Handguns In Home Boost Suicide Risk Among Elderly

A handgun in the home significantly increases the risk of suicide in men over the age of 50, researchers from the University of Rochester Medical Center show in an article in the July-August issue of the American Journal of Geriatric Psychiatry.

People with a handgun in the home were more than twice as likely to kill themselves compared to similar people who don't have access to handguns. The finding wasn't true for long guns such as rifles and shotguns, whose presence did not boost suicide risk.

The findings are included in a special issue of the journal, devoted to the subject of suicide among the elderly. Other topics include why suicidal thoughts are rare among older African-Americans; the roles that a poor social support network and lack of sleep play in suicide among the elderly; and how impaired thinking from physical illnesses in aging people contributes to depression and hopelessness. Rochester psychiatrist Yeates Conwell, M.D., who led the handgun study, edited the special issue.

Firearms are by far the most common method of suicide used by both men and women in later life. Among men over the age of 65, firearms played a role in 71 percent of cases. It's part of the reason why older people who attempt suicide are five times more likely to kill themselves than younger people who try to take their own lives.

Conwell, who directs the university's Center for the Study and Prevention of Suicide, decided to take a very detailed look at suicides among men in two Upstate New York counties. Just as doctors will ask why one group of people develop heart disease while another group does not, the team compared suicide victims to similar people who did not kill themselves, in an attempt to identify the factors that put people at risk.

The team studied suicides among people age 50 and older from December 1996 to January 2001 in the Rochester and Syracuse areas, including Monroe and Onondaga counties. Taking part in the study, funded by the National Institute for Mental Health, were Conwell; Paul Duberstein, Ph.D.; Kenneth Connor, Psy.D.; Christopher Cox, Ph.D.; and Eric Caine, M.D.

Survivors of 86 people who killed themselves agreed to take part in the study. For those patients the team set out to perform "psychological autopsies," interviewing family members, friends, neighbors, co-workers, and others to learn as much as they could about the suicide victims. The team also reviewed the victims' health records. The scientists then compared their findings to those from 86 very similar people in those counties who were still living -- people in similar life circumstances who had chosen not to kill themselves.

The presence of a handgun in the home stood out as a significant risk, even when scientists took into account other risk factors such as mental illness. In other words, an elderly person with a psychiatric problem such as depression was more than twice as likely to kill himself or herself if there was a gun in the home.

"This is a generation that is very comfortable with guns for sport such as hunting. Many lived through World War II or the Korean War and are familiar with firearms, so the presence of a gun is not unusual," says Conwell. "But it becomes a serious issue when the person develops a depression. If someone is clinically depressed and has a firearm, that's a very dangerous combination.

"We're not saying that guns are responsible for suicides. There are many factors involved. Rather, it's a question of risk, and how best to adjust for that risk. It's important to recognize that the gun is there and that it poses some danger. If the person becomes depressed and vulnerable for other reasons, the gun becomes potentially lethal," he says.

Scientists know that the biggest risk factor for suicide is a psychiatric illness like clinical depression. Once it's identified as a problem, depression is treated effectively for four out of five patients. But among the elderly, the illness is often unrecognized and inadequately treated for several reasons, Conwell says.

Doctors might focus on physical problems or diseases instead of psychological problems, or patients might think symptoms like fatigue or loss of appetite have a physical cause when they may be symptoms of depressive illness. Some people think it's normal for people to "feel low," sleep poorly, or have less energy as they age, when really the change may be a sign that the person is depressed. And elderly people today oftentimes don't speak about their feelings openly, a key step in identifying depression.

Conwell says that gun ownership is a topic that psychiatrists and other therapists should bring up with their patients. In his own work specializing in the treatment of elderly patients, he is becoming more and more comfortable discussing issues like guns.

"Just like primary care doctors have adjusted to asking questions about a person's sex life, to help prevent diseases like HIV, we need to discuss the presence of firearms in the home as well," he says. "Patients generally understand that doctors need to understand their overall well being, and they accept those questions and answer them in a straightforward manner."

Conwell suggests that to assure safety, families and health care providers of an elderly person who is depressed ask whether there are any guns in the house, and if there are, to have the gun removed, at least until the depression is evaluated and treated. This is especially true for depressed elderly men; older white men are more likely than any other group in the nation to take their own lives.

"Restriction of access to handguns may be an effective, universal preventive intervention for reducing rates of suicide in later life," the authors write in the journal. They note that critics often state that if guns weren't available, the same people would kill themselves in a different way. Research has been mixed, but recent studies show that restricting gun access does cut down on the number of suicides, Conwell says.

The study also showed that older people who keep a gun either unlocked or loaded, or both, are more likely to use it to kill themselves. "There is an element of impulsivity in the suicides of some older adults," says Conwell. "These may be the folks that would particularly benefit from restricting access."

The Rochester group is leading a nationwide effort, funded by the National Institutes of Health, to identify and then publicize the best ways to prevent suicide. The team is bringing experts together in a five-year process to review current efforts, develop a consensus of best practices, and discuss future research initiatives to reduce suicide.