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About the Episode
In Episode 3 of (Re)Search for Solutions, we discuss firearm suicide prevention. Firearm suicides make up about two-thirds of deaths by firearms, but suicide is sometimes downplayed in conversations about preventing gun violence.
Sonali interviews Kerry Keyes, psychiatric epidemiologist at Columbia University, about her research on gun violence and suicide. Kerry also shares how suicide has affected her and her family. Sonali also talks with Doreen Marshall, Vice President of Programs at the American Foundation for Suicide Prevention [AFSP] about their efforts to prevent firearm suicide and to support survivors of suicide loss.
Special thanks to Kyle Oliver for help with mastering this episode.
Listen Here, or on Apple Podcasts, Spotify, SoundCloud, or Google Podcasts.
Related Media and Resources
National Suicide Prevention Lifeline: Call 1-800-273-TALK (1-800-273-8255)
Crisis Text Line: Text TALK to 741741
American Foundation for Suicide Prevention {AFSP}
Simulating the Suicide Prevention Effects of Firearms Restrictions Based on Psychiatric Hospitalization and Treatment Records: Social Benefits and Unintended Adverse Consequences by Kerry & Colleagues | American Journal of Public Health
Assessing the impact of alcohol taxation on rates of violent victimization in a large urban area: an agent‐based modeling approach by Kerry & colleagues | Addiction / PubMed
Coronavirus Could Make America’s Gun Problem Even Deadlier | The New York Times
EPISODE TRANSCRIPT
Sonali: It is difficult for our team to fully capture the enormity of this moment in just a few words. In addition to the ongoing covid-19 pandemic, our country - indeed the world - is simultaneously reckoning with the pandemic of racism and the national reckoning that protests against police brutality have brought forth. Structural racism is embedded in the social institutions that also serve communities. As a result, the lives of Black people are disproportionately impacted by racist responses and actions that characterize the systems of education, justice, and law enforcement. Academia, the institutional base from which we as researchers come to this issue, is similarly driven by structural racism, in its past and present, with the voices, perspectives, and experiences of Black scholars largely missing or diminished. We are committed to keep doing better to shape this series with these realities actively in mind. We know this remains a deeply challenging time and we have never been more grateful to be in conversation with you, our listeners. Stay well and take good care.
Sonali: In this episode, we discuss suicide, and how it connects with gun violence prevention. If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK. That’s 1-800-273-8255. Or contact the Crisis Text Line by texting TALK to 741741. Suicide is preventable. Visit AFSP.org for more resources on support, education, and prevention.
Doreen: I think many people think that deaths that occur using a firearm are predominately due to violence or self protection, and really two thirds of all firearm deaths are suicide. We know over half of all suicides are by firearm, and in some states that can be upwards, close to 70 per cent, are by firearm. So, again it's about I think educating the public about those numbers. Because it's not what we hear generally.
Sonali: The voice you just heard was Doreen Marshall, Vice President of Programs at the American Foundation for Suicide Prevention. In this episode, we focus on the intersection of gun violence and suicide. We'll hear more from Doreen later in the episode. But first I talk with Kerry Keyes, epidemiologist at Columbia University, about her research on gun violence and suicide. Kerry also shares how suicide has affected her and her family.
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Sonali: (Re)Search for Solutions is a series where we cover research related to pressing issues in our world today. During this season, we're focusing on unexpected and creative ways that researchers are looking at solutions to the persistence of gun violence. I'm Sonali Rajan, a professor in the Department of Health and Behavior Studies at Teachers College, Columbia University, working with the Media and Social Change lab.
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Sonali: Kerry Keyes is an Associate Professor of epidemiology, and co-director of the Psychiatric Epidemiology training program at Columbia University's Mailman School of Public Health. I visited her at her office to talk about her work. As a psychiatric epidemiologist, Kerry studies suicide, gun violence, and their intersection.
Sonali: [in interview] When people talk about gun violence as an issue, how come suicide isn't at the forefront of that conversation? I was on this panel last year where there was this Fox News commentator as part of this panel, and he was quoting this NRA talking point that says as gun ownership has increased, gun violence has decreased over the past 20 years. And, that's technically true if you exclude suicides, and so he was like, but like suicides, he was basically like suicides don't count. It was, was essentially what he was saying. Like that's not really the issue at hand. The issue at hand are these like mass shootings or that's what we're trying to prevent is like the bad guy with the gun.
