and Firearms of the US Department of the Treasury.* In order to get a reasonable estimate of the exposure of. Americans to firearms, the cumulative number of ...
Firearms and Youth Suicide JEFFREY H. BOYD, MD, MPH, AND EVE K. MO§CICKI, SCD, MPH 10 _
Abstract: The firearm suicide rate for persons aged 10 to 24 has increased from 2.3 per 100,000 in 1933 to 5.5 per 100,000 in 1982. Over the same period, the suicide rate for this age group by all methods other than firearms has only risen from 2.5 to 3.3. The most dramatic rise in the firearm suicide rate has occurred primarily since 1970, notably among males aged 15 to 24. During the 1960s and 1970s there was a substantial increase in the number of civilian firearms in the
8
Ages 20-24 Both Sexes
Firearms
6
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United States. (Am J Public Health 1986, 76:1240-1242.) 1930
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Introduction Relatively little attention has been directed toward the role played by firearms in the recent dramatic climb in suicides among young people,'-22 despite the documented increase in the firearm suicide rate throughout the twentieth century.7"2-'4 The number of civilian firearms has risen in recent years,7,23* but a causal relationship between increased civilian firearms and the increased firearm suicide rate is difficult to demonstrate. 12,13,15-18,24,25 The focus of this paper is on the use of firearms in youthful suicides.
Method Annual suicide rates from 1933 to 1982 are estimated for each five-year age group from 10 to 24 by dividing the number of suicides by the population estimate for each year and age group.26 The numbers of suicides from 1933 to 1979 are from the annual vital statistics records for each year.27-29 The numbers of suicides, 1980-82, are from unpublished data from the Division of Vital Statistics, National Center for Health Statistics. The numbers of suicides by firearms within five-year age groups are not available for the years 1939 through 1949. The category of suicide by firearms or explosive is referred to here as "suicide by firearms," since less than 1 per cent of such suicides are due to explosives.'9 Data on the number of civilian firearms are from the Census Bureau23 and from the Bureau of Alcohol, Tobacco and Firearms of the US Department of the Treasury.* In order to get a reasonable estimate of the exposure of Americans to firearms, the cumulative number of firearms was divided by the total population for each year.
Results Suicide by firearms is the leading method of suicide for persons aged 10 to 24 throughout 1933 to 1982, and accounts for the majority of the increase in the overall rate for this age group. The firearm suicide rate increased 139 per cent, from 2.3 per 100,000 in 1933 to 5.5 per 100,000 in 1982. The suicide *Stanford L: Firearms in Commerce. Unpublished tables, Public Affairs
Office, Bureau of Alcohol, Tobacco and Firearms, US Dept of the Treasury, 1981.
From the Epidemiology and Psychopathology Branch, Divison of Clinical Research, National Institute of Mental Health. Address reprint requests to Jeffrey H. Boyd, MD, Epidemiology and Psychopathology Branch, DCR, NIMH, Room IOC-09, Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857. This paper, submitted to the Journal September 25, 1985, was revised and accepted for publication January 23, 1986.
1240
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-
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Year FIGURE 1-Rates of suiide per 100,000 population for adolescents of both sexes In three age groups, by firearms and all other methods, United States, 1933-38 and 195082.
rate for this age group by all other methods increased only 32 from 2.5 in 1933 to 3.3 in 1982. Figure 1 shows the suicide rates for both sexes ages 10 to 14, 15 to 19, and 20 to 24 years. In the youngest age group, the firearm suicide rate parallels the suicide rate for all other means. For the two older age groups, the firearm suicide rate parallels the suicide rate for all other methods until about 1970, after which the firearm suicide rate increases dramatically. The increase in the suicide rate for all other methods for persons aged 15 to 24 has been substantial but not as per cent,
impressive. The firearm suicide rate has climbed three times faster than the suicide rate for all other methods for 15 to 19-year-olds, and ten times faster for 20 to 24-year-olds. The recent rise in the youth firearm suicide rate is primarily accounted for by males aged 15 to 24, shown in Figure 2. In this age group, the rate of suicide by both firearms and other means has increased since 1960, but in recent years the climb in the suicide rate by firearms has outpaced the climb in the rate of suicide by other means. Although the increase in firearm suicides is most draAJPH October 1986, Vol. 76, No. 10
PUBLIC HEALTH BRIEFS 18 r 16 F 14 F
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1940
1950
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FIGURE 2-Rates of suicide per 100,000 population for males aged 15-19 and 20-24 years of age, by firearms and all other methods, United States, 1933-38 and 1950482.
