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Department of Psychoanalysis and Psychotherapy and Institute for Medical Psychology, Medical University of Vienna, Austria
Furtbach Hospital for Psychiatry and Psychotherapy, Stuttgart, Germany
Section of Medical Statistics, Medical University of Vienna, Austria
Institute for Medical Psychology, Medical University of Vienna, Austria
Correspondence: Dr Nestor D. Kapusta, Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, Waehringer Guertel 18–20, A-1090 Vienna, Austria. Tel: +43 1 40400 3064; fax: +43 1 4277 9656; email: nestor.kapusta{at}meduniwien.ac.at
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ABSTRACT |
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Aims To evaluate the impact of firearm legislation reform on firearm suicides and homicides as well as on the availability of firearms in Austria.
Method Official statistics on suicides, firearm homicides and firearm licences issued from 1985 to 2005 were examined. To assess the effect of the new firearm law, enacted in 1997, linear regression and Poisson regressions were performed using data from before and after the law reform.
Results The rate of firearm suicides among some age groups, percentage of firearm suicides, as well as the rate of firearm homicides and the rate of firearm licences, significantly decreased after a more stringent firearm law had been implemented.
Conclusions Our findings provide evidence that the introduction of restrictive firearmlegislation effectively reduced the rates of firearm suicide and homicide. The decline in firearm-related deaths seems to have been mediated by the legal restriction of firearm availability. Restrictive firearm legislation should be an integral part of national suicide prevention programmes in countries with high firearm suicide rates.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONREFERENCES |
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The availability of firearms in homes has been shown to be a risk factor for suicide (Kellermann et al, 1992) and homicide (Dahlberg et al, 2004). Furthermore, peer-reviewed publications provide vast evidence to support the view that changes in firearm legislation have influenced the rate of firearm suicides in the USA (Ludwig & Cook, 2000), Canada (Caron, 2004), Australia (Ozanne-Smith et al, 2004) and New Zealand (Beautrais et al, 2006), whereas there is only some evidence from continental Europe and Britain to suggest the same (Hawton et al, 1998; Haw et al, 2004). Other researchers have shown that different state firearm regulations across the USA have influenced suicide (Conner & Zhong, 2003) and homicide rates (Rosengart et al, 2005).
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METHOD |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONREFERENCES |
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Austrian firearm legislation
The Austrian firearms law was adapted in July 1997 after the European
Council Directive 91/477/EEC on the control of the acquisition and possession
of weapons was implemented in European Union member states. The transposition
of the European directive into Austrian national law brought changes
concerning the acquisition of firearms over 60 cm in length, which had
previously enjoyed a more liberal regime. Moreover, the new law abolished the
previous possibility of obtaining a firearm without specifying a reason. In
addition to the European Directive, other restrictions were implemented in
Austria. The legal criteria for obtaining a category B weapon (handguns,
semi-automatic firearms or repeating firearms) for the first time now include
psychological testing, being at least 21 years of age, and background checks.
Furthermore, the new legislation also specifies safe firearm storage
regulations and a 3-day `cooling-off' waiting period for category C and D
weapons (including long firearms with smooth bore and rifled barrels)
(Commission of the European Communities,
2000).
Data collection
Records for each year between 1985 and 2005 in Austria were examined. The
starting year was set at 1985 because of recording restrictions at the
Ministry of the Interior, where data on firearm licences were obtained. Data
on the number of suicides per year and the number of firearm homicides per
year (with external cause-of-death codes according to ICD–9 and
ICD–10), as well as data on the size of the general population and on
unemployment rates, were obtained from Statistics Austria. Details on these
data have been described elsewhere
(Etzersdorfer et al,
2006). The figures on alcohol consumption per capita were obtained
from the Austrian Alcohol Coordination and Information Centre
(Uhl et al,
2006).
Statistical analysis
To assess the effect of the enactment of the 1997 firearm law, a regression
of the number of firearm licences per 100 000 inhabitants per year was
performed with an autoregressive error model of first order to compare time
trends before and after enactment. Similarly, Poisson regressions were
performed to compare time trends of firearm suicides, of firearm suicides as a
percentage of total suicides and of the total number of homicides, before and
after the law was enacted (using SAS/STAT version 8 for Windows). Because of
underdispersion, we allowed the variance estimate in both models to depend on
an underdispersion factor estimated from the data. Data on total suicides
indicated overdispersion, hence total suicides were modelled with negative
binomial distribution. The regression model included linear time trends
allowing for a change point in 1998. Changing population sizes were taken into
account by including the respective changes in the model. To distinguish
between the effects of the new legislation and other factors known to
influence rates of suicide and homicide, unemployment rates and average
alcohol consumption per capita were included in the analysis as covariates. In
the calculation of the regression model of homicide rates, the ratio of young
men in the population was also included as a covariate. All parameter
estimates are reported with 95% confidence intervals. The analysis is based on
figures for firearm licences, suicide, firearm suicide, firearm homicide and
population sizes in the period 1985–2005. The two-tailed significance
level was set at 5%.
