We do not know if the airing of “13 Reasons Why” caused an increase in suicide or not, and that in and of itself is astonishing. In the world of very advanced techniques for collecting and monitoring data, and in a world that we are led to believe is on the edge of the next epidemic, you would think the suicide rate could be estimated on the fly, with minor corrections later. Climate scientists are able to assimilate tens of thousands of data readings taken multiple times a day around the world into estimates of global surface temperatures. There is a daily ongoing estimate that I assume uses only part of the data, and at the end of every month, the data are crunched and the estimate spilled out, and only rarely is there a correction needed.
Anyway, we don’t have that information but there are two pieces of information we do have. One is from an older study.
There is evidence to suggest that some of the variation in suicide rates is accounted for by some of the variation in internet search rate. (This is not a causal statement, but a statistical statement.) From the abstract of the study:
… a set of suicide-related search terms, the trends of which either temporally coincided or preceded trends of suicide data, were associated with suicide death. These search factors varied among different suicide samples. Searches for “major depression” and “divorce” accounted for, at most, 30.2% of the variance in suicide data. When considering only leading suicide trends, searches for “divorce” and the pro-suicide term “complete guide of suicide,” accounted for 22.7% of variance in suicide data.
A recent piece by Madhumita Murgia in the Washington Post reported the connection between that older work and a current study showing that Internet search activity in relation to suicide spiked at the time that the Netflix series “13 Reasons” (based on this book) was released.
The 13-episode series, which was released all at once, chronicles 13 tapes that Hannah sends to those she blames for her actions. The series has captured the imagination of kids across the country. In April, it set a record for the most-tweeted-about show in 2017, when it was mentioned more than 11 million times within three weeks of its March 31 launch.
All suicide queries were cumulatively 19% (95% CI, 14%-24%) higher for the 19 days following the release of 13 Reasons Why, reflecting 900?000 to 1.5 million more searches than expected (Figure). For 12 of the 19 days studied, suicide queries were significantly greater than expected, ranging from 15% (95% CI, 3%-32%) higher on April 15, 2017, to 44% (95% CI, 28%-65%) higher on April 18, 2017.
Seventeen of the top 20 related queries were higher than expected, with most rising queries focused on suicidal ideation. For instance, “how to commit suicide” (26%; 95% CI, 12%-42%), “commit suicide” (18%; 95% CI, 11%-26%), and “how to kill yourself” (9%; 95% CI, 4%-14%) were all significantly higher. Queries for suicide hotlines were also elevated, including “suicide hotline number” (21%; 95% CI, 1%-44%) and “suicide hotline” (12%; 95% CI, 5%-19%). Last, public awareness indicative searches, such as “suicide prevention” (23%; 95% CI, 6%-40%) or “teen suicide” (34%; 95% CI, 17%-52%), were elevated.
Additional surveillance will clarify our findings, including estimating changes in suicide attempts or calls to national suicide hotlines. Nonetheless, our analyses suggest 13 Reasons Why, in its present form, has both increased suicide awareness while unintentionally increasing suicidal ideation.
So, yes, “13 Reasons” may have had the effect in spiking suicide rates for a short term, but until we know we should not make too much of it. But generally I would like to see mortality and morbidity data more frequently updated.
This message is primarily for those living in the United States. In the US, we have an outdated Constitutional amendment that has been interpreted by many, including the courts, in a way that hampers effective legislation to address what is clearly a major problem with the proliferation and use of firearms in inappropriate ways. We are frequently reminded of this by the regular occurrence of mass killings such as the recent event in Oregon. But really, that is a small part of the problem, numerically. I lay out some of the numbers below, and address some of the arguments that regulation of guns should be absent or minimal. We have another problem as well, one that is paralleled in many other areas of policy. Special interest groups such as the National Rifle Association, through pressure and campaign financing, control much of the Congress.
Other countries have addressed their gun violence problem effectively. We can too. But in order for that to happen, this has to happen:
1) The specious arguments against gun regulation have to be called out for what they are, and ultimately, ignored.
2) Citizen pressure on our elected representatives has to be increased significantly.
3) Organized efforts against the gun industry and the gun lobby have to be supported.
Your role as a citizen is critical. There are three steps you can take. Here, I’m asking you to take one of them, the one that requires the least effort and would likely have the largest impact. First, the other two. You can learn more about the gun problem, by reading this post to the end, and reading other material. After that, don’t let the gun supporters off easy when they pull out their arguments. Tell them they are wrong, and why. I understand and respect the fact that most of you are not going to do this, but some of you may be inclined to do so, and I thank you for that. Another idea is to check your investments (like your 401k) to see if you are supporting the gun industry. If so, see if you can fix that. You can find information about that here.
