Understanding the Risk of Firearms: Suicide vs. Homicide

[Melissa Mills]

If you watch the news or TV shows, you might be led to believe that there is a high risk of firearm homicide. Researchers from Northeastern University, University of Washington, and Harvard University conducted a study into the perceptions of gun violence and the leading cause of death in the United States. They found that the presence of a firearm in a home increases the risk for suicide, which is more common than firearm homicide.

So, what's behind our misconception about gun violence and how do you educate the community about the real dangers?

Looking at the Numbers

According to the Brady Campaign, the oldest organization in the gun violence prevention movement, 96 people die every day in the United States from gun violence. Of these 96, 34 are murdered, and 59 die from suicide. That means nearly twice as many people die from firearm suicide compared to firearm homicide. There are also 246 people shot daily who survive - 183 are injured in an attack, 49 are shot unintentionally, 4 are shot in a legal intervention, and 11 survive a suicide attempt.

A 2014 study published in the Annals of Internal Medicine reported that access to firearms in the home increases your risk of violent death by suicide, homicide, or unintentional injury. There was a direct correlation to the risk of suicide among people who had access to firearms compared to those without access. The study also reported that the US has one of the highest rates of access to firearms in the world.

Could impulsivity and the ease of access to a gun place some people at a higher risk of committing suicide or homicide? The study suggests that it's possible. Yet, there are no hard data to support the claim. States with the highest rates of firearms, also have a higher percentage of firearm violence compared to non-firearm violence.

Is it a Public Health Issue?

According to the American Public Health Association (APHA), gun violence is an issue that is deeply rooted in our culture and must be addressed through a public health approach. Violence research should be conducted to ensure that guns don't fall into the wrong hands. APHA also believes that access to mental health services must be expanded to those who need it most to decrease the number of suicides by firearms.

Do Nurses Have a Role In the Firearms Debate?

Every day nurses in Emergency Rooms across the country come face-to-face with the gun violence issue. They might deal with victims of homicide, suicide, and unintentional shootings.

Nurses who work in schools have become far too familiar with the issue over the past few years. The National Association of School Nurses released a Position Brief in which they state that school shootings in the US are an urgent public health crisis. The NASN advocates for safe school environments for all children and recognizes the emotional and physical effects that gun violence has on our students. This doesn't account for nurses in the ICU, rehabilitation units, and many other settings that might care for gunshot victims.

Unfortunately, healthcare workers can fall victim to gun violence, too. Recent research has highlighted the prevalence of suicide among nurses. And, gun violence in hospitals and other healthcare facilities seems to happen at an alarming rate. In fact, just a few weeks ago, a young doctor was killed in the parking lot of Mercy Hospital in Chicago at the hands of her former fiancee.

What Can You Do To Help?

Gun violence is a hot political debate these days. No matter which side of the aisle you stand on, as a nurse there are a few things you can do to help keep patients safe:

1. Educate patients about the risks inherent in having a gun in their home. It's particularly important to speak to parents of young children about safe storage of all firearms.
2. Connect patients with mental health concerns to services as quickly as possible. Many patients have mental health needs that if left unattended can quickly lead to violence towards themselves or others.
3. Participate in violence prevention and intervention programs at your hospital or facility. None of us want to discuss or consider that a shooting could happen at our workplace, but unfortunately, the risk is real.
4. Write to your elected officials to make your viewpoints on the issues known.
5. Advocate for more research to be done to increase our understanding of homicide, suicide, and those who commit both.

What are your thoughts on the firearm statistics? Do you feel that nurses have a place in the firearm debate? Let us know your thoughts in the comments below.

[macawake, MSN]

The 2nd amendment is way more important now than at any time in our country's previous history. We have at both the state and federal level- government that doesn't want to follow the law. Presidents, governors & legislators who actively subvert the will of the people by gerrymandering, over-ruling voters & trying to kneecap their successors when they lose elections.

I do agree that there is clear evidence of some pretty blatant attacks on your status as a functioning democracy. However, I'm not sure how you think your peashooters will protect you against that. (Compared to what the government has, they might as well be peashooters).

If you think 10,000 intentional deaths a year by firearms is bad, think about what happens to an unarmed population under a totalitarian government.