Kerry: You know, I've heard the same argument, you know even when people say, well 38,000 people die by a gun every year, there's, there's this like "yeah, but" that occurs. Like, "yeah, but most of those are suicides." Which, I have the same reaction as you as someone who studies suicide. Is like, those are moms and dads and sons and daughters and people and families. You know I think that suicide can be incomprehensible to think about. And I think that people really don't like to, people don't like to think about it. Even people who've had suicide affect their family. Like, it, it's just too much to consider, the, the amount of devastation that is caused by a suicide. And so I think, I think some of the reluctance on the part of national media and even just everyday conversations among people about this issue of gun violence, to not include the devastating impact of suicide as part of that picture, is that it's a very uncomfortable topic to talk about, and to think about. But I agree with you that that doesn't change what we know from the data. That this is a huge part of, of gun violence in the United States is, is people taking their own lives. And so of course needs to part of the policy conversation. Equally on the same footing as the need for prevention of person to person violence is the need for prevention for self-inflicted violence.
In 2017, for example, more than 47,000 individuals in the U.S. died by suicide. Were recorded to have died by suicide. And there are imperfections in the recording of suicide, so that's probably an underestimate. That number is, has increased 30 per cent in the last fifteen years. So suicide is increasing precipitously in the U.S.. So much so that suicide is one of the, one of the contributors, along with overdose, to the decline in life expectancy that we've seen in the U.S. in the past several years. About half of suicides in the United States are via firearm. Gun availability is such a huge part of gun suicide. So, suicide rates correlate with gun ownerships. If someone has a gun in the home, they're much more likely to try to die by suicide using a firearm. And so just the availability and the ubiquity of guns in a given community will predict the population level rate of firearm suicide. So any policy that restricts availability and access to firearms, regardless of the impact of that policy on firearm violence writ large, there's a think a solid evidence base that it will have an impact on self-inflicted violence. But there's this misconception that people who, that people who are suicidal, that if they don't have a firearm with them, they'll just, they'll just try using something else. And there's a ton of research that suggests that that's not the case. That if you prevent lethal, access to lethal means of suicide, you not only reduce the lethality of suicide, but you can reduce the suicidal behavior overall.
Sonali: Kerry and co-principal investigator Magdalena Cerdá work with a team of other experts to study violence in New York City, including suicide, by building mathematical models.
Kerry: We were really interested in understanding this connection between, or, or this misunderstood connection between mental illness and violence. Especially when mass shooter events happens, there's this discussion of well, you know, we don't have a violence problem we have a mental illness problem. You hear kind of those same refrains, and then on the other side, you have a lot of scholars who question the association between mental illness and violence. That for, for most psychiatric disorders there's no connection between perpetration of violence. For all psychiatric disorders there's a connection with self-inflicted harm.
Sonali: Kerry and her team answer questions about this misunderstood link between mental illness and violence using a computer program called an agent based model. She says it’s a bit like the game Sim City, where users can program characters in the game to have certain behaviors. The agent-based model uses hundreds of thousands of agents, basically dots on a computer screen that represent people. Then it runs a simulation that predicts what happens when people interact using statistics from the real world, such as the availability of guns and how many people live in a given area.
Kerry: So, the simulation that we have focused on so far, looks at different types of background-check disqualifications and tries to model how broad and sort of unconstitutionally over-sweeping disualifications would need to be in order to have a population level impact on suicide, on, on population rates of suicide. Because, you know you can identify people who are at very high risk for committing suicide by firearm, and that's a very small group of people. And yet, every day, there are suicides in the United States.
Sonali: When Kerry says population-level rates, she’s talking about the number of people in the entire population, for example in New York City or the United States. If the total number of people that fall into a category of high risk for committing suicide is much smaller than the total number of suicides, then efforts that target just those people can only have a small impact on the total number of suicides, because there just weren’t many people in those high risk categories to begin with compared with the overall numbers. Background check disqualifications are a way of removing access to guns from people who meet certain criteria for being in a high risk category, but as Kerry explains, there aren’t enough people in those high risk categories to make a big difference in overall rates of suicide.
Kerry: And that's not to say that those disqualification criteria aren't important. Because among people who have these very high risk criteria, you can reduce their risk of suicide by 80, 90, or, you know upwards of 100 percent if you disarm them effectively, right. So, that's not to say that we shouldn't be disarming people who have very high risk criteria. But the idea that you're gonna have a, a, a high population level impact using those types of criteria, even on something that is connected strongly with psyciatric diagnoses, like firearm suicide, it's just not understanding the scope of the problem that we have in the United States. Other things that we've done in the model so far that have had a much bigger impact on community violence are things like alcohol taxes. Population level policies that regulate products that we know have a strong association with violence.
