Firearms, Accidental Deaths, Suicides and Violent Crime: An Updated Review of the Literature with Special Reference to the Canadian Situation
- 4.1 Suicide and Firearm Suicide
- 4.2 International Comparisons
- 4.3 Factors Associated with Suicide
- 4.4 Attempted Suicide and Firearms
- 4.5 Lethality of Attempted Firearm Suicides
- 4.6 Link Between Overall Availability of Firearms and Suicide
- 4.7 The Accessibility and Lethality of Firearms as a Suicide Method
In Canada, about 80 percent of firearm-related deaths are suicides (Hung, 1997). The total number of suicides, including those committed with a firearm, rose consistently during the 1960s and most of the 1970s. In the late 1970s, suicide rates leveled out and decreased modestly, and fewer people used firearms to commit suicide. Researchers also noted considerable regional variations in these trends (Department of Justice, 1996: 45; Hung, 1997a).
In the 1970s, firearm suicides represented 35.6 percent of the total number of suicides in Canada. That figure fell to 32 percent in the 1980s and to 27.8 percent in the first six years of the 1990s (Department of Justice Canada, 1996:46; Hung, 1997). In 1995, almost a quarter of the 4,000 people who committed suicide in Canada used a firearm.
In contrast with the prevailing situation in the United States, where handguns are more commonly used in suicide attempts, it is clear from available data that when a firearm is used in a suicide attempt in Canada, it generally tends to be a long gun. The report of The Firearms Smuggling Group included information on all firearms recovered in one year by ten police agencies across the country. Eighty percent of the 264 recovered firearms that had been involved in an attempted or completed suicide were long guns (Department of Justice Canada, 1995b; see also: Proactive Information Services, 1997).
Total suicide and firearm suicide rates per 100,000 population vary considerably from one country to another. Canada’s total suicide rate of 12.9 is similar to Australia (12.7), Norway (12.3), and the United States (11.5). Estonia (40) and Japan (17.9) are among the countries that have higher rates than Canada, while several other countries have rates below one per 100,000 population (United Nations, 1998: 112-113).
When examining firearm suicides, the Canadian rate of 3.3 per 100,000 population is similar to Australia (2.4), and New Zealand (2.5), and much lower than Finland (5.8), and the United States (7.2). Firearm suicides are less common in the United Kingdom, Japan, and 11 other countries that had rates well below one per 100,000 population (United Nations, 1998: 108-109; see also: Cantor et al., 1996). The percentage of suicides committed with firearms for the 34 countries that reported data through the survey ranged from 0.2 percent in Japan, to 70 percent in Brazil (Idem: 105). The average percentage was 18.7 (Ibidem). The proportion of suicides committed with firearms was 26 percent in Canada and 62.7 in the United States (Idem: 112-113).
Suicide is a complex phenomenon, and one that has received much attention since the early beginnings of social and behavioural sciences. Some of the factors associated with suicide, both at a societal level and at an individual one, are well known. Among social, cultural and economic factors are, in particular, rapid social changes and urbanization, which affect the way in which individuals integrate into society and adjust socially. Relevant individual factors may include sex, age, race or ethnicity, marital status, physical, mental and spiritual health, social adaptation and integration, and an individual’s capacity to cope successfully with painful or stressful life events. Drug and alcohol consumption, as well as other forms of escapist individual adaptation to stress, are also and not surprisingly associated with suicidal tendencies.
In the last 20 years, researchers have paid more attention to another set of factors: those related to the physical environment. They include proximal risk factors such as the presence of a potential rescuer, the availability of sophisticated emergency treatment facilities and, in particular, the relative availability of culturally-acceptable lethal means of committing suicide. It is believed that these factors may mediate between the societal and individual risk factors.
The patterns of firearm suicides are not identical to the overall patterns of suicide. Men are four times more likely to commit suicide than women (Statistics Canada, Causes of Death) and they are 13 times more likely to do so with a firearm. Among males who commit suicide, age seems to be another factor which affects the choice of firearms as a suicide method. Male suicide rates, in Canada as well as in most western countries, tend to be the lowest for adolescents, although these rates have increased without explanation during the 1970s and 1980s.
Alcohol and drugs appear to play a different role in firearm suicide than in suicides in general (Carrington and Moyer, 1994; Marzuk et al., 1992). The kind of mental health problem involved may also play a role in the choice of a suicide method (Carrington and Moyer, 1994a; Cooper et al., 1994).
