The Impact of Firearm Ownership, Violence, and Policies on Mental Health: A Systematic Scoping Review.

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

This column describes federal and state laws to restrict access to firearms among people with mental illness. The contribution to public safety of these laws is likely to be small because only 3%-5% of violent acts are attributable to serious mental illness, and most do not involve guns. The categories of persons with mental illnesses targeted by the laws may not be at higher risk of violence than other subgroups in this population. The laws may deter people from seeking treatment for fear of losing the right to possess firearms and may reinforce stereotypes of persons with mental illnesses as dangerous.

Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach.

Evidence-based, well-implemented, and enforced gun policies can reduce gun violence, and this vision can be realized with the help of physicians. As the details of policy proposals unfold and the p...

(Reprinted with permission from APA Resource Document, June 2018).

Since 2004, the suicide rate among US Army soldiers has exceeded the rate of death from combat injury. It is critical to establish factors that increase the risk of acting on suicidal thoughts to guide early intervention and suicide prevention. To assess whether firearm ownership, use, storage practices, and accessibility are associated with increased risk of suicide. In this case-control study, suicide cases (n = 135) were defined as US Army soldiers who died by suicide while on active duty between August 1, 2011, and November 1, 2013. Next-of-kin and Army supervisors of soldiers who died by suicide (n = 168) were compared with propensity-matched controls (n = 137); those soldiers with a suicidal ideation in the past year (n = 118) provided structured interview data. Data were analyzed from April 5, 2018, to April 2, 2019. Firearm ownership, storage, and accessibility were assessed by using items from the World Health Organization Composite International Diagnostic Interview screening scales along with items created for the purpose of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) study. Among the 135 suicide decedents, next-of-kin reported that they had greater accessibility to firearms compared with propensity-matched controls. Specifically, suicide decedents were more likely to own 1 or more handguns compared with propensity-matched controls (odds ratio [OR], 1.9; 95% CI, 1.0-3.7; χ21 = 4.2; false discovery rate [FDR] P = .08), store a loaded gun at home (OR, 4.1; 95% CI, 1.9-9.1; χ21 = 12.2; FDR P = .003), and publicly carry a gun when not required for military duty (OR, 3.2; 95% CI, 1.4-7.3; χ21 = 7.4; FDR P = .02). The combination of these 3 items was associated with a 3-fold increase in the odds of suicide death (OR, 3.4; 95% CI, 1.2-9.4; χ21 = 5.4; FDR P = .05). Storing a loaded gun with ammunition at home or publicly carrying a gun when not on duty was associated with a 4-fold increase in the odds of suicide death (OR, 3.9; 95% CI, 1.9-7.9; χ21 = 14.1; FDR P = .002). In this study, in addition to gun ownership, ease and immediacy of firearm access were associated with increased suicide risk. Discussion with family members and supervisors about limiting firearm accessibility should be evaluated for potential intervention.

Young adults in their 20s are at high relative risk for self- and other-directed firearm injury, but little is known about gun access patterns for this group. To describe the longitudinal patterns of firearm access from childhood to young adulthood and to estimate whether violence experienced as a child or as an adult is associated with gun ownership in young adulthood. The Great Smoky Mountains Study included participants from 11 contiguous, mostly rural counties in the Southeastern US. The first wave was completed in 1993 and the most recent in 2019. Periodic survey data were gathered in adolescence through participants' late 20s. In 2023, adjusted Poisson regression with incident rate ratios (IRRs) and 95% CIs were used to estimate associations between violence and gun ownership in young adulthood in 3 age cohorts from the original sample. Violent experiences in childhood (bullying, sexual and physical abuse, violent events, witnessing trauma, physical violence between parents, and school/neighborhood dangerousness) or adulthood (physical and sexual assault). Initiating gun ownership was defined as no gun access or ownership in childhood followed by gun ownership at age 25 or 30 years. Maintaining gun ownership was defined as reporting gun access or ownership in at least 1 survey in childhood and ownership at age 25 or 30 years. Among 1260 participants (679 [54%] male; ages 9, 11, and 13 years), gun access or ownership was more common in childhood (women: 366 [63%]; men: 517 [76%]) than in adulthood (women: 207 [36%]; men: 370 [54%]). The most common longitudinal pattern was consistent access or ownership from childhood to adulthood (373 [35%]) followed by having access or ownership in childhood only (408 [32%]). Most of the violent exposures evaluated were not significantly associated with the outcomes. Being bullied at school was common and was associated with reduced ownership initiation (IRR, 0.76; 95% CI, 0.61-0.94). Witnessing a violent event was significantly associated with increased probability of becoming a gun owner in adulthood (IRR, 1.24; 95% CI, 1.03-1.49). In this cohort study, gun ownership and access were transitory, even in a geographic area where gun culture is strong. Early adulthood-when the prevalence of gun ownership was relatively low-may represent an opportune time for clinicians and communities to provide education on the risks associated with firearm access, as well as strategies for risk mitigation.

