1. From a systematic review of the literature, there is a significantly increased risk of both suicide and homicide among individuals in households with accessible firearms.
Evidence Rating Level: 1 (Excellent)
Study Rundown: The majority of both successful suicides and homicides in the United States are firearm-related, with an estimated 31,000 deaths annually. The goal of this systematic review was to examine the risk associated between household firearm ownership and becoming a suicide or homicide victim. Fourteen observational studies of suicide were pooled, and household firearm access demonstrated a statistically significant increase in the risk of suicide. Similarly, five homicide studies were analyzed, and firearm access also increased the risk of becoming a homicide victim. Notably, all but one of the studies selected for analysis showed a statistically significant increase in the risk of both suicide and homicide. The primary weakness of this review is that most of the included studies were of case-control design, although this is typical for many scientific investigations of death. In summary, from the available data, there appears to be a significant increase in both suicide (OR 3.24; 95%CI 2.41-4.40) and homicide risk (OR 1.94; 95%CI 1.44-2.93) in patients in firearm-accessible households.
In-Depth [systematic review]: From an initial 6,902 studies identified in the evidence search, 15 were included in the review, with independent data analysis by two authors. From the studies, the most common suicide and homicide victims were men (75% and 79%, respectively). Additionally, although most suicide victims were white, most homicide victims were non-Hispanic black or another race. Among 11 of the case-control studies, firearm access ranged from 62.7-75% among the case patients and between 26.4-50.8% among controls. The odds ratio (OR) for increased suicide risk was 3.24 (95%CI 2.41-4.40), with a range of 1.38-10.38. Similarly, the OR for increased homicide risk was 1.94 (95%CI 1.44-2.93), with a range of 1.41-2.7. Furthermore, both study groups had substantial heterogeneity, with I2=89% and τ=0.45 for the suicide studies and I2=66% and τ=0.21 for the homicide studies.
Additionally, a subgroup analysis demonstrated that women had a significantly higher risk of homicide victimization than men (p<0.001). The major limitations of this review are that the firearm-accessibility was determined only by survey interview, as well as the presence of potential confounders within the individual studies, such as differences in the rates of mental illness in the study populations and the presence of unblinded interviews. Despite these, the consistently increased OR determined in all the studies included demonstrate a strong correlation of household firearm access with increased risk of both suicide and homicide.
By Sai Folmsbee and Aimee Li, MD
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