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Firearm legislation reform in the European Union: Impact on firearm availability, firearm suicide and homicide rates in Austria

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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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BackgroundBackground The availability ofThe availability of
firearmsin homes and at aggregate levelsfirearmsin homes and at aggregate levels
is a risk factor for sui cide and homi cide.is a risk factor for sui cide and homi cide.
One method of reducing access to suicidalOne method of reducing access to suicidal
meansis the restriction of firearmmeans is the restr i ction of fi r earm
availabil i ty through more stri ngentavai labi l ity through more stri ngent
legis lation.legis lation.
AimsAims To eval uate the impact of fi rearmTo evaluate the impact of f irearm
legislationreform on firearm suicides andlegislationreform on firearm suicides and
homi c i des as well as on the ava il ability ofhomi c i des as well as on the av a ilabili ty of
firearmsin Austria.firearms in Austria.
MethodMethod Official statistics on suicides,Official statistics on suicides,
firearm homicides and firearmlicencesfirearm homicides and firearmlicences
issued from1985 to 2005 were examined.issued from1985 to 2005 were examined.
To assess the eff ect ofthe new fi r earmlaw,To assess the effect of the new fi rearm law ,
enacted in1997, linear regression andenacted in1997, linear regression and
Poisson regressions were performed usi ngPo i ssonregress i ons wer e perfo r med usi n g
data from before and af ter the law reform.data from before and aft er the law reform.
ResultsResults The rate of firearm suicidesThe rate of fi rearm suicides
among some age groups, percentage ofamong some age groups, p ercentage of
f irearm suicides, as wellas the rate offi rearm suicides, as wel l as the rat e of
firearm homicides and the rate of firearmfirearmhomicides and the rate of firearm
licences, significantly decreased after alicences, significantly decreased after a
more stringent firearm law had beenmore str ingen t fi r earm law had been
i mp lemen t ed.i mp lemen t ed.
ConclusionsConclusions Our fi ndi ngs pro v ideOur fi nd i ngs prov i de
ev idence that the in t roduction ofev idence that the in troduction of
restr ictive fir earm legis lation effectivel yrestricti ve fi rearm legis lation effective ly
reduced the rat es of firearm suicide andreduced the rates of fi rearm suicide and
homi c i de .The dec li ne in fi r earm-re l a tedhomi c i de .The dec li ne i n fi r earm-related
deaths seems to have been mediated bydeaths seems to have been mediated by
the legal restr iction of fi rearm availabi l i ty.the legal restri ction of fi rearm avai labi l i ty.
Restr ictive f irearm legis lation shou ld be anRestri ctive firearm legis lation should be an
i n t egra l part of national su ic ide preven t ionintegral part of national suicide prevention
programmesin countries with highprogrammesin countries with high
firearm suiciderates.fi rearm suicide rates.
Declaration of interestDeclaration of interest None.None .
A recent study (World Health Organiza-A recent study (World Health Organiza-
tion, 2006) has pointed to the possibilitytion, 2006) has pointed to the possibility
of preventing disease by controlling envir-of preventing disease by controlling envir-
onmental factors; it has been estimated thatonmental factors; it has been estimated that
more than 20% of total suicides in Northmore than 20% of total suicides in North
America and Europe can be attributed toAmerica and Europe can be attributed to
environmental factors, one of which isenvironmental factors, one of which is
access to firearms. Suicide preventionaccess to firearms. Suicide prevention
measures include the training of primarymeasures include the training of primary
healthcare personnel, school-based pro-healthcare personnel, school-based pro-
grammes, improvement of the availabilitygrammes, improvement of the availability
of telephone hotlines and crisis centres, im-of telephone hotlines and crisis centres, im-
plementation of guidelines for the media’splementation of guidelines for the media’s
portrayal of suicide, and the restriction ofportrayal of suicide, and the restriction of
access to methods and means of suicideaccess to methods and means of suicide
(Bertolote, 2004). One of the methods of(Bertolote, 2004). One of the methods of
reducing access to suicidal means is thereducing access to suicidal means is the
restriction of firearm availability throughrestriction of firearm availability through
more stringent firearm legislation (Mannmore stringent firearm legislation (Mann
et alet al, 2005). Generally, studies on the im-, 2005). Generally, studies on the im-
pact of firearm availability and legislationpact of firearm availability and legislation
on suicide rates can be divided into threeon suicide rates can be divided into three
categories: cross-sectional comparisons ofcategories: cross-sectional comparisons of
firearm availability and suicide rates infirearm availability and suicide rates in
different countries; cross-sectional correla-different countries; cross-sectional correla-
tions of the stringency of firearm controltions of the stringency of firearm control
and suicide rates in the USA; and quasi-and suicide rates in the USA; and quasi-
experimental studies examining the impactexperimental studies examining the impact
of changes in firearm legislation on suicideof changes in firearm legislation on suicide
rates (Brent, 2001).rates (Brent, 2001).
The availability of firearms in homesThe availability of firearms in homes
has been shown to be a risk factor for sui-has been shown to be a risk factor for sui-
cide (Kellermanncide (Kellermann et alet al, 1992) and homicide, 1992) and homicide
(Dahlberg(Dahlberg et alet al, 2004). Furthermore, peer-, 2004). Furthermore, peer-
reviewed publications provide vast evidencereviewed publications provide vast evidence
to support the view that changes in firearmto support the view that changes in firearm
legislation have influenced the rate of fire-legislation have influenced the rate of fire-
arm suicidesarm suicides in the USA (Ludwig & Cook,in the USA (Ludwig & Cook,
2000), Canada2000), Canada (Caron, 2004), Australia(Caron, 2004), Australia
(Ozanne-Smith(Ozanne-Smith et alet al, 2004) and New, 2004) and New
Zealand (BeautraisZealand (Beautrais et alet al, 2006), whereas, 2006), whereas
there is only some evidence from continentalthere is only some evidence from continental
Europe and Britain to suggest the sameEurope and Britain to suggest the same
(Hawton(Hawton et alet al, 1998; Haw, 1998; Haw et alet al, 2004)., 2004).
Other researchers have shown that differentOther researchers have shown that different
state firearm regulations across the USA havestate firearm regulations across the USA have
influenced suicide (Conner & Zhong, 2003)influenced suicide (Conner & Zhong, 2003)
and homicide rates (Rosengartand homicide rates (Rosengart et alet al, 2005)., 2005).
METHODMETHOD
We examined suicide and homicide rates inWe examined suicide and homicide rates in
Austria recorded before and after a newAustria recorded before and after a new
firearm law came into effect. We expandedfirearm law came into effect. We expanded
a longitudinal approach from a recent studya longitudinal approach from a recent study
which evaluated the association betweenwhich evaluated the association between
changes in firearm availability and suicidechanges in firearm availability and suicide
rates in the USA (Millerrates in the USA (Miller et alet al, 2006) and, 2006) and
accounted for the availability of firearms.accounted for the availability of firearms.
Since the accuracy of survey data and otherSince the accuracy of survey data and other
proxy variables of firearm availability haveproxy variables of firearm availability have
recently been questioned (Millerrecently been questioned (Miller et alet al,,
2004), the number of officially issued fire-2004), the number of officially issued fire-
arm licences was used to assess the avail-arm licences was used to assess the avail-
ability of firearms.ability of firearms.
Austrian firearm legislationA ustrian firearm legislation
The Austrian firearms law was adapted inThe Austrian firearms law was adapted in
July 1997 after the European Council Di-July 1997 after the European Council Di-
rective 91/477/EEC on the control of therective 91/477/EEC on the control of the
acquisition and possession of weaponsacquisition and possession of weapons
was implemented in European Union mem-was implemented in European Union mem-
ber states. The transposition of the Eur-ber states. The transposition of the Eur-
opean directive into Austrian national lawopean directive into Austrian national law
brought changes concerning the acquisitionbrought changes concerning the acquisition
of firearms over 60 cm in length, which hadof firearms over 60 cm in length, which had
previously enjoyed a more liberal regime.previously enjoyed a more liberal regime.
Moreover, the new law abolished the pre-Moreover, the new law abolished the pre-
vious possibility of obtaining a firearmvious possibility of obtaining a firearm
without specifying a reason. In addition towithout specifying a reason. In addition to
the European Directive, other restrictionsthe European Directive, other restrictions
were implemented in Austria. The legalwere implemented in Austria. The legal
criteria for obtaining a category B weaponcriteria for obtaining a category B weapon
(handguns, semi-automatic firearms or(handguns, semi-automatic firearms or
repeating firearms) for the first time nowrepeating firearms) for the first time now
include psychological testing, being at leastinclude psychological testing, being at least
21 years of age, and background checks.21 years of age, and background checks.
