Article

Firearm Suicides And Availability Of Firearms: The Swiss Experience

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  • University of Applied Sciences, Fribourg, Switzerland
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Abstract

This study aimed to examine the association between the availability of firearms at home, and the proportion of firearm suicides in Switzerland in an ecological analysis. The data series were analysed by canton and yielded a fairly high correlation (Spearman's rho=0.60). Thus, the association holds also at a sub-national level.

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... In no other European country do so many people die by suicide with firearms as in Switzerland [1]. Among males who die by suicide, firearms are the most common method (29.7%) in Switzerland [2], as well as in the USA [2,3]. ...
... Between these military drills, the enlisted store their army firearms mostly at home and the majority of these weapons usually go into private ownership after the period of service has expired. Firearms are present in about one third of Swiss households [1]. In about 40% of suicides using firearms, army weapons are used [7]. ...
... Suicide prevention by restriction of means is particularly promising in the case of firearms. Numerous studies from various countries have shown that, in a given population, the occurrence of households with firearms correlates with the frequency of suicides by this method [1,6,8,[11][12][13][14][15][16][17][18][19][20][21][22]. The occurrence of households with firearms further correlates with the total suicide rate [12][13][14][15][16][17][18][23][24][25][26][27][28][29][30]. ...
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Aims: In comparison with other central European countries, Switzerland has a high prevalence of gun ownership and a high rate of suicide by shooting. After the Army XXI reform in 2003, which reduced personnel from about 400,000 to approximately 200,000, a decline in suicides by firearms and a decline in the total number of suicides was observed in national data spanning the period from 2000 to 2010. It is, however, unclear whether this decline can be linked to the reduced availability of military guns. This study explored whether the decline in suicide by firearms is related to the decline of suicides by army weapons. Methods: In 83.1% (n = 1112) of the 1338 suicides by firearm between 2000 and 2010 in Switzerland, the firearm could be categorised as an army weapon or a non-army weapon. The army weapon was used in 39.1% of these suicides. In comparison with other firearms, those who used army weapons tended to be younger and more likely to have a university degree. A prior suicide attempt was found less often in cases using a military weapon than other firearms. After the Army XXI reform, there was a significant drop in suicides by males aged 18 to 43 years using an army weapon, but no change in male suicide rates in the same age group who used a non-army weapon. The drop was statistically linked to a reduction of suicide by the army gun. Results: The army weapon was used in 39.1% of suicides by firearm between 2000 and 2010 in Switzerland. In comparison with other methods, those who used army weapons tended to be younger and more likely to have a university degree. A prior suicide attempt was found less often in cases using a military weapon than other methods. After the Army XXI reform, there was a significant drop in suicides by males aged 18 to 43 years using an army weapon, but no change in males' suicide rates in the same age group who used a non-army weapon. The drop was statistically linked to a reduction of suicide by the army gun. Conclusions: Males who use army weapons differ from those who use other types of weapons. The significant drop in suicides was found in males aged 18 to 43 but there was no change in males of the same age group who used a non-army weapon. These results support the hypotheses that the observed drop in suicides is linked to the Army XXI reform and that restriction of access to guns is essential for reducing suicides by firearm.
... In der Schweiz [67 -69] und der USA [70 -72] kommen im internationalen Vergleich ein höherer Anteil der Suizidenten durch Schusswaffen um als in Ländern mit einem restriktiveren Waffengesetz. Ein Zusammenhang zwischen der Verfügbarkeit von Schusswaffen mit einer hohen Suizidrate durch Schusswaffen wird jedoch leider immer noch von manchen Politikern oder Vertretern der Waffenlobby in Frage gestellt [73]. In der Schweiz sind schon mehrere politische Vorstösse für ein restriktiveres Waffengesetz, insbesondere auch im Umgang mit Dienstwaffen gescheitert [73]. ...
... Ein Zusammenhang zwischen der Verfügbarkeit von Schusswaffen mit einer hohen Suizidrate durch Schusswaffen wird jedoch leider immer noch von manchen Politikern oder Vertretern der Waffenlobby in Frage gestellt [73]. In der Schweiz sind schon mehrere politische Vorstösse für ein restriktiveres Waffengesetz, insbesondere auch im Umgang mit Dienstwaffen gescheitert [73]. Ein Umdenken scheint hier jedoch dringend angezeigt, nicht zuletzt auch deshalb, weil Schusswaffen die Möglichkeit des erweiterten Suizides vereinfachen, eine besonders tragische Form des erweiterten Homozides-Suizides, die regelmässig zu Familiendramen führt [69]. ...
... Ein Umdenken scheint hier jedoch dringend angezeigt, nicht zuletzt auch deshalb, weil Schusswaffen die Möglichkeit des erweiterten Suizides vereinfachen, eine besonders tragische Form des erweiterten Homozides-Suizides, die regelmässig zu Familiendramen führt [69]. In der Schweiz stirbt pro Tag etwa ein Mensch durch eine Schusswaffe, wobei bei etwa einem Viertel dieser Suizide nachweislich eine Dienstwaffe der Armee verwendet wurde [73]. Dementsprechend muss bei suizidalen Jugendlichen, die gegebenenfalls Zugang zu einer Schusswaffe ihrer Eltern oder Geschwister haben könnten, aktiv nach häuslichen Waffen gefragt werden [72]. ...
