History of alcohol offenses associated with higher suicide risk for men who bought handguns

Access to firearms is a known risk factor for suicide, but new research from the UC Davis Violence Prevention Research Program (VPRP) finds that, among handgun purchasers, those with a history of alcohol charges have more than twice the risk of suicide. The study was published in Preventive Medicine.

“We know access to firearms is a strong risk factor for suicide. And we know from prior studies that substance use is a risk factor for suicide. But no one has looked at whether substance use is associated with increased suicide risk among firearm owners,” said Julia Schleimer, the lead author of the study and a research data analyst at VPRP. “This is an important gap because, for policy and prevention efforts, we need evidence on contributing factors that are associated with increased risk above and beyond access to firearms alone.”

Overall, the study showed that handgun purchasers who had alcohol charges (without drug charges) had more than two times the risk of suicide compared with handgun purchasers with neither alcohol nor drug charges. The risk was greatest among those who had two or more alcohol arrests or convictions, and those whose last alcohol charge was during the year before or the two years after a handgun purchase.

Drug charges, however, did not seem to indicate an elevated level of risk for suicide.

How researchers conducted the study

To determine whether there was an increased risk of suicide for handgun purchasers with drug and alcohol charges and convictions, the researchers analyzed data for all the men who legally purchased a handgun in California during 2001 — 101,377 in total. The study focused on men because over 90% of the purchases that year were by men, and no women with substance use-related charges died by suicide.

The researchers used data from the California Department of Justice to see how many of the men with legal handgun purchases had alcohol- or drug-related criminal charges dating back to January 1, 1990, such as an arrest for driving under the influence (DUI) or drug charges. They then checked records from the California Department of Public Health to see how many of the 2001 cohort had died by suicide through the period ending December 31, 2015.

“One of the key findings of the study is that more recent and repeat alcohol charges were associated with the greatest risk of suicide, including firearm suicide,” Schleimer said.

Of the 101,377 men who legally purchased a handgun in California in 2001, 594 died by suicide, almost 90% of whom used a firearm. That translates to a rate of 42 suicides per 100,000 population. The suicide rate among males in the U.S. is 21.5 per 100,000 population, according to the Centers for Disease Control.

Study findings could help suicide mitigation efforts

Suicide is a major public health crisis in the United States, resulting in over 47,500 deaths in 2019. The number of suicides outnumbers homicides by almost two and a half times. Suicide is the 10th leading cause of death in the United States for all age groups. For individuals between the ages of 10 and 34, it is the second leading cause of death.

Firearm suicide attempts are particularly lethal — almost 90% result in death. Firearm access is a well-established risk factor for suicide. Other studies also link alcohol and drug use with a higher risk of suicide.

The new results show that handgun owners with alcohol offenses may benefit from reducing firearm access or alcohol use.

“This study helps us better identify the populations at elevated risk of suicide, which can, in turn, inform clinical interventions, firearm policy and substance use prevention and treatment efforts. For example, clinicians might counsel patients who have alcohol dependence and who own firearms about risk reduction strategies like safe firearm storage and temporary firearm transfer,” Schleimer said.

The majority of people who survive a suicide attempt do not go on to die by suicide. Given the lethality of firearm suicide attempts, restricting access to firearms among those at risk of self-harm may save lives.

Public health professionals have repeatedly called for alcohol and drug-related firearm restrictions. The study provides evidence for the potential utility of such restrictions related to DUI; however, the authors note that structural racism in the criminal legal system would need to be considered.

“Suicides are the most common cause of firearm deaths in the United States,” said Rose Kagawa, an assistant professor in the Department of Emergency Medicine and senior author of the study. “Understanding risk factors for firearm suicide, particularly among people seeking to purchase handguns, can contribute to life-saving supports and services.”

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Additional authors on the study include Susan L. Stewart from the UC Davis Department of Public Health Sciences, and Mona A Write, Aaron B. Shev, Christopher D. McCort, Rameesha Asif-Sattar, Sydney Sohl, Susan L. Stewart and Garen Wintemute from the Violence Prevention Research Program.  

Funding

This study was funded by the VPRP and grants 1R01AA023551-01A1 from the National Institute on Alcohol Abuse and Alcoholism, 2014-255 from the California Wellness Foundation, and 2016-219 from the Heising-Simons Foundation and by the Robertson Fellowship in Violence Prevention Research. The funders had no role in the design, analysis, or interpretation of results.

About VPRP

VPRP is a multi-disciplinary program of research and policy development focused on the causes, consequences and prevention of violence. Studies assess firearm violence, the social conditions that underlie violence, and the connections between violence, substance use and mental illness. VPRP is home to the University of California Firearm Violence Research Center, which launched in 2017 with a $5 million appropriation from the state of California to conduct leading-edge research on firearm violence and its prevention. For more information, visit health.ucdavis.edu/vprp/.