Skip to main navigation menu Skip to main content Skip to site footer

Viewpoint

Vol. 153 No. 1 (2023)

Suicide in Switzerland: why gun ownership can be deadly

  • Wolfgang Stroebe
DOI
https://doi.org/10.57187/smw.2023.40026
Cite this as:
Swiss Med Wkly. 2023;153:40026
Published
06.01.2023

Abstract

There is a great deal of empirical evidence that owning a firearm increases the risk of dying from suicide. Most suicides are impulsive. Nearly 50% of survivors of suicide attempts report that they took less than 10 minutes between the decision to die and their suicide attempt. The great majority of these suicide survivors never make another attempt and die of natural causes. Because nearly 90% of firearm suicide attempts have a deadly outcome, gun owners are unlikely to have such a second chance. These impulsive suicide attempts are typically carried out with the means at hand. Swiss men have much higher firearm suicide rates than men in other European countries and this excess is likely to be due to their easy access to guns, because army conscripts have to keep their guns at home. When the number of conscripts was nearly halved in 2003/4 as a result of the Swiss Army Reform XXI, the number of army-issued firearms was reduced by an estimated 20%. An analysis of suicide rates before and after the reform indicated that male (but not female) suicide rates decreased by 8%, with no evidence of substitution with other means of suicide. If the army would require that the remaining half of conscripts had to keep their weapons at their barracks rather than at home, a further decrease in male suicide rates could be expected.