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Zusammenfassung. Suizidprävention und Behandlung von Suizidalität bei Adoleszenten ist ein komplexes Unterfangen. Subjektiv erlebte Insuffizienzgefühle, Hoffnungslosigkeit und das Gefühl der eigenen Nutzlosigkeit, kombiniert mit einem konkreten Suizidwunsch und dem Vermögen, diesen in die Tat umzusetzen, sind wichtige Indikatoren zur Einschätzung des Suizidrisikos. Suizidversuche als stärkster Risikofaktor für einen Suizid sollen immer ernst genommen werden, auch wenn diese im Rahmen von situationsbedingten Problemen auftreten. Persönlichkeitsmerkmale wie erhöhte Impulsivität oder Kränkbarkeit sind zu beachten. Die Früherkennung psychischer Störungen wie Depressionen, Angststörungen, bipolar-affektiver Störungen oder Erkrankungen aus dem psychotischen Formenkreis bietet die Grundlage für eine effektive Behandlung der zugrundeliegenden Probleme und bringt eine grosse Chance zur Reduktion der Suizidhäufigkeit mit sich. Besondere Vorsicht ist geboten, wenn eine komorbide Suchterkrankung vorhanden ist. Während einer suizidalen Krise erweist sich die Aufrechterhaltung oder Etablierung tragfähiger Beziehungen mit dem Betroffenen als zentraler Wirkfaktor. Bei Suizidalität und zunehmendem Rückzug aus Beziehungen ist der frühzeitige Einbezug von Experten dringend angezeigt. Bei akuter Suizidalität muss die Einweisung in eine psychiatrische Klinik in Erwägung gezogen werden. Persönlichkeitsbedingte wiederkehrende Suizidalität benötigt spezifische Behandlungsansätze für die zugrundeliegende Problematik unter Berücksichtigung der Vermeidung einer iatrogenen Verstärkung.
... A study that compared several indirect measures to survey estimates of gun ownership found that the percent suicides committed with guns produced the most consistent results (Kleck, 2004). However, because this study was conducted in the USA, it cannot necessarily be assumed that the percentage of gun-related suicides is as good a measure of gun possession in other countries (e.g., Adjacic-Gross et al., 2010). ...
... Finally, a study conducted in Switzerland compared the proportion of suicides committed with a gun in Cantons with high versus those with relatively low proportion of gun-owning households (Adjacic-Gross et al., 2010). For men, 32.6% of all suicides were committed by guns, whereas for women, the percentage was only 3.4%. ...
... The relatively high proportion of firearm suicides in male adolescents (*26%) compared with international data can to a large part be explained by the high availability of firearms in Switzerland. The higher the availability of firearms, the higher is the proportion of firearm suicides [1, 2]. In Switzerland and in the US, where the proportion of households owing firearms was highest (36 and 32%), the proportion of firearm suicides was also higher (27 and 57%) than in 18 other Western countries [1]. ...
... Furthermore, it would have been interesting to examine whether there are differences in the suicide methods used across the country. For example, the proportion of firearm suicides varies substantially between Swiss cantons (15–33%), and it has been shown to be positively related to the availability of firearms [2]. Rates of suicides by jumping also differ considerably between Swiss regions [24]. ...
Article
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Although relatively rare, suicide is a leading cause of death in children and adolescents in the Western world. This study examined whether children and adolescents are drawn to other methods of suicide than adults. Swiss suicides from 1998 to 2007 were examined. The main methods of suicide were analysed with respect to age and gender. Of the 12,226 suicides which took place in this 10-year period, 333 were committed by children and adolescents (226 males, 107 females). The most prevalent methods of suicide in children and adolescents 0-19 years were hanging, jumping from heights and railway-suicides (both genders), intoxication (females) and firearms (males). Compared to adults, railway-suicides were over-represented in young males and females (both P < .001). Jumping from heights was over-represented in young males (P < .001). Thus, availability has an important effect on methods of suicide chosen by children and adolescents. Restricting access to most favoured methods of suicide might be an important strategy in suicide prevention.
... Suicide is an important public health issue and is the 10 th leading cause of death worldwide [5]. In the general population, the annual global suicide rate is reported as 11.4 per 100 000 population and there is one death every 40 seconds [6]. In Ethiopia, the prevalence of suicidal ideation and attempted suicide among general population were ranged from 1 to 55% and 0.6% to 14% respectively [7]. ...
Article
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Background Suicide is a serious cause of mortality worldwide and is a psychiatric emergency. Among prisoners, it is the leading cause of death compared to the general population. However, suicide in prison is a neglected public health issue especially in middle- and low-income countries including Ethiopia. Therefore, this study aimed to assess the prevalence and associated factors of suicidal behavior among prisoners in Dilla Town Correctional Center, South Ethiopia. Methods An institution-based cross- sectional study was conducted from May13- June 13, 2020 in the Dilla Town Correctional Center. The simple random sampling technique was used to select 650 prisoners. Data were collected by face-to—to-face interview. Suicidal ideation and attempts were assessed by using the suicidality module of World Mental Health survey initiative version of the World Health Organization composite International diagnostic interview. Data were coded, entered with EP-data version 3.1, and analyzed by using Statistical Package for Social Science version 24. Multivariate binary logistic regression analysis was used to determine the significant association between explanatory variables and outcome variables at 95% CI. The results The prevalence of suicidal ideation and attempt among prisoners were 21.9% (95%CI, 18.4–25.2) and 13.1% (95%CI, 10.6–15.8), respectively. Female sex [(AOR) = 2.6, 95%CI, (1.39, 8.2)], divorced/widowed [AOR = 3.67, 95%CI, (2.05, 6.58)], family history of mental illness [AOR = 2.49, 95%CI, (1.41, 4.38)], common mental disorder [AOR = 1.98, 95%CI, (1.25, 3.16)] and poor social support [AOR = 2.68, 95%CI, (1.42, 5.06)] were statistically associated with suicidal ideation. Whereas, female sex [AOR = 3.24, 95%CI, (1.89, 9.4)], previous incarceration [AOR = 2.38, 95%CI, (1.2, 5.16)], and family history of mental illness [AOR = 2.08, 95%CI, (1.11, 3.9)] were associated with suicide attempt. Conclusion The prevalence of suicidal ideation and attempts among prisoners were high. The special attention in early screening and treatment of suicide among prisoners and collaborating with health institutions is important for better management and prevention.
... These weapons remain in private homes for as long as citizens serve in the army, and often beyond that time [4]. The prominent role of firearms and the high prevalence of gun ownership have also been observed in suicide deaths, especially among young males [25,26]. Our study thus confirmed the leading role of firearms in the deaths of both victims and perpetrators. ...
