Public Health Partnership for the Prevention of Firearm Violence

Article Summary: Presence of any gun in the home dramatically increased odds of suicide

Citation: Kellerman, AL, Rivara, FP, Somes, G, et al. Suicide in the home in relation to gun ownership. N Engl J Med 1992;327:467-72.


At time of publication, more than 29,000 Americans died from firearm-assisted suicide each year. Over time, the rate of suicide involving firearms has increased while the rate of suicide through other means has remained constant.

Study Overview

The purpose of this study is to evaluate the association between suicide and the availability of a firearm in the home. This study used a case-control design in an attempt to reduce the potential for confounding factors. A case was defined as a suicide of a resident of either Shelby County, TN or King County, WA that occurred between August 23, 1987 and April 30, 1990. A key respondent was selected as a proxy for each case. Researchers randomly selected controls from the same neighborhoods as each case proxy, resulting in 438 matched pairs. Case proxies and controls were each interviewed to collect data on the presence and storage of any guns in the home, victim’s history of mental illness, victim’s alcohol use, and demographic information.


The final conditional logistic-regression model controlled for six covariates: living alone, less than a high school education, alcohol use, drug use, hospitalization from alcohol use, use of prescription medication for mental illness. Results found the adjusted odds of suicide in the home was 5.8 times greater when one or more handgun was kept in the home, compared to no guns kept in the home. Additionally, the odds of a suicide in the home were 5.6 times greater in a home with an unlocked gun, and 9.2 times greater in a home with a loaded gun when compared to a control-case home with no gun.


Limitations of this study include potential underreporting of sensitive information (i.e., alcohol abuse) by controls. Both counties in this study were mostly urban; the results may not be generalizable to rural communities. Additionally, this study only examined the relationship between gun ownership and suicides that occurred inside the home.

Bottom Line

In this case-control study of completed suicides in two U.S. counties, the adjusted odds of suicide in the home was 5.8 times greater in the presence of any handgun in the home, 5.6 times greater in the presence of any unlocked gun, and 9.2 times greater in the presence of any loaded gun, relative to no guns in the home.

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As a longtime advocate for violence prevention policies, APHA recognizes a comprehensive public health approach to addressing the growing gun violence crisis is necessary.

APHA's gun violence prevention resources include:

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Resource Organizations

The following organizations and agencies are valuable resources for information about firearms and the health of the public: firearm injury prevention, firearm policy, firearm research, firearm ownership, firearms and interpersonal violence or suicide, mass shootings, children and firearms. While some of the organizations focus solely on issues related to firearms, others have a range of topics that they cover, but include firearm-related issues as part of their work. The links will take you to their websites so you can do a more thorough search of the work that they do.
Brady (formerly the Brady Campaign to Prevent Gun Violence)
Center for American Progress
The Coalition to Stop Gun Violence
Everytown for Gun Safety
Moms Demand Action
Newtown Action Alliance
States United to Prevent Gun Violence
Violence Policy Center
Women Against Gun Violence


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