Firearms, Accidental Deaths, Suicides and Violent Crime: An Updated Review of the Literature with Special Reference to the Canadian Situation
- 4.8 Evidence of Method Substitution in Suicide
- 4.9 Firearm-Related Suicide in Children and Youth
- 4.10 Various Approaches to Suicide Prevention
- 4.11 Summary
Much of the research on preventing firearm suicides focuses on substituting or displacing the method of choice. These terms refer to how certain methods to commit suicide in a given population may change when a particular method is no longer available. This research has produced competing claims about whether the displacement effect exists, about the period of time over which it can be expected to occur, and whether it tends to be more present in some types of suicides as opposed to others (Carrington and Moyer, 1994a; Mayhew, 1996: 22).
One must be able to measure the changes in both successful and unsuccessful suicide attempts to determine whether methods are being substituted and, if so, to what extent, given what is known about the relative lethality of different suicide methods. This is not usually possible since we don’t have reliable information on non-fatal attempts. Most studies to date have focused simply on examining the relative variations in rates of total suicides, fatal firearm suicides, and fatal suicides from other methods, under different conditions of firearm availability.
When fewer people commit suicide with a firearm and the overall suicide rate does not increase, displacement is not occurring. This general method of assessing the presence of a method substitution effect has resulted in conflicting evidence on whether or not it occurs, and almost no evidence on how the effect might actually work. However, Carrington and Moyer (1994; 1994a), analysing trends in fatal suicide attempts in Canada concluded that there was a decrease in levels of firearm and total suicide rates and that there was no indication that other methods were being substituted.
There is another explanation for the changes that are sometimes observed in suicide methods for a given population, such as the shift from firearm suicides to hanging, strangulation and suffocation observed in Australia around 1995 (Mukherjee, 1997), and that do not appear to be explained by significant changes in the availability of the methods. These changes are better described as method shifts rather than method substitutions. These may be precipitated by factors other than whether a particular method has become more or less available.
After World War II and until the late 1970s, there was an increase in the number of adolescents who committed suicide in North America and in many European countries (Sakinofsky and Leenaars, 1997; Cantor et al., 1996). Despite this increase, the phenomenon of suicide among children and adolescents has fortunately not reached the proportions that it has for young adults (Moyer and Carrington, 1992; Hung, 1997). During the last 10 years, the number of Canadian adolescents who have committed suicide has remained fairly stable, while the overall rate of firearm suicide has decreased slightly.
In Canada, as is the case for adults, suicide among adolescents is predominantly a male phenomenon; however, the percentage of girls committing suicide is significantly higher among aboriginal youths. A Manitoba study of suicides committed between 1984 and 1988 by individuals under the age of 24 confirmed the high ratio of 5.2 male suicides to every female suicide. The study also revealed that 61 percent of these suicides were committed by young adults between the ages of 20 and 23 (Sigurdson et al., 1994). The study observed a statistically significant difference between the sexes in the choice of methods; males were more likely than females to use a more lethal method. Overall, most of the victims hanged themselves; firearms presented the next most common choice (Ibidem).
In Canada, the phenomenon of suicide among aboriginal youths is particularly alarming. Based on data gathered between 1987 and 1991, the Royal Commission on Aboriginal Peoples (1994), found that an aboriginal between the age of 10 and 19 was 5.1 times more likely to die from suicide than a non-aboriginal youth. Aboriginal girls were eight times more vulnerable than non-aboriginal girls, and aboriginal boys were 4.7 times more vulnerable than non-aboriginal boys.
The study by Sigurdson and colleagues (1994) revealed that native youths were less likely than non-natives to use a firearm and more likely to use hanging to commit suicide. Firearms were used in 28.3 percent of cases involving Métis and native youths, as opposed to 55.6 percent of cases of non-natives (Sigurdson et al., 1994: 400). Similar findings were also reported by Malchy and his colleagues (1997), who examined suicide incidents among Manitoba’s aboriginal people between 1988 and 1994. In addition, their data did not show significant differences between suicides committed by aboriginal people who lived either on or off a reserve (Malchy et al., 1997).