Article
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Background Homicide–suicides are rare but catastrophic events. This study examined the epidemiology of homicide-suicide in Switzerland. Methods The study identified homicide–suicide events 1991–2008 in persons from the same household in the Swiss National Cohort, which links census and mortality records. The analysis examined the association of the risk of dying in a homicide–suicide event with socio-demographic variables, measured at the individual-level, household composition variables and area-level variables. Proportional hazards regression models were calculated for male perpetrators and female victims. Results are presented as age-adjusted hazard ratios (HR) with 95% confidence intervals (95%CI). Results The study identified 158 deaths from homicide–suicide events, including 85 murder victims (62 women, 4 men, 19 children and adolescents) and 68 male and 5 female perpetrators. The incidence was 3 events per million households and year. Firearms were the most prominent method for both homicides and suicides. The risk of perpetrating homicide-suicide was higher in divorced than in married men (HR 3.64; 95%CI 1.56–8.49), in foreigners without permanent residency compared to Swiss citizens (HR 3.95; 1.52–10.2), higher in men without religious affiliations than in Catholics (HR 2.23; 1.14–4.36) and higher in crowded households (HR 4.85; 1.72–13.6 comparing ≥2 with <1 persons/room). There was no association with education, occupation or nationality, the number of children, the language region or degree of urbanicity. Associations were similar for female victims. Conclusions This national longitudinal study shows that living conditions associated with psychological stress and lower levels of social support are associated with homicide-suicide events in Switzerland.
... However, as illustrated in Table 1, in Finland the only notable differences in these potential risk factors between the North and South are in the poorer accessibility to health centres (due to long distances) and the greater number of firearms per person in the North. Generally speaking, the greater the number of firearms, the higher is the rate of firearm suicides in a specific region, as shown in several studies [21][22][23][24][25]. With specific relation to rural-urban differences in suicide rates, researchers have suggested that the rural excess in male suicides is related to easier access to firearms in rural settings [6,9,20,26]. ...
Article
There are more firearms in Northern Finland as compared to Southern Finland, and a positive association between suicide rates and the number of firearms in a given region has been demonstrated in previous literature. Accordingly, the authors compared firearm suicide rates of Finnish adolescent (under 18 years) males in the two geographic regions. Young adult (18-24 years) and adult (25-44 years) males were used as reference groups. National data on cases of suicide in Northern and Southern Finland between 1972 and 2009 were obtained from Statistics Finland. Firearm suicides (n = 5,423) were extracted according to ICD-classification (ICD-8/9: E955, ICD-10: X72-X75). The distribution of types of firearms (hunting gun, handgun, other) employed in suicides was also investigated. The adolescent male firearm suicide rate in Northern Finland was almost three times higher than that observed in Southern Finland, while there was no difference in rates of suicide by other methods. A northern excess in firearm suicide rates was also found among young adult and adult males. Hunting guns were the most common type of firearms employed in young male suicides, and their use was especially common in Northern Finland. Our results indicate that the use of firearms plays a major role in explaining the northern excess in young Finnish male suicide rates, and emphasize a need to advance suicide prevention according to specific regional characteristics.
... In addition, more people die from suicide than from traffic accidents [2]. Even though the relevance of suicide in Switzerland is known and notable national and regional suicide studies have been published (e.g. on methods used [7][8][9][10], inpatient suicides [11], suicidal behaviour in the emergency setting [12,13] or after hospital discharge [14], treatment studies [15] and assisted suicide [16][17][18][19][20][21]), there is so far no national suicide prevention strategy. For developing a prevention strategy, Bertolote and Fleischmann reported the importance of not focusing solely on completed suicide, but including suicide attempts, which are known to be one of the strongest risk factors for completed suicide [1,[22][23][24][25][26][27][28][29]. ...
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This article presents epidemiological and clinical findings from the Basel research centre parti-cipating in the WHO/EURO Multicentre Study on Suicidal Behaviour. Between January 2003 and December 2006, 984 suicide attempts were documented for patients presenting at medical institutions with a suicide attempt. The mean suicide attempt rate was 164/100,000 inhabitants. Women attempted suicide nearly twice as often as men. The highest suicide attempt rates were found for women aged 20-24 years, for men aged 30-34 years, and for people who were unmarried, of foreign nationality, and of low education or low employment status. 'Soft methods' were used significantly more often than 'hard methods'. Of the suicide attempt methods employed, a relatively high proportion was accounted for by self-poisoning with drugs (X60-64), especially with non-steroidal anti-inflammatory drugs, benzodiazepines and antidepressants. Significant gender differences were found in the various methods and in the frequency of psychiatric diagnoses. A total of 98.7% of the attempters were diagnosed with a psychiatric disorder according to ICD-10; 35% suffered from an affective disorder. Men were significantly more frequently affected by substance abuse disorder or psychosis, whereas in women adjustment disorders and personality disorders were diagnosed significantly more often. This study offers the first published representative data of an entire Swiss county. Established sociodemographic and clinical risk factors for suicide attempts were reproduced. The identification of risk factors contributes to developing local targeted prevention strategies, for example education of risk groups and caregivers, and pharmacolegal consequences for package sizes. Gender- and age-specific prevention and aftercare programmes are indicated.
... Another analysis of Austria found that firearm regulations enacted in 1997 had a statistically significant effect on suicide rates [30]. A very recent study in Switzerland, finds a positive association between firearm ownership and firearm suicides at the local level [31]. ...
Article
To empirically assess the impact of firearm regulation on male suicides. A negative binomial regression model was applied by using a panel of state level data for the years 1995-2004. The model was used to identify the association between several firearm regulations and male suicide rates. Our empirical analysis suggest that firearms regulations which function to reduce overall gun availability have a significant deterrent effect on male suicide, while regulations that seek to prohibit high risk individuals from owning firearms have a lesser effect. Restricting access to lethal means has been identified as an effective approach to suicide prevention, and firearms regulations are one way to reduce gun availability. The analysis suggests that gun control measures such as permit and licensing requirements have a negative effect on suicide rates among males. Since there is considerable heterogeneity among states with regard to gun control, these results suggest that there are opportunities for many states to reduce suicide by expanding their firearms regulations.