References

  1. Stroebe W. Firearm possession and violent death: A critical review. Aggress Violent Behav. 2013 Nov;18(6):709–21. https://doi.org/10.1016/j.avb.2013.07.025 DOI: https://doi.org/10.1016/j.avb.2013.07.025
  2. Stroebe W. Firearm availability and violent death: the need for a culture change in attitudes toward guns. Anal Soc Issues Public Policy. 2016 Dec;16(1):7–35. https://doi.org/10.1111/asap.12100 DOI: https://doi.org/10.1111/asap.12100
  3. Stroebe W, Leander NP, Kruglanski AW. Is it a dangerous world out there? The motivational bases of American gun ownership. Pers Soc Psychol Bull. 2017 Aug;43(8):1071–85. https://doi.org/10.1177/0146167217703952 DOI: https://doi.org/10.1177/0146167217703952
  4. Kellermann AL, Rivara FP, Somes G, Reay DT, Francisco J, Banton JG, et al. Suicide in the home in relation to gun ownership. N Engl J Med. 1992 Aug;327(7):467–72. https://doi.org/10.1056/NEJM199208133270705 DOI: https://doi.org/10.1056/NEJM199208133270705
  5. Cummings P, Koepsell TD, Grossman DC, Savarino J, Thompson RS. The association between the purchase of a handgun and homicide or suicide. Am J Public Health. 1997 Jun;87(6):974–8. https://doi.org/10.2105/AJPH.87.6.974 DOI: https://doi.org/10.2105/AJPH.87.6.974
  6. Dahlberg LL, Ikeda RM, Kresnow MJ. Guns in the home and risk of a violent death in the home: findings from a national study. Am J Epidemiol. 2004 Nov;160(10):929–36. https://doi.org/10.1093/aje/kwh309 DOI: https://doi.org/10.1093/aje/kwh309
  7. Grassel KM, Wintemute GJ, Wright MA, Romero MP. Association between handgun purchase and mortality from firearm injury. Inj Prev. 2003 Mar;9(1):48–52. https://doi.org/10.1136/ip.9.1.48 DOI: https://doi.org/10.1136/ip.9.1.48
  8. Wiebe DJ. Homicide and suicide risks associated with firearms in the home: a national case-control study. Ann Emerg Med. 2003 Jun;41(6):771–82. https://doi.org/10.1067/mem.2003.187 DOI: https://doi.org/10.1067/mem.2003.187
  9. Killias M. International correlations between gun ownership and rates of homicide and suicide. CMAJ. 1993 May;148(10):1721–5.
  10. Killias M, Van Kesteren J, Rindlisbacher M. Guns, violent crime, and suicide in 21 countries. Can J Criminol. 2001 Oct;43(4):429–48. https://doi.org/10.3138/cjcrim.43.4.429 DOI: https://doi.org/10.3138/cjcrim.43.4.429
  11. Kaplan MS, Geling O. Firearm suicides and homicides in the United States: regional variations and patterns of gun ownership. Soc Sci Med. 1998 May;46(9):1227–33. https://doi.org/10.1016/S0277-9536(97)10051-X DOI: https://doi.org/10.1016/S0277-9536(97)10051-X
  12. Miller M, Azrael D, Hemenway D. Firearm availability and unintentional firearm deaths, suicide, and homicide among 5-14 year olds. J Trauma. 2002 Feb;52(2):267–74. https://doi.org/10.1097/00005373-200202000-00011 DOI: https://doi.org/10.1097/00005373-200202000-00011
  13. Miller M, Azrael D, Hemenway D. The epidemiology of case fatality rates for suicide in the northeast. Ann Emerg Med. 2004 Jun;43(6):723–30. https://doi.org/10.1016/j.annemergmed.2004.01.018 DOI: https://doi.org/10.1016/j.annemergmed.2004.01.018
  14. Miller M, Lippmann SJ, Azrael D, Hemenway D. Household firearm ownership and rates of suicide across the 50 United States. J Trauma. 2007 Apr;62(4):1029–34. https://doi.org/10.1097/01.ta.0000198214.24056.40 DOI: https://doi.org/10.1097/01.ta.0000198214.24056.40
  15. Siegel M, Rothman EF. Firearm ownership and suicide rates among US men and women, 1981–2013. Am J Public Health. 2016 Jul;106(7):1316–22. https://doi.org/10.2105/AJPH.2016.303182 DOI: https://doi.org/10.2105/AJPH.2016.303182
  16. Balestra S. Gun prevalence and suicide. J Health Econ. 2018 Sep;61:163–77. https://doi.org/10.1016/j.jhealeco.2018.08.003 DOI: https://doi.org/10.1016/j.jhealeco.2018.08.003
  17. Reisch T, Steffen T, Habenstein A, Tschacher W. Change in suicide rates in Switzerland before and after firearm restriction resulting from the 2003 “Army XXI” reform. Am J Psychiatry. 2013 Sep;170(9):977–84. https://doi.org/10.1176/appi.ajp.2013.12091256 DOI: https://doi.org/10.1176/appi.ajp.2013.12091256
  18. Small Arms Survey (2018). Global firearms holdings. https://www.smallarmssurvey.org/database/global-firearms-holdings
  19. Conner A, Azrael D, Miller M. Suicide case-fatality rates in the United States, 2007 to 2014: a nationwide population-based study. Ann Intern Med. 2019 Dec;171(12):885–95. https://doi.org/10.7326/M19-1324 DOI: https://doi.org/10.7326/M19-1324
