The majority of US gun deaths are suicides. Here’s how to prevent them
In 2022, the number of US gun suicides reached an all-time high: 73 people dying by gun suicide every day, or a total of nearly 27,000 deaths that year.
Despite years of intense debate over gun violence in the US, this central fact still receives little attention: the majority of the country’s gun deaths are suicides, not homicides.
Experts say stigma and misinformation are still getting in the way of preventing more of these deaths. Paul Nestadt, an assistant professor of psychiatry at Johns Hopkins University, spoke to the Guardian about the country’s rising number of suicides, the role of guns and mental health – and what works to save lives. The conversation has been lightly edited for length and clarity.
More than half of this country’s 50,000 suicides per year are committed with guns. What are some misconceptions about guns and suicide?
There’s this myth that suicide is this carefully considered thing. But there’s been studies that look at the time between decision and action, through interviews with suicide survivors. It’s impulsive. The vast majority of people came to their decision about suicide, and attempted it the same day.For three-quarters of people, it’s within an hour. A quarter of them within five minutes. People use what they have available. Lying in bed at two in the morning, you reach for what you have in your bedside drawer. If that’s a bottle of Tylenol, the survival rate is 98%, and the people who survive keep on surviving.
Firearms, however, have a 90% fatality rate. There’s not going to be a chance to get help, get better, which is what most people do. That’s why having a firearm in the house triples the
risk of suicide. There’s even more of a correlation in the case of young people. Kids don’t have as many other options.
When it comes to guns and suicide, a lot of Americans believe that if someone wants to die by suicide, they will find a way to do it, so there’s no point in trying to restrict access to firearms when people are at risk. Is that true?
A survey asked Americans: “If somebody was going to jump off the Golden Gate Bridge and they were prevented, do you think they would find some other way to do it?” About threequarters said that most or all of the people who were thwarted would find some other way. It’s a common belief. But it isn’t true.
There was a large study of people who did try to jump off the Golden Gate Bridge. Researchers were able to find 515 people who either survived the fall, or who were physically pulled off the ledge. The researchers followed up with them for 26 years. Only 4.9% of those people went on to die by suicide. Ninety-five percent – the vast majority – kept surviving. This speaks to the impulsivity of suicide.
People who have survived the Golden Gate Bridge fall and now talk about it, like Kevin Hines, capture what it’s like: when you’re in the midst of that fall, metaphorically or in reality, all of the problems you’re dealing with stop seeming so important. That’s why it’s so important that the method people use on the first suicide attempt isn’t so terribly lethal.
What are some ways to approach suicide prevention with firearms, given that estimates show a quarter to a third of Americans own guns?
If someone in the house is experiencing depression or has a substance use issue, the gun might temporarily be stored outside the house. Firearm ranges, gun shops and police stations – lots of people will let you temporarily store a gun with them. In Maryland, they have a map you can find on a government website, of people who have agreed to hold your gun for you in a crisis. Those safe-storage maps are a great tool.
If there’s a kid in the house, and there must be a gun, it really needs to be stored safely, locking it up with ammunition stored separately.
There are also red-flag laws, or extreme-risk protection orders. If you’re worried about a family member or somebody who might be at risk who has access to a firearm, depending on your state, a family member, the police or clinicians can petition for the guns to be temporarily removed.
Is there evidence that any of these gun-suicide prevention strategies work?
Just about any law that reduces firearm access tends to demonstrate a reduction in firearm suicide. One study from 2004 found that just passing child-access prevention laws – which say that if there’s a kid in the house, you need to keep any guns locked up – reduced suicide rates among teenagers by 8%.
There was a really good study in 2017, looking at Connecticut’s extremerisk protection law, and it found that for every 10 or 11 guns seized by a risk warrant, there was one life saved from firearm suicide. Another study found that Indiana’s extreme-risk protection law reduced firearm suicide by 7.5% over 10 years, without any increase in other means of suicide.
That’s pretty good. You wouldn’t want to use these laws if you didn’t have evidence they worked, because you’re impacting someone’s constitutional right.
It was really after the 2018 Parkland school shooting that many other states started passing these laws, and the intent for most of the legislators was to prevent mass shootings. There’s also been evidence that these laws work to prevent mass shootings, but it’s in suicide that we really see their effects, because the majority of gun deaths are suicides.
The suicide rate in the US has risen in recent years. Are the demographics of who is at risk changing?
White Americans have had about twice the rate of suicide of Black, Latino or Asian populations. Indigenous people also have a really high suicide rate. In 2021, we saw the largest single-year increase in suicide in the general population since the year 2000. And there was a 16% increase in Black suicide, by far the largest increase in Black suicide we’ve ever seen. In particular, firearm suicide in Black Americans skyrocketed. That’s what drove the entire increase.