... Indeed, the United Kingdom and Japan are often referenced as support for this premise as they both maintain strict gun control and have lower homicide rates than those observed in the U.S.-a country that allows the ownership of a broad range of firearms (Miron 2001;Rosenbaum 2012). This argument is certainly not novel; variation in gun policy has long been propped up as the "silver bullet" that explains differences in rates of violence between countries (Ajdacic- Gross et al. 2006;Ajdacic-Gross et al. 2010;Grabherr et al. 2010;Hurka and Knill 2020;Lankford 2016;Miron 2001). Yet other work has contended that countries maintaining less restrictive gun control laws, particularly Israel, Switzerland, and New Zealand, have exhibited low homicide rates (Kleck 1997;Miron 2001) or that violent events, mass-casualty or otherwise, are mitigated and deterred through permissive gun laws and widespread firearm availability (Kates 1989;Kates 1997;Kleck 1997;Lott 2003;Poe 2001;Tennenbaum 1992). ...
Article
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Objectives: This study examines the association between a country’s gun availability and firearm-related terrorism. Methods: Employing data from 140 countries, we assess the possible relationship between a country’s rate of suicide by firearm and their count of terrorist attacks involving a firearm through a series of structural equation models. Results: Collectively, we find that there is a positive relationship between gun availability and firearm-related terrorism in 2016 and 2017. However, this result fails our robustness check and is sensitive to the inclusion of the U.S. Conclusion: With important caveats, we believe the U.S. to be unique in terms of both gun availability and terrorism.
... As a counter-example to the U.S. case, about 32 percent of both U.S. and Swiss homes have guns, yet gun homicides rates are lower in Switzerland. On the other hand, Switzerland has a high proportion of firearm suicides (23.6 percent between 1998 and 2007) and the correlation between gun availability and suicide with guns is high (Ajdacic-Gross et al., 2010). In cantons where firearms ownership is higher, the proportions of firearm suicides are higher. ...
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Rates of all types of violence have dropped in the U.S., but are high compared with other developed countries—and the numbers of children and youth affected are high. In this report, we review risk and protective factors for violence, and suggest opportunities for reducing it. - See more at: http://www.childtrends.org/?publications=preventing-violence-a-review-of-research-evaluation-gaps-and-opportunities#sthash.v8phAow2.dpuf
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On a regular basis, news stories appear in the media about public shootings where shooters use their guns to open fire and kill people in shopping malls or on school campuses. Mostly these stories deal with incidents in the United States. Over the last years, however, a number of European countries have experienced similar public shooting incidents. Notable cases were the shootings at Tuusula and Kauhajoki in Finland (2007 and 2008), the killings in Cumbria in the UK (2010), the Utøya attacks by Anders Breivik in Norway (2011), and the shootings at Alphen aan den Rijn in the Netherlands and Liège in Belgium in 2011. Public shootings draw a high level of media attention. Less striking in the public eye, but not less significant – not least in quantitative terms –, are the numbers of people in Europe killed by firearms in the context of gun-related crime or in domestic shootings. It is estimated that between 2000 and 2010, over 10,000 victims of murder or manslaughter were killed by firearms in the 28 Member States of the European Union (EU). Every year, over 4000 suicides by firearm are registered in the EU. This means that, on average, there are 0.24 homicides and 0.9 suicides by firearm per 100,000 population in Europe every year. Compared with the US or other countries around the globe, the rates of gun-related violent death in Europe are rather low, certainly where the homicide rates are concerned. This does not mean, however, that the problem of gun violence has not appeared on the European policy radar in recent years. On the contrary, the attention devoted to the problem by law enforcement agencies and policy-makers has been growing. Reacting not only to shooting incidents such as those mentioned above, but also to warnings by police and law enforcement agencies that criminals are increasingly willing to use (heavy) firearms and that illegal trafficking in firearms is on the rise, a number of European countries have announced policy interventions targeted at reducing levels of gun-related violence and crime. The European Commission has also become an active actor in firearms policy. In October 2013 it announced a plan to reduce gun violence in Europe, in which it defined the misuse of firearms, whether legally-owned or illicitly manufactured or acquired, as “a serious threat to the EU’s security from both an internal and an external perspective”. One of the major problems the Commission identified in its initial policy papers was the problem of a lack of sound and adequate knowledge about firearms in Europe. The commission noted that “a lack of solid EU-wide statistics and intelligence hampers effective policy and operational responses”. One of the ambitions of the EU’s firearms policy is, therefore, to address the gaps in knowledge concerning gun violence. An additional problem is that the lack of reliable and comprehensive information on firearms in Europe is not limited to the sphere of law enforcement and policy-making. European scholarly research focusing specifically on firearms availability, gun control and gun-related violence is scarce. There is a research community in Europe focusing on small arms and light weapons (SALW), but it is predominantly concerned with the export of firearms and the connections between these arms flows and violence in developing, transitional or fragile states outside Europe. Scientific research on firearms and gun-related violence in the domestic European context is much less advanced. The scanty research efforts made in this field by epidemiologists, criminologists and legal scholars remain fragmented, and suffer from the fact that there is no integrated scholarly community dealing with gun-related issues. Language barriers, moreover, often prevent the wider dissemination of research results. Given this relative lack of European firearms research, American studies are still clearly dominant at present in research on the links between the availability of firearms and gun-related violence. Greene and Marsh have calculated that out of the 665 studies on firearms and violence that they reviewed, 64% were about the USA. Of the remaining studies not on the USA, 13% concerned cross-national comparisons or articles in which the geographical focus was unspecified (such as reviews), while 8% were about developing countries. Only 15% concerned other developed countries such as Canada, Australia, the UK and Germany. Given the particularities of the American context, and more specifically the fact that the US has one of the highest rates of gun-related deaths and crime among industrialized democracies, simply transposing the results of American research to the European context is problematic. What are the levels of firearms availability in Europe? Are there links between the levels of gun ownership in European countries and these countries’ rates of violence and violent death? And what is the impact of European gun laws on public safety and health? The absence of evidence specifically for the European context makes it difficult for policy-makers and researchers to find impartial and unbiased answers to these questions. Hence the pressing need for research that specifically focuses on gun-related violence in the European context: and with the present report, we would like to make a contribution to that effort. As we are moving into largely uncharted territory, our analysis of the European situation will necessarily be exploratory. Our primary ambition is to collect and take stock of the fragmented evidence that is available on gun-related violence in Europe. Our geographical coverage will be broader than the EU and encompasses a group of approximately 40 European countries, although in some instances we will limit our analyses to the EU28. In the report’s first chapter, we briefly dwell on one of the most crucial variables in research on gun control and violence: the level of gun ownership in society. Although the prevalence or availability of firearms is a key variable, collecting adequate data on levels of gun ownership can be troublesome. In chapter 1 we therefore devote some space to a critical assessment of the available statistics for Europe. Next, in chapter 2, we look at gun-related violence in Europe. Given the absence of good data on gun-related violence in general, including information not only on mortality but also on injuries and other forms of firearms-related victimization, we will focus exclusively on violent deaths – which seems a legitimate methodological choice for exploratory purposes. We urge the reader, however, to keep in mind that gun-related violence is a much more complex phenomenon than this focus might suggest. As is normal in research dealing with gun control not only from a public safety but also a public health perspective , we shall look both at gun-related homicides and at suicides. Taking the analysis further, we then ask in chapters 3 and 4 whether rates of gun possession and violent death in Europe are correlated: do high levels of gun possession in European countries correlate with high levels of homicide and suicide? The results of probing that question lead us to suggest that research into gun possession and violent death should also factor in the effects of firearms legislation. Specific European research into this question is scarce, which makes it difficult at the moment to arrive at conclusions for the whole of Europe. In chapter 5 we therefore focus on the results of three recent studies on the effects of stricter gun legislation on violent death rates in Austria, Belgium and Switzerland.
