Effects of changes in permit-to-purchase handgun laws in Connecticut and Missouri on suicide rates
Introduction
In the United States, suicide is the second leading cause of death for persons age 15–34 years, and the tenth leading cause of death overall (CDC, 2015a). In 2013 alone, more than 40,000 individuals lost their lives to suicide, compared to approximately 16,000 homicides (CDC, 2015b). More than half of all suicides were committed with a firearm (CDC, 2015a).
Household-level and state-level studies have found that access to firearms is positively associated with suicide risk after controlling for other risk factors (Anglemyer et al., 2014). Case fatality rates for suicide attempts by firearm exceed 90% (Miller et al., 2004). Though many commonly think that a person contemplating suicide will use an equally lethal alternative method if the original means of suicide is restricted, suicidal ideation is often transient (Miller et al., 2006, Deisenhammer et al., 2009). And for many individuals attempting suicide, the time between suicidal ideation and attempt can be as little as 10 min (Deisenhammer et al., 2009). If a person's access to particularly lethal means can be restricted during periods of distress or impulsivity, a suicide may be prevented. For these reasons, suicide prevention research has explored what impact lethal means restriction can have on suicide attempts and completion (Hawton, 2007, Barber and Miller, 2014).
Laws requiring permits to purchase firearms represent one method of means restriction for firearms, especially for some high-risk individuals, which require handgun purchasers to obtain a permit-to-purchase (PTP) that is contingent upon the applicant passing a background check. These PTP laws typically require an in-person application at a law enforcement agency and, in some cases, applicants must successfully complete safety training and experience significant waits for review. Permits are required for virtually all transfers of handguns including those conducted by private unlicensed sellers. A background check requirement for private sales should prevent a sale to someone with a prohibiting condition that reflects heightened risk for suicide, including conviction for violent crimes, being under a restraining order for domestic violence, multiple offenses involving drugs or alcohol abuse, and being involuntarily committed to a mental hospital or found by a court to be a threat to themselves or others due to mental illness. Also, the additional time required to obtain a gun in states with a PTP law could restrict access to firearms among those not already owning firearms during times of suicidal ideation or planning. Federal law does not require a permit or background check for handgun purchasers are only required under federal law if the seller is a licensed gun dealer.
Missouri had a PTP law for handguns in place beginning in 1921. Anyone wanting to legally purchase a handgun from a licensed dealer or private seller was required to apply in-person at a local sheriff's office. A PTP for a handgun was issued to approved individuals and good for 30 days. Missouri's PTP law was repealed effective August 28, 2007, reducing a barrier to handgun access for prohibited persons. Prior research evidence indicates that the PTP law repeal was associated with an increase in the diversion of guns to criminals Webster et al., 2013 and homicides committed by firearms in Missouri (Webster et al., 2014).
Prior to 1995, Connecticut's laws regarding background checks for handgun sales could be characterized as vague. In 1965, the state enacted a law requiring all handgun sellers and buyers to use a written application that was to be mailed to the local authorities prior to a sale. If that municipal authority were to “have knowledge” that the buyer had a felony conviction, then the authority would notify that seller that no sale could take place. A one week waiting period — extended to two weeks in 1975 — was also instituted. A new state law went into effect in October 1994, establishing an optional eligibility certificate for handgun buyers that could be issued by local authorities upon the purchaser passing a background check. Holders of an eligibility certificate for handgun purchases were not required to comply with the waiting period. Local authorities were instructed to make a “reasonable effort” to determine if any applicant was ineligible to own a handgun. It was not until October 1, 1995 that Connecticut established a mandatory PTP system applicable to all handgun buyers and made it illegal to sell a handgun to anyone who did not have an eligibility certificate. Such certificates required the applicant to pass a background check and successfully complete an 8-hour handgun safety course. A recent study demonstrated that enactment of Connecticut's PTP law was associated with decreases in firearm homicides and had no impact on homicides committed by other means (Rudolph et al., 2015).
The current study was designed to estimate the effects that these two changes in PTP handgun laws had on suicide rates. Prior research has shown a negative association between the presence of PTP laws and suicide rates;Andrés and Hempstead, 2011, Fleegler et al., 2013 however, most of the variation examined in these studies was cross-sectional and did not focus on whether the policies changed the risk of suicides over time in states when they adopted or repealed a PTP law. A recently published study by Anestis et al. (Anestis et al., 2015) also explored this topic, however, this study had important limitations including that it principally estimated cross-sectional associations. Our study seeks to provide a thorough and rigorous evaluation of the impact of changing PTP handgun laws on suicide in Connecticut and Missouri.
Section snippets
Design
A quasi-experimental research design was used with annual, state-level suicide rates and counts to contrast differences pre- versus post-PTP law change in Connecticut and Missouri compared with states that did not experience a PTP law change. State-level data for suicides were available for the years 1981–2012. Suicides were stratified by mechanism (firearm vs. non-firearm) to test the specificity of the policy effects and examine if possible method substitution occurred following the PTP law
Synthetic control model
Table 1 compares the mean value of predictors in the treated unit and the synthetic control for the period prior to the PTP law change. The means are averaged over the entire pre-law-change period except for the lagged firearm and non-firearm suicide rates.
The intervention states and their respective synthetic controls are very similar on baseline suicide rates and predictors. There are some divergences between, for instance, the value of Connecticut's gun availability proxy and its synthetic
Discussion
Prior research produced evidence suggesting that handgun purchaser licensing laws were associated with lower suicide rates, but focused principally on cross-sectional associations (Andrés and Hempstead, 2011, Fleegler et al., 2013, Anestis et al., 2015). This study investigates if recent changes in permit-to-purchase (PTP) handgun laws led to changes in suicide rates in ways consistent with the hypothesis that these laws reduce suicides by decreasing the availability of a highly lethal means of
Financial disclosure
No financial disclosures were reported by the authors of this paper.
Conflict of interest statement
This study was funded by The Joyce Foundation. The funder had no role in the study design, collection, analysis, or interpretation of the data, writing of the report, or the decision to submit the report for publication.
Acknowledgments
This study was funded by The Joyce Foundation (Impact of Permit-to-Purchase Handgun Licensing Laws on Violent Crime, 12-34373). Each author contributed substantially to the study design; collection, analysis, and interpretation of data; and writing the report. No financial disclosures were reported by the authors of this paper.
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