The percentage of suicides involving a firearm, for both males and females, varies considerably across regions and is associated with, among other things, the availability of firearms. For example, while current research indicates that suicides are more frequent in urban areas (Carrington and Moyer, 1994), the percentage of suicides involving a firearm tends to be lower in urban areas than in rural ones (Moyer and Carrington, 1992).
Ethnic factors may also affect the choice of suicide method (Lester, 1994). In Canada, firearm suicide rates are highest among aboriginal people; however, the percentage of suicides involving a firearm, as opposed to other methods, is lower among aboriginal people than it is for non-aboriginal victims (Carrington and Moyer, 1994a; Malchy et al., 1997; Royal Commission on Aboriginal Peoples, 1994; Sigurdson et al., 1994: 400). In Australia, Burnley (1995) found that some regional and social class factors were associated with the means of committing suicide.
All of these observations confirm there are several factors that intervene in the choice of suicide methods.
Most studies on the role of situational determinants or on the availability of firearms in suicide attempts look only at fatal attempts. In Canada, estimates of the number of non-fatal attempts that occur in relation to the number of fatal suicides have produced ratios ranging from 26:1 to 49:1, depending on the methodology (Sakinofsky and Leenaars, 1997). The absence of data on unsuccessful suicide attempts limits the conclusions that one can draw.
The role of a given situational determinant of suicide compared to others is perhaps best understood by comparing successful and unsuccessful attempts. Unfortunately, few studies so far have done so. A notable exception is a case-control study in New Zealand that compared 197 individuals who committed suicide and 302 individuals who made unsuccessful suicide attempts with 1,208 randomly-selected community control subjects (Beautrais and Joyce, 1996). The study indicated that access to a firearm was not associated with a significant increase in the overall risk of suicide, although such access was associated with an increased probability that a firearm would be chosen as the method of suicide (Ibidem).
There has not been enough research on multiple suicide attempts and on the role of situational determinants such as accessibility of a firearm, in such instances. It is not known, for example, whether an unsuccessful attempt will bring an individual to switch to a more lethal method. In Manitoba, researchers looked at all cases of youth suicide between 1984 and 1988. They examined the files of 204 youths under 24 years old who had previously attempted suicide and who eventually succeeded in their attempt (Sigurdson et al., 1994). The findings revealed that the youths most often tried numerous times to commit suicide before being successful. One or more previous suicide attempts were reported in 65.2 percent of the cases for females, and 35.2 percent of the cases for males. The authors suggested that males were more likely to use a lethal method, such as a firearm or hanging, and were therefore more likely to be successful in an early attempt than females, who most frequently chose drugs (Sigurdson et al., 1994: 399).
Firearms constitute a particularly lethal and effective method of attempting suicide. Because of their very nature, firearm injuries resulting from a suicide attempt are frequently fatal. Research in Canada and the United States indicates that more people who attempt suicide with firearms succeed than those who choose other methods (Gabor: 1994). A New Zealand study that looked at successful and unsuccessful suicide attempts showed that among serious suicide attempts, the rate of fatality varied with the method used. The methods with the highest fatality rate were: gunshot (83.3 percent); hanging (82.4 percent;) and carbon monoxide poisoning (66.7 percent) (Beautrais and Joyce, 1996: 744).
In the United States, where more information exists on non-fatal suicide attempts, researchers noted that some survivors wounded themselves in non-vital areas, indicating that some suicide attempts were not necessarily intended to cause death (Barber et al., 1996). However, several studies have shown that self-inflicted firearm wounds are more likely to result in death than firearm wounds inflicted under other circumstances, such as an accident (Bretsky et al., 1996; Barber et al., 1996).
The observed correlation between firearm availability and suicide in general (Killias, 1993; 1993a; 1993b; 1996; Gabor, 1994; 1995) is not as solid as some might expect. In Canada, provincial comparisons of firearm ownership levels and overall rates of suicide found that levels of firearm ownership had no correlation with regional suicide rates (Carrington and Moyer, 1994a: 172). Furthermore, the Canadian rate of firearm suicides has dropped without evidence of a similar reduction in the rate of firearm ownership.
At the very least, this observation suggests that the overall availability of firearms is not the only factor that affects the suicide rate, or even the rate of firearm suicides. There are frequent variations in firearm suicide rates that cannot be attributed directly to a change in the availability of firearms or of alternate methods. Carrington and Moyer (1994) observed that in some provinces, the rate of suicides involving other methods has declined since 1978 in a manner similar to that of the firearm suicide rate. They discovered no obvious reason for this and none attributable directly to the prevalence of firearms or the existence of new firearm regulations.