Furthermore, the new legislation alsoFurthermore, the new legislation also
specifies safe firearm storage regulationsspecifies safe firearm storage regulations
and a 3-day ‘cooling-off’ waiting periodand a 3-day ‘cooling-off’ waiting period
for category C and D weapons (includingfor category C and D weapons (including
long firearms with smooth bore and rifledlong firearms with smooth bore and rifled
barrels) (Commission of the Europeanbarrels) (Commission of the European
Communities, 2000).Communities, 2000).
Data collectionDa ta collection
Records for each year between 1985 andRecords for each year between 1985 and
2005 in Austria were examined. The start-2005 in Austria were examined. The start-
ing year was set at 1985 because of record-ing year was set at 1985 because of record-
ing restrictions at the Ministry of theing restrictions at the Ministry of the
Interior, where data on firearm licencesInterior, where data on firearm licences
were obtained. Data on the number of sui-were obtained. Data on the number of sui-
cides per year and the number of firearmcides per year and the number of firearm
homicides per year (with external cause-homicides per year (with external cause-
of-death codes according to ICD–9 andof-death codes according to ICD–9 and
ICD–10), as well as data on the size of theICD–10), as well as data on the size of the
general population and on unemploymentgeneral population and on unemployment
rates, were obtained from Statistics Austria.rates, were obtained from Statistics Austria.
253253
BRITISH JOURNAL OF PSYCHIATRYBRITISH JOURNAL OF PSYCHIATRY (2007), 191, 253^257. doi: 10.1192/bjp.bp.106.032862(2007), 191, 253^257. doi: 10.1192/bjp.bp.106.0328 62
Fi rearm legisl ation refo rm i n the E uropean Uni on:Fi rearm legislati on refo rm in the Eur opean Uni on:
i mpact on firearm a vail ability, fi r earm suici d ei mpact on firearm a vailab ility, fi r earm suici d e
and homicide rates in Austriaand homicide rates in Austria
NESTOR D. KAPUSTA, ELMAR ETZERSDORFER, CHRISTOPH KRALLNESTOR D. KAPUSTA, ELMAR ETZERSDORFER, CHRISTOPH KRALL
anda nd GERNOT S ONNECKGER NOT SONNECK
AUTHOR S P ROOFAUTHOR S P ROOF
KAPUSTA ET ALKAPUSTA ET AL
Details on these data have been describedDetails on these data have been described
elsewhere (Etzersdorferelsewhere (Etzersdorfer et alet al, 2006). The, 2006). The
figures on alcohol consumption per capitafigures on alcohol consumption per capita
were obtained from the Austrian Alcoholwere obtained from the Austrian Alcohol
Coordination and Information CentreCoordination and Information Centre
(Uhl(Uhl et alet al, 2006)., 2006).
Statistical analysisStatistical analysis
To assess the effect of the enactment of theTo assess the effect of the enactment of the
1997 firearm law, a regression of the num-1997 firearm law, a regression of the num-
ber of firearm licences per 100 000 inhabi-ber of firearm licences per 100 000 inhabi-
tants per year was performed with antants per year was performed with an
autoregressive error model of first orderautoregressive error model of first order
to compare time trends before and afterto compare time trends before and after
enactment. Similarly, Poisson regressionsenactment. Similarly, Poisson regressions
were performed to compare time trends ofwere performed to compare time trends of
firearm suicides, of firearm suicides as afirearm suicides, of firearm suicides as a
percentage of total suicides and of the totalpercentage of total suicides and of the total
number of homicides, before and after thenumber of homicides, before and after the
law was enacted (using SAS/STAT versionlaw was enacted (using SAS/STAT version
8 for Windows). Because of underdisper-8 for Windows). Because of underdisper-
sion, we allowed the variance estimate insion, we allowed the variance estimate in
both models to depend on an underdisper-both models to depend on an underdisper-
sion factor estimated from the data. Datasion factor estimated from the data. Data
on total suicides indicated overdispersion,on total suicides indicated overdispersion,
hence total suicides were modelled with ne-hence total suicides were modelled with ne-
gative binomial distribution. The regressiongative binomial distribution. The regression
model included linear time trends allowingmodel included linear time trends allowing
for a change point in 1998. Changing popu-for a change point in 1998. Changing popu-
lation sizes were taken into account bylation sizes were taken into account by
including the respective changes in theincluding the respective changes in the
model. To distinguish between the effectsmodel. To distinguish between the effects
of the new legislation and other factorsof the new legislation and other factors
known to influence rates of suicide and ho-known to influence rates of suicide and ho-
micide, unemployment rates and averagemicide, unemployment rates and average
alcohol consumption per capita were in-alcohol consumption per capita were in-
cluded in the analysis as covariates. In thecluded in the analysis as covariates. In the
calculation of the regression model ofcalculation of the regression model of
homicide rates, the ratio of young men inhomicide rates, the ratio of young men in
the population was also included as athe population was also included as a
covariate. All parameter estimates are re-covariate. All parameter estimates are re-
ported with 95% confidence intervals.ported with 95% confidence intervals.
The analysis is based on figures for firearmThe analysis is based on figures for firearm
licences, suicide, firearm suicide, firearmlicences, suicide, firearm suicide, firearm
homicide and population sizes in the periodhomicide and population sizes in the period
1985–2005. The two-tailed significance1985–2005. The two-tailed significance
level was set at 5%.level was set at 5%.
RESULTSRESULTS
During the observation period 6071 fire-During the observation period 6071 fire-
arm suicides were counted. Of these,arm suicides were counted. Of these,
95.1% were by men and 4.9% by women.95.1% were by men and 4.9% by women.
When firearm suicides by men are split intoWhen firearm suicides by men are split into
age groups, 3.3% of all firearm suicidesage groups, 3.3% of all firearm suicides
were by men aged under 19 years, 62.9%were by men aged under 19 years, 62.9%
by men aged 20–64, and 28.8% by menby men aged 20–64, and 28.8% by men
aged 64 or older. Of all suicides, 0.2% wereaged 64 or older. Of all suicides, 0.2% were
by females aged 19 years or younger, 3.8%by females aged 19 years or younger, 3.8%
by women aged 20–64 and 0.9% byby women aged 20–64 and 0.9% by
women aged 64 or older.women aged 64 or older.
Figure 1 shows the trend of the firearmFigure 1 shows the trend of the firearm
suicide rate, prior to and after enactment ofsuicide rate, prior to and after enactment of
the legislation. We observed no significantthe legislation. We observed no significant
time trend in the total number of firearmtime trend in the total number of firearm
suicides between 1985 and 1997suicides between 1985 and 1997
((ww
22
¼0.04, d.f.0.04, d.f.¼18,18, PP¼0.84). During this0.84). During this
period the mean firearm suicide rate wasperiod the mean firearm suicide rate was
3.96 per 100 000 (s.d.3.96 per 100 000 (s.d.¼ 0.19). In the period0.19). In the period
1998–2005, we observed a significant nega-1998–2005, we observed a significant nega-
tive trend (tive trend (ww
22
¼88.0,88.0, PP550.0001) with a0.0001) with a
steady decline in the firearm suicide ratesteady decline in the firearm suicide rate
of 4.7% each year (Table 1). The firearmof 4.7% each year (Table 1). The firearm
suicide rate reached a low of 2.67 persuicide rate reached a low of 2.67 per
100 000 in the year 2005. The change in100 000 in the year 2005. The change in
the time trend after 1998 is significantthe time trend after 1998 is significant
((ww
22
¼46.0,46.0, PP550.0001) even when adjusted0.0001) even when adjusted
for unemployment and alcohol consump-for unemployment and alcohol consump-
tion (tion (ww
22
¼19.9,19.9, PP550.0001).0.0001).
When the firearm suicide rates wereWhen the firearm suicide rates were
analysed by age group and gender, the onlyanalysed by age group and gender, the only
significant trend changes after the legisla-significant trend changes after the legisla-
tion reform could be found in the grouption reform could be found in the group
of women aged 20–64 years (of women aged 20–64 years (ww
22
¼9.9,9.9,
PP¼0.0016), in men aged 20–64 years0.0016), in men aged 20–64 years
((ww
22
¼81.7,81.7, PP550.0001) and in men 65 years0.0001) and in men 65 years
old or older (old or older (ww
22
¼6.4,6.4, PP¼ 0.01). The group0.01). The group
of persons aged under 19 years and womenof persons aged under 19 years and women
more than 64 years old showed no signifi-more than 64 years old showed no signifi-
cant trend change in suicide by firearmscant trend change in suicide by firearms
after enactment of the law. When all agesafter enactment of the law. When all ages
were pooled for each gender, the trend ofwere pooled for each gender, the trend of
firearm suicides after enactment changedfirearm suicides after enactment changed
significantly among both women and mensignificantly among both women and men
(women:(women: ww
22
¼12.5,12.5, PP¼0.0004; men:0.0004; men: ww
22
¼
28.9,28.9, PP 550.0001).0.0001).