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RESULTS |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONREFERENCES |
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Figure 1 shows the trend of
the firearm suicide rate, prior to and after enactment of the legislation. We
observed no significant time trend in the total number of firearm suicides
between 1985 and 1997 (
2=0.04, d.f.=18, P=0.84).
During this period the mean firearm suicide rate was 3.96 per 100 000
(s.d.=0.19). In the period 1998–2005, we observed a significant negative
trend (2=88.0, P<0.0001) with a steady decline in
the firearm suicide rate of 4.7% each year
(Table 1). The firearm suicide
rate reached a low of 2.67 per 100 000 in the year 2005. The change in the
time trend after 1998 is significant (2=46.0,
P<0.0001) even when adjusted for unemployment and alcohol
consumption (2=19.9, P<0.0001).
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When the firearm suicide rates were analysed by age group and gender, the
only significant trend changes after the legislation reform could be found in
the group of women aged 20–64 years (2=9.9,
P=0.0016), in men aged 20–64 years (2=81.7,
P<0.0001) and in men 65 years old or older (2=6.4,
P=0.01). The group of persons aged under 19 years and women more than
64 years old showed no significant trend change in suicide by firearms after
enactment of the law. When all ages were pooled for each gender, the trend of
firearm suicides after enactment changed significantly among both women and
men (women: 2=12.5, P=0.0004; men: 2=
28.9, P<0.0001).
We observed a significant negative time trend in the total number of
suicides before 1998 (2=131.0, d.f.=18, P<0.0001),
as well as in the period 1998–2005 (2=23.4,
P<0.0001). The overall suicide rate decreased from 27.6 per 100
000 in 1985 to 16.7 per 100 000 in 2005. The change in the trend was not
significant (2=0.3, P=0.590), even when adjusted for
unemployment and alcohol consumption (2=0.03,
P=0.870).
During the examined pre-legislation period, a significant positive time
trend in firearm suicides as a percentage of total suicides was observed
(2=68.5, d.f.=18, P<0.0001). During this period
the percentage of firearm suicides increased from 14.3% in 1985 to 19.3% in
1997. Conversely, during the post-implementation period, a significant
negative time trend was observed (2=30.5,
P<0.0001), with a decrease to 16.8% in 2005
(Fig. 2). The growth factor of
the percentage of firearm suicides per year, derived from Poisson regression
analysis, was +2.6% prior to and –2.9% following the change in
legislation (Table 1).
Consequently, with 1998 set as offset, the change in trend was significant
(2=53.5, P<0.0001).
Figure 3 shows the course of
suicide methods in the examined period. After the implementation of the
firearm law, no increase in other methods was observed.
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Figure 4 shows the time
trend of the total number of firearm homicides, indicating no significant
trend before 1998 (2=0.04, d.f.=18, P=0.840) with a
mean of 0.39 (s.d.=0.08) firearm homicides per 100 000. The growth factor
during this period was a modest +0.2% per year. A negative time trend was
observed in the post-1998 period (2=23.6,
P<0.0001); the growth factor was –2.3% per year. Firearm
homicides reached a 20-year low of 0.16 per 100 000 in the year 2005. The
change in the firearm homicide trend pre- and post-legislation was significant
(2=14.3, P=0.0002). When adjusted for unemployment,
alcohol consumption and the proportion of young men in the population, the
trend change remained significant (2=3.9, P=0.049)
(Table 1).
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONREFERENCES |
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The observed decline in the number of firearm suicides among some age groups after enactment of more stringent legislation is in congruence with previous studies. In the USA, the Brady Handgun Violence Prevention Act has been shown to have reduced suicide rates among people aged 55 years and over (Ludwig & Cook, 2000). In Canada, Leenaars & Lester (1997) observed a decrease in firearm suicides, but this effect was not apparent for those over 65 years old. In Australia a decline in the firearm suicide rate, especially among younger men, was observed in metropolitan and provincial cities after legal restrictions were introduced in 1992 (Cantor & Slater, 1995). The decline in firearm suicides in Australia was further accelerated after the enactment of a more stringent firearm law in 1996 (Goldney, 2006). Data from New Zealand showed that the mean firearm suicide rate decreased after assessment of firearm reliability and licence tests were introduced in 1992 (Beautrais et al, 2006). Besides this decline in firearm suicides, a decrease in firearm suicides as a percentage of total suicides was also observed, similar to the decrease observed in our findings. The decrease in the percentage of firearm suicides has been discussed as ruling out the possibility that the decline in firearm-related suicides is due to changes in overall suicide rates (Beautrais et al, 2006).
