300000
250000
200000
150000 Fatal
Non-Fatal
100000
50000
0
Firearms Poisoning
Firearms represent 0.8% of non-lethal attempts and 51.5% of suicide deaths ( 84.1% lethality rate)
Poisoning represents 52.6% of non-lethal attempts and 16.1% of suicide deaths ( 2.6% lethality rate)

• Suicide is more than five times more likely in homes with a gun
(Simon, 2007)
• This risk is further amplified when the gun is stored unsafely
(Brent, 2001)
• At least some subpopulations of veterans appear more likely than non-veterans to own guns
(Lambert & Fowler, 1997)
• Replicated recently in Army National Guard sample
(Khazem et al., in press)
• Some evidence that veterans frequently keep loaded firearms by their bed and that a large portion of those that do have considered suicide using that particular firearm
(Freeman et al., 1994)

Ideation Action
Capability
• The vast majority of those who think about suicide do not attempt and the vast majority of those who attempt do not die
(Nock et al., 2008)
• To move from ideation to action (and death), an individual needs a capability for suicide
(Joiner, 2005; Klonsky & May, 2015; O’Conner, 2011)
• Fearlessness about death/bodily harm
• Elevated pain tolerance
• Access to and familiarity with lethal means

• Strong evidence base supporting that restricting access to and/or increasing safe storage of highly lethal means results in large and sustained drops in overall suicide rates
Nonfirearm
• Detoxification of gas
• Installation of bridge barriers
Firearm
• Israeli military
• Australia

“If somebody really wants to die, won’t they just find another way?”
• The notion of method substitution repeatedly fails to garner empirical support
(Daigle, 2005;
Law et al., 2014; Lester & Abe, 1998)
• Interventions that focused on restricting access to means at suicide hotspots associated with 91% reduction in suicides
(Pirkis et al., 2015)
If method substitution were supported by data, you would expect means restriction/safety to only reduce suicide rates by a specific method, not the overall suicide rate

Michael D. Anestis & Joye C. Anestis
University of Southern Mississippi
Anestis, M.D., & Anestis, J.C. (2015). Suicide rates and state laws regulating access and exposure to handguns. American Journal of Public Health, 105, 2049-2058.

1.
Universal background checks
2.
Mandatory waiting periods
3.
Gun lock requirements
4.
Restriction of open carry
% Suicides by
Firearms
Law
Overall Suicide
Rate
Law
Overall Suicide
Rate
Firearm Suicide
Rate
% Suicides by
Firearms
Comparison with traffic laws and traffic deaths
Change in Law Change in
Suicide Rate

N Overall Suicide Firearm Suicide
Waiting Period
Background Check
Yes
No
11
40
Yes
No
17
34
Open Carry Restricted
11.45
15.72
11.42
16.49
4.43
8.98
4.53
9.74
Yes
No
20
31
12.16
16.50
5.58
9.56
Gun Lock Required
Yes
No
4
47
9.20
15.28
2.68
8.45
% Firearms
35.8%
55.8%
36.8%
58.8%
42.1%
57.5%
28.5%
53.4%

Waiting Period
Background Check
Open Carry
Gun Lock
Overall Suicide Rate
R 2 b
.43
2.27
Firearm Suicide Rate p
η 2 R
.07
.60
2 b
2.37* p
η 2
.12
.51
3.52** .19
.67
3.15** .26
.50
.46
3.03**
4.09**
.18
.64
2.38**
.11
.60
3.07**
.20
.10
% by Firearms
R 2 b p
η 2
.74
.07* .09
.77
.10** .21
.75
.07* .13
.76
.14** .17
Each analysis controlling for poverty, education, race/ethnicity, age, & population density
Length of waiting period correlated with all three outcomes at r < -.50

Independent Variable
Waiting Period
Total
Direct
Indirect
Background Check
Total
Direct
Indirect
Open Carry
Total
Direct
Indirect
Gun Lock
Total
Direct
Indirect
R 2
Coefficient
(SE)
.42
-4.28 (1.21)
-1.42 (1.25)
-2.86 (0.93)
.46
-5.07 (0.93)
-2.77 (1.21)
-2.30 (0.89)
.29
.18
-4.35 (0.96)
-2.42 (0.97)
-1.93 (0.69)
-6.07 (1.88)
-2.47 (1.77)
-3.60 (1.01) p
.001
.261
<.001
.026
<.001
.016
.002
.169
95% CI lower
-5.30
-4.28
-4.36
-6.06
95% CI upper
-1.42
-0.73
-0.47
-1.93
.26
.25
.25
κ 2
.29

State
California
DC
Oklahoma
South Dakota
Law Change
Restrict Open Carry
Extend Waiting Period
Restrict Open Carry
Repeal Waiting Period
% Change in Suicide Rate (US Rate)
1 Year Post Law Law Change - 2013
-3.5% (2.1%) -1.0% (2.7%)
-2.2% (2.1%)
-1.7% (0.6%)
7.6% (3.3%)
-1.5% (2.7%)
-1.7% (0.6%)
8.9% (8.2%)

• No texting while driving
• Primary enforcement of seatbelt requirement
• Hands free mobile phone use
• Same list of covariates as used in firearm law analyses
• None of the laws was associated with statewide traffic deaths
Legislation may be more effective at impacting behaviors for which there is not already a culture of safety in place

michael.anestis@usm.edu