  20. Miller M, Azrael D, Barber C. Suicide mortality in the United States: the importance of attending to method in understanding population-level disparities in the burden of suicide. Annu Rev Public Health. 2012 Apr;33(1):393–408. https://doi.org/10.1146/annurev-publhealth-031811-124636 DOI: https://doi.org/10.1146/annurev-publhealth-031811-124636
  21. Paashaus L, Forkmann T, Glaesmer H, Juckel G, Rath D, Schönfelder A, et al. From decision to action: suicidal history and time between decision to die and actual suicide attempt. Clin Psychol Psychother. 2021 Nov;28(6):1427–34. https://doi.org/10.1002/cpp.2580 DOI: https://doi.org/10.1002/cpp.2580
  22. Deisenhammer EA, Ing CM, Strauss R, Kemmler G, Hinterhuber H, Weiss EM. The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt? J Clin Psychiatry. 2009 Jan;70(1):19–24. DOI: https://doi.org/10.4088/JCP.07m03904
  23. Rimkeviciene J, Hawgood J, O’Gorman J, De Leo D. Personal stigma in suicide attempters. Death Stud. 2015;39(10):592–9. https://doi.org/10.1080/07481187.2015.1037972 DOI: https://doi.org/10.1080/07481187.2015.1037972
  24. Florentine JB, Crane C. Suicide prevention by limiting access to methods: a review of theory and practice. Soc Sci Med. 2010 May;70(10):1626–32. https://doi.org/10.1016/j.socscimed.2010.01.029 DOI: https://doi.org/10.1016/j.socscimed.2010.01.029
  25. Runeson B, Tidemalm D, Dahlin M, Lichtenstein P, Långström N. Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study. BMJ. 2010 Jul;341 jul13 1:c3222. https://doi.org/10.1136/bmj.c3222 DOI: https://doi.org/10.1136/bmj.c3222
  26. Hawton K, Zahl D, Weatherall R. Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. Br J Psychiatry. 2003 Jun;182(6):537–42. https://doi.org/10.1192/bjp.182.6.537 DOI: https://doi.org/10.1192/bjp.182.6.537
  27. Daigle MS. Suicide prevention through means restriction: assessing the risk of substitution. A critical review and synthesis. Accid Anal Prev. 2005 Jul;37(4):625–32. https://doi.org/10.1016/j.aap.2005.03.004 DOI: https://doi.org/10.1016/j.aap.2005.03.004
  28. Kreitman N. The coal gas story. United Kingdom suicide rates, 1960-71. Br J Prev Soc Med. 1976 Jun;30(2):86–93. https://doi.org/10.1136/jech.30.2.86 DOI: https://doi.org/10.1136/jech.30.2.86
  29. Lubin G, Werbeloff N, Halperin D, Shmushkevitch M, Weiser M, Knobler HY. Decrease in suicide rates after a change of policy reducing access to firearms in adolescents: a naturalistic epidemiological study. Suicide Life Threat Behav. 2010 Oct;40(5):421–4. https://doi.org/10.1521/suli.2010.40.5.421 DOI: https://doi.org/10.1521/suli.2010.40.5.421
  30. Studdert DM, Zhang Y, Swanson SA, Prince L, Rodden JA, Holsinger EE, et al. Handgun ownership and suicide in California. N Engl J Med. 2020 Jun;382(23):2220–9. https://doi.org/10.1056/NEJMsa1916744 DOI: https://doi.org/10.1056/NEJMsa1916744
  31. Wintemute GJ, Parham CA, Beaumont JJ, Wright M, Drake C. Mortality among recent purchasers of handguns. N Engl J Med. 1999 Nov;341(21):1583–9. https://doi.org/10.1056/NEJM199911183412106 DOI: https://doi.org/10.1056/NEJM199911183412106
  32. Edwards G, Nesson E, Robinson JJ, Vars F. Looking down the barrel of a loaded gun: the effect of mandatory handgun purchase delays on homicide and suicide. Econ J (Lond). 2018 Dec;128(616):3117–40. https://doi.org/10.1111/ecoj.12567 DOI: https://doi.org/10.1111/ecoj.12567
  33. Dunton ZR, Kohlbeck SA, Lasarev MR, Vear CR, Hargarten SW. The association between repealing the 48-hour mandatory waiting period on handgun purchases and suicide rates in Wisconsin. Arch Suicide Res. 2022;26:1327–35. DOI: https://doi.org/10.1080/13811118.2021.1886209
  34. Värnik A, Kõlves K, van der Feltz-Cornelis CM, Marusic A, Oskarsson H, Palmer A, et al. Suicide methods in Europe: a gender-specific analysis of countries participating in the “European Alliance Against Depression”. J Epidemiol Community Health. 2008 Jun;62(6):545–51. https://doi.org/10.1136/jech.2007.065391 DOI: https://doi.org/10.1136/jech.2007.065391
  35. Thoeni N, Reisch T, Hemmer A, Bartsch C. Suicide by firearm in Switzerland: who uses the army weapon? Results from the national survey between 2000 and 2010. Swiss Medical Weekly. 2018 Sep 23(37). DOI: https://doi.org/10.4414/smw.2018.14646
  36. GSoA Zeitung. (2022). In verschiedenen Varianten überall erhältlich. Retrieved from: https://www.gsoa.ch/newspaper/verschiedenen-varianten-uberall-erhaltlich/