We observed a significant negative timeWe observed a significant negative time
trend in the total number of suicides beforetrend in the total number of suicides before
1998 (1998 (ww
22
¼131.0, d.f.131.0, d.f.¼ 18,18, PP550.0001), as0.0001), as
well as in the period 1998–2005 (well as in the period 1998–2005 (ww
22
¼23.4,23.4,
PP550.0001). The overall suicide rate de-0.0001). The overall suicide rate de-
creased from 27.6 per 100 000 in 1985 tocreased from 27.6 per 100 000 in 1985 to
16.7 per 100 000 in 2005. The change in16.7 per 100 000 in 2005. The change in
the trend was not significant (the trend was not significant (ww
22
¼0.3,0.3,
PP¼0.590), even when adjusted for unem-0.590), even when adjusted for unem-
ployment and alcohol consumptionployment and alcohol consumption
((ww
22
¼0.03,0.03, PP¼0.870).0.870).
During the examined pre-legislationDuring the examined pre-legislation
period, a significant positive time trend inperiod, a significant positive time trend in
firearm suicides as a percentage of totalfirearm suicides as a percentage of total
suicides was observed (suicides was observed (ww
22
¼68.5, d.f.68.5, d.f.¼18,18,
PP550.0001). During this period the per-0.0001). During this period the per-
centage of firearm suicides increased fromcentage of firearm suicides increased from
14.3% in 1985 to 19.3% in 1997. Con-14.3% in 1985 to 19.3% in 1997. Con-
versely, during the post-implementationversely, during the post-implementation
period, a significant negative time trendperiod, a significant negative time trend
was observed (was observed (ww
22
¼30.5,30.5, PP550.0001), with0.0001), with
a decrease to 16.8% in 2005 (Fig. 2). Thea decrease to 16.8% in 2005 (Fig. 2). The
growth factor of the percentage of firearmgrowth factor of the percentage of firearm
suicides per year, derived from Poisson re-suicides per year, derived from Poisson re-
gression analysis, was +2.6% prior to andgression analysis, was +2.6% prior to and
772.9% following the change in legislation2.9% following the change in legislation
(Table 1). Consequently, with 1998 set as(Table 1). Consequently, with 1998 set as
offset, the change in trend was significantoffset, the change in trend was significant
((ww
22
¼53.5,53.5, PP550.0001). Figure 3 shows the0.0001). Figure 3 shows the
course of suicide methods in the examinedcourse of suicide methods in the examined
period. After the implementation of theperiod. After the implementation of the
firearm law, no increase in other methodsfirearm law, no increase in other methods
was observed.was observed.
Figure 4 shows the time trend of the to-Figure 4 shows the time trend of the to-
tal number of firearm homicides, indicatingtal number of firearm homicides, indicating
no significant trend before 1998 (no significant trend before 1998 (ww
22
¼0.04,0.04,
d.f.d.f.¼18,18, PP¼0.840) with a mean of 0.390.840) with a mean of 0.39
(s.d.(s.d.¼ 0.08) firearm homicides per0.08) firearm homicides per
100 000. The growth factor during this per-100 000. The growth factor during this per-
iod was a modest +0.2% per year. A nega-iod was a modest +0.2% per year. A nega-
tive time trend was observed in the post-tive time trend was observed in the post-
1998 period (1998 period (ww
22
¼23.6,23.6, PP550.0001); the0.0001); the
growth factor wasgrowth factor was 772.3% per year. Fire-2.3% per year. Fire-
arm homicides reached a 20-year low ofarm homicides reached a 20-year low of
0.16 per 100 000 in the year 2005. The0.16 per 100 000 in the year 2005. The
change in the firearm homicide trend pre-change in the firearm homicide trend pre-
and post-legislation was significantand post-legislation was significant
((ww
22
¼14.3,14.3, PP¼ 0.0002). When adjusted for0.0002). When adjusted for
unemployment, alcohol consumption andunemployment, alcohol consumption and
the proportion of young men in the popu-the proportion of young men in the popu-
lation, the trend change remained signifi-lation, the trend change remained signifi-
cant (cant (ww
22
¼3.9,3.9, PP¼ 0.049) (Table 1).0.049) (Table 1).
Finally, we observed a significant posi-Finally, we observed a significant posi-
tive time trend in firearm licences pertive time trend in firearm licences per
100 000 before 1998 (Fig. 5) with an esti-100 000 before 1998 (Fig. 5) with an esti-
mated increase of 140 per year (mated increase of 140 per year (tt¼ 6.85,6.85,
PP550.0001) and a significant negative time0.0001) and a significant negative time
trend after the law with an estimated de-trend after the law with an estimated de-
crease of 125 per year (crease of 125 per year (tt¼773.52,3.52,
254254
AUTHOR S P ROOFAUTHORS PROOF
Fig. 1Fig. 1 Firearm suici de rates before and after theFirearm suicide rates before and after the
1 997 firearm leg islati on (squares ind icate counted1997 firearm legislat ion (squares indicate counted
numbers, line shows numbers predicted throughnumbers, line shows numbers predicted through
regression models).regression models).
IMPACT OF FIREARM LEGISLATION ON SUICIDEIMPACT OF F IREARM LEGISL ATION ON SUICIDE
PP¼0.0026). Hence, the change in the trend0.0026). Hence, the change in the trend
of firearm licence rates is also significantof firearm licence rates is also significant
((tt¼ 775.28,5.28, PP550.0001). Significant positive0.0001). Significant positive
autocorrelation (autocorrelation (PP¼0.0015) was observed0.0015) was observed
(Table 1).(Table 1).
DIS CUSSIONDISCUSSION
More stringent firearm legislation has beenMore stringent firearm legislation has been
suggested as an evidence-based suicide pre-suggested as an evidence-based suicide pre-
vention strategy (Mannvention strategy (Mann et alet al, 2005). We ex-, 2005). We ex-
amined the effects of a firearm legislationamined the effects of a firearm legislation
reform in Austria over a period of 12 yearsreform in Austria over a period of 12 years
prior to and 8 years following its enact-prior to and 8 years following its enact-
ment. The results show that the firearmment. The results show that the firearm
suicide rate decreased among women agedsuicide rate decreased among women aged
20–64 years, men aged 20–64 years and20–64 years, men aged 20–64 years and
men aged 65 years or older; firearmmen aged 65 years or older; firearm
suicides as a percentage of total suicidessuicides as a percentage of total suicides
decreased; the firearm homicide ratedecreased; the firearm homicide rate
decreased; and the overall firearm licencedecreased; and the overall firearm licence
rate decreased after enactment of the newrate decreased after enactment of the new
law. These results hold true even when ad-law. These results hold true even when ad-
justing for common confounders of suicidejusting for common confounders of suicide
rates such as unemployment and average al-rates such as unemployment and average al-
cohol consumption per capita as well as thecohol consumption per capita as well as the
proportion of young men in the population.proportion of young men in the population.
The observed decline in the number ofThe observed decline in the number of
firearm suicides among some age groupsfirearm suicides among some age groups
after enactment of more stringent legislationafter enactment of more stringent legislation
is in congruence with previous studies. Inis in congruence with previous studies. In
the USA, the Brady Handgun Violencethe USA, the Brady Handgun Violence
Prevention Act has been shown to havePrevention Act has been shown to have
reduced suicide rates among people agedreduced suicide rates among people aged
55 years and over (Ludwig & Cook,55 years and over (Ludwig & Cook,
2000). In Canada, Leenaars & Lester2000). In Canada, Leenaars & Lester
(1997) observed a decrease in firearm sui-(1997) observed a decrease in firearm sui-
cides, but this effect was not apparent forcides, but this effect was not apparent for
those over 65 years old. In Australia a de-those over 65 years old. In Australia a de-
cline in the firearm suicide rate, especiallycline in the firearm suicide rate, especially
among younger men, was observed inamong younger men, was observed in
metropolitan and provincial cities aftermetropolitan and provincial cities after
legal restrictions were introduced in 1992legal restrictions were introduced in 1992
(Cantor & Slater, 1995). The decline in(Cantor & Slater, 1995). The decline in
255255
AUTHOR S P ROOFAUTHOR S P ROOF
Ta b l e 1Ta b l e 1 Parameter estimates derived from the Poisson regression model.Parameter estimates derived from the Poisson regression model.
