The New England Journal of Medicine June 4, 2020 pp2259-2260 “Reconsidering Risks of Gun Ownership and Suicide in Unprecedented Times” by Chana A. Sachs, M.D., M.P.H. and Stephen J. Bartels, M.D.
This Editorial reviews a remarkable study “Handgun Ownership and Suicide in California” ibid 2220-2229 by D.M. Studdert, Yifan Zhang, Sonja A. Swanson et al.
As the COVID-19 pandemic emerged in March 2020 Americans went on a gun buying spree tallying “the second highest total in decades…” Other notable spikes followed mass shootings, Sandy Hook, and calls for more gun regulation-Sachs and Bartels surmise that “many consider a firearm to be a form of personal protective equipment during a national emergency”.
The study focused on California and only on the individual buying the gun. Using the state’s voter log of 26,000,000 a group of 676,425 were identified that had no record of prior gun ownership but legally purchased one or more handguns between October 18, 2004 and December 31, 2016. In an average follow-up of 6.9 years “2.6% of the cohort obtained at least one new handgun”. In that group “18,000 suicides were observed, with nearly 40% completed with firearms”. This finding, or course, is not surprising as “access to a firearm is an independent risk factor for death by suicide…”
What is new are findings that after a ten-day waiting period (Days 11-30 after purchase) …”the risk of death from suicide is 100 times higher in the 20 days after a handgun has been acquired as before…[the purchase]. Also new “Women who were new handgun owners were more likely to die by suicide with a firearm that women who did not own a gun (hazard ratio 35.2; 95% CI, 29.6 to 41.8, [Read as 95% confident the fold increase is 29.6-41.8]. This was true for men as well but much less so at 7.3-8.4 fold. "Women attempt suicide more frequently than men but have fewer completed suicides, largely because the means they tend to use (e.g. poisons) are less lethal thant those men tend to use (e.g., guns or hanging)."-from Studdert et al.
Key applications from this study are ask women and men about new gun ownership when assessing risk of suicide and partner with gun-shop owners to raise buyer awareness about resources regarding suicide prevention.
Key limitations of the study was the focus on California and not being able to study if new gun purchase impacted the risk of suicide in other members of the household.