421Suicide and Life-Threatening Behavior 40(5) November 2010
2010 The American Association of Suicidology
Decrease in Suicide Rates After
a Change of Policy Reducing
Access to Firearms in Adolescents:
A Naturalistic Epidemiological Study
Gad Lubin, MD, Nomi Werbeloff, PhD, Demian Halperin, MD,
Mordechai Shmushkevitch, MD, Mark Weiser, MD, and Haim Y. Knobler, MD
The use of firearms is a common means of suicide. We examined the effect
of a policy change in the Israeli Defense Forces reducing adolescents’ access to
firearms on rates of suicide. Following the policy change, suicide rates decreased
significantly by 40%. Most of this decrease was due to decrease in suicide using
firearms over the weekend. There were no significant changes in rates of suicide
during weekdays. Decreasing access to firearms significantly decreases rates of
suicide among adolescents. The results of this study illustrate the ability of a rela-
tively simple change in policy to have a major impact on suicide rates.
Suicide is the third most common cause of
death among children and adolescents aged
10 to 24 years in the United States. Around
the world, use of firearms is a common means
of suicide, ranging from 38% of all suicides
in Europe (Perret, Abudureheman, Perret-
Catipovic, Flomenbaum, & La Harpe, 2006)
to 60–70% in the United States (Shields,
Hunsaker, & Hunsaker, 2006; Singh & La-
throp, 2008). In particular, the availability of
firearms has been shown to have an effect on
suicide rates among adolescents and young
men (Brent et al., 1991; Brent et al., 1993;
Grossman et al., 2005; Kellermann et al.,
1992; Miller, Azrael, & Hemenway, 2002;
Miller, Hemenway, & Azrael, 2004; Miller,
Lippmann, Azrael, & Hemenway, 2007; Shen-
assa, Rogers, Spaulding, & Roberts, 2004;
Sloan, Rivara, Reay, Ferris, & Kellermann,
1990). Further, more stringent regulation of
access to firearms has been shown to reduce
overall suicide rates (Kellermann et al., 1992;
Lewis, Hawton, & Jones, 1997; Marzuk et
al., 1992) and rates of suicide by firearms
(Caron, 2004; Carrington & Moyer, 1994;
Goldney, 2006; Haw et al., 2004; Kapusta,
Etzersdorfer, Krall, & Sonneck, 2007; Loftin,
McDowall, Wiersma, & Cottey, 1991; Lud-
wig & Cook, 2000; Rich, Young, Fowler,
Wagner, & Black, 1990), particularly among
young men (Beautrais, Fergusson, & Hor-
wood, 2006; Bridges, 2004; Cantor & Slater,
1995; Cheung & Dewa, 2005; Leenaars,
Moksony, Lester, & Wenckstern, 2003; Les-
ter & Leenaars, 1993; Ozanne-Smith, Ashby,
Newstead, Stathakis, & Clapperton, 2004;
Webster, Vernick, Zeoli, & Manganello, 2004).
The Israeli Defense Force (IDF) is a
Gad Lubin, Mordechai Shmushkevitch,
Mark Weiser, and Haim Knobler are with the
Division of Mental Health, Medical Corps, IDF,
Israel; Nomi Webeloff, Demian Halperin, and
Dr. Weiser are affiliated with the Department of
Psychiatry, Sheba Medical Center in Tel Has-
homer, Israel; Dr. Webeloff is also associated with
Ashkelon Academic College, and Dr. Weiser is
with the Sackler School of Medicine at Tel Aviv
Address correspondence to Gad Lubin,
IDF, Division of Mental Health, Medical Corps,
Ramat Gan, Ramat Gan, 52621 Israel; E-mail:
Firearms and Adolescent Suicide Rates
poulation-based army that utilizes mandatory
induction to draft all 18–21-year-old adoles-
cents in the country. Approximately 90% of
all suicides in the IDF are performed using
firearms, and during the years 2003–2005
there were, on average, 28 suicides per year,
of which 26.3 were suicides by firearm. Sui-
cide prevention has become a major priority
of the IDF Mental Health Department, and
considerable efforts have been made to de-
crease rates of suicide in the military.
As Israel is a relatively small country,
many IDF soldiers go home over the week-
end, and took their weapons with them. The
IDF changed its policy in 2006, dictating that
soldiers should leave their weapons at their
bases when headed home for weekend leave.
This policy change was just part of a suicide
prevention program that also included dis-
semination of information regarding suicide
prevention, and a declaration by the IDF
chief of staff that suicide prevention was one
of the major goals of the IDF for that year.
We describe here the impact of this policy,
which reduced availability of firearms while
on leave, on rates of suicide in soldiers aged
18 to 21.
Previous studies have suggested that
although restricted access to firearms is asso-
ciated with decreased rates of suicide, the re-
duction in the rates of suicide by firearms is
offset by increases in suicide by other means,
leading to no overall decrease in suicide rates
(Cheung & Dewa, 2005; Rich et al., 1990;
Sloan et al., 1990). Therefore, we examined
the effect of reduced access to firearms on
suicide by firearms and total suicide rates.
Because the change in policy mostly affected
access to firearms on weekends, we also ex-
amined changes in rates of suicides on week-
ends and weekdays separately.
firearms, suicide during weekends, and sui-
cide during weekdays. Because the policy
change was made in 2006, rates of suicide be-
tween the years 2003–2005 were compared
to those of 2007–2008.
The overall rates of suicide before the
policy change are in line with rates of suicide
in adolescents in this age group (Mann et al.,
2005; Perret et al., 2006; Powell, Fingerhut,
Branche, & Perrotta, 2000). Following the
change in policy total suicide rate decreased
by 40%, from an average of 28 per year dur-
ing 2003–2005 to an average of 16.5 per year
in 2007–2008 (T = 3.35, p = .04). Most of this
decrease in suicide rates was due to a de-
crease in suicide using firearms over the
weekend, from an average of 10 per year
(2003–2005) to an average of 3 per year
(2007–2008) (T = 17.44, p < .001). There
were no significant changes in rates of suicide
We found a 40% decline in the num-
ber of suicides annually after the change of
policy reducing access to firearms during
weekends. This is in line with previous stud-
ies that have found that restricting access to
firearms is effective in decreasing both sui-
cide rates due to firearms and overall suicide
rates (Ozanne-Smith et al., 2004; Webster et
al., 2004). These data clearly emphasize the
effectiveness of decreasing access to firearms
on suicide prevention; the 40% decrease in
rates of suicide is an achievement unparal-
leled by any other means of suicide preven-
tion (Mann et al., 2005).
Contrary to previous studies, we did
not find a compensatory increase in suicide
performed by other means (Cheung & Dewa,
2005; Rich et al., 1990; Sloan et al., 1990).
This might indicate that easy access to fire-
arms might increase rates of impulsive sui-
cide attempts, whereas the need to plan, at
The rates of suicide before and after
the change of policy regarding bringing
home weapons on leave were compared by
independent samples t tests, performed sepa-
rately for total suicide rates, suicides using
Lubin et al. 423
least somewhat, other means of suicide might
deter some from committing suicide.
These data are limited in that they
were collected only in the Israeli military;
however, as the IDF is based on a mandatory
draft, soldiers in the IDF can be considered
to be a population-based sample, and as such
these results should be applicable to other
populations of adolescents. The results of
this study indicate that decreasing access to
firearms can significantly decrease rates of
suicide among adolescents, a finding that
should encourage policy makers to decrease
access to firearms.
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Manuscript Received: July 23, 2009
Revision Accepted: July 23, 2009