Sonali: Products that have a strong association with violence, like guns. But there are many efforts to prevent firearm suicide that don’t involve limiting general access to firearms, especially since gun rights are an area of intense political controversy in the United States. We talked with Doreen from the American Foundation for Suicide Prevention, or AFSP, about their efforts to prevent firearm suicides. AFSP is the largest funder of suicide prevention research in the United States. They also run events and programs in all 50 states. And Doreen is the Vice President of Programs and a psychologist by training. She works with chapters around the country on prevention education and loss and healing programs.
Doreen: AFSP's always been involved in preventing firearm suicide. So, we've done that in a number of ways historically. We've funded research related to firearms and suicide prevention. We've promoted and encouraged lethal mean counseling, for clinicians. We've supported extreme risk protection order legislation, particularly that legislation that has a potential to impact suicide or prevent suicide. As well as working with a number of groups on suicide prevention education.
Sonali: Doreen mentioned lethal means counseling and extreme risk protection orders. Lethal means counseling means working with physicians to talk to patients who are at high risk of suicide about voluntarily limiting their access to firearms. Extreme risk protection orders refer to legislation that has been introduced in several states that would limit or remove access to firearms for people who fall under certain criteria for being at high risk for suicide.
Doreen: One of the reasons that we've looked at those bills and, and supported several of them, has to do with, when a person is in a suicidal crisis we really want to put time and space between them and their chosen method to end their life. And because firearms, are, are a highly lethal method in terms of suicide, what we really want to do is make sure that when someone is in that kind of risk, high risk period, that we have a way to kind of buy them some time. Because we know that unfortunately suicide by firearm happens quickly and is often fatal. So the support of ERPOs, as we call them, is really around that notion of putting time and space between a, a person at risk, who's stuggling and their chosen method.
Sonali: Kerry explains more about why buying some time is so important when it comes to preventing firearm suicide.
Kerry: Suicide attempts using a firearm are very lethal. So upwards of 90 percent or over 90 percent of people who attempt suicide using a firearm die from that attempt. If we're moving the firearm discussion for a moment from the policy space of just what families can do to protect their loved ones from firearm suicide, you know how people are storing their guns, you know how they're storing their ammunition, that is a huge part of prevention. Especially because, you know, suicide affects young people. Who are often very impulsive and you know this is a major reason why firearm suicide can become so pernicious. Among people, for example, who've recovered from firearm suicide, they do these interviews and they say how long before you attempted did you decide that you were going to die by suicide? That you wanted to die by suicide. And it's less than an hour in the majority of cases.
Sonali: In addition to efforts to understand and prevent suicide, it's crucial to provide support to people who have suffered from suicide loss. Kerry generously shared her and her family's experience of suicide loss.
Kerry: About two years ago, in the beginning of 2018, my son's father, who I wasn't with currently, died by suicide here in Brooklyn. And, since then, when suicide touched my life and touched our family's life so dramatically, you know, I've come to understand obviously much more personally the way that suicide has a devastating impact on families. On children. You know, my son was seven years old when his died. And trying to explain to a child that their father died by suicide is a really difficult thing to do. A really difficult concept for children to understand. And the process of helping my son grieve and learn about how his dad died, and walking through that with no stigma and with no shame, and with total honesty, and, and answering all the questions that come along with that, has been a really remarkable journey, that I think has obviously informed my scholarship quite a bit, but you know, more importantly has formed a, a major role in my parenting. Of how you help a child who experiences an adverse childhood event.
My son and I both volunteer with the American Foundation for Suicide Prevention as part of this effort of, we're not gonna let this experience be in the shadows. And recently, there's an international survivors of suicide loss day. And we went to an event in the city. And so, in the afternoon we had to break into groups. And so, you know, you kind of go to a different room based on your suicide loss, and it's like, you know, lost a sister, lost a spouse, lost, you know, a friend. And there was one for lost a parent as a child. And so we go to this group and it was fascinating to me to hear other people in the room who were my son's age when they lost their parents talk about it. There were people who didn't get to go to their parents' funeral. And they are, fifty years later, really upset about it. I mean, haven't been able to move past, I never got to go to my dad's funeral. I never got to say goodbye. Nobody told me how he died. For years. Right, like those kinds of things have stuck with those people for decades. You know, and I remember saying in that group like, I get it from the parental standpoint, cause you want, your first instinct is to protect. You know, I, I always say that like with my son, I wanted to be like, your dad's on vacation. I'm not sure when he's coming back. Any day now. And just keep saying that over and over, forever. [Sonali in background: until he's fifty.] Like, that was my plan. And, you know, luckily I had really qualified professionals in my community to say, that's not a good idea. Please that don't tell them that your, that his father is on vacation. Right, and so, my son in that group got to share his experience - he said no, I tol- I gave a speech at my dad's funeral. You know, I, there w-, no one's ever said that this was like something that I should keep to myself. Or not talk about. And, you know, everyone in that room was blown away by how different my son's experience of a parental suicide was compared to theirs, and I think theirs is probably the norm.