Not sure where you got the figure 10,000? These are the stats I found:

FastStats - Homicide

These homicide statistics are for the year 2016. Total number of homicides for that year appear to be 19,362 (which translates to 6.0 deaths by homicide/100,000). Out of the total amount of homicides, 14,415 were firearm homicides.

FastStats - Suicide and Self-Inflicted Injury

The total number of suicides for the same year was 44,965 which amounts to 13.9 deaths by suicide per 100,000 population. Out of the total number of suicides 22,938 were committed with a firearm.

So unless my math is completely off, that's a total number of 37,353 intentional deaths caused by firearms in 2016. Did the numbers go down dramatically in 2017?

By the way; 6.0/100,000 homicides per year is a high rate if you compare it to almost every European country. From memory, in 2016 we had approximately 1.2/100,000 homicides in my country and while very low by international standards, that's still more than twice the rate of our neighbor, Norway. If, on the other hand, you prefer to compare yourself to some of the more dangerous countries in South America or Africa, you're doing just fine.

Considering how large a percentage of your homicides are committed with firearms, I'm amazed that anyone can deny that you have a gun problem. But hey, carry on...

Anyway, it doesn't really make a difference for the sake of this argument whether you have 10,000 firearms-caused intentional deaths or closer to 40,000 (well it matters to the victims and their loved ones of course), but what on earth makes you believe that your Second Amendment can protect you against a totalitarian/tyrannical government? I'm trying hard not to be too darn condescending, but that notion is actually quite quaint (18th century or thereabouts) and somewhat laughable.

Even if your Second Amendment rights were greatly increased to include for example tactical nukes (not gonna happen), your government has much bigger nuclear weapons and other scary crap. Not to mention the immense power they have to control you with the surveillance technology they have at their disposal. Face it, if your country (or my country) ever comes under the control of an authoritarian/totalitarian regime, your and my respective liberties as we know them, don't stand a fighting chance. Whatever guns you happen to possess will do diddly-squat to protect you from a tyrannical government.

Moms, mayors, parkland students & giffords are all puppet organizations funded by one rich new-Yorker who doesn't share any "common sense" mentality, he wants New York style laws implementated nationwide.

How incredibly disrespectful of you to dismiss the opinions of people, including teenagers, who've been through hell as being members of a puppet organization. You actually think you can just invalidate their LIVED EXPERIENCES by labeling them "puppets". Shame on you.

You're a tool of a handful of billionaires who want America disarmed & they're trying to make their voices louder by pretending to be "grassroots" organizations.

You sound like a conspiracy theorist. What are the "handful of billionaires" planning on doing once they confiscate your guns? Please enlighten us.

Who are they? Do you care to name them?

I agree with you.

OldDude, I realize that I used the wording "as a European", but really I don't understand the huge passion many American have for their guns, the same way that some Americans don't understand the unbridled infatuation.....