Growth factor (95% CI)Growth factor (95% CI)
11
Change inChange in
growth factorgrowth factor
Test for trend changeTest for trend change
Before 1998Before 1998 After 1998After 1998 % (95% CI)%(95%CI) ww
22
PP
Model 1 (unadjusted)Model 1 (unadjusted)
Per centage of firearm suicide sPer cen tage of firear m sui cid es
among all suicidesamong all suicides
1.026 (1.01.026 (1.019 to 1.032)19 to 1.032) 0.9710.97 1
(0.961 to 0.981)(0.961 to 0.981)
775.2 (5.2 (776.7 to6.7 to 773.9)3.9) 53.053.0 550.0000.00011
Firearm suicide rateFirearm suicide rate 1.000 (0.994 to 1.01.000 (0.994 to 1.010)10) 0.949 (0.935 to 0.964)0.949 (0.935 to 0.964) 774. 9 (4.9 (775.9 to5. 9 to 773.9)3.9) 45.745.7 550.0000.00011
Total suicide r ateTotal suicide rate 0.975 (0.971 to 0.979)0.975 (0.971 to 0.979) 0.978 (0.971 to 0.985)0.978 (0.971 to 0.985) 0.3 (0.3 (771.0 to 1.3)1.0 to 1.3) 0.280.28 0.590.59
Firearm homicide rateFirearm homicide rate 1.002 (0.977 to 1.029)1.002 (0.977 to 1.029) 0.877 (0.832 to 0.923)0.877 (0.832 to 0.923) 7712.5 (12.5 (7718.2 to18.2 to 77 6.2)6.2) 14.314.3 550.0000.00011
Model 2 (adjusted)Model 2 (adjusted)
Per centage of firearm suicide sPer cen tage of firear m sui cid es
among all suicidesamong all suicides
22
1.026 (1.01.026 (1.016 to 1.038)16 to 1.038) 0.978 (0.963 to 0.993)0.978 (0.963 to 0.993) 774.8 (4.8 (776.7 to6.7 to 772.8)2.8) 21.821.8 550.0000.00011
Firearm suicide rateFirearm sui cid e rate
22
1.00 (0.968 to 1.01.00 (0.968 to 1.013)13) 0.953 (0.937 to 0.969)0.953 (0.937 to 0.969) 774.8 (4.8 (776.9 to6.9 to 772.7)2.7) 19.919.9 550.0000.00011
Total suicide r ateTotal suicide rate
22
0.975 (0.969 to 0.982)0.975 (0.969 to 0.982) 0.974 (0.964 to 0.984)0.974 (0.964 to 0.984) 770.1 (0.1 (771.4 to 1.3)1.4 to 1.3) 0.030.03 0.870.87
Firearm homicide rateFirearm homicide rate
33
0.994 (0.894 to 1.10)0.994 (0.894 to 1.10) 0.895 (0.791 to 1.00.895 (0.791 to 1.013)13) 779.9 (9.9 (7718.9 to18.9 to 770.1 )0.1) 3.93.9 550.0000.00011
1. A growth factor of e.g. 1.05 indicates an increase in the suicide rate of 5% per year.1. A growth factor of e.g. 1.05 indicates an increase in the suicide rate of 5% per year.
2. Adj usted for unem plo y ment and per capita alcohol consumpt ion.2. Adj usted for unemp lo y ment and per capita alcohol consum ption.
3. Adjusted for unemployment, per capita alcohol consumption and proportion of young men in the population.3. Adj usted for unemploy ment, per capita alcohol consumption and propor tion of young men in the population.
Fig. 2Fig. 2 Firearm suicides as a percentage of totalFirearm suicides as a percentage of total
suicides.suicides.
Fig. 3Fig. 3 Course of suicide methods before and after the1997 firearm legislation.Course of suicide methods before and after the 1997 firearm legislation.
KAPUSTA ET ALKAPUSTA ET AL
firearm suicides in Australia was further ac-firearm suicides in Australia was further ac-
celerated after the enactment of a morecelerated after the enactment of a more
stringent firearm law in 1996 (Goldney,stringent firearm law in 1996 (Goldney,
2006). Data from New Zealand showed2006). Data from New Zealand showed
that the mean firearm suicide rate de-that the mean firearm suicide rate de-
creased after assessment of firearm reliabil-creased after assessment of firearm reliabil-
ity and licence tests were introduced inity and licence tests were introduced in
1992 (Beautrais1992 (Beautrais et alet al, 2006). Besides this, 2006). Besides this
decline in firearm suicides, a decrease indecline in firearm suicides, a decrease in
firearm suicides as a percentage of totalfirearm suicides as a percentage of total
suicides was also observed, similar to thesuicides was also observed, similar to the
decrease observed in our findings. Thedecrease observed in our findings. The
decrease in the percentage of firearm sui-decrease in the percentage of firearm sui-
cides has been discussed as ruling out thecides has been discussed as ruling out the
possibility that the decline in firearm-possibility that the decline in firearm-
related suicides is due to changes in overallrelated suicides is due to changes in overall
suicide rates (Beautraissuicide rates (Beautrais et alet al, 2006)., 2006).
A series of studies is also available fromA series of studies is also available from
Canada, where the criminal code wasCanada, where the criminal code was
amended in 1977 (Bill C-51). Some studiesamended in 1977 (Bill C-51). Some studies
reported a decrease in firearm suicide ratesreported a decrease in firearm suicide rates
after enactment of the reform (Richafter enactment of the reform (Rich et alet al,,
1990; Carrington & Moyer, 1994; Leenaars1990; Carrington & Moyer, 1994; Leenaars
et alet al, 2003). Although Rich, 2003). Although Rich et alet al (1990) sug-(1990) sug-
gested possible switching effects from firearmgested possible switching effects from firearm
suicides to suicides by jumping, comparing 5-suicides to suicides by jumping, comparing 5-
year periods before and after the reform, ayear periods before and after the reform, a
subsequent study (Carrington & Moyer,subsequent study (Carrington & Moyer,
1994) with a longer observation period1994) with a longer observation period
found this trend to be insignificant. Thefound this trend to be insignificant. The
findings on the effects of legal restrictionfindings on the effects of legal restriction
in Canada have been replicated by a furtherin Canada have been replicated by a further
study, after two additional firearm lawsstudy, after two additional firearm laws
(Bills C-17 and C-68) were enacted in(Bills C-17 and C-68) were enacted in
1991 and 1995; subsequent to this legisla-1991 and 1995; subsequent to this legisla-
tion, firearm suicides, the percentage oftion, firearm suicides, the percentage of
firearm suicides and firearm homicidesfirearm suicides and firearm homicides
further decreased (Bridges, 2004). How-further decreased (Bridges, 2004). How-
ever, when re-examining these Canadianever, when re-examining these Canadian
data, Leenaarsdata, Leenaars et alet al (2003) found evidence(2003) found evidence
of switching for men but not women. Sinceof switching for men but not women. Since
firearm suicide rates among women ac-firearm suicide rates among women ac-
counted for a small proportion of all fire-counted for a small proportion of all fire-
arm suicides in our study, switchingarm suicides in our study, switching
effects for each gender were not calculated.effects for each gender were not calculated.
The potential switch to other suicideThe potential switch to other suicide
methods is a complex phenomenon whichmethods is a complex phenomenon which
is often misinterpreted. Since firearm sui-is often misinterpreted. Since firearm sui-
cides (as a percentage of all suicides) declinecides (as a percentage of all suicides) decline
after an effective law, the proportion ofafter an effective law, the proportion of
other methods of suicide logically increases.other methods of suicide logically increases.
But this does not explain a possible switch-But this does not explain a possible switch-
ing phenomenon one has to consider theing phenomenon one has to consider the
course of suicide rates. Accordingly, acourse of suicide rates. Accordingly, a
switching phenomenon would be reflectedswitching phenomenon would be reflected
in an increase in absolute suicides by allin an increase in absolute suicides by all
other methods (or some of the methods)other methods (or some of the methods)
after the enactment of a more stringent fire-after the enactment of a more stringent fire-
arm law, which was not observed in ourarm law, which was not observed in our
work.work.