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The International Crime Victimisation Survey (ICVS) is the most far-reaching programme of fully standardised sample surveys looking at householders' experience of crime in different countries. The first ICVS took place in 1989, the second in 1992, the third in 1996 and the fourth in 2000. Surveys have been carried out in 24 industrialised countries since 1989, and in 46 cities in developing countries and countries in transition. This report deals with seventeen industrialised countries which took part in the 2000 ICVS. The reason for setting up the ICVS was the inadequacy of other measures of crime across country. Figures of offences recorded by the police are problematic due to differences in the way the police define, record and count crime. And since victims report most crimes the police know about, police figures can differ simply because of differences in reporting behaviour. It is also difficult to make comparisons of independently organised crime surveys, as these differ in design and coverage. For the countries covered in this report, interviews were mainly conducted by telephone (with samples selected through variants of random digit dialling). The overall response rate in the 17 countries was 64%. Samples were usually of 2,000 people, which mean there is a fairly wide sampling error on the ICVS estimates. The surveys cannot, then, give precise estimates of crime in different countries. But they are a unique source of information and give good comparative information. Each participating country paid for its own fieldwork. The Dutch Ministry of Justice also provided financial assistance for overheads. Technical aspects of the surveys in many countries were co-ordinated by a Dutch company, Interview-NSS, who subcontracted fieldwork to local survey companies. The NSCR and Leiden University managed survey results. The results in this report relate mainly to respondents' experience of crime in 1999, the year prior to the 2000 survey. Those interviewed were asked about crimes they had experienced, whether or not reported to the police.
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Research on the role of firearms in violence and fatal events has focused heavily on American data and research. This implies certain limitations, since the United States is one of the Western countries with exceptionally high homicide and gun ownership rates. Thus, the American context offers only limited variance in the most prominent independent as well as dependent variables. International comparisons offer challenging new perspectives. This research is based on data on gun availability in private households, collected through the international victimization surveys of 1989, 1992, and 1996, and World Health Organization data on homicide and suicide from 21 countries. It updates and extends former research conducted on this issue, based on the surveys of 1989 and 1992. In addition, data from the International Crime Victimization Surveys were used on total and gun-related robbery and assault (including threats).
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The 1996 Australian National Firearms Agreement introduced strict access limitations. However, reports on the effectiveness of the new legislation are conflicting. This study, accessing all cases of suicide 1997-2004, explores factors which may impact on the choice of firearms as a suicide method, including current licence possession and previous history of legal access. Detailed information on all Queensland suicides (1997-2004) was obtained from the Queensland Suicide Register, with additional details of firearm licence history accessed from the Firearm Registry (Queensland Police Service). Cases were compared against licence history and method choice (firearms or other method). Odds ratios (OR) assessed the risk of firearms suicide and suicide by any method against licence history. A logistic regression was undertaken identifying factors significant in those most likely to use firearms in suicide. The rate of suicide using firearms in those with a current license (10.92 per 100,000) far exceeded the rate in those with no license history (1.03 per 100,000). Those with a license history had a far higher rate of suicide (30.41 per 100,000) compared to that of all suicides (15.39 per 100,000). Additionally, a history of firearms licence (current or present) was found to more than double the risk of suicide by any means (OR = 2.09, P < 0.001). The group with the highest risk of selecting firearms to suicide were older males from rural locations. Accessibility and familiarity with firearms represent critical elements in determining the choice of method. Further licensing restrictions and the implementation of more stringent secure storage requirements are likely to reduce the overall familiarity with firearms in the community and contribute to reductions in rates of suicide.
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Accurate information about preferred suicide methods is important for devising strategies and programmes for suicide prevention. Our knowledge of the methods used and their variation across countries and world regions is still limited. The aim of this study was to provide the first comprehensive overview of international patterns of suicide methods. Data encoded according to the International Classification of Diseases (10th revision) were derived from the WHO mortality database. The classification was used to differentiate suicide methods. Correspondence analysis was used to identify typical patterns of suicide methods in different countries by providing a summary of cross-tabulated data. Poisoning by pesticide was common in many Asian countries and in Latin America; poisoning by drugs was common in both Nordic countries and the United Kingdom. Hanging was the preferred method of suicide in eastern Europe, as was firearm suicide in the United States and jumping from a high place in cities and urban societies such as Hong Kong Special Administrative Region, China. Correspondence analysis demonstrated a polarization between pesticide suicide and firearm suicide at the expense of traditional methods, such as hanging and jumping from a high place, which lay in between. This analysis showed that pesticide suicide and firearm suicide replaced traditional methods in many countries. The observed suicide pattern depended upon the availability of the methods used, in particular the availability of technical means. The present evidence indicates that restricting access to the means of suicide is more urgent and more technically feasible than ever.