What do we know about what might be driving the increase in gun suicide?
I think the simplest answer is: there are more guns in this country now. There was a dramatic increase in firearm purchasing in 2020, starting in March, with the pandemic. Firearm sales were record-breaking all through 2020 and 2021.
We’ve seen spikes in gun purchasing in the past, like when Barack Obama was elected, but those had tended to be people who already owned guns who were buying their 12th or 13th gun. The gun purchasers in 2020 and 2021 were much more new gun owners. They were much more in blue states than in red states. Studies found that more of these gun owners were Black, and more were living in urban settings. It was a different kind of gun owner. And those were exactly the populations that saw an increase in firearm suicide.
How significant a role does mental health play in gun suicide, versus gun homicide?
Even if we were to remove all firearm homicides that involve mental illness, that would barely make a dent in firearm homicides in this country.
Most gun deaths are actually suicides. And about 90% of people who die by suicide have some form of mental illness that contributed to their suicide deaths.
About 1% to 5% of people with depression per year will die by suicide. That’s approximately 1% to 3% of the US population.
Substance dependance adds a lot of risk. Ten percent of people with schizophrenia will die by suicide, which is a lot. Also, people with anorexia or other eating disorders have a very high suicide rate. People don’t often think of this, but people with dementia and Parkinson’s have tremendously high suicide rates, especially early in the diagnosis. It’s really something we have to pay attention to.
Mass shootings and other interpersonal violence are incredibly tragic, and very much need to be focused on. But the things that we can to do prevent suicide deaths with guns will potentially save the most lives.
This is part of an ongoing interview series on the connections between mental health and gun violence. Read the first installment on why it’s “misleading and counterproductive” to blame mass shootings on mental health here.
• In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org or text HOME to 741741 to connect with a crisis counselor. In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
release of my finite eggs: all of it seems to force the issue, reopening the question even when I’ve felt content to mark it closed.
***
“I think the first thing to do is validate your own ambivalence, or indecision, or indifference – whatever it is,” says Gina Rushton, from her darkening bedroom in Sydney. I’d spoken to her over Zoom that same morning to talk through her own mixed feelings about motherhood.
Rushton was 27 and, like me, erring on the side of not having children when, in 2019, she was rushed into emergency surgery with abdominal pain. A doctor informed Rushton that she had endometriosis, and her left ovary was “dead”. The diagnosis complicated her chances of conceiving, and prompted her to reconsider. Without it, Rushton tells me, “I probably would have put the decision off for as long as possible.”
As a journalist, her response was to report the subject out. Rushton spent a year writing her book The Parenthood Dilemma, which came out this year, unpicking the associated threads of fertility, climate anxiety and unequal parenting. Her goal, Rushton writes, was to understand how people decided to become parents “without living in permanent denial or perpetual dread”.
“Because we’re socialized to believe that ‘you just know’ if you want kids or not, validating the idea that it is a question is really helpful,” she says. “From there, I think it becomes easier to sift through what your actual hopes and fears are.”
I had earlier sought counsel from that all-knowing modern-day oracle: Google. Search for “should I have a child”, and one name crops up repeatedly. For the past 30 years, the marriage and family therapist Ann Davidman has been running support groups for individuals who feel stuck in their indecision.
Her “parenthood clarity courses” help participants to figure out step by step what they actually want(Davidman’s emphasis) – rather than what they think they should want, or fear. Each program lasts three months. “I don’t think there’s any quicker way,” Davidman says, when I reach her over Zoom.
Davidman’s starting point is also to treat parenthood as a question, “not an assumption”. She sees it as an individual and deeply personal decision, to be interrogated outside of the question of a relationship. “I don’t treat it as a couples issue,” she says. “Really, 90% is about really trying to uncover what it is that you want for you, from within – not in reaction to childhood, or society, or something that doesn’t ever get challenged.”
Straight couples often join Davidman’s motherhood and fatherhood groups simultaneously but separately; same-sex couples are split up into different cohorts so that they can reach their own conclusions. Sometimes, Davidman says, partners end up realizing that they do want children – but not in that relationship.
Davidman’s method works by boosting self-knowledge, making our concerns and desires known. But what about those factors outside our control, like housing, childcare and the future of the planet?
A recent study, by researchers at University College London, found that stronger concerns about climate breakdown were associated with a desire for fewer children, or none at all.
But, Davidman suggests, that might be a bit of a smokescreen. “Because the climate crisis is so obvious, it’s very easy to hang your hat on it,” she says. “You can talk about that till the cows come home; it doesn’t change the level of fear.”