The easy step you can take, and likely the most effective, is to send a note right now to your representative in Congress. I’m told (see this) that a written letter delivered by the US Post Office has a significantly larger impact when it arrives on the desk of your Congressperson than an email (or tweet or a signature on a petition), so do please spend the stamp and do that if you can. But an email is good too, and if that is all you have time for, please do it.
Write your own note, but here are a few suggestions.
Write your Senators.
You have two US Senators. Find out who they are and get their contact details here. Usually there is a form to fill out. I suggest you say something like this:
I am a voter living in your state, and you represent me in the US Senate.
Firearms have become one of the most significant sources of injury and death in the United States. Yet Congress has done little to address this problem. We have made cars and toasters safer with sensible regulation, but have not done so with firearms.
I am writing you to urge you to take action to address this problem. Also, please tell me what you have done so far and what you plan to do in the immediate future.
your name here
Write your representative in Congress
You have one representative in the US House. Find out who that is here. Send that person a note as well. An example:
I am a voter living in your district, and you represent me in the House of Representatives.
I am writing to ask what actions you have taken to reduce gun violence and deploy sensible regulations of firearms. Also, what actions do you plan to take in the near future?
Gun violence has become one of the most serious problems we face in this country, including massive numbers of youth suicide. Yet, Congress has failed to act effectively to address this problem. I urge you to to do so.
your name here
Read the rest of my post if you want more background before writing the notes. Or, just do it if you don’t feel the need to do so. Ask your friends and relatives to write their reps. Ask your Facebook friends and Twitter followers, and your buddies on Instagram and Pinterest to help out.
Gun morbidity and mortality rivals other sources
When people talk, especially in social media, about this or that alleged dangerous thing (pesticides, nuclear radiation wafting from Fukushima to California, failure to purge, vaccination) it is very rare that Godwin’s Law comes into play (the mention of the Nazis or Holocaust to eventually come up). But quite often someone will make the comparison between the deadly issue of concern and car deaths. “More people die in their cars than by eating GMO corn,” someone will say.
Indeed, we see reference to automobile deaths as a misleading rhetorical device to diminish the importance of firearm fatalities. I’ll quote from Briebart: “The Centers for Disease Control and Prevention’s (CDC) final report on death statistics for 2013 shows there were 35,369 deaths from motor vehicle accidents versus 505 deaths from the accidental discharge of firearms. That is not a typo—35,369 versus 505. Americans are 70 times more likely to die in a vehicle accident than by the accidental discharge of a firearm.”
The truth is that the average annual rate of death by firearms is currently about 32,529. About 67,000 people are injured annually by firearms in the US. So, while you were not looking, cars got safer. The annual rate of death by car has declined steadily in recent decades owing to increases safety standards, even as the rate of cars per person on the road has increased. It is about half as dangerous to ride around in a car these days than it was before aggressive implementation of safety laws, and for some groups this number has declined even more (i.e., children).
It is also true that gun related deaths and injuries have declined over time, but not by much (in recent decades) and the rates are now going back up. The reasons for the decline about 20 years ago are not entirely clear, but probably have to do with changes in crime related violent deaths. In the late 1980s and 1990s, there were major changes in the nature and character of the illegal drug trade, and major efforts to clamp down on drug production and distribution caused a significant increase in violence followed by a decrease in many communities. Murder cities (often with special names like Murderapolis for Minneapolis) emerged temporarily around that time as organized gangs changed territories and tactics. From one study:
Previous research points to several potential contributing factors including the cycling up and down of youth firearm homicides (more so than adult homicides), changes in markets for illegal drugs (particularly the crack cocaine market which swept across urban cities in the 1980s and crested about 1990), changes in juvenile arrest policies and penalties for drug-related crime in the Violent Crime Control and Law Enforcement Act of 1994, improved economic conditions, and an increase in community-based policing strategies and primary prevention strategies for youth, families, schools and communities
So the current situation, 67,000 injuries and over 32,000 deaths annually, being one of the major non-disease causes of morbidity and mortality in the US, especially for youth, is a mild improvement from a period of chaos a few decades ago, and the rate of injury and death is staring to climb again.