Limiting firearm access is essential to decreasing teen suicide. Previous efforts have focused on household firearms; however, less is known about firearm access and possession among teens at increased suicide risk. Our objective was to estimate prevalence of firearm possession and access among high school-aged teens with recent depression and/or lifetime history of suicidality (DLHS). We conducted a probability-based, cross-sectional Web survey of 1914 parent-teen dyads between June 24, 2020, and July 22, 2020, with data weighted to generate a nationally representative sample of US teenagers (aged 14-18). Logistic regression analyses examined the difference between teens with and without DLHS for: (1) personal firearm possession, (2) perceived firearm access, and (3) method of firearm attainment. Among high school-aged teens, 22.6% (95% confidence interval [CI], 19.4-25.8) reported DLHS, 11.5% (95% CI, 8.7-14.3) reported personal firearm possession, and 44.2% (95% CI, 40.2-48.2) endorsed firearm access. Teens experiencing DLHS had increased perceived access (adjusted odds ratio, 1.56; 95% CI, 1.07-2.28) compared with non-DLHS peers. There was no association between DLHS and personal firearm possession (adjusted odds ratio, 0.97; 95% CI, 0.47-2.00). Among teens reporting firearm possession, those with DLHS were more likely to have acquired it by buying/trading for it (odds ratio, 5.66; 95% CI, 1.17-27.37) and less likely receiving it as a gift (odds ratio, 0.06; 95% CI, 0.01-0.36). High school-aged teens experiencing DLHS have higher perceived firearm access compared with lower-risk peers. Providers should speak directly to high school-aged teens at increased suicide risk about firearm access, in addition to counseling parents.

This paper shows the connection between gun policy and crime rate and the public attitude towards the gun policy after a mass shooting and discusses how to prevent gun shootings in the United States. We found that there is less connection between gun policy and crime rate. Mass shootings are highly related to the death rate. The publics attitude also relates to mass shootings and gun policy. By studying the papers of others, we found that gun policies have a powerful impact on American society, especially after significant shootings. People's attitudes towards gun policy will change after a principal shooting, whether by gun owners or non-gun owners, but the change will not last long. At the same time, different states under different parties will have different ways of implementing gun policies. Many investigators have suggested that the federal government should strengthen background checks on applicants to prevent mass shootings. Gun policies need to be more strictly enforced, not only by the government but also by communities and individuals within their spheres. This has a more noticeable effect on preventing large-scale shootings.

Back to table of contents Previous article Next article Professional NewsFull AccessAPA Board Urges Public-Health Approach to Gun ViolenceMark MoranMark MoranPublished Online:3 Feb 2015https://doi.org/10.1176/appi.pn.2015.2a15AbstractAn APA position statement calls for protection of the rights of individuals with mental illness and opposes reporting of nonadjudicated events related to treatment for mental illness.APA is calling for a public-health approach to the problem of firearms-related violence, while also supporting protections for the legitimate rights of individuals with mental illness.At its December 2014 meeting, APA's Board of Trustees approved the "Position Statement on Firearm Access, Acts of Violence, and the Relationship to Mental Illness and Mental Health Services," which draws from policies from related position papers approved in the last 15 years. The new position statement supports several regulatory measures regarding firearms-related violence—including background checks and waiting periods for all gun sales, reasonable restrictions on access to firearms, and ensuring that physicians are free to make clinically appropriate inquiries of patients and others about possession of and access to firearms.But the statement also emphasizes that only a small percentage of violence against others is attributable to people with mental disorders (estimated at 3 percent to 5 percent of the U.S. population, excluding substance use disorders). The statement calls for a fair process for restoration of firearms rights for individuals who have been barred from gun ownership and opposes restriction of gun ownership simply on the basis of nonadjudicated events (see box).Protection of Rights of Mentally IllThe APA position statement on "Firearm Access, Acts of Violence, and the Relationship to Mental Illness and Mental Health Services" includes language supporting policies to protect the rights of people with mental illness. Specifically the statement says the following: "Given that the right to purchase or possess firearms is restricted for specific categories of individuals who are disqualified under federal or state law, the criteria for disqualification should be carefully defined and should provide for equal protection of the rights of those disqualified. There should be a fair and reasonable process for restoration of firearm rights for those disqualified on such grounds."The position statement also says, "Nonadjudicated events should not serve as sufficient grounds for a disqualification from gun ownership and should not be reported to the [federal gun reporting] system. The adjudicatory process provides important protections that ensure the accuracy of determinations (such as dangerousness-based civil commitment), including the right to representation and the right to call and cross-examine witnesses.""APA recognizes the critical public-health need for action to promote safe communities and reduce morbidity and mortality due to firearms-related violence," APA President Paul Summergrad, M.D., told Psychiatric News. "Many deaths and injuries from gun violence can be prevented through common-sense national and state legislative and regulatory measures. However, the vast majority of gun violence toward others is not attributable to mental illness. We view the problem of firearms-related injury and death as requiring a broader public-health approach rather than one that focuses narrowly on mental disorders or on the small number of cases in which serious mental illness is a precipitating factor in gun violence directed at others."APA's position statement puts our Association on record as supporting a public-health approach to gun violence while also protecting the legitimate rights of individuals with mental illness. Regardless of our views on gun ownership, persons with the broad range of mental disorders, which after all include anxiety, postpartum depression, and posttraumatic stress disorders, should not be subject to more stringent controls over gun ownership than persons convicted of criminal offenses."In comments to Psychiatric News, Steven Hoge, M.D., chair of the APA Council on Psychiatry and Law (which helped formulate the position statement), and council vice chair Debra Pinals, M.D., emphasized that the statement policies, which were spelled out in a number of previous statements, go back to the late 1990s."For all APA members, and especially for those of us who get called by the press to comment on the subject of firearms-related violence, the new position statement pulls together prior statements in keeping with the evolving landscape pertaining to firearms, mental illness, and reporting requirements into a national database," Hoge said.Pinals, who chaired the work group for the APA Council on Psychiatry and Law that drafted this position statement and accompanying resource document, noted that many states have adopted legislation that loosens rather than tightens firearms restrictions, and some have broadened the focus on individuals with mental disorders who are reported into a national database. "For this reason, it is important that APA point to and support broader-based public-health approaches rather than focus on mental illness in a way that is stigmatizing and unequal in its treatment of a particular class of individuals," she said. "The statement aims to hold the line to ensure that physicians can make appropriate inquiries into firearms access as part of clinical care; that training, education, and research related to firearms violence continue to be funded; and that efforts that minimize firearms access for all people known to be at risk of danger be strengthened."She added, "The statement continues to recognize that suicide risk by firearms for individuals with mental illness is a significant issue. However, as noted in the statement, contrary to popular belief, violence to others, though tragic and in some cases involving emotional and mental disorders, is not overall accounted for by mental illness." ■All position statements can be accessed in APA's policy-finder database. ISSUES NewArchived