On the other hand, the firearm suicide rate is higher where firearms are more widely available (Carrington and Moyer, 1994: 169; Dudley et al., 1996). A case-control study among members of a large health maintenance organization showed a positive association between the legal purchase of a handgun and a higher, long-lasting risk of violent death, including suicide (Cummings et al., 1997). While availability most certainly affects the choice of method (Beautrais and Joyce, 1996; Gabor, 1994: 39; 1995), it is equally clear that other factors, such as social customs or cultural acceptability, play a role in that decision.
In Australia, data on male suicide between 1992 and 1995 revealed noticeable changes in choices of suicide methods. The clear decrease in suicide by firearms was compensated by an increase in suicide by hanging, strangulation and suffocation. These changes did not seem to be accompanied by a change in the overall availability of firearms in the country (Mukherjee, 1997).
In Finland, an analysis of violent methods associated with the high and increasing suicide mortality rate among young adults aged 15 to 24 between 1965 and 1975 showed that firearms and hanging accounted for most of that increase (Ohberg et al., 1996). However, the authors stated that
"these changes were not accompanied by similar changes in the availability of firearms during that period. Moreover, an increased total suicide rate as well as that by automobile exhaust fumes in young adults after 1982 coincided with a widely presented Finnish movie which featured this method of committing suicide"(Ibidem).
The main question is whether the increased availability of firearms is more likely to facilitate completed suicides. If it does, the overall rate of firearm ownership should be related to the rate of suicide. So far, however, the evidence about that particular hypothesis is contradictory (Gabor, 1994: 40-41) and mostly inconclusive. Perhaps this is because few studies were able to accurately measure changes in overall availability of firearms.
While national or provincial studies examine the impact of the availability of firearms on suicide rates at the macro level, other studies examine the impact that an accessible firearm may have on an individual contemplating suicide. Some of the research cited in the previous review showed that accessible firearms were generally a risk factor for suicide (Gabor, 1994: 41; 1995: 203). There is also clear evidence that when firearms are available, it is statistically related to how often that particular suicide method was chosen (Carrington and Moyer, 1994a).
However, even when someone has access to a firearm, that person does not necessarily choose it to commit suicide. A case-control study conducted in New Zealand of 452 serious suicide attempts (Beautrais and Joyce, 1996) suggested that, while people who had access to a firearm were more likely to choose it as a method of suicide, the access itself did not necessarily mean that the person was more likely to commit the act (Idem: 746). Of the subjects who had access to a firearm at home, one-third used one to make a serious suicide attempt and two-thirds employed other methods. Of the 387 people who did not have access to a firearm at home, only two chose that method (Ibidem).
Whether firearms are accessible, and then choosing one to commit suicide, are related in a complex way. For instance, military personnel are familiar with firearms and have easy access to them. A U.S. study found that military males committed suicide about half as often as their counterparts in the national population, and were not more likely to choose a firearm over another method. The rate of overall suicide for females in the military was comparable to that of the national female population, but military females chose firearms more frequently as a method of suicide (Helmkamp, 1995).
Because suicides are intentional acts and because a variety of methods exist for which availability cannot be controlled, there is disagreement among researchers on whether controlling the availability of one method, such as firearms, would significantly contribute to preventing suicide in general. Rich and Young argue that
"removing one available method may not offer much in the way of protection in individual cases" (1995: 1105).
Perhaps little can be done to prevent someone who is strongly determined to commit suicide from doing so. However, in many cases, the suicidal intent may not be very strong and may only be temporary. According to Gabor (1994: 49; 1995: 204) there is clear evidence that many suicide attempts are impulsive. Many attempts are not carefully calculated or planned but are precipitated by stressful events and facilitated by the consumption of intoxicants. One can hypothesize that in such cases, the absence of a readily accessible firearm could contribute to preventing a fatal outcome in one of three ways:
- If the method of choice is not available, an individual considering suicide may not be able to act on the intention, and that intention may eventually disappear.
- If effective lethal means are available, such as a firearm, the weakly motivated or ambivalent individual may use it impulsively, particularly under the disinhibiting influence of alcohol or drugs (Carrington and Moyer, 1994a: 177).
- The individual may choose another, less lethal method to carry out the attempt and possibly fail.
In sum, the individual and situational factors influencing the choice of a firearm as the suicide method, given its accessibility, are still not well understood. Controlling the accessibility of firearms may affect existing behaviour patterns and prevent some suicides. What remains unclear is how, in what circumstances, and for what kind of suicide attempts this might be the case. Lester (1993: 49) concluded his own review of the research on the preventive effect of controlling suicide facilitators by suggesting that far more research is required to document under what conditions a preventive effect may operate.
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