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Better screening of gun owners could save lives lost to suicide, study shows

Guns are the leading method of suicide in the U.S., but gun owners with a history of suicidal thoughts and behaviors are less likely to report it.
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This story discusses suicide. If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit for additional resources.

Although mental health stigmas have dissipated over recent years, talking about such struggles, especially suicide, matter more than ever.

Last month, singer Naomi Judd died by suicide from a firearm. And research from late April found that suicides among adolescents rose in many states in 2020. In July, the National Suicide Hotline received a designated three-digit dialing code — 988. And overall, the U.S. suicide rate has increased by more than 30% since 2000, making it the 12th leading cause of death in the country, according to the American Foundation for Suicide Prevention.

One bright spot that experts point to? Suicide is preventable. An important prevention tool that health care professionals use is screening patients for suicidal thoughts as they seek therapy, psychiatric care, or medical care in emergency room situations.

But a new study from Ohio State University Wexner Medical Center, based on online surveys of 10,625 U.S. adults taken between March and April 2020, demonstrates the shortcomings in the type of questions asked during these screenings, particularly when addressing gun owners.

Gun owners and suicide

The study measured patterns of passive (thoughts alone) and active (recently attempted or gotten close) suicidal ideation and behaviors. The results showed patterns were similar among gun owners and non–gun owners who had a lower probability of suicidal behavior, but when comparing gun owners and non-gun owners who had active suicidal ideation and behaviors, the patterns were different.

In particular, among the group of individuals who had recently attempted suicide or gotten close, gun owners were less likely than non-gun owners to report experiencing suicidal ideation — a concerning finding since firearms remain the leading method of suicide in America. The research indicates that gun owners think about suicidal differently from non-gun owners, suggesting a need for different suicide screening questions.

“The traditional way of screening for suicide is asking people questions like, ‘Do you want to die?’ or, ‘Have you wished that you were dead?’ and then escalating a line of questioning from there,” explained Craig Bryan, Psy.D., one of the study’s authors and a clinical psychologist at Ohio State University College of Medicine. “But what we’ve learned is that gun owners don’t interpret their intentions as being connected to death and will answer those questions differently than non-gun owners,” he said.

For many people, suicide isn’t about wanting to die but rather wanting to escape one’s life or a bad situation, Bryan told TODAY, adding that gun owners are unique because “they have a lethal method of escaping at the ready that they may turn to in a moment of extreme distress.”

“We’ve learned that gun owners and non-gun owners are very different when it comes to the types of suicidal thoughts they say they’ve had,” Bryan explained. “The key difference being that gun owners were much, much less likely to say that they were experiencing thoughts about wanting to die.”

Cindy Graham, Ph.D., a clinical psychologist at Brighter Hope Wellness Center in Maryland, told TODAY the risk assessment for mental health professionals already includes a “range of questions with the goal of catching both passive and active suicidal ideation,” but she agrees with the study’s findings that increased screening is necessary to reduce suicide rates.

“Broader questions about plans and opportunity for carrying out suicide helps to clarify who is at risk for carrying out suicide in moments of impulsivity,” she said.

Why are guns a leading method of suicide in the U.S.?

The theory of “suicide coupling” may explain how guns have become a leading method of suicide in the U.S. The concept of coupling was popularized by author Malcolm Gladwell in his book “Talking to Strangers,” where he defines it as “the idea that behaviors are linked to very specific circumstances and conditions.”

In the context of suicide, coupling means that when someone strongly associates a behavior with a specific method, they are more likely to eventually end their life that way if the method continues to be present and available, and they're less likely to once access to that method is removed.

"As we understand coupling and firearms, there are strong implications that if less people owned a gun, there would be less suicides, just as limited access to bridges commonly associated with suicide have proven to limit the number of suicides in that area," Bryan said. “We do think there is an association with the convenience of this method that is unique to our country.” 

Although the Ohio State University’s study shows that gun owners are less likely to report suicidal ideation, it also shows they were more  likely to have considered how they’d want to end their life. “Gun owners who regularly see a firearm in their home may imagine themselves using it for suicidal behavior,” Bryan explained.

That visualization coupled with convenient access to a lethal weapon may cause them to want to go through with suicide “in a moment that becomes emotionally charged.”

Asking better questions

One of the improvements Bryan hopes will come from the study is a shift in the way health care professionals screen patients for suicidal ideation.

“We’ve known for many decades that about half of those who kill themselves deny suicidal ideation in advance,” Bryan said. “What we’ve tried to understand in doing this study is how we were missing this. Realizing how different groups think about suicide is an important first step.”

Bryan suggested that screeners frame questions around wanting to escape one’s life (versus “wanting to die”) and ask about different types of suicidal thoughts to ensure that more suicide-prone people are discovered and helped.

Barbara Stanley, Ph.D., a professor of medical psychology at Columbia University, agreed that asking better screening questions is crucial but said some tools already exist; more health care professionals just need to be aware and willing to use them.

“There are screening tools that take only a few minutes to administer that ask the questions (this study) is referring to,” she said. She pointed to the C-SSRS, Columbia Suicide Severity Rating Scale, as one example. “These screening questions ask about passive, active, method, suicidal intent, suicidal intent with a plan and recent suicidal behavior.” 

Bryan said he hopes identifying a broader spectrum of individuals with suicidal ideation will save more lives.

“People are being screened by school guidance counselors and in just about every medical setting at this point,” he said. “But perhaps we’re just not asking the right questions.”