Sonali: Doreen explains how AFSP supports people who have lost someone close to them to suicide.
Doreen: I do think regardless of how a person or family loses someone to suicide, these are typically devastating losses. They are often unexpected, often violent. And so, we spend a lot of time helping those who have lost someone to suicide, one, understand that they're not alone. There's a community of people both working to prevent suicide but also to support those who have lost someone. We do believe that suicide is preventable, and, a lot of our education is around educating folks around risk and warning signs. But I do think the support piece can't be understated. Most of us know someone who died by suicide. We, we know those numbers are large enough that most of us can at least identify someone if it wasn't someone close to us that died. And so making sure there's plenty of support out there through our programs is another key mission of what we do at AFSP.
Sonali: We talked with Doreen about some things people can do right now to help prevent firearm suicide.
Doreen: I think it's also about just helping people understand that we all have mental health, just like we have physical health, and that mental health can be connected to suicide risk. So, someone who is struggling with their mental health, it's a big indicator that we need to, to look closer and to ask more questions, particularly if we suspect that they may be thinking about suicide. You know, particularly around firearm ownership, I, I do think what you will find is that people own firearms for all sorts of reasons, and that this, the suicide prevention piece about this is less about whether or not a person should own a firearm, and more about taking steps to own it responsibly and understanding suicide risk as part of that. One of the questions that we're asked sometimes is, you know, why work with firearm owners or the firearm owning community around suicide prevention. And, I, I think the short answer is that the numbers tell us a lot that with over half of all suicides being by firearm, for us to reach our goal of reducing the suicide rate twenty percent by 2025, which is our project 2025, we can't ignore firearm suicide. It's a big part of, of the picture. The campaign that we've worked on and the materials we've worked on with the National Shooting Sports Foundation are around this theme of having a brave conversation. And, in summary what that is, is, first being aware that people around you may be struggling - people are going through tough times. They may have mental health concerns. But also, to not be afraid to ask directly about suicide. And then also to not be afraid to talk to your colleague or friend about firearm ownership and access. Meaning that if this is somebody that you've known and, you know, you go hunting with, or, or you know owns a firearm, to go beyond not only asking have they had, been having thoughts of suicide, but if they are, to also talk with them and help them strategize around securing their firearm. If it's not possible to, to not have the firearm in the home at all, making sure it's secured in a safe where keys are not accessible, making sure it's stored locked and unloaded, disassembling the firearm in a way so that if I were somebody that was having thoughts of ending my life, that it would be difficult for me to reach for my firearm quickly.
Sonali: You can learn about AFSP at AFSP.org, and you can find your local chapter on the website. AFSP.org has information on suicide prevention including statistics, ways to start a conversation, warning signs, and ways to find support. If you or someone you know is in crisis, please dial the National Suicide Prevention Lifeline - 1-800-273-TALK. That's 1-800-273-8255. There are trained people to answer calls 24/7.
Kerry: When my ex-husband, when I found out that he died by suicide, that's the first suggestion that I got. I said, I called my friend and I was like, I, you know, this has happened, what do I do? I don't, do I tell, like, what do I do? And she said call the Suicide Lifeline. And I was like, really, I thought that was for people who are experiencing a suicidal crisis. And she said no, it's for everybody. It's for anyone who has a, you know a concern or, you know, needs information on anything. You know, I'm worreid about my neighbor because he's going through a relationship [music starts to fade in] break-up, how do I have a conversation with him about, you know, a, a firearm transfer. Or, I just found out my ex-husband died by suicide, what now? You know, and so, I did. I called the Suicide Lifeline, and it was really helpful.
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Sonali: This epsode was produced by Sonali Rajan, Lalitha Vasudevan, Joe Riina-Ferrie, and Azsaneé Truss. It was edited by Joe Riina-Ferrie with the help of the Research for Solutions team.
Our music is “Research Area” by Poitr Pacyna and can be found on shockwave-sound.com.
You can find us online at ResearchforSolutions.com, and you can listen to our next episode on Apple Podcasts, Spotify, SoundCloud, and Google Play. Please subscribe, rate and review! We’ll be back soon.
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