California Psychiatric Association

Volume III No.1
January 1996

Protection or Peril?

Firearms were the leading cause of trauma deaths in California in 1991 according to the National Center for Health Statistics. Nationwide, every two years, more Americans are killed by firearms than were killed in all 11 years of the Vietnam War. As of 1991, suicide was the predominant cause of firearm death in this country.

The cost in lives is horrific enough. However, the economic cost to the health care system dramatizes the problem even more. Firearm injuries are the third most costly cause of injury in the U.S. They represent 0.5% of all injuries but account for 9% of the U.S. total lifetime cost of injury The aggregate cost of 34,893 persons hospitalized for firearm injuries at the King/Drew Medical Center in Los Angeles from January 1978 through December 1992 was $264,506,344. Ninety-Six percent of this cost was borne directly or indirectly by Public Funds. These costs don't include the cost of psychiatric care provided to those emotionally traumatized by death or injury.

The idea that violence in America could be viewed as a public health problem has been slow to catch on. Resistance to this idea began to evaporate in 1983 when the National Center for Disease Control created a violence epidemiology branch and resolved to study violence with firearms as a possible causative agent. Several of these studies have now been completed and reveal important data about the risks and benefits of possessing a firearm. Some of the more important findings include:

1. People who keep guns in their homes appear to be at greater risk of homicide in the home than people who do not. Most of the risk is due to a substantially greater risk of homicide at the hands of a family member or intimate acquaintance.(1)

2. Firearms are twice as likely to be found in the homes of adolescent suicide victims than in the homes of those adolescents who make a suicide attempt. There was no difference in the methods of storage of firearms among the groups studied so that even guns stored, locked or separate from ammunition were associated with suicide by firearm.(2)

3. The presence of one or more firearms in the home was found to be associated with an increased risk of suicide almost five times greater than when there were no guns in the home.(3)

4. That for every case of self-protection homicide involving a firearm kept in the home, there were 1.3 accidental deaths, 4.6 criminal homicides and 37 suicides involving firearms. Handguns were used in 70.5% of these deaths.(4)

5. For each instance in which a homeowner used a gun for self-protection, there were 11 unintentional firearm injuries.(5)

6. Firearm-associated family and intimate assaults were 12 times more likely to result in death than non-firearm associated assaults.(6)

Purchasers of firearms should be provided data such as this so that they can carefully weigh the risks of gun ownership. These and other studies indicate that owning a firearm may be a hazard that is increasingly having profound impact, not only on the personal lives of those affected by death or injury, but also on the soaring cost of health care.

(1) Kellerman. et al., New England Journal of Medicine, October, 1993 Vol. 329, page 1084.
(2) Brent, et al., Journal of the American Medical Association, December, 1991, Vol. 266, p. 2989.
(3) Kellerman, et al., New England Journal of Medicine, August, 1992, Vol. 327, page 467.
(4) Kellerman, et al., New England Journal of Medicine, 1986, Vol. 314, p. 1557.
(5) Joyce, et al., American Journal of Epidemiology, 1991, Vol. 134. p.511.
(6) Saltzman, Journal of the American Medical Association. 1992, Vol. 269. p. 3043.

The purpose of this newsletter is to provide brief information on important developments and ideas in the medical specialty of psychiatry that can contribute to cost-effective mental health care.

Published by the California Psychiatric Association
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