Besides cross-sectional studies on theBesides cross-sectional studies on the
association of firearm availability and fire-association of firearm availability and fire-
arm suicides in the USA (Dahlbergarm suicides in the USA (Dahlberg et alet al ,,
2004; Miller2004; Miller et alet al, 2004) and Austria, 2004) and Austria
(Etzersdorfer(Etzersdorfer et alet al, 2006), longitudinal, 2006), longitudinal
studies have shown that firearm suicidesstudies have shown that firearm suicides
are associated with household firearm own-are associated with household firearm own-
ership (Millerership (Miller et alet al, 2002; Haw, 2002; Haw et alet al, 2004)., 2004).
Our results support and supplement theseOur results support and supplement these
findings, additionally demonstrating that afindings, additionally demonstrating that a
change in firearm legislation has an impactchange in firearm legislation has an impact
on firearm availability. A change in firearmon firearm availability. A change in firearm
legislation simultaneously alters the num-legislation simultaneously alters the num-
ber of firearm licences and the firearmber of firearm licences and the firearm
suicide rate, and this emphasises thesuicide rate, and this emphasises the
hypothesised association between bothhypothesised association between both
variables.variables.
In a cross-sectional study we have re-In a cross-sectional study we have re-
cently shown that there is a trend towardscently shown that there is a trend towards
higher firearm suicide rates in counties withhigher firearm suicide rates in counties with
higher firearm licensing rates (Etzersdorferhigher firearm licensing rates (Etzersdorfer
et alet al, 2006). These findings have been de-, 2006). These findings have been de-
scribed as representing an urgent publicscribed as representing an urgent public
health issue (Leenaars, 2006). Along withhealth issue (Leenaars, 2006). Along with
the results of the longitudinal analysis re-the results of the longitudinal analysis re-
ported here, there is even more evidenceported here, there is even more evidence
to support the view that a reduction in fire-to support the view that a reduction in fire-
arm suicides and firearm homicides can bearm suicides and firearm homicides can be
achieved by restriction of firearm availabil-achieved by restriction of firearm availabil-
ity through implementation of more strin-ity through implementation of more strin-
gent firearms legislation.gent firearms legislation.
Limitations of the studyLi m itations of the study
Because of the limiting ecological design ofBecause of the limiting ecological design of
this study, it must be noted that the de-this study, it must be noted that the de-
creasing firearm homicide and suicidecreasing firearm homicide and suicide
trends we observed although having sig-trends we observed although having sig-
nificantly changed in and after the year ofnificantly changed in and after the year of
the legal reform – may be attributable to so-the legal reform – may be attributable to so-
cio-economic or other factors. The influ-cio-economic or other factors. The influ-
ence of well-known confounders such asence of well-known confounders such as
consumption of alcohol per capita and un-consumption of alcohol per capita and un-
employment did not significantly diminishemployment did not significantly diminish
the positive effects of the new law as ob-the positive effects of the new law as ob-
served in our study. This has also beenserved in our study. This has also been
found in earlier multivariate models, wherefound in earlier multivariate models, where
the association of firearm availability andthe association of firearm availability and
firearm suicide rates has not been ruledfirearm suicide rates has not been ruled
out (Ludwig & Cook, 2000; Lenaarsout (Ludwig & Cook, 2000; Lenaars et alet al,,
2003; Miller2003; Miller et alet al, 2006)., 2006).
Since the accuracy of survey data andSince the accuracy of survey data and
other proxy variables of firearm availabilityother proxy variables of firearm availability
are questionable (Millerare questionable (Miller et alet al, 2004), the, 2004), the
number of officially issued firearm licencesnumber of officially issued firearm licences
was used to assess the availability of fire-was used to assess the availability of fire-
arms. We acknowledge that this measurearms. We acknowledge that this measure
is an underestimation of firearm availabil-is an underestimation of firearm availabil-
ity, but it is the only available measure fority, but it is the only available measure for
Austria. Another limitation of our resultsAustria. Another limitation of our results
is that aggregated data analyses allow nois that aggregated data analyses allow no
direct conclusion about individuals. Millerdirect conclusion about individuals. Miller
et alet al (2002) discussed the possibility that(2002) discussed the possibility that
individuals who die by suicide may notindividuals who die by suicide may not
share the characteristics (level of income,share the characteristics (level of income,
available firearm) of the group from whichavailable firearm) of the group from which
they were drawn. However, this does notthey were drawn. However, this does not
limit the growing evidence that morelimit the growing evidence that more
stringent firearm legislation reduces firearmstringent firearm legislation reduces firearm
deaths in the overall population.deaths in the overall population.
Finally, it could be argued that the de-Finally, it could be argued that the de-
crease in firearm suicide rates observed increase in firearm suicide rates observed in
our study might be a randomly found effectour study might be a randomly found effect
of an overall decline in suicide rate and notof an overall decline in suicide rate and not
due to the change in legislation. This isdue to the change in legislation. This is
found to be improbable when the declinefound to be improbable when the decline
in post-legislation firearm homicides is alsoin post-legislation firearm homicides is also
taken into consideration. We could showtaken into consideration. We could show
that, along with a decline in the numberthat, along with a decline in the number
256256
AUTHOR S P ROOFAUTHOR S P ROOF
Fig. 4Fig. 4 Firearm homicide rates.Firearm homicide rates.
Fig. 5Fig. 5 Firearm licence rates before and after theFirearm licence rates before and after the
1 997 firearm leg isl ation.1997 fi rearm legislation.
IMPACT OF FIREARM LEGISLATION ON SUICIDEIMPACT OF F IREARM LEGISL ATION ON SUICIDE
of firearm suicides, the number of firearmof firearm suicides, the number of firearm
homicides also decreased after enactmenthomicides also decreased after enactment
of the new legislation. The firearm homi-of the new legislation. The firearm homi-
cide rate trend had previously been steady,cide rate trend had previously been steady,
but it decreased after enactment, whereasbut it decreased after enactment, whereas
the overall suicide rate was in continuousthe overall suicide rate was in continuous
decline both before and after the legal re-decline both before and after the legal re-
form. We argue that the effect of changesform. We argue that the effect of changes
in firearm laws can be observed in twoin firearm laws can be observed in two
different measures: firearm suicides anddifferent measures: firearm suicides and
firearm homicides. Restrictive firearm legis-firearm homicides. Restrictive firearm legis-
lation has previously been shown to reducelation has previously been shown to reduce
firearm suicides as well as homicides infirearm suicides as well as homicides in
cross-sectional (Conner & Zhong, 2003;cross-sectional (Conner & Zhong, 2003;
RosengartRosengart et alet al, 2005) and longitudinal, 2005) and longitudinal
studies (Loftinstudies (Loftin et alet al, 1991; Leenaars &, 1991; Leenaars &
Lester, 1994; LeenaarsLester, 1994; Leenaars et alet al, 2003; Bridges,, 2003; Bridges,
2004).2004).
Implications of the studyImplications of the study
Suicide prevention plans encounter resis-Suicide prevention plans encounter resis-
tance when they demand more stringenttance when they demand more stringent
firearm laws, because national firearm re-firearm laws, because national firearm re-
strictions inevitably affect many people, in-strictions inevitably affect many people, in-
cluding those who are not at risk of suicide.cluding those who are not at risk of suicide.
Yet it should also be remembered that thoseYet it should also be remembered that those
who are at risk will be more effectively pro-who are at risk will be more effectively pro-
tected by such laws. Some researchers statetected by such laws. Some researchers state
that suicide prevention strategies are basedthat suicide prevention strategies are based
on two different approaches, which shouldon two different approaches, which should
be balanced – namely, the restriction of thebe balanced – namely, the restriction of the
means of suicide and the prevention ofmeans of suicide and the prevention of
mental disorders (Gunnell & Lewis,mental disorders (Gunnell & Lewis,
2005). They rightly point to the fact that re-2005). They rightly point to the fact that re-
striction of means does not address the rootstriction of means does not address the root
cause of the problem. However, until thecause of the problem. However, until the
effective prevention of mental disorderseffective prevention of mental disorders
realistically becomes our long-term aim,realistically becomes our long-term aim,
we should recall that the restriction ofwe should recall that the restriction of
means very probably does prevent suicidemeans very probably does prevent suicide
in the short term, thereby increasing thein the short term, thereby increasing the
likelihood of people who are suicidal re-likelihood of people who are suicidal re-
ceiving professional help in time. Despiteceiving professional help in time. Despite
its limitations, this study provides evidenceits limitations, this study provides evidence
from a European country that firearm sui-from a European country that firearm sui-
cides and homicides may indeed be pre-cides and homicides may indeed be pre-
vented through legal restriction of thevented through legal restriction of the
availability of firearms. Therefore, we re-availability of firearms. Therefore, we re-
commend that further steps be taken incommend that further steps be taken in
Austria and in other countries to reduceAustria and in other countries to reduce
the availability of firearms.the availability of firearms.