As is the case on any anonymous internet forum, you of course have no way of knowing all the details of my life. Here are some of them. I'm Scandinavian by birth. I've lived in about a dozen countries on four different continents, as a child and as an adult. I have lived a couple of years in California. When I did, the people around me were for the most part, very "gun-friendly". Who's "gun-friendly" in California you might wonder. I've offered up enough personal details about myself for now, so I'll let you figure that one out :)

~~~~

Some posters seem almost paranoid that someone's coming for their guns. I believe they are victims of scare-mongering courtesy of the gun lobby. It's not even practically achievable to take all guns from people, you simply have too many of them in circulation. I don't think there are many people who even actually support trying to do it.

It's really pretty telling that any attempts to address the problem of firearms homicides are met by that level of hysteria. Why isn't it possible to discuss the problem and impact of deaths caused by firearms, without people frantically expressing worry about having their guns confiscated. Why can't we even talk about what can be done in order to reduce the number of homicides?

Which brings me to the rest of macawake's post, parts of which have surprised me. Apparently he or she greatly misunderstands US gun laws. We're actually in agreement on these things:

It really shouldn't be surprising that we agree on some things. I don't hate guns. What I hate is the lacking will to do anything about the large number of deaths caused by firearms. For a first-world country you really are unique in that sense. Your countries' response to all those dead children, is to do nothing. Kids will keep on getting murdered when they go to school. The only thing I've heard suggested, apart from the mandatory thoughts and prayers, is to arm teachers. What a bass-ackwards defeatist approach. Just surrender to the idea that the world is such an unsafe place that kids have to spend their formative years in an environment that resembles a prison more than a educational institution.

There have been several instances recently of using cargo trucks to mow down innocent people in Europe. Obviously trucks aren't the problem. Now some countries are working hard to eliminate knives, even kitchen knives. News flash: Knives aren't the problem, either, and it's.not.going.to.work.

This punctuation thing seems contagious

Yes, there have been several instances in Europe of trucks being used as weapons by terrorists. They have a habit of doing monstrous things like that as well as flying planes into buildings. So what should we do? Should we just resign to the fact that people who are capable of doing really vile things, or should we try to take measures and implement policies that at least decreases the risk of such events happening again?

The truck terrorists favor large open areas where a lot of people congregate or major shopping streets with many pedestrians or crowded bridges with a lot of foot traffic. So can you outlaw trucks? No, that's impractical. But you can, and it's being done, build physical obstacles that prevents, or at least lessens the speed that they are able to reach, in the areas where people walk.

So what can you do to lessen the risk of for example another school massacre or attack on concert-goers? What can you do, apart from turning teachers into Rambos, to at least minimize the number of injuries and deaths should another attack or shooting take place?

Thinking that more guns is the solution to a gun problem, is in my opinion only making the problem worse.

You never answered my question regarding why you think that other countries don't have the amount of mass shootings that you do, despite schools being so called "gun-free zones" in those countries as well. Do you have any therories?

Reading your post, you sound so certain regarding what.will.not.work. I have no way near that level of confidence, despite actually having a degree in Criminology. (My first degree, prior to nursing). Why do you dismiss ideas out of hand? Have you decided that murdered kids is something you just have to accept and you're simply not going to try different solutions? Do you think that crime incidence is a static phenomenon and whatever rate you have of a certain crime, is the one you're destined to have in perpetuum?

[Sparki77]

1. The "bad guys " (used as an umbrella term) will always find a way to possess a firearm. They do not/will not follow any type of law. I am stating the obvious.

2. Automatic guns, which have been banned for purchase since 1986 I believe, and are the type of guns used by the military only, are often lumped in with semi-automatic guns. The wording is not interchangeable.

3. AR does NOT stand for Assault/Automatic Rifle. It is a brand name, Armalite. This is a redundant fact that still somehow causes confusion even though it's been stated a billion and one times.

4. I am all for complete and thorough background checks. My state is notoriously difficult to obtain a license in.

5. Mental health options/availability is severely lacking, as is addiction treatment facilities.

6. I have my LTC concealed.

7. I also own an "AR" type platform rifle that only fires as fast as I can pull the trigger. That is not considered an assault rifle by any means though it still somehow causes confusion as certain groups will directly or indirectly have people believe.

8. The only reason I do not own an actual AR-15 is because my state banned them without any forewarning to licensed carriers and FFL dealers.

9. This post is just a reflection of my thoughts at the moment.....I am not looking for a debate here.

