title: Prevention of Firearm Suicide in the United States: What Works and What Is Possible.
abstract: OBJECTIVE
  About 21,000 suicides in the United States in 2014 involved a firearm. The authors reviewed evidence from around the world regarding the relationship between firearm ownership rates and firearm suicide rates and the potential effectiveness of policy-based strategies for preventing firearm suicides in the United States.
  
  
  METHODS
  Relevant publications were identified by searches of PubMed, PsycINFO, MEDLINE, and Google Scholar from 1980 to September 2015, using the search terms suicide AND firearms OR guns. Excluding duplicates, 1,687 results were found, 60 of which were selected for inclusion; these sources yielded an additional 10 studies, for a total of 70 studies.
  
  
  RESULTS
  Case-control and ecological studies investigating geographic and temporal variations in firearm ownership and firearm suicide rates indicate that greater firearm availability is associated with higher firearm suicide rates. Time-series analyses, mostly from other countries, show that legislation reducing firearm ownership lowers firearm suicide rates. Because the Second Amendment curtails legislation broadly restricting firearm access in the United States, the emphasis is shifted to restricting access for those at risk of harming themselves or others. Most suicides involve guns purchased years earlier. Targeted initiatives like gun violence restraining orders, smart gun technology, and gun safety education campaigns potentially reduce access to already purchased firearms by suicidal individuals. Such measures are too new to have evidence of effectiveness.
  
  
  CONCLUSIONS
  Broadly reducing availability and access to firearms has lowered firearm suicide rates in other countries but does not appear feasible in the United States. Approaches restricting access of at-risk individuals to already purchased firearms by engaging the public and major stakeholders require urgent implementation and outcome evaluation for firearm suicide prevention.
authors.affiliation: From the Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York; and the Department of Psychiatry, Columbia University, New York.
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
authors.affiliation: From the Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York; and the Department of Psychiatry, Columbia University, New York.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Michel
mesh_terms: D005389:Firearms / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D010067:Ownership / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D000092864:Suicide Prevention