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257257
AUTHOR S P ROOFAUTHOR S P ROOF
NESTOR D .KA PUSTANESTOR D.KAPUSTA, MD, Department of Psychoanalysis and Psychotherapy and Institute for Medical, MD, Department of Psychoanalysis and Psychotherapy and Institute for Medical
Psychology, Medical University of Vienna, Austria;Psychology, Medical University of Vienna, Austria; ELMAR ETZERSDORFERELMAR ETZERSDORFER, MD, Furtbach Hospital for,MD,FurtbachHospitalfor
Ps ychiatry and Ps ychot he rapy, S tutt gart, Germany;Psychiatry and Psychotherapy, Stuttgart,Germany; CHRISTOPH KRALLCHRISTOPH KRALL, PhD, Section of Medical Statistics,, PhD, Section of Medical Statistics,
Medical University of Vienna, Austria;Medical University of Vienna, Austria; GERNOT SONNECKGERNOT SONNECK, MD, Institute for Medical Psychology, Medical, MD, Institute for Medical Psychology, Medical
University of Vienna, AustriaUniversity of Vienna, Austria
Correspondence: Dr Nestor D.Kapusta , Medical Univer sity of Vienna,Depar tment of PsychoanalysisCorrespondence: Dr Nestor D.Ka pusta, Medical University of Vienna,D epartment of Psychoa nalysis
and Psychotherapy,Waehringer Guertel 18^20, A-109 0 Vienna, Austria. Tel: +43 1 4 04 0 0 3 064;and Psychotherapy,Waehringer Guertel18^20, A-10 90 Vienna,Austria.Tel: +43 1 4 04 0 0 306 4;
fax: +43 1 427 7 9656; email: n estor.kapustafax: +43 1 4277 9656; email: nestor.kapusta@@meduniwien.ac.atmeduniwien.ac .at
(First received 30 October 2006, final revision 29 March 2007, accepted 12 April 2007)(First received 30 October 2006, final revision 29 March 2007, accepted 12 April 2007)
... A recent comprehensive review of firearm-control legislation worldwide identified the association between firearm-related laws (regarding restrictions on purchase, access, or use of firearms) and suicide deaths by firearm in certain countries [17]. After the firearm legislation reform in the European Union in 1997, Kapusta and coauthors [19] found that the law was associated with reductions in firearm suicide in Austria (change in trends in pre-/post-law periods = −9.9%). Similarly, Australia's 1996 gun law reforms were followed by more accelerated declines in suicide mortality by firearm, with the ratio between pre-and post-law trends of 0.954 [20]. ...
... The available literature on the association between firearm-related laws and the rate of firearm-related suicides has reported on studies regarding the legislations and rate of suicide by firearm in high income countries [17][18][19][20], mainly in the United States of America [17,18,36]. A longitudinal study of US states from 2012 to 2016, indicated that the total number of firearm laws and Gun Violence Restricting Order laws was negatively associated with firearm-related suicide rate among older adults ages 55-64 and >65 years-old (p<0.001) ...
... However, a cross-sectional state-level study in the United States of America showed that not all of the firearm laws were associated with reduced mortality of suicide by firearm: whiles reductions in firearm-related suicide deaths were associated with law that enforced firearm identification and permit processes, the increased suicide rates were associated with three laws and the remaining 20 laws were inconclusively associated [38]. Apart from the variety of laws / the differences in law implementation methods / the diversity in law enforcement efforts / the severity of punishments associated with legal violations / specifics of firearm-related policies across countries, some confounding social and state-level factors act both before and after the respective laws [19,38]. For example, some of the countries with the highest mortality rates of suicide by firearm have the highest social well-being indicators (GDP, GDP per capita, HDI) at the same time (the United States of America, Norway, France, Finland, Canada, Denmark). ...
... Five studies were published in peer-reviewed journals [18][19][20][21][22] and one report was published by researchers associated with the Flemish Peace Institute in Belgium [1]. Two studies were published between 2000 and 2010 [20,21]. ...
... Five studies were published in peer-reviewed journals [18][19][20][21][22] and one report was published by researchers associated with the Flemish Peace Institute in Belgium [1]. Two studies were published between 2000 and 2010 [20,21]. Four studies were published between 2010 and 2020 [1,18,19,22]. ...
... Four studies were published between 2010 and 2020 [1,18,19,22]. Four of the six studies limit their research to examining the link between access to firearms and firearm-enabled violence to one country [18,[20][21][22]. Those studies originate from Austria (n = 2) [20,22], Norway (n = 1) [18] and Switzerland (n = 1) [21]. ...
Article
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Background Higher availability of firearms has been connected to higher rates of interpersonal violence in previous studies. Yet, those studies have focused mainly on the United States, or used aggregated international data to study firearm violence. Whether those aggregated findings are applicable to understanding the phenomenon in continental Europe specifically remains unclear. The aim of this systematic review is to bring together all studies that exclusively use European data. Methods Nine databases were searched, resulting in more than 1900 individual studies. These studies were assessed on relevance and eligibility for this study, based on their title, abstract and full text. Information on study characteristics, operationalizations of main concepts and study results were extracted from the six eligible studies. Results Four studies assessed the impact of firearm restrictive regulations on the rate of firearm homicides. Two other studies correlated rates of firearm availability and -violence. Results vary: some studies show a clear decline once availability of firearms is restricted, while others indicate a limited effect on only a very specific subgroup, such as female victims, or national guards with weapons at home. Moreover, studies used various operationalizations for firearm availability, thereby decreasing the comparability of findings. Conclusion Empirical research exclusively using European data is still lacking. To increase comparability of future studies, methodological inconsistencies and regional gaps need to be overcome. Assessing how firearm availability can be measured with reliable and valid proxies across countries will be a crucial first step to improve future research on the link between firearms and firearm violence.
... 18 Similarly, following the introduction of more restrictive firearm legislation in the European Union in 1997, firearm suicide (and homicide) rates decreased in Austria. 19 Based on these findings, Kapusta et al. concluded, "Restrictive firearm legislation should be an integral part of national suicide prevention programs in countries with high firearm suicide rates" (Ref. 19, p 253). ...
... 19 Based on these findings, Kapusta et al. concluded, "Restrictive firearm legislation should be an integral part of national suicide prevention programs in countries with high firearm suicide rates" (Ref. 19, p 253). Given public opinion data in the United States showing high levels of support for a range of firearm restriction policies among gun owners and nongun owners, one might expect such an approach to suicide reduction to be highly feasible. ...
Article
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Restricting suicidal individuals’ access to firearms is essential in the United States where firearms, which are unique in the combination of lethality and widespread availability, account for approximately half of all suicides. Although not typically conceived of as a suicide prevention tool by policymakers, ERPO laws have functioned primarily as legislated firearm restriction policies in their implementation, most commonly targeting suicidal individuals. Further, data suggest that these laws are effective, with estimates suggesting that one suicide might be averted for every 10 or 11 firearm seizures carried out under ERPO statutes. Relative to other common pharmacologic and psychosocial approaches to suicide prevention, ERPO laws may be uniquely efficient, likely due to their effectiveness in narrowly directing firearm seizures toward individuals who present an extremely high risk of suicide. Building on the knowledge gained from ERPO laws regarding their role in the pantheon of suicide prevention tools, the promotion of nonlegalistic means restriction approaches appears desirable, including more widespread dissemination of firearm safety counseling strategies and the development of social norming approaches that promote a shared sense of responsibility for keeping firearms away from family and friends in crisis. Although ERPO laws will continue to play an important role where other, less coercive interventions have failed, it is hoped that this commentary also promotes interest among psychiatrists in nonlegalistic firearm means restriction approaches to suicide prevention.
... En Rusia se analizó la asociación del homicidio con el consumo de alcohol (Pridemore y Chamlin, 2006), y en otro estudio realizado con datos de 1980 y 2005 se determinó que las tasas de mortalidad por violencia son sensibles a los cambios en las ventas de vodka por habitante, mas no a los cambios en las ventas de alcohol en general (Evgeny, 2010). La introducción de leyes restrictivas sobre la posesión y la adquisición de armas en Austria en 1997 estuvo relacionada con la reducción de la tasa de homicidios por arma de fuego (Kapusta et al., 2007). En un estudio realizado en Manchester en 2005 se evidenció que la eliminación de las restricciones sobre los horarios de expendio de alcohol no generó un incremento general de violencia, pero si existió un gradual cambio de la violencia de fin de semana hacia horas más tardías (Humphreys, Eisner y Wiebe, 2013). ...
