Guns, Depression, and Suicide Prevention: Is It Time for Universal Home Safety Screening?

Abstract

Perlis and colleagues 1 describe the convergence of firearm ownership and symptoms consistent with a clinically significant depressive condition among respondents to a carefully crafted and demographically weighted internet survey. As part of an effort to examine the consequences of COVID-19, the authors used the 9-Item Patient Health Questionnaire (PHQ-9) depression screening scale as well as a dichotomous yes or no question regarding gun ownership. Additionally, they inquired about recency of purchase, future plans for acquiring guns, and reasons for obtaining them.Of the 24 770 respondents, 6929 (28.0%) were positive, with a PHQ-9 score 10 or greater, of whom nearly a third owned a gun-of which more than 35% had purchased their firearm during the pandemic. However, depressive symptoms were not preferentially associated with ownership.Among persons with depression, those who owned guns were significantly more likely to be younger, male, and White; to have higher income; to be rural dwelling and living in the southern United States; and to express an affiliation with the Republican party. Most respondents indicated that their purchases were for protection against crime, although persons with depression noted this relatively less often, while more frequently affirming gun acquisition due to COVID-19 and for protection against someone known to them. Other common reasons included hunting and target shooting as well as concerns regarding protection against the government, the election, and the lockdown.Participants with depression had purchased their guns more recently; of those who were not owners, there was greater expressed interest in a near future purchase as compared with respondents who did not own a firearm and did not have depression. While the authors conducted others analyses, their major conclusion suggested that "our results may facilitate focused interventions to diminish suicide risk and increase firearm safety among individuals with 2 major suicide risk factors." 1 Suicide Prevention-Writ LargeIt is useful to place suggestions for preventing suicide, attempted suicide, and risk-related outcomes, such as drug-related fatalities (ie, "self-injury mortality" 2 ), into a broader public health context. 3 We know that large scale public health efforts to restrict access to lethal methods of suicide have the greatest potential population impact by fundamentally impeding the ability of persons to select a more lethal option for suicide. 3 However, results can be ambiguous. National bans of highly hazardous pesticides can lead to declines in suicide, 4 yet a major community-based, clusterrandomized trial regarding the effectiveness of lockable household pesticide storage containers found no effect. 5 Australia enacted firearm laws during the mid-1990s and early 2000s, which appeared to be associated with a decline in suicide rates during the early 2000s, only to see a relatively steady rise during the second decade of this century. 6 Prevention initiatives that depend on one-on-one clinical interactions and e...