A series of studies is also available from Canada, where the criminal code was amended in 1977 (Bill C-51). Some studies reported a decrease in firearm suicide rates after enactment of the reform (Rich et al, 1990; Carrington & Moyer, 1994; Leenaars et al, 2003). Although Rich et al (1990) suggested possible switching effects from firearm suicides to suicides by jumping, comparing 5-year periods before and after the reform, a subsequent study (Carrington & Moyer, 1994) with a longer observation period found this trend to be insignificant. The findings on the effects of legal restriction in Canada have been replicated by a further study, after two additional firearm laws (Bills C-17 and C-68) were enacted in 1991 and 1995; subsequent to this legislation, firearm suicides, the percentage of firearm suicides and firearm homicides further decreased (Bridges, 2004). However, when re-examining these Canadian data, Leenaars et al (2003) found evidence of switching for men but not women. Since firearm suicide rates among women accounted for a small proportion of all firearm suicides in our study, switching effects for each gender were not calculated.
The potential switch to other suicide methods is a complex phenomenon which is often misinterpreted. Since firearm suicides (as a percentage of all suicides) decline after an effective law, the proportion of other methods of suicide logically increases. But this does not explain a possible switching phenomenon – one has to consider the course of suicide rates. Accordingly, a switching phenomenon would be reflected in an increase in absolute suicides by all other methods (or some of the methods) after the enactment of a more stringent firearm law, which was not observed in our work.
Besides cross-sectional studies on the association of firearm availability and firearm suicides in the USA (Dahlberg et al, 2004; Miller et al, 2004) and Austria (Etzersdorfer et al, 2006), longitudinal studies have shown that firearm suicides are associated with household firearm ownership (Miller et al, 2002; Haw et al, 2004). Our results support and supplement these findings, additionally demonstrating that a change in firearm legislation has an impact on firearm availability. A change in firearm legislation simultaneously alters the number of firearm licences and the firearm suicide rate, and this emphasises the hypothesised association between both variables.
In a cross-sectional study we have recently shown that there is a trend towards higher firearm suicide rates in counties with higher firearm licensing rates (Etzersdorfer et al, 2006). These findings have been described as representing an urgent public health issue (Leenaars, 2006). Along with the results of the longitudinal analysis reported here, there is even more evidence to support the view that a reduction in firearm suicides and firearm homicides can be achieved by restriction of firearm availability through implementation of more stringent firearms legislation.
Limitations of the study
Because of the limiting ecological design of this study, it must be noted
that the decreasing firearm homicide and suicide trends we observed –
although having significantly changed in and after the year of the legal
reform – may be attributable to socio-economic or other factors. The
influence of well-known confounders such as consumption of alcohol per capita
and unemployment did not significantly diminish the positive effects of the
new law as observed in our study. This has also been found in earlier
multivariate models, where the association of firearm availability and firearm
suicide rates has not been ruled out
(Ludwig & Cook, 2000;
Lenaars et al, 2003; Miller
et al, 2006).
Since the accuracy of survey data and other proxy variables of firearm availability are questionable (Miller et al, 2004), the number of officially issued firearm licences was used to assess the availability of firearms. We acknowledge that this measure is an underestimation of firearm availability, but it is the only available measure for Austria. Another limitation of our results is that aggregated data analyses allow no direct conclusion about individuals. Miller et al (2002) discussed the possibility that individuals who die by suicide may not share the characteristics (level of income, available firearm) of the group from which they were drawn. However, this does not limit the growing evidence that more stringent firearm legislation reduces firearm deaths in the overall population.
Finally, it could be argued that the decrease in firearm suicide rates observed in our study might be a randomly found effect of an overall decline in suicide rate and not due to the change in legislation. This is found to be improbable when the decline in post-legislation firearm homicides is also taken into consideration. We could show that, along with a decline in the number of firearm suicides, the number of firearm homicides also decreased after enactment of the new legislation. The firearm homicide rate trend had previously been steady, but it decreased after enactment, whereas the overall suicide rate was in continuous decline both before and after the legal reform. We argue that the effect of changes in firearm laws can be observed in two different measures: firearm suicides and firearm homicides. Restrictive firearm legislation has previously been shown to reduce firearm suicides as well as homicides in cross-sectional (Conner & Zhong, 2003; Rosengart et al, 2005) and longitudinal studies (Loftin et al, 1991; Leenaars & Lester, 1994; Leenaars et al, 2003; Bridges, 2004).
Implications of the study
Suicide prevention plans encounter resistance when they demand more
stringent firearm laws, because national firearm restrictions inevitably
affect many people, including those who are not at risk of suicide. Yet it
should also be remembered that those who are at risk will be more effectively
protected by such laws. Some researchers state that suicide prevention
strategies are based on two different approaches, which should be balanced
– namely, the restriction of the means of suicide and the prevention of
mental disorders (Gunnell & Lewis,
2005). They rightly point to the fact that restriction of means
does not address the root cause of the problem. However, until the effective
prevention of mental disorders realistically becomes our long-term aim, we
should recall that the restriction of means very probably does prevent suicide
in the short term, thereby increasing the likelihood of people who are
suicidal receiving professional help in time. Despite its limitations, this
study provides evidence from a European country that firearm suicides and
homicides may indeed be prevented through legal restriction of the
availability of firearms. Therefore, we recommend that further steps be taken
in Austria and in other countries to reduce the availability of firearms.
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Received for publication October 30, 2006. Revision received March 29, 2007. Accepted for publication April 12, 2007.
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