... 47 Several other countries have shown that firearm-related injury and death are largely preventable and that policy change can have considerable impact. [48][49][50][51][52][53][54] Although media attention focuses largely on firearm violence in urban centres, our findings highlight that men in rural Ontario are at high risk for death from firearm-related injuries secondary to self-harm. Different injuryprevention strategies may be needed to address specific at-risk groups in different settings. ...
Article
Background: Firearm-related injury is an important and preventable cause of death and disability. We describe the burden, baseline characteristics and regional rates of firearm-related injury and death in Ontario. Methods: We conducted a population-based cross-sectional study using linked data from health administrative data sets held at ICES. We identified residents of Ontario of all ages who were injured or died as a result of a firearm discharge between Apr. 1, 2002, and Dec. 31, 2016. We included injuries classified as assault, unintentional, self-harm or undetermined intent secondary to handguns, rifles, shotguns and larger firearms. The primary outcome was the incidence of nonfatal and fatal injuries resulting in an emergency department visit, hospital admission or death. We also describe regional and temporal rates. Results: We identified 6483 firearm-related injuries (annualized injury rate 3.54 per 100 000 population), of which 2723 (42.3%) were fatal. Assault accounted for 40.2% (1494/3715) of nonfatal injuries and 25.5% (694/2723) of deaths. Young men, predominantly in urban neighbourhoods, within the lowest income quintile were overrepresented in this group. Injuries secondary to self-harm accounted for 68.0% (1366/2009) of injuries and occurred predominantly in older men living in rural Ontario across all income quintiles. The case fatality rate of injuries secondary to self-harm was 91.7%. Self-harm accounted for 1842 deaths (67.6%). Interpretation: We found that young urban men were most likely to be injured in firearm-related assaults and that more than two-thirds of self-harm-related injuries occurred in older rural-dwelling men, most of whom died from their injuries. This highlights a need for suicide-prevention strategies in rural areas targeted at men aged 45 or older.
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Introduction Suicide by firearm is a major public health problem in many countries. But, studies that investigated the mortality of suicide by firearm on a global scale are still limited. The aim of this study was to assess the global, regional and national trends in mortality of suicide by firearm from 1990 to 2019. Method Mortality data of suicide by firearm was presented using the age-standardized rates (ASRs, expressed per 100,000). Joinpoint regression analysis was used to assess trends of mortality of suicide by firearm: the average annual percent change (AAPC) with the corresponding 95% confidence interval (95%CI) was calculated. Results A total of 52,694 (45,110 male and 7584 female) deaths of suicide by firearm were reported worldwide in 2019. The global ASR of suicide by firearm was six-fold higher in males than in females (1.15 per 100,000 and 0.19 per 100,000, respectively), and varied greatly across countries: the highest rates were in Greenland (24.52 per 100,000 and 2.69 per 100,000, respectively) and the United States of America (10.13 per 100,000 and 1.66 per 100,000, respectively), while the lowest rates (0.05 per 100,000 or less) were observed in China, Japan and Singapore. Globally, the mortality of suicide by firearm had a decreasing tendency from 1990 to 2019 in both sexes together (AAPC = -2.0% per year; 95%CI = -2.1 to -1.9). Conclusion Decreasing trends in mortality of suicide by firearm were observed in majority of countries across the world, but not in all. Future research should determine more effective ways to further reduce mortality of suicide by firearm.
Chapter
Suicidality remains an incredible mortality threat to adolescents in the United States. While self-harm continues to serve as a concerning risk factor for suicide, reassuring evidence suggests that the majority of individuals that survive their first suicide attempt will ultimately never complete suicide. Therefore, the lethality of suicide method makes a significant impact on the likelihood of ultimate survival for these adolescents. As such, several historical public health initiatives have successfully implemented lethal means reduction strategies to prevent suicide mortality. As firearms remain the most common suicide method among American teenagers with the highest fatality rate, physician counseling, legislative efforts, and health campaigns focused on reducing the accessibility of firearms serve as a promising path towards reducing adolescent mortality.
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Introduction In the U.S., state-level household firearm ownership is strongly associated with firearm suicide mortality rates. Whether the recent increases in firearm suicide are explained by state-level household firearm ownership rates and trends remains unknown. Methods Mortality data from the U.S. National Vital Statistics System and an estimate of state-level household firearm ownership rate were used to conduct hierarchical age–period–cohort (random-effects) modeling of firearm suicide mortality between 2001 and 2016. Models were adjusted for individual-level race and sex and for state-level poverty rate, unemployment rate, median household income in U.S. dollars, population density, and elevation. Results Between 2001 and 2016, the crude national firearm suicide mortality rate increased from 6.8 to 8.0 per 100,000, and household firearm ownership rate remained relatively stable, at around 40%. Both variables were markedly heterogeneous and correlated at the state level. Age–period–cohort models revealed period effects (affecting people across ages) and cohort effects (affecting specific birth cohorts) underlying the recent increases in firearm suicide. Individuals born after 2000 had higher firearm suicide rates than most cohorts born before. A 2001–2006 decreasing period effect was followed, after 2009, by an increasing period effect that peaked in 2015. State-level household firearm ownership rates and trends did not explain cohort effects and only minimally explained period effects. Conclusions State-level firearm ownership rates largely explain the state-level differences in firearm suicide but only marginally explain recent increases in firearm suicide. Although firearms in the home increase firearm suicide risk, the recent national rise in firearm suicide might be the result of broader, more distal causes of suicide risk.
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Background: 100,000 Americans are shot annually and 39,000 die. State laws restricting firearm sales and use have been shown to decrease firearm deaths, yet little is known about what impacts their passage or repeal. We hypothesized that spending by groups that favor firearm restrictive legislation would increase new state firearm restrictive laws (FRL) and that states increasing these laws would endure fewer firearm deaths. Methods: We acquired 2013-2018 state data on spending by groups against firearm restrictive legislation (A-FRL) and for it (F-FRL) regarding lobbying, campaign, independent and total expenditures from the National Institute on Money in State Politics. State level political party representation data was acquired from the National Conference of State Legislatures. Mass shooting data was obtained from the Mass Shooter Database of the Violence Project and firearm death rates were obtained from CDC WONDER and FBI UCR databases. FRL were obtained from the State Firearms Law Database. A univariate panel linear regression with fixed effect for state was performed with change in FRL from baseline as the outcome. A final multivariable panel regression with fixed effect for state was then utilized. Firearm death rates were compared by whether states increased, decreased or had no change in FRL. Results: 22 states gained and 13 lost FRL while 15 states had no net change (44%, 26% and 30%, p=0.484). In multivariable regression accounting for partisan control of state government, F-FRL groups outspending A-FRL groups had the largest association with increased FRL (β 1.420, 95% CI 0.63 to 2.21, p<0.001). States which gained FRL had significantly lower firearm death rates (p<0.001). Relative to states with no change in FRL, states which lost FRL had an increase in overall firearm death of 1 per 100,000 individuals. States which gained FRL had a net decrease in median overall firearm death of 0.5 per 100,000 individuals. Conclusions: Higher political spending by groups in favor of restrictive firearm legislation has a powerful association with increasing and maintaining FRL States which increased their FRL, in turn, showed lower firearm death rates. Level of evidence: Retrospective cohort study, level 3 evidence.
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One tactic which has been suggested to prevent suicide and homicide is to restrict the availability of lethal means for these acts. The effectiveness of this tactic over the life span was explored by examining the impact of the passage of gun control legislation in Canada in 1977 (Bill c-51). The results indicated that, while the use of firearms for suicide was reduced a little after passage of this Act, this effect was not apparent for those over the age of 65. However, for homicide, the effect of the passage of the gun control legislation was stronger for victims over the age of 55. Several suggestions were made for future research on this topic. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Whether restricting access to handguns will reduce firearm-related homicides and suicides is currently a matter of intense debate. In 1976 the District of Columbia adopted a law that banned the purchase, sale, transfer, or possession of handguns by civilians. We evaluated the effect of implementing this law on the frequency of homicides and suicides. Homicides and suicides committed from 1968 through 1987 were classified according to place of occurrence (within the District of Columbia or in adjacent metropolitan areas where the law did not apply), cause (homicide or suicide), mechanism of death (firearms or other means), and time of occurrence (before or after the implementation of the law). The number of suicides and homicides was calculated for each month during the study period, and differences between the mean monthly totals before and after the law went into effect were estimated. In Washington, D.C., the adoption of the gun-licensing law coincided with an abrupt decline in homicides by firearms (a reduction of 3.3 per month, or 25 percent) and suicides by firearms (reduction, 0.6 per month, or 23 percent). No similar reductions were observed in the number of homicides or suicides committed by other means, nor were there similar reductions in the adjacent metropolitan areas in Maryland and Virginia. There were also no increases in homicides or suicides by other methods, as would be expected if equally lethal means were substituted for handguns. Restrictive licensing of handguns was associated with a prompt decline in homicides and suicides by firearms in the District of Columbia. No such decline was observed for homicides or suicides in which guns were not used, and no decline was seen in adjacent metropolitan areas where restrictive licensing did not apply. Our data suggest that restrictions on access to guns in the District of Columbia prevented an average of 47 deaths each year after the law was implemented.