[OldDude]

macawake...I'll admit I overreacted to your post and offer my apologies...we need to sit down for a couple beers. We could have an interesting conversation.

[akulahawkRN, ADN, RN, EMT-P]

Can you clarify what you mean by this? Do you mean that mass shooters are just looking for fame? If so, why do you feel that mass shootings occur so frequently in the U.S., and why, in other countries with tighter gun control, do fame seekers somehow manage to seek fame in other ways besides mass murder? What do you feel is unique to the U.S.?

There really is no further need to clarify. When it comes to "mass shootings" do understand that there is no fixed definition of what this is. Broadly, it can refer to more than 3 victims, whether killed or just injured. The FBI has used a definition of more than 4 persons murdered in a single event or within close proximity. They have also used a definition of 3 persons murdered in a single event or in close proximity. If you look at "just" injuries, the number of incidents skyrockets. If you use a much more restrictive definition of 4 persons murdered, the number of incidents plummets. Under one definition, there could be around 300 incidents per year, using another, it's less than 100, often substantially lower.

I go by what the FBI uses because that's a common reference that all law enforcement can use to report such incidents nationally.

[klone, MSN, RN]

3. AR does NOT stand for Assault/Automatic Rifle. It is a brand name, Armalite. This is a redundant fact that still somehow causes confusion even though it's been stated a billion and one times.

Thanks, Tomi.

I'm sure that fact gives a lot of comfort to the parents of the babies who died at Sandy Hook, or my personal friend, who's daughter was killed in the Santa Fe High School shooting last May.

It doesn't stand for Assault Rifle?? Well, THAT'S sure as **** a relief!

[akulahawkRN, ADN, RN, EMT-P]

I also want the strictest laws possible, but I believe there are a lot of responsible owners like Dude who should be able to have a handgun or hunting rifle. I don't see the need for an orificenal. I also think the Second Amendment is outdated as written. So there.

And therein lies the problem. Who decides what constitutes an orificenal? Who decides how many is too many? If the Second Amendment is outdated as written, what other Amendments are also outdated as written? That's a very deep rabbit hole. While the various Amendments do have their limits, they also protect modern era stuff. You cannot have one Amendment protect only those items of the era in which it was written while simultaneously having other Amendments that were written in the same era protect modern things too.

The Second Amendment is a Fundamental Right. That alone limits how strict the laws concerning arms can be. Because the field of Second Amendment decisions is very small and limited, we haven't yet seen the full scope of what the Second Amendment covers. It's been less than 10 years (as I write this) that the Second Amendment has been applied to the States. In that time, there have been conflicting decisions across the Court Circuits that have yet to be resolved. I guarantee you that the Supreme Court is looking for "the right" case to resolve the conflicts in a very clean manner. Most of the cases petitioned to that court aren't all that clean and SCOTUS doesn't want to wade into those cases. There's a case out of Hawaii that's very clean and may eventually reach SCOTUS. If it stays reasonably clean, it will probably be taken for consideration. It's a pure "bear" case and is better than some of the cases that originated in California.

I'll say it again: This is a subject that's still very new to the Courts. It's going to take years, if not decades, to fully flesh this out to where the public has a good grasp of what's protected and what isn't.

[akulahawkRN, ADN, RN, EMT-P]

Thanks, Tomi.

I'm sure that fact gives a lot of comfort to the parents of the babies who died at Sandy Hook, or my personal friend, who's daughter was killed in the Santa Fe High School shooting last May.

It doesn't stand for Assault Rifle?? Well, THAT'S sure as **** a relief!

Adam Lanza, the Sandy Hook shooter, killed his mother and then stole her guns before going to the school...

Also, in case you didn't know, the Santa Fe HS shooting didn't involve ANY semi-auto weapons. None. Explosives and a Molotov Cocktail were also employed (thankfully didn't go off). The shooter stole those from his dad.

[klone, MSN, RN]

I didn't actually do research to determine which shootings took place with AR-15s and which ones didn't, because it's frankly completely irrelevant.

[LibraSunCNM, BSN, MSN, CNM]

There really is no further need to clarify. When it comes to "mass shootings" do understand that there is no fixed definition of what this is. Broadly, it can refer to more than 3 victims, whether killed or just injured. The FBI has used a definition of more than 4 persons murdered in a single event or within close proximity. They have also used a definition of 3 persons murdered in a single event or in close proximity. If you look at "just" injuries, the number of incidents skyrockets. If you use a much more restrictive definition of 4 persons murdered, the number of incidents plummets. Under one definition, there could be around 300 incidents per year, using another, it's less than 100, often substantially lower.

I go by what the FBI uses because that's a common reference that all law enforcement can use to report such incidents nationally.