matic among males aged 15 common method of suicide
to 24, firearms are also the most for males aged 10 to 14, and for females aged 10 to 24 (tables available upon request to
authors). In these age and sex groups, however, the growth in the overall suicide rates has been much less intense, and the increase in suicides by firearms is only slightly greater than the increase in suicides by other means. Figure 3 shows the domestic production, imports, and exports of civilian firearms for the United States from 1960 to 1978. Domestic production of firearms increased sharply throughout the 1960s, with a modest decline from 1975 to 1978. Imports and exports have remained relatively stable, and contribute little to the overall volume of commerce in civilian firearms. Figure 4 shows the estimated number of firearms per 100 Americans from 1968 to 1979. This number rose from 51 in 1968 to 75 in 1979,7 an increase of 47 per cent. Discussion
Limitations-It is well known that suicide statistics underestimate the actual number of suicides, although the magnitude of the undercount cannot be measured. Changes in the International Classification of Diseases codes, particularly the 7th and 8th Revisions, could also contribute to an underestimate ofthe suicide rate.7"1 It is possible that firearm suicide, being fairly blatant and undeniable, is subject to less of an undercount than are other forms of suicide. If all forms AJPH October 1986, Vol. 76, No. 10
FIGURE 3-Estimated annual domestic production, Imports, and exports of civilian firearms, in millions of guns, United States, 1960-78.
of suicide were rising, but the rise in suicides by other means were differentially understimated, the importance of the increase in firearm suicides might be overestimated. The data from the Bureau of Alcohol, Tobacco and Firearms show about 3 per cent more guns produced every year than do the Census Bureau data.23 By either count, however, there has apparently been a proliferation of civilian firearms during the 1960s and 1970s. The proportion of families possessing a firearm has remained constant at about 50 per cent from 1959 until 1977.3° The increase in the number of firearms during this time suggests that families that have always owned firearms now own more firearms; there are no direct trend data on the number of firearms per gun-owning family, however.30 It is possible, but has not been demonstrated, that an increase in the number of firearms per family means that a larger proportion of young people have access to a firearm. Is There a Causal Relationship?-It is not possible to draw conclusions about causal relationships from the data presented in this article. While the suicide rate for methods other than firearms has increased for all persons ages 10-14, 15-19, and 20-24, the firearm suicide rate has climbed more rapidly than the rate for suicide by other means. The question of causal relationships has been debated for firearm suicides for all age groups. 1213"15-1824'25 Some investigators suggest that a firearm is more lethal than other methods of suicide, and that a young person struck with a suicidal urge might be more likely to inffict a fatal gunshot wound if there is a firearm available. Others see little or no causal relationship between the increasing number of fire1241
PUBLIC HEALTH BRIEFS
100
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oL
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6. Secretary's task force: youth and suicide. ADAMHA News. Rockville, MD: Alcohol, Drug Abuse and Mental Health Admin, 1985; 11:1-2. 7. Moscicki EK, Boyd JH: Epidemiologic trends in firearm suicides among adolescents. Pediatrician 1983-85; 12:52-62. 8. Rosenberg ML, Mercy JA, Smith JC: Violence as a public health problem: a new role for CDC and a new alliance with health educators. Educ Horizons 1984; 62:124-127. 9. Mercy JA, Tolsma DD, Smith JC, Conn JM: Patterns of youth suicide in the United States. Educ Horizons 1984; 62:124-127. 10. Ford A, Rushforth NB, Rushforth N, Hirsch C, Adelson L: Violent deaths in a metropolitan county: II. changing patterns in suicides (1959-1974). Am J Public Health 1979: 69:459-464. 11. Weed J: Suicide in the United States: 1958-1982. In: Taube, Barrett, Mental Health United States, 1985. National Institute of Mental Health, DHHS Pub No (ADM)85-1378. Washington, DC: Govt Print Office, in press. 12. Boyd J: The increasing rate of suicide by firearms. N EngI J Med 1983; 308:872-874. 13. Boyd J: (Letter to editor) Suicide by firearms. N Engl J Med 1984;
310:48-49. 25
0
1976 1978 1979 1972 1974 1970 1968 FIGURE 4-Estimated cumulative number of civilian firearms and handguns per 100 population, United States, 1968-79.