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To examine international correlations between reported rates of household gun ownership and rates of homicide and suicide with a gun. Survey. People who responded to a telephone survey conducted by the 1989 International Crime Survey in 11 European countries, Australia, Canada and the United States. Positive correlations were obtained between the rates of household gun ownership and the national rates of homicide and suicide as well as the proportions of homicides and suicides committed with a gun. There was no negative correlation between the rates of ownership and the rates of homicide and suicide committed by other means; this indicated that the other means were not used to "compensate" for the absence of guns in countries with a lower rate of gun ownership. Larger studies are needed to examine more closely possible confounding factors such as the national tendency toward violent solutions, and more information on the type and availability of guns will be helpful in future studies. Nevertheless, the correlations detected in this study suggest that the presence of a gun in the home increases the likelihood of homicide or suicide.
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The purpose of this study was to compare the clinical and demographic profiles of patients who deliberately harmed themselves, either by jumping from a great height or by using firearms, and survived. The study consisted of an 18-year retrospective case history analysis of survivors of jumping and shooting identified from the database of consultation-liaison psychiatry referrals at a hospital in Sydney, Australia. Clinical and demographic information was collated and analyzed. Fifty-one patients who had shot themselves and 31 patients who had jumped, all of whom had survived, were assessed by the consultation-liaison psychiatry team. There were clear differences between the two groups. Those who jumped were more likely to be single, unemployed, and psychotic. Those who used firearms were more likely to be male, abuse alcohol, have a forensic history, and have an antisocial or borderline personality disorder. In this study, the subjects who attempted suicide by shooting themselves and those who did so by jumping had different profiles of mental state, personality function, and psychiatric diagnosis. The importance of mental state and specific psychiatric diagnosis as determinants of the method used has been neglected in studies of suicide. These factors should be considered along with others such as accessibility and acceptability of means, since these differences may be important when suicide prevention is considered. It is also important for psychiatrists providing consultation-liaison services to be aware of these differences in order to ensure optimal treatment of survivors.
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(1) To quantify lethality of firearms relative to other suicide methods, (2) to quantify the extent to which suicide mortality may be reduced by limiting access to firearms. Data on suicides and hospitalised para-suicides that occurred in the state of Illinois from 1990 to 1997 were combined. Total number of episodes for each suicide method was estimated as the sum of the number of suicides and the number of para-suicides for that method. Gender and suicide method were used as proxies for intention to die, and estimated lethality of suicide methods within method-gender groups (for example, male firearm users). Logistic regression was used to quantify the lethality of firearms relative to other suicide methods. Excess mortality associated with the use of firearms was estimated by conservatively assuming that in the absence of firearms the next most lethal suicide method would be used. From January 1990 to December 1997, among individuals 10 years or older in the state of Illinois, there were 37,352 hospital admissions for para-suicide and 10,287 completed suicides. Firearms are the most lethal suicide method. Episodes involving firearms are 2.6 times (95% CI 2.1 to 3.1) more lethal than those involving suffocation-the second most lethal suicide method. Preventing access to firearms can reduce the proportion of fatal firearms related suicides by 32% among minors, and 6.5% among adults. Limiting access to firearms is a potentially effective means of reducing suicide mortality.
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In 2002, an estimated 877,000 lives were lost worldwide through suicide. Some developed nations have implemented national suicide prevention plans. Although these plans generally propose multiple interventions, their effectiveness is rarely evaluated. To examine evidence for the effectiveness of specific suicide-preventive interventions and to make recommendations for future prevention programs and research. Relevant publications were identified via electronic searches of MEDLINE, the Cochrane Library, and PsychINFO databases using multiple search terms related to suicide prevention. Studies, published between 1966 and June 2005, included those that evaluated preventative interventions in major domains; education and awareness for the general public and for professionals; screening tools for at-risk individuals; treatment of psychiatric disorders; restricting access to lethal means; and responsible media reporting of suicide. Data were extracted on primary outcomes of interest: suicidal behavior (completion, attempt, ideation), intermediary or secondary outcomes (treatment seeking, identification of at-risk individuals, antidepressant prescription/use rates, referrals), or both. Experts from 15 countries reviewed all studies. Included articles were those that reported on completed and attempted suicide and suicidal ideation; or, where applicable, intermediate outcomes, including help-seeking behavior, identification of at-risk individuals, entry into treatment, and antidepressant prescription rates. We included 3 major types of studies for which the research question was clearly defined: systematic reviews and meta-analyses (n = 10); quantitative studies, either randomized controlled trials (n = 18) or cohort studies (n = 24); and ecological, or population- based studies (n = 41). Heterogeneity of study populations and methodology did not permit formal meta-analysis; thus, a narrative synthesis is presented. Education of physicians and restricting access to lethal means were found to prevent suicide. Other methods including public education, screening programs, and media education need more testing. Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates. Other interventions need more evidence of efficacy. Ascertaining which components of suicide prevention programs are effective in reducing rates of suicide and suicide attempt is essential in order to optimize use of limited resources.
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Switzerland has one of the highest rates of firearm suicides in the world. International studies show a positive correlation between the rate of households with guns and femicides with guns. Because its defense system requires a militia to keep personal firearms at home, Switzerland has a high rate of households with a gun. Records of suicides in the region of Basel between 1992 and 1996 were reviewed. Suicides with either army weapons or private firearms and suicides by other means were compared. Methods and types of homicides that occurred in the region at the same time were also analyzed. Firearm suicides were clearly the most frequent means of suicide. They were also used in 30.0% of domestic homicides, although other means were used at similar rates. Firearms for suicide were mainly used by men, especially army weapons. These men were younger, professionally better qualified, and fewer had ever been treated in one of the local state psychiatric services. The use of firearms for suicide, rather than homicide, and particularly of army weapons by young, well-educated men, requires more attention in debates and informed policy regarding access to firearms and suicide prevention in Switzerland.