There currently is no evidence that children and youths are necessarily more or less likely than other age groups to use a firearm as opposed to another method. However, because adolescents who commit suicide seem to do so impulsively, many researchers hope that situational prevention methods, such as reducing access to firearms, may be an effective way to prevent adolescent suicide (e.g., Brent et al., 1993; Brent and Perper, 1995; Dudley et al., 1996).
The observed decrease in firearm suicide in Canada could be unrelated to the efforts that have been made since 1977 to regulate access to firearms more effectively. However, the Canadian experience appears to demonstrate that regulating the ownership and use of firearms can significantly affect the level of firearm suicides without reducing the level of firearm ownership. This is a conclusion that seldom receives attention in discussions about the prevalence of firearms and suicide.
Since 1977, Canadian legislation has included a number of measures that did not affect the level of firearm ownership but may nevertheless have contributed to preventing firearm suicide. Although these legislative measures can theoretically help prevent firearm suicides, there has been little research on the extent to which they were effectively implemented or enforced, and even less research on whether they have had a measurable impact.
Existing restriction and registration measures applying to handguns may have contributed to suicide prevention. However, the extent to which they did is still largely a matter of speculation. Given the problems that have been observed with the consistent enforcement of these measures (Wade and Tennuci, 1994: 32) and given that handguns are less frequently used in suicide attempts than unrestricted weapons, it is not clear what contribution these control measures have effectively made to preventing suicide.
Canadian legislative measures include a system of firearm acquisition certificates and a process to screen out applicants who represent a risk to themselves or to public safety. They provide for a cooling-off period in cases where a person does not yet have a firearm acquisition certificate. Some researchers believe that the cooling-off period could be one of the reasons that the number of firearm suicides was successfully reduced in Canada (Carrington and Moyer, 1994; 1994a). Although this explanation is certainly plausible, it is only a hypothesis. Little is known about when people acquire the firearm they subsequently used to commit suicide, or about who owned the firearms that were used in suicides. Firearms are rarely acquired specifically to commit suicide (Brent and Perper, 1995; Gabor, 1994) and this would seem to suggest that in many cases, the victim had owned the firearm for some time or otherwise had access to a firearm.
Cantor and Slater (1995) measured the impact of the 28-day cooling-off period that was introduced in Queensland, Australia, in 1992. The legislation was based on the rationale that a distressed but unlicensed firearm purchaser could be restricted. The study compared the two years before and after enactment of the legislation, and examined firearm suicide patterns in non-metropolitan areas, where firearms were more prevalent, to those of the metropolitan areas. The study produced some tentative evidence that the 28-day cooling-off period could reduce suicide rates, especially among younger men.
The Canadian legislation also includes requirements on safe handling and storage of firearms by businesses and individual owners, and a requirement for persons who wish to acquire a firearm to complete a firearm safety course. Promoting and ensuring the safe storage of firearms is a popular way to prevent firearm suicides. Research evidence on the effectiveness of this particular strategy is generally lacking. It has been argued that firearms that are not safely stored or that are kept loaded for self-protection or other reasons create a risk. In particular, it is often argued that impulsive adolescent suicide can be prevented by restricting immediate access to lethal agents such as a loaded gun (Brent et al., 1993). However, the relevance of this method of prevention is less clear among adolescents who suffer from psychiatric disorders (Ibidem).
The legislation also provides for the possibility of prohibition orders against certain persons, when it is deemed that their safety or the safety of the public could bethreatened if they acquire a firearm or remain in possession of the firearms they already own. Prohibition orders may also be useful to remove a firearm or limit firearm access for people who have been identified as suicidal. The number of prohibition orders issued each year in Canada has increased rapidly in the last 18 years (Hung, 1997; Wade and Tennuci, 1994: 21). In 1996, 21,535 prohibition orders were issued. At the end of 1996, the Canadian Police Information Centre System recorded 58,094 persons prohibited from possessing firearms, ammunition or explosive substances (Hung, 1997). What remains unknown, however, is how frequently prohibition orders are used specifically to prevent suicide. There is no research on whether that particular method has proved effective in preventing firearm suicides, or suicides in general.
