical capability in suicidal action using reported gun-specific behaviors. Guns are used in more suicide deaths than any other method (Centers for Disease Control and Prevention, 2016). Second, the community sample in this study was relatively large relative to others in the literature with substantial suicide attempt and gun use history. Given the importance of predicting the transition from ideation to action, more work needs to be done with the relatively rare individuals who have attempted suicide. Lastly, self-report of suicide attempt is often inflated by such things as reports of NSSI. In the current study, suicide attempt history was assessed by trained personnel via empirically supported semistructured suicide history interview (Linehan & Comtois, 1996). In sum, these findings provide a more nuanced view of the relationship between guns and suicide beyond simple gun ownership and have direct theoretical and clinical implications for future suicidology work.
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