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The availability of firearms in homes and at aggregate levels is a risk factor for suicide and homicide. One method of reducing access to suicidal means is the restriction of firearm availability through more stringent legislation. To evaluate the impact of firearm legislation reform on firearm suicides and homicides as well as on the availability of firearms in Austria. Official statistics on suicides, firearm homicides and firearm licences issued from 1985 to 2005 were examined. To assess the effect of the new firearm law, enacted in 1997, linear regression and Poisson regressions were performed using data from before and after the law reform. The rate of firearm suicides among some age groups, percentage of firearm suicides, as well as the rate of firearm homicides and the rate of firearm licences, significantly decreased after a more stringent firearm law had been implemented. Our findings provide evidence that the introduction of restrictive firearmlegislation effectively reduced the rates of firearm suicide and homicide. The decline in firearm-related deaths seems to have been mediated by the legal restriction of firearm availability. Restrictive firearm legislation should be an integral part of national suicide prevention programmes in countries with high firearm suicide rates.
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To identify the most frequent gender-specific suicide methods in Europe. Proportions of seven predominant suicide methods utilised in 16 countries participating in the European Alliance Against Depression (EAAD) were reported in total and cross-nationally. Relative risk (RR) relating to suicide methods and gender was calculated. To group countries by pattern of suicide methods, hierarchical clustering was applied. Data on suicide methods for 119,122 male and 41,338 female cases in 2000-4/5 from 16 EAAD countries, covering 52% of European population were obtained. Hanging was the most prevalent suicide method among both males (54.3%) and females (35.6%). For males, hanging was followed by firearms (9.7%) and poisoning by drugs (8.6%); for females, by poisoning by drugs (24.7%) and jumping from a high place (14.5%). Only in Switzerland did hanging rank as second for males after firearms. Hanging ranked first among females in eight countries, poisoning by drugs in five and jumping from a high place in three. In all countries, males had a higher risk than females of using firearms and hanging and a lower risk of poisoning by drugs, drowning and jumping. Grouping showed that countries might be divided into five main groups among males; for females, grouping did not yield clear results. Research on suicide methods could lead to the development of gender-specific intervention strategies. Nevertheless, other approaches, such as better identification and treatment of mental disorders and the improvement of toxicological aid should be put in place.
Article
OBJECTIVE: Accurate information about preferred suicide methods is important for devising strategies and programmes for suicide prevention. Our knowledge of the methods used and their variation across countries and world regions is still limited. The aim of this study was to provide the first comprehensive overview of international patterns of suicide methods. METHODS: Data encoded according to the International Classification of Diseases (10th revision) were derived from the WHO mortality database. The classification was used to differentiate suicide methods. Correspondence analysis was used to identify typical patterns of suicide methods in different countries by providing a summary of cross-tabulated data. FINDINGS: Poisoning by pesticide was common in many Asian countries and in Latin America; poisoning by drugs was common in both Nordic countries and the United Kingdom. Hanging was the preferred method of suicide in eastern Europe, as was firearm suicide in the United States and jumping from a high place in cities and urban societies such as Hong Kong Special Administrative Region, China. Correspondence analysis demonstrated a polarization between pesticide suicide and firearm suicide at the expense of traditional methods, such as hanging and jumping from a high place, which lay in between. CONCLUSION: This analysis showed that pesticide suicide and firearm suicide replaced traditional methods in many countries. The observed suicide pattern depended upon the availability of the methods used, in particular the availability of technical means. The present evidence indicates that restricting access to the means of suicide is more urgent and more technically feasible than ever.
Article
BACKGROUND: The Forty-Ninth World Health Assembly recently declared violence a worldwide public health problem. Improved understanding of cross-national differences is useful for identifying risk factors and may facilitate prevention efforts. Few cross-national studies, however, have explored firearm-related deaths. We compared the incidence of firearm-related deaths among 36 countries. METHODS: Health officials in high-income (HI) and upper-middle-income countries (UMI) with populations greater than one million were asked to provide data using ICD-9 codes on firearm-related homicides, suicides, unintentional deaths and deaths of undetermined intent, as well as homicides and suicides for all methods combined. Thirty-six (78%) of the 46 countries provided complete data. We compared age-adjusted rates per 100,000 for each country and pooled rates by income group and geographical location. RESULTS: During the one-year study period, 88,649 firearm deaths were reported. Overall firearm mortality rates are five to six times higher in HI and UMI countries in the Americas (12.72) than in Europe (2.17), or Oceania (2.57) and 95 times higher than in Asia (0.13). The rate of firearm deaths in the United States (14.24 per 100,000) exceeds that of its economic counterparts (1.76) eightfold and that of UMI countries (9.69) by a factor of 1.5. Suicide and homicide contribute equally to total firearm deaths in the US, but most firearm deaths are suicides (71%) in HI countries and homicides (72%) in UMI countries. CONCLUSIONS: Firearm death rates vary markedly throughout the industrialized world. Further research to identify risk factors associated with these variations may help improve prevention efforts.
Article
It is unclear whether suicides by different methods are distinguishable by their sociodemographic or clinical characteristics. We set out to investigate whether completed suicides by different methods show disparities in their sociodemographic and clinical characteristics. Within the National Suicide Prevention Project in Finland, all 1,397 suicides occurring April 1, 1987, through March 31, 1988, were investigated using the psychological autopsy method. Disparities were found in characteristics of suicide completers using different methods. Intoxication suicides were more often female and had a history of both previous attempts and psychiatric treatment, whereas suicides by shooting were the opposite in character. Victims using vehicle exhaust gas were most frequently younger males who had experienced a recent interpersonal loss or other adverse event and committed suicide while intoxicated with alcohol. Thus, typical characteristics associate with certain suicide methods, probably due to differences in availability and acceptability of the methods. Various restrictions on the availability of suicide methods are likely to exert their possible impact on somewhat different subpopulations at risk. In terms of suicide prevention, it seems reasonable to target availability restrictions for certain identifiable groups of potential suicide attempters. For instance, carefulness in the practice of prescribing of intoxicating substances to particular psychiatric patients seems justified.