arms and the increasing firearm suicide rate among the young. Despite the lack of established causal relationships, these data suggest a strategy for physicians when confronted with a potentially suicidal or depressed young person. Since it is conceivable that some suicides could be prevented if the family firearms were removed, it would be wise always to inquire about access to firearms, and to try to remove those firearms from the person at risk for suicide. This approach is consistent with one of the general principles of injury prevention: it is easier to remove the physical agent of potential injury than it is to modify risk-taking behavior.'4"15'3' 33
14. Seiden RH, Freitas RP: Shifting patterns of deadly violence. Suicide Life-Threat Behav 1980; 10:195-209. 15. Hudgens RW: (Editorial) Preventing suicide. N Engl J Med 1983; 308:897-898. 16. Maxwell SL: (Letter to editor) Suicide by firearms. N Engl J Med 1984; 310:46-47. 17. Stolinsky D: (Letter to editor) Suicide by firearms. N Engi J Med 1984; 310:47. 18. Sommers PM: (Letter to editor) Suicide by firearms. N Engi J Med 1984; 310:47-48. 19. Centers for Disease Control: Suicide-United States, 1970-1980. MMWR June 21, 1985; 34(24):353-357. 20. Rivara FP: Epidemiology of violent deaths in children and adolescents in the United States. Pediatrician 1983-85; 12:3-10. 21. Alexander G, Gibbs T, Massey R, Altekruse J: South Carolina's suicide mortality in the 1970s. Public Health Rep 1982; 97:476-482. 22. Murphy G, Wetzel R: Suicide risk by birth cohort in the United States, 1949 to 1974. Arch Gen Psychiatry 1980; 37:519-523. 23. US Bureau of the Census: Statistical abstract of the United States: 1980. Washington DC: Govt Print Office, 1980, p 830 (Table 1476). 24. Markush RE, Bartolucci AA: Firearms and suicide in the United States. Am J Public Health 1984; 74:123-127. 25. Westermeyer J: (Editorial) Firearms, legislation, and suicide prevention. Am J Public Health 1984; 74:108. 26. US Bureau of the Census: Current population reports, Series P-25, No. 311, Estimates of the Population of the United States by Single Years of Age, Color, and Sex: 1900-1959. Washington DC: Govt Print Office, 1965; No. 519 (1960-1973), 1974; No. 917 (1970-1981), 1982; No. 949 (1980-1983), 1984. 27. US Bureau of the Census: Mortality Statistics, 1933-1951. Washington DC, Govt Print Office, 1936-1951 (published annually). 28. National Office of Vital Statistics: Mortality data. Vital Statistics of the United States. Washington DC: Govt Print Office, published annually,
1950-1958.
REFERENCES 1. Holinger P: Adolescent suicide: an epidemiological study of recent trends. Am J Psychiatry 1978; 135:754-756. 2. Holinger P: Violent deaths among the young: recent trends in suicide, homocide, and accidents. Am J Psychiatry 1979; 136:1144-1147. 3. Holinger PC, Holinger DP, Sandlow J: Violent deaths among children in the United States, 1900-1980: an epidemiologic study of suicide, homicide, and accidental deaths among 5- to 14-year olds. Pediatrician 1983-85; 12:11-19. 4. Boor M: Methods of suicide and implications for suicide prevention. J Clin Psychol 1981; 37:70-75. 5. Centers for Disease Control: Suicide Surveillance, 1970-1980. Atlanta, GA: CDC, April 1985.
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29. National Center for Health Statistics: Mortality data. Vital Statistics of the United States. Washington DC: Govt Print Office, published annually since 1959. 30. Wright JD, Rossi PH, Daly K: Under the Gun: Weapons, Crime, and Violence in America. Hawthorne, NY: Aldine Publishing, 1983. 31. Baker S. Dietz P: Injury prevention. In: Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention, Background papers. DHEW (PHS) Pub. No. 79-55071A. Washington DC: Govt Print Office, 1979, pp 53-80. 32. Baker S, Dietz P: The epidemiology and prevention of injuries. In: Zuidema, Rutherford, Ballinger: The Management of Trauma, 3d Ed. Philadelphia: WB Sanders, 1979. 33. Haddon W, Baker S: Injury Control. In: Clark, MacMahon: Preventive and Comm Med. Boston: Little, Brown, and Co. 1981.
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