School Shootings in the U.S.: What Is the State of Evidence?

* Associate Professor of Law and Associate Director of the Center for Studies in Criminal Justice, University of Chicago. Jerald Kessler, now a third-year student at the University of Chicago Law School, performed with diligence and creativity as a research assistant on this project. Steven Harris, a second-year student at the Law School, conducted a helpful survey of the literature on intent in violent attack. The Chicago Police Department, in particular Mr. Michael Spiotto, provided access to the department files on reported fatal and nonfatal attacks that were used in this study. 1 Franklin E. Zimring, Is Gun Control Likely To Reduce Violent Killings?, 35 U. Chi. L. Rev. 721-24, 730-37 (1968). A third report, Homicide in Chicago, 1965-70, grows out of the same research project, a study of violent attack in Chicago supported by the Center for Studies in Criminal Justice at the University of Chicago. Other data on the issue of weapon dangerousness are developed in George D. Newton and Franklin E. Zimring, Firearms and Violence in American Life (Staff Report (7) to the Nat'l Comm'n on the Causes and Prevention of Violence 1969). See, e.g., id. at 44 and 177-79 (relationship between relative degree of gun use and extent to which guns are more lethal than knives), 46-47 (death rates from gun vs. nongun armed robbery), 69-74 (effect of increase in gun ownership and use on death from assault in Detroit), 76-77 (relationship between relative gun use in robbery and assault in major cities).

Longitudinal Assessment of Changes in Mental and Sexual Health Outcomes Due to COVID-19 Among Latinx SMM and TGW.

No Easy Answers: Emergency Physicians Engage in Gun Control Debate

<p>The United States (U.S.) currently ranks number one in the world in both the quantity of privately owned guns and the rate of private gun ownership. These privately owned firearms, which include rifles, shotguns and handguns, are predominantly owned by middle-aged, 35-54, white men, but the gaps have been steadily closing over the years, especially depending on the type of firearm, in all areas including gender, age, race, education level, political affiliation and geographic location. Gun violence is a leading cause of injury death in the U.S. In examining gun violence and potentially reducing its incidence, this article reviews gun ownership, access and utilization in the U.S., outcomes of gun violence, and the impact of community involvement in reducing gun violence. Specific areas of focus include the current state of background checks, with a focus on mental illness, and the role of medical professionals in guiding gun policy development. Gun violence continues to negatively impact the safety of individuals, families and communities. This article will emphasize the importance of social mobilization in enacting meaningful changes in gun policy and the development of relationships among healthcare professionals, social workers, and community members so as to further reduce and/or prevent gun violence.</p>