Depending on the circumstances, the police are also authorized to search and seize firearms with or without a warrant, when they have reasonable grounds to believe that a person’s safety is at risk. All of these measures could theoretically help prevent firearm suicides; however, there has been little research on the extent to which these measures have been effectively implemented and enforced, and even less research on whether they have had a measurable impact.
Controlling when and how firearms are available, accessible, or used by persons is one method of suicide prevention; unfortunately, research evidence has contributed fairly little to an understanding of how effective this approach can be. Such prevention strategies must be part of a broader suicide prevention approach. Therefore, it will remain very difficult to isolate the effect of a particular measure from the combined effect of all the others. To paraphrase the question asked by Martin and Goldney (1997), with so many important and poorly understood changes occurring simultaneously, how do we know which program or set of events is responsible for the observed changes?
- At 80 percent, firearm suicides account for the majority of firearm deaths in Canada.
- The firearm suicide rates for Canada rose consistently during the 1960s and most of the 1970s, stabilized toward the end of the 1970s and then tended to decrease.
- The percentage of suicides involving a firearm appears to be decreasing, but it remains a source of concern. In 1995, there were close to 4,000 suicides committed in Canada and almost a quarter of these involved a firearm.
- Where a firearm is used for suicide in Canada, it generally tends to be a long gun.
- Internationally, both total suicide rates and firearm suicide rates vary considerably. Canada’s total suicide rate is similar to Australia, Norway and the United States, while Estonia and Japan share the highest rates of suicide.
- With respect to firearm suicide, Canada is once again similar to Australia and to New Zealand, but is situated at a rate considerably higher than the U.K. and lower than that of Finland and the United States. Japan has very few firearm suicides.
- Men are more likely than women to commit suicide, and are much more likely to use a firearm. Among males who commit suicide, age is a factor that affects the choice of firearms as a suicide method. Alcohol, drugs and mental health problems all seem to be variables that may also affect the method chosen.
- Although suicides are more common in urban areas, the percentage of firearm suicides is higher in rural jurisdictions.
- Aboriginal Canadians, particularly youths, have a much higher overall suicide rate than others, but the percentage of firearm suicide is lower than that for non-aboriginal victims.
- Non-fatal suicide attempts have been estimated to outnumber successful ones by a ratio ranging from 26:1 to 49:1.
- Access to a firearm may not necessarily be associated with a significant increase in the risk of suicide, although such access appears to be associated with an increased probability that a firearm would be chosen as the method of suicide.
- The individual and situational factors that may influence individual choices of a method, given its relative availability, are still not well understood. Controlling the availability of some means of committing suicide may affect existing behaviour patterns and perhaps prevent some suicides. What is not clear is how, under what circumstances, and for what kind of suicide attempts this might be the case.
- There has been insufficient research conducted on multiple suicide attempts and on the role of situational determinants in such instances. It is not known whether, generally, an unsuccessful attempt will bring an individual to switch to a more lethal method.
- The fatality rate of firearms as a suicide method is highest among all methods, although it is followed closely by hanging and carbon monoxide poisoning.
- The observed correlation between firearm availability and suicide in general is not as solid as some might expect. In Canada, provincial comparisons found no correlation between suicide rates and overall levels of firearm ownership. However, it is empirically indisputable that where firearms are more widely available, the firearm suicide rate is higher.
- Perhaps little can be done to prevent a person who is strongly determined to commit suicide, although prevention may be possible in the majority of cases where the suicidal impulse is temporary. In such instances, the absence of a readily available firearm may stall the individual long enough to prevent a suicidal act.
- The relative availability of culturally acceptable suicide methods is only one of the many factors that affect the choices individuals make when considering suicide.
- Since a large proportion of youth suicides are impulsive, prevention techniques tend to focus on preventing such a situation, through such methods as making firearms less available to youth.
- Authors have emphasized the importance of integrating various methods to prevent suicide, increasing cooperation between mental health professionals and other authorities, and recognizing and caring for people at high risk of suicide.
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