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January 22, 2015

Guns + violent deaths: What is the role of firearms availability?

There is no question that guns and violent deaths are associated, said Pitt faculty member David Brent in his Jan. 9 lecture, “Do the Means Justify the Ends? The Role of Firearms Availability in Violent Death.”

“What we don’t know,” Brent said, “is how to take that knowledge and translate it into action, which probably involves legislative action.”

As the endowed chair in suicide studies and professor of psychiatry, pediatrics, epidemiology and clinical and translational science, Brent has made a career of researching the relationship between firearms and homicide, suicide and injury. He noted that America has “by far the most guns per capita of any developed country,” and that in the U.S. in 2010, there were more than 31,000 deaths by bullet: 11,078 homicides, 19,392 suicides and 606 accidents.

“We do believe in American exceptionalism,” he said, “but this probably isn’t where we want to exceed.”

Deaths from firearms in the U.S., particularly among young people, occur in “frightening numbers,” he reported. American adolescents and young adults have a 43 times greater chance of dying by gun homicide than in other, comparably developed countries.

Contrary to popular belief, mental illness is not associated with most shootings, he noted. While more than 25 percent of individuals have or will have one mental disorder during his/her lifetime, suicide is a bigger risk among those without a psychiatric disorder. While those with psychosis, substance abuse or personality disorders have a higher proportional representation as perpetrators of homicides, they are not involved in the majority of killings.

Mass shootings (defined as the killing of four or more people) get all the publicity but are rare, representing less than 0.2 percent of gun deaths.

Since 2005, an average of 55 people have died in mass shootings each year. While such shootings have prompted talk about reforming gun laws, they haven’t spurred much action. “There really hasn’t been much change in the firearms death rate in the U.S. over the last 15 years,” he said.


Brent set out the case that gun availability often does increase the chance of violent death, although the relationship is not always clear-cut. States with higher gun ownership, for instance, have higher suicide but not higher homicide rates. Yet restricting access to guns does not necessarily eliminate suicides.

He cited a 1992 study that showed that suicidal people in Manhattan more often jumped from high buildings and used prescription drugs to overdose than those in suburban Staten Island, where residents’ greater car and garage access led to more deaths by carbon monoxide poisoning.

Still, the decision to commit homicide or suicide, Brent noted, “is usually pretty impulsive, especially with people under 40.” Thus, without guns, a fatality might not occur. Gun suicide attempts are two and a half times more successful than hanging attempts, and 220 times more fatal than poisoning. He also displayed the results of a 2014 study that found a three-fold increase in the risk of suicide and a two-fold increase in the risk of homicide if there is a gun in the household.

His own study of 130 suicides showed that, for those under 16, “having a gun in the home contributes more to the risk than psychopathology,” while the opposite is true for those over 16.

A 1991 study in California discovered that, among people who had recently purchased a gun, “the risk of suicide decays exponentially from the time of purchase,” but there is still an elevated risk of using that gun in a suicide for the next six years. In 2003, another researcher found three years of increased risk of committing homicide after a person purchases a gun.


Changes in gun laws, and thus gun availability, offer natural experiments to show how guns and violence are related. In general, legislation that restricts gun ownership, curbs firearms trafficking or provides for stronger background checks correlates in reverse with gun deaths.

On the other hand, laws that make permissions for concealed carry of weaponry harder to obtain are “not particularly significant” in decreasing deaths, nor are restrictions to one gun purchase per month.

Australian legislative changes following a 1996 mass shooting in Tasmania, which left 35 dead, created a gun buy-back program that netted 650,000 firearms, restricted the private ownership of certain types of weapons and added background checks and police approval for gun purchases. Gun deaths already were declining “but they accelerated [down] at this point,” Brent noted. In Austria, which implemented similar restrictions, gun purchases declined and the gun suicide and homicide rates dropped. Plus, he noted, there was “no evidence of method substitution” — no greater use of knives to kill, say, by those who might have used a gun prior to the new laws.

“No one approach is going to be effective here, and depending on the country and the culture, it may have no effect,” he said. “Given that the laws in this country may never change, what can we do?”

Laws that lock up firearms and restrict child access to guns, for one, can cause decreases in suicide and homicide rates, he said. Such laws, when locally advocated and enforced, he pointed out, are more effective for suicide and homicide prevention “across the age spectrum.”

One study Brent cited examined firearm safety counseling given to parents by their children’s primary care physicians. Advised to remove guns from homes, 75 percent of parents surveyed said they would listen to a doctor’s recommendations but only 17 percent actually would get rid of their guns. Another study involving counseling of psychiatric outpatient adolescents’ families found that, after counseling families to get guns out of the house, only one-fourth of gun owners removed their weapons and one-fifth of them acquired another gun during the survey period.

People were more likely to listen if their child had undertaken a previous suicide attempt, by whatever means, and were more likely to remove weapons if the counseling was done directly to the gun owner. And they were most likely to obey the recommendation if it were simply to lock up a gun, and were given free gun locks.

“Even 5-10 percent in safe storage can have a big impact,” Brent said of household guns. “And the intervention doesn’t take long.”

He added: “We still need to assess access and presence of guns in the houses of our patients,” but he suggested that counseling be “more of a negotiation” about safe storage than gun ownership.

—Marty Levine