What’s important is interrogating, and understanding your fear – because otherwise, Davidman says, “we are not thinking clearly”.
This process can help to clarify what you personally need before you can decide to become a parent, such as a financial safety net or a co-parent committed to sharing the load.
That was Davidman’s experience, decades ago. “I wanted children, but over the years, the conditions that I needed and wanted never came into place, and so at some point, I actually made the decision to get off that track and live childfree,” she says.
Clarity about a decision allows people to live without regret, Davidman explains. People fear picking the wrong path – but, if you’re clear on your reasons, “and don’t just sleepwalk into it”, it’s easier to travel, says Davidman. Deciding to have children, or not, doesn’t inoculate you against regret, she points out. “It’s still up to you to figure out how to have a fulfilling life.”
I’m reminded of a conversation I had, aged 19, with an older friend who was painfully aware of her biological clock.
She was unsure whether she wanted children, but felt such pressure that she would raise the question on first dates with men she’d just met.
Thirteen years later, I vividly remember thinking that I would only ever be open to children if I found myself in a suitable relationship; I would never seek out a partner specifically to go halves.
It was no passing thought, or idle judgment; it seems to spring from somewhere stable and essential deep within me. I’ve never questioned it since.
I think we’ve all had the odd realization like that, or are capable of them: thoughts that ring clear and true like a bell. The trouble, often, is hearing them above the noise.
***
At the end of her two-year investigation into parenthood, Rushton realized she’d been wrong. She thought she didn’t want to have a child because the “world is burning”. Now, she says, “I actually think that was kind of a cop-out.”
After all, we agree, the climate crisis hasn’t stopped us from taking international flights, or eating meat – or any of the other things that we really want to do.
Because of the dearth of ways of thinking and talking about choosing to remain childfree, it’s still more socially acceptable to invoke an apocalyptic future than it is to say that you value your independence, or getting eight hours of sleep every night.
“I’m fucking terrified about the next 50 summers I have in Australia,” says Rushton. But, like her other doubts about parenting, “most of these questions aren’t resolved whether you have a kid or not.
“Every mum I know is anxious about climate change, or having issues with their partner, or thinking about gender roles. It’s less about ‘yes’ or ‘no’, and more about ‘What do I need to feel content in my decisions in a precarious future?’”
Rushton remains undecided about whether she’s going to have children – but she has more clarity about the question. Writing her book forced her to confront her ambient dread and uncover her “self-delusion”, she says.
Readers have told her that it’s done the same for them, presenting them with prompts to reflect on alone or with their partner.
Davidman has also condensed her teachings into a book (written with Denise L Carlini, Davidman’s former partner, with whom she devised the course). But, she warns, it should be a personal process. “Only you can know what’s right for you,” she says. “That’s why interviewing other people about how they came to their decision isn’t really all that helpful.”
It can even add to your confusion. For all the increased awareness of family planning, fertility and the childfree movements, they are still not easy subjects to talk about, Davidman says.
Earlier in her career, the typical person who came to see her was in their late 30s or early 40s; they’re generally now in their early 30s, or sometimes even their 20s. “What hasn’t changed is that, to this day, people will say to me: ‘I thought I was the only one who didn’t know’.”
Whatever we decide, we’ll probably always wonder about the path not taken. Even people who are contentedly childfree will likely feel pangs of “What if?”, Rushton points out.
“We also all know mums who some days just want to be out with their friends having martinis, and can’t – that doesn’t mean they don’t love their children, or regret them.”
We can’t know the future, but we can honor the question – particularly when, amid creeping reproductive injustice, not everyone has the choice. “Some people think it’s neurotic and self-indulgent to dither over it this much,” says Rushton. “But I actually think it’s a deeply compassionate, altruistic thing to give this much thought to what kind of parent you’d be, and whether that’s the best thing for the child.”
For Davidman, what’s missing from the conversation is tolerance for ambivalence – “to be able to not know, without judgment”. And for those who do feel sure that they want a family, or don’t, it doesn’t hurt to inquire more deeply within.
“There’s never a risk in challenging certainty,” says Davidman, “because if something’s true, it will remain true.”
That’s why, as I enter into the final leg of my fertile years, I feel content to hold the question lightly – to remain open to those moments of clarity, and trust them.
“What everyone’s really trying to stave off here is regret,” says Rushton – but it’s hard to imagine yourself regretting a decision that’s considered, informed and feels true to you.
Because we’re socialized to believe that ‘you just know’ if you want kids or not, validating the idea that it is a question is really helpful
Gina Rushton