Article
Case-control studies show an association between firearms in the home and completed suicide, with higher risks associated with loaded guns and handguns in the home. Quasi-experimental studies also show a relationship between greater restrictiveness of gun control laws and lower suicide rates by firearms and overall, although some studies fail to show an effect or show method substitution. A prospective study shows that handgun purchasers have an elevated risk for suicide for up to 6 years after the purchase. Relatively few studies have examined the impact of intervention to encourage families to store guns safely or remove firearms from the home on suicidal outcome.
Article
Suicide rates are affected by many factors—psychiatric, biological, familial and situational. This paper focuses on one potential risk factor for completed suicide in the United States—the availability of firearms. Whether the availability of firearms might increase the rate of attempted suicide is not examined. This article is not an exhaustive review of every existing firearm-related suicide study. Rather, it provides a detailed review of the most commonly cited, representative, and thorough empirical studies in the published peer-reviewed literature relating firearms and suicide, focusing largely on the United States. The empirical studies reviewed are grouped according to whether the unit of analysis is the individual (e.g., case-control studies) or a population (e.g., ecological studies) and further divided depending on whether the analysis uses cross-sectional or time-series (longitudinal) data. We begin with a very brief overview of the suicide problem in the United States.
Article
The Forty-Ninth World Health Assembly recently declared violence a worldwide public health problem. Improved understanding of cross-national differences is useful for identifying risk factors and may facilitate prevention efforts. Few cross-national studies, however, have explored firearm-related deaths. We compared the incidence of firearm-related deaths among 36 countries. Health officials in high-income (HI) and upper-middle-income countries (UMI) with populations greater than one million were asked to provide data using ICD-9 codes on firearm-related homicides, suicides, unintentional deaths and deaths of undetermined intent, as well as homicides and suicides for all methods combined. Thirty-six (78%) of the 46 countries provided complete data. We compared age-adjusted rates per 100,000 for each country and pooled rates by income group and geographical location. During the one-year study period, 88,649 firearm deaths were reported. Overall firearm mortality rates are five to six times higher in HI and UMI countries in the Americas (12.72) than in Europe (2.17), or Oceania (2.57) and 95 times higher than in Asia (0.13). The rate of firearm deaths in the United States (14.24 per 100,000) exceeds that of its economic counterparts (1.76) eightfold and that of UMI countries (9.69) by a factor of 1.5. Suicide and homicide contribute equally to total firearm deaths in the US, but most firearm deaths are suicides (71%) in HI countries and homicides (72%) in UMI countries. Firearm death rates vary markedly throughout the industrialized world. Further research to identify risk factors associated with these variations may help improve prevention efforts.
Article
We investigated changes in the proportion of firearm suicides in Western countries since the 1980s and the relation of these changes to the change in the proportion of households owning firearms. Several countries had an obvious decline in firearm suicides: Norway, United Kingdom, Canada, Australia, and New Zealand. Multilevel modeling of longitudinal data confirmed the effect of the proportion of households owning firearms. Legislation and regulatory measures reducing the availability of firearms in private households can distinctly strengthen the prevention of firearm suicides.
Article
No recent cross-country examinations for youth suicide trends and methods for Europe were found. The aim of the study is to specify differences in suicide rates, trends and methods used among 15-24 years olds by gender across 15 European countries. Data for 14,738 suicide cases in the age group 15-24 in 2000-2004/5 were obtained and analysed. Suicide rates ranged 5.5-35.1 for males and 1.3-8.5 for females. Statistically significant decline since 2000 was observed in Germany, Scotland, Spain, and England for males and in Ireland for females. Hanging was most frequently used for both genders, followed by jumping and use of a moving object for males and jumping and poisoning by drugs for females. Male suicides had a higher risk than females of using firearms and hanging and lower risk of poisoning by drugs and jumping. There were large differences between single countries. The limitations of the study are the small numbers of specific suicide methods in some countries as well as the re-categorisation of ICD-9 codes into ICD-10 in England, Ireland and Portugal. Further, the use of suicides (X60-X84) without events of undetermined deaths (Y10-Y34) continues to be problematic considering the possibility of "hidden suicides". The present study shows that suicide rates among young males are decreasing since 2000 in several European countries. Analysis of suicide methods confirms that there is a very high proportion of hanging in youths, which is extremely difficult to restrict. However, besides hanging there are also high rates of preventable suicide methods and reducing the availability of means should be one of the goals of suicide prevention.
Swiss Crime Survey. Die Kriminalitä t in der Schweiz im Lichte der Opferbefragungen von 1984-2005. Bern: Stä mpfli
  • Killias M S Haymoz
  • Lamon
Killias M, Haymoz S, Lamon P. Swiss Crime Survey. Die Kriminalitä t in der Schweiz im Lichte der Opferbefragungen von 1984-2005. Bern: Stä mpfli; 2007.
BFS) Schweizerische Todesursachenstatistik: Richtlinien fü r die a ¨ rztliche Bescheinigung der Todesursachen
  • R Bundesamt Fü
  • Statistik
Bundesamt fü r Statistik (BFS). Schweizerische Todesursachenstatistik: Richtlinien fü r die a ¨ rztliche Bescheinigung der Todesursachen. Bern: BFS; 1996.
Die Sterblichkeitsstatistik in der Schweiz Datenqualitä t der Todesursachen und der Berufsbezeichnungen Amtliche Statistik der Schweiz, Nr. 155. Bern: Bundesamt fü r Statistik
  • Ce Minder
  • W Zingg
Minder CE, Zingg W. Die Sterblichkeitsstatistik in der Schweiz. Datenqualitä t der Todesursachen und der Berufsbezeichnungen. Amtliche Statistik der Schweiz, Nr. 155. Bern: Bundesamt fü r Statistik; 1989.
Firearms availability and suicide
  • Brent Da Bridge
Brent DA, Bridge J. Firearms availability and suicide. Am Behav Sci 2003;46: 1192–210.
Swiss Crime Survey. Die Kriminalitä t in der Schweiz im Lichte der Opferbefragungen von
  • M Killias
  • S Haymoz
  • P Lamon
Killias M, Haymoz S, Lamon P. Swiss Crime Survey. Die Kriminalitä t in der Schweiz im Lichte der Opferbefragungen von 1984-2005. Bern: Stä mpfli; 2007.