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To examine the effect of specific firearm control legislation on firearm and overall suicide rates. Retrospective survey of data from the Register of the Suicide Research and Prevention Program, Queensland Department of Health. The hypothesis was tested that the legislation would reduce firearm and overall suicides more in metropolitan and provincial city areas than in rural areas, where firearm ownership is higher. State of Queensland 1990-1993. Suicide rates by age, sex and method for metropolitan, provincial city and rural areas in the two years before (1990-1991) and after (1992-1993) legislation. Mean annual firearm suicide rates declined significantly (P < 0.05) in metropolitan and provincial city areas after legislation (from 3.6 to 2.3 per 100,000 and from 5.2 to 3.1 per 100,000, respectively), with significant declines among men and in the 15-29 years age group. Rates increased slightly in rural areas (from 7.2 to 8.2 per 100,000). Overall suicide rates declined in provincial areas only, with minimal change in metropolitan areas and a slight rise in rural areas. These results provide preliminary evidence that firearm control legislation, including a 28-day "cooling-off" period before firearm purchase, reduces suicide rates, especially among younger adult men.
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Recently, Lester and Leenaars (1993) examined the effects on suicide of Canada's Criminal Law Amendment Act of 1977 (Bill C-51), enforced from 1978 on, which required acquisition certificates for all firearms, restricted the availability of some types of firearms to certain types of individuals, set up procedures for handling and storing firearms, required permits for those selling firearms, and increased the sentences for firearms offenses. After enforcement of the act, the firearm suicide decreased in Canada indicated by the percentage of suicides using firearms. The present study examined the effects of this bill on homicide in Canada. Method.-Data were obtained from Statistics Canada (Annual) for the period 1969 to 1985 on homicides committed in Canada by each method. This permitted a comparison of the period 1969 to 1976 prior to the passage and enforcement of Bill C-51 with the period 1978 to 1985 afterwards. Results and discussion.-The data are shown in Table 1. Whereas the total homicide rate in Canada in the period 1969 to 1976 did not change significantly after the passage of Bill C-51, the homicides by firearm decreased significantly, as did the percentage of homicides involving a firearm. However, the homicide rate by all other methods increased after passage of Bill C-51. These results indicate, therefore, that the passage of a bill to strengthen controls on firearms in Canada was associated with a reduced rate in use of firearms for homicide. However, there was evidence that individuals intent on murder may have switched to other means for murder since the rate using
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Farmers in the UK have an elevated risk of suicide. It has been suggested that this may be related to their ease of access to dangerous means for suicidal behaviour. The extent to which farmers use these means and changes in their use may be relevant to suicide prevention. Data on 719 deaths in farmers of both genders in England and Wales between 1981 and 1993 in which a verdict of suicide or undetermined cause (open verdict) was recorded were analysed. Of 702 deaths in male farmers, firearms were involved in 40.0%, hanging in 29.6%, carbon monoxide in 16.4%, poisoning in 8.0% (over half of which involved agricultural or horticultural poisons) and other methods in 6.1%. There was a considerable excess of deaths due to firearms compared with the distribution of methods of suicide and open verdict deaths in males in the general population. Hanging was also somewhat more frequent. During the study period there was a reduction in firearm death rates, particularly after 1989 when there was national legislation on firearm ownership, registration and storage. There were also fewer farming suicides after this date. By the end of the study period hanging was more frequent than deaths involving firearms. Farmers who commit suicide tend to use methods to which they have easy access. Restriction of the ready availability of such methods, particularly in farmers known to be depressed or otherwise at risk, might prevent some suicides.
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The evidence linking firearms in the home to risk for suicide is reviewed. These data come from epidemiological, case-control, quasiexperimental, and prospective studies. The convergent finding from this wide range of studies is that there is a strong relationship between firearms in the home and risk for suicide, most firmly established in the United States.
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It has been suggested that limiting access to firearms could prevent many suicides, but this belief is controversial. To assess the strength of the association between the availability of firearms and suicide, we studied all suicides that took place in the homes of victims in Shelby County, Tennessee, and King County, Washington, over a 32-month period. For each suicide victim (case subject), we obtained data from police or the medical examiner and interviewed a proxy. Their answers were compared with those of control subjects from the same neighborhood, matched with the victim according to sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods. During the study period, 803 suicides occurred in the two counties, 565 of which (70 percent) took place in the home of the victim. Fifty-eight percent (326) of these suicides were committed with a firearm. After excluding 11 case subjects for various reasons, we were able to interview 80 percent (442) of the proxies for the case subjects. Matching controls were identified for 99 percent of these subjects, producing 438 matched pairs. Univariate analyses revealed that the case subjects were more likely than the controls to have lived alone, taken prescribed psychotropic medication, been arrested, abused drugs or alcohol, or not graduated from high school. After we controlled for these characteristics through conditional logistic regression, the presence of one or more guns in the home was found to be associated with an increased risk of suicide (adjusted odds ratio, 4.8; 95 percent confidence interval, 2.7 to 8.5). Ready availability of firearms is associated with an increased risk of suicide in the home. Owners of firearms should weigh their reasons for keeping a gun in the home against the possibility that it might someday be used in a suicide.
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The authors describe suicide rates in Toronto and Ontario and methods used for suicide in Toronto for 5 years before and after enactment of Canadian gun control legislation in 1978. They also present data from San Diego, Calif., where state laws attempt to limit access to guns by certain psychiatric patients. Both sets of data indicate that gun control legislation may have led to decreased use of guns by suicidal men, but the difference was apparently offset by an increase in suicide by leaping. In the case of men using guns for suicide, these data support a hypothesis of substitution of suicide method.
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To assess the impact of the 1978 Canadian gun control law on suicide rates in Ontario, the authors compared firearm and nonfirearm suicide rates for 1965-1977 with those for 1979-1989. There was a decrease in level and trend over time of firearm and total suicide rates and no indication of substitution of other methods. These decreases may be only partly due to the legislation.
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In February 1994, the Brady Handgun Violence Prevention Act established a nationwide requirement that licensed firearms dealers observe a waiting period and initiate a background check for handgun sales. The effects of this act have not been analyzed. To determine whether implementation of the Brady Act was associated with reductions in homicide and suicide rates. Analysis of vital statistics data in the United States for 1985 through 1997 from the National Center for Health Statistics. Total and firearm homicide and suicide rates per 100,000 adults (>/=21 years and >/=55 years) and proportion of homicides and suicides resulting from firearms were calculated by state and year. Controlling for population age, race, poverty and income levels, urban residence, and alcohol consumption, the 32 "treatment" states directly affected by the Brady Act requirements were compared with the 18 "control" states and the District of Columbia, which had equivalent legislation already in place. Changes in rates of homicide and suicide for treatment and control states were not significantly different, except for firearm suicides among persons aged 55 years or older (-0.92 per 100,000; 95% confidence interval [CI], -1.43 to -0.42). This reduction in suicides for persons aged 55 years or older was much stronger in states that had instituted both waiting periods and background checks (-1.03 per 100,000; 95% CI, -1.58 to -0.47) than in states that only changed background check requirements (-0.17 per 100,000; 95% CI, -1.09 to 0.75). Based on the assumption that the greatest reductions in fatal violence would be within states that were required to institute waiting periods and background checks, implementation of the Brady Act appears to have been associated with reductions in the firearm suicide rate for persons aged 55 years or older but not with reductions in homicide rates or overall suicide rates. However, the pattern of implementation of the Brady Act does not permit a reliable analysis of a potential effect of reductions in the flow of guns from treatment-state gun dealers into secondary markets. JAMA. 2000;284:585-591