Did you not understand my questions? You haven't answered any of them. How a mass shooting is defined isn't actually what I asked, because I think we both know that even if we fiddle with semantics, the *amount of gun violence* in the U.S. still far outweighs that of other countries with stricter gun laws.

I'll ask again---if you think mass shooters in the U.S. do it for "fame," why do you think this is a phenomenon unique to the U.S.? How could that be explained?

[pixierose, BSN, RN]

Adam Lanza, the Sandy Hook shooter, killed his mother and then stole her guns before going to the school...

Also, in case you didn't know, the Santa Fe HS shooting didn't involve ANY semi-auto weapons. None. Explosives and a Molotov Cocktail were also employed (thankfully didn't go off). The shooter stole those from his dad.

I think there is a point being missed here.

With Adam Lanza, there was an entire *dynamic* going on there. He didn't merely steal guns; his mother purchased these types of guns for him. So many, many factors came into play with Sandy Hook that ultimately failed those 26 people who lost their lives. This was a kid who was on the radar briefly, whose mom all but gave up, whose dad and brother hadn't spoken with him in about 3 years. He was anorexic. So many things failed.

Mental illness played a role with this kid. But the shear amount of weapons in this household, the high number of rounds he was able to unload in such a short amount of time, also played a role.

Relative to other countries, we do not have a disproportionately high number of mentally ill people. We do not have a disproportionately high number of extremists. What separates us from every other developed nation in the world is the sheer number of guns that exist in this country and the ease with which they can be acquired. We have 120.5 guns for every 100 people; that's more guns than people.

A March 2016 study in the American Journal of Medicine found that Americans are 25 times more likely to die from gun homicide than people in other wealthy countries. Why?

Women in the U.S. are 16 times more likely to be killed with a gun than women in other high-income countries. Why?

And in case we begin to lose sight ... Firearms are the second leading cause of death for American children and teens and the first leading cause of death for Black children and teens. Black children and teens are 15 times more likely than white children and teens of the same age to die by gun homicide. A very real public health issue, indeed.

So what do we do?

We focus on mass shootings and wring our hands, blasting lack of mental health services. But that ain't the whole of it. Then give our thoughts and prayers and wait for the next one.

We focus on those darn inner cities and thank our lucky stars "we don't live there and WE'RE safe, gosh darn it ... I'M responsible, it's those hooligans in the cities." And then we forget about it the next moment, forgetting that "hey, this is actually a public HEALTH concern too ..."

Slippery slope or not, if the government decides to go all rogue, the peashooters don't stand a chance. We don't have years, decades, to wait for what's protected. There needs to be a change; it won't happen and people will keep dying.

[OldDude]

I didn't actually do research to determine which shootings took place with AR-15s and which ones didn't, because it's frankly completely irrelevant.

Very good point...the AR15 has been targeted as the poster child for mass shooting/gun violence and everything evil and wicked about guns...I have "traditional" deer rifles that are considerably more powerful than the AR15, shoot just as fast, and could be outfitted with the same magazine capacity, but have a lot of polished wood, a gleaming barrel, and look like you grandpa's gun displayed over the fireplace. No relevance, exactly, no relevance.

[rzyzzy]

And THIS, THIS post is a big part of the problem.

You have no clue what you're talking about, making it impossible for both sides to meet in the middle. You have pre conceived notions of what these "moms/mayors/high schooler students against guns" are.

I'm part of the Sandy Hook Promise. I'm actually a promise leader. We're not out to take every damn handgun out there. We're not even funded by rich New Yorkers. We start at the community level, working with schools and students ... we focus on mental health initiatives. And yes, we work on gun control initiatives.

What a disgusting comment, "parkland students and gifford's are all puppet organizations ..."

.... I'm going to go ahead and say that those who experienced mass shootings and gun violence first hand can have center stage allllllllllllll they want. Do I need to even say why?

I'm not against guns. I'm not against people like OldDude owning guns. I'm against misinformation like you just spouted as a reason to keep your guns. I'm against the whole, "it's my right as the second amendment intended!" as a reason to keep your guns. I'm against the NRA having so much power.

We have to talk about gun violence. The sad fact is, many gun owners (as seen by this thread) don't want to. They point to, "well, I'm safe and most of us are." Ok. Great. So what can we do about those that kill? Because something has to give, and it ain't all mental health, lack of family values, or everybody else's fault.

It's not even a secret that both moms against gun violence and the parkland "survivors" are funded by Michael Bloomberg. David Hogg was / is not a "survivor" of the parkland shooting, he was at home when it happened. Giffords is literally a puppet of her money-chasing husband - this has all been well documented. And the Brady campaign is still "handgun control inc", with the same agenda today that they had in 1975.

There's no need for a "conversation" that involves only one side sacrificing their constitutional rights.