We can keep suicidal individuals from committing suicide successfully by making sure they can't get a gun, say researchers at Harvard School of Public Health.

The article in The New England Journal of Medicine (NEJM) was written by Matthew Miller, assistant professor of health policy and management ans associate director of the Harvard Injury Control Research Center, and David Hemenway, professor of health policy and director of the Harvard Injury Control Research Center.

Suicide is the second-leading cause of death among Americans 40 years old and younger, according to their statistics. Among Americans of all ages, more than half of all completed suicides are gun suicides. Additionally, an estimated one-third to four-fifths of all suicide attempts, according to studies, are impulsive--with 24% taking less than 5 minutes between the decision to kill themselves and the actual attempt, while 70% took less than 1 hour.

Keeping suicidal individuals away from lethal means during these crisis periods is crucial. Attempts involving drugs or cutting, which account for more than 90% of all suicidal acts, prove fatal far less often than firearms.

"The temporary nature and fleeting sway of many suicidal crises is evident in the fact that more than 90% of people who survive a suicide attempt do not go on to die by suicide," write the authors. "A suicide attempt with a firearm rarely affords a second chance."

The onus is on doctors to make sure suicidal patients don't have access to guns, they say, and they encourage physicians to assess a patient's access to lethal means, including how to approach family members about the possible presence of a gun in the home.

But given the self-limiting nature of suicidal crises, often caused by an immediate stressor, such as the breakup of a romantic relationship, the loss of a job or a run-in with police, how can doctors prevent it? If 24% of suicides are acted on within 5 minutes, it is not reasonable that a doctor can prevent it, unless doctors are in the anti-gun business as part of their jobs.

Said Miller, lead author of the NEJM Perspective article: "We are proposing a population-based approach to reducing suicide. This approach recognizes that the physical environment (e.g., the availability of household guns in the U.S., the toxicity of pesticides in Sri Lanka, a frequent method of suicide there) can have a profound effect on the likelihood of completed suicide--and that the physical environment can be modified to save lives. This approach is based on understanding that the number of Americans who die each year can be reduced not only by reducing the rate at which Americans attempt suicide (the traditional target of screening and treatment prevention efforts) but also, and perhaps most dramatically, by making it less likely that suicide attempts prove fatal. One of the best ways to reduce the probability that an impulsive suicidal act proves fatal is to remove firearms from the home."

Miller and co-author David Hemenway state that the empirical evidence linking suicide risk in the U.S. to the presence of firearms in the home is compelling. They point to U.S. case-control studies that have found that a gun in the home is associated with a greatly increased risk of suicide, typically twice to 10 times that in homes without guns depending on the sample population (e.g. adolescents vs. older adults) and the way in which the firearms were stored. Case-control studies have also found that the higher risk of completed suicide in homes with firearms applies not only to the gun owner but also to the gun owner's spouse and children.

"Too many clinicians seem to believe that anyone who uses a gun to attempt suicide must be serious enough that if a gun were not available, they would find an equally lethal way to kill themselves," said Hemenway. "This belief is invalid. Physicians need to embrace all effective measures that can prevent completed suicide, including means restriction."

Article: "Guns and Suicide in the United States," Matthew Miller, David Hemenway, NEJM, September 4, 2008, 359; 10