Most gun deaths are suicide (20,000 a year), followed by homicide (11,000 a year) and accident (under 600 a year). Despite the obvious importance of rampage killings such those over the last few years in Roseburg (10 dead), Charlestown (9 dead), Ila Vista (7 dead), Fort Hood II (3 dead), Washington DC (13 dead), Santa Monica (5 dead), Newtown (27 dead), Brookfield (3 dead), Minneapolis (6 dead), Oak Creek (6 dead), Aurora (12 dead), Oakalnd (7 dead), Seal Beach (8 dead), Tucson (6 dead), Manchester (8 dead), Huntsville (3 dead), Fort Hood I (13 dead), Binghamton (13 dead), most of the homicides are not random mass killings. But, since the victims of rampage killings are entirely innocent, and the killings are sudden, unexpected, shocking, and often target children, they constitute a significant part of the problem.
Anatomy of a suicide
Let’s talk about the single most important gun related problem for a moment: suicide.
Sensible gun laws can prevent thousands of gun related deaths a year. When people talk about suicide, gun owners often bring up the idea that suicide is a mental health issue, not a gun issue. Well, yes, suicide is a mental health issue, but it is abysmally incorrect to say that it is not a gun issue. Here is why.
The majority of firearms related deaths in the US are due to suicide. A recent study showed that about 20,000 people in the US die of suicide using a firearm. This is the largest single cause of firearms related death.
If a person attempts suicide by poison, their success rate is about 2.5%. Cutting and stabbing has a success rate of less than 1%. Jumping has a success rate of just under 20%.
The total amount of time from choosing to commit suicide and carrying out an attempt at doing so, on average, is incredibly short, measured in minutes. (There is obviously a large spread for this number.)
When a person attempts suicide and lives, the chances that they will attempt suicide again is very low. The rate of trying an additional attempt is about 10%. A large proportion of those who do attempt suicide change their minds and seek medical attention, or others find out what is going on and intervene, saving the person’s life.
The rate of success of suicide by firearm is about 85%. When a firearm is used there is little chance to reconsider. A large percentage of those who attempt suicide and do so with a gun probably would have gotten past this period in their lives had they used a different method. I don’t have data on this, but I suspect this is more true for younger people. Also, one could argue that people should be allowed to kill themselves. I’ve seen gun owners make this argument. However, while that may be true for some individuals, especially older ones, it is a rather cynical answer to the suicide problem and certainly does not apply to adolescence or young people.
It is probably the case that a large number of people who kill themselves with guns obtain the guns simply because they are easy to obtain. Given the short span of time between choosing to take one’s own life and carrying out such an act, it is likely that most of these guns were already in the household. It is likely that many young people who kill themselves with guns obtain a gun owned by the adults in the household, a gun that is kept unlocked with ammunition readily available, perhaps the gun already loaded.
Among those who make the strongest statements against any kind of gun regulation, based on numerous conversations I’ve had, seem to be many who prefer to keep a firearm loaded and at the ready, in a nightstand drawer or some other convenient location. In a household with younger kids, this is extraordinarily irresponsible. While it might be difficult to imagine how laws or regulations could change this extremely dangerous and selfish behavior, having such laws would allow for vigorous prosecution after the fact, and may lead to more thoughtful and safe behavior by such individuals in the long run.
But what about guns as self protection?
The most vehement and vitriolic verbiage spewed to support unfettered ownership of guns seems to come from those who live in fear of home invasions or other attacks, and feel that they require a readily available firearm to protect themselves. It is quite possible that this honestly does apply to a very small number of individuals, but that is a special case that we should find a way to handle as a society. Most people who have this view are not such special cases. Also, when one has the view that enemies can enter the home at any moment and kill you, and thus you must be protected, then one must also believe that one’s personal gun must be loaded and ready, not locked up or secured, at all times. And that is unconscionable behavior, and should not be legal.
A gun kept in your home is more likely to be used to kill or injure an innocent person in an unintentional shooting, a suicide, or by a criminal who has taken it, then to be used in effective self defense (see this. A gun can be used to intimidate an attacker, but it is not clear that this is a strategy that is more effective than other non-gun related strategies (see study below). Many call for more widespread gun ownership in order to “take down” criminals involved in random violent acts out in public spaces. But there is about one gun in the US per person, a lot of people claim to carry them around, yet these self-defense guns are almost never actually used. This is probably because criminals are non-random in their behavior, and individuals armed with legal (or illegal) firearms are rarely in just the right place at the right time. Also, when people do pull out guns and start firing them, it is not uncommon for the outcome to be something other than the bad guy being “neutralized” with no one else injured.
Claims that guns are used defensively millions times every year have been widely discredited. Using a gun in self-defense is no more likely to reduce the chance of being injured during a crime than various other forms of protective action. At least one study has found that carrying a firearm significantly increases a person’s risk of being shot in an assault; research published in the American Journal of Public Health reported that, even after adjusting for confounding factors, individuals who were in possession of a gun were about 4.5 times more likely to be shot in an assault than those not in possession. (source)
A recent study looked at the use of firearms for self protection.
The data for the study come from information on personal contact crimes from the National Crime Victimization Survey for 2007 through 2011. They looked at cases where an offender intended to steal property.
Among 14,000+ cases just under 1% involved the use of a gun in self defense. When the incident was over, on average, 4.2% of the victims were injured regardless of how it went down, 4.1% were injured when a gun was used in self defense. In the case of an attempt to steal property, 55.9 percent of the time the property was taken overall, with a slight reduction to 38.5% when the victim used a gun, and if the victim used a self defense weapon other than a gun, 34.9% of the time the property was lost.
So, you can stop a robbery with a gun, a little. But any weapon at all has a similar success rate. And you have a good chance of being injured.
An interesting result of that study is from the literature review. The researchers found almost no good studies that would inform of the basic question that many assume the answer to: Can you really protect yourself with a gun? The assumption that we should have lax gun laws so one can defend oneself, with the cost of tens of thousands dead each year, is a rather bold and unfounded one. The study is a bit nuanced and complex, and the researchers admit that the data are insufficient to examine many important questions. From the conclusion:
…the data provide little evidence that using a gun in self-defense reduces injury. Slightly more than 4% of victims were injured during or after a self-defense gun use—the same percentage as were injured during or after taking all other protective actions. Some self-protective actions were associated with higher probabilities of subsequent injury. The reader must be warned, however, that the sample of those injured after using a gun (5/127) is really too small to warrant strong conclusions. The large majority of crime victims who are injured are injured before they take any action.
The evidence suggests that using a weapon in self-defense may reduce the likelihood of losing property during the commission of crime. However, it is not clear that using a gun is better or worse than using other weapons…
Having such lax laws, and a loud minority in favor of keeping those laws lax, and of course other factors, probably contribute to a sort of gun fetish among those sometimes referred to as “gun nuts.” How do you know if you are a gun nut? If you keep a loaded gun in your house, if you keep guns and ammo unlocked, if you are just a regular person with no special security requirements but have a concealed carry permit, or if you think 20,000 suicides by gun per year is not a problem related to gun regulation, then you are probably a gun nut. On occasion a gun owner sets up a trap in their home, luring burglars or home invaders known to be working in the neighborhood so they can be shot “legally.” That is of course, very rare. But if you think that is OK you are probably a gun nut. For that matter, if you think it is OK when a teenage boy, on a dare, enters a home thought to be vacant and is shot dead for it, you might be a gun nut. These are all self-justifying excuses to argue against sensible regulation of guns.
Our society as a whole pays a huge cost, greater than the costs of international or domestic terrorism, so that individuals who have this gun fetish can do more or less what they want. The benefit for this lackadaisical and protectionist view of firearms is virtually non-existent. Those who suffer from the nearly unregulated presence of so many guns are accommodating the desires of individuals who want unfettered access to toys they happen to find enjoyable, at best. At worse, our society is accommodating monsters, people who believe that carnage counted in the tens of thousands is necessary so they can be wrong about safety and wrong about security.
With our current gun laws, we are paying a very high price to support unjustified ignorance and madness.
Arthur L. Kellerman et al., Injuries and Deaths Due to Firearms in the Home, 45 J. Trauma 263, 263, 266 (1998).
Branas, Charles et al. 2009. Investigating the Link Between Gun Possession and Gun Assault, 99 Am. J. Pub. Health 2034.
Fowler, Katherine ,Linda L. Dahlberg, Tadesse Haileyesus, Joseph L. Annest. 2015. Firearm injuries in the United States. Special Issue on the Epidemiology and Prevention of Gun Violence. Volume 79.
Hemenway, David, Sara Solnick. 2014. The epidemiology of self-defense gun use: Evidence from the National Crime Victimization Surveys 2007–2011. Special Issue on the Epidemiology and Prevention of Gun Violence. Volume 79.
Hemenway, David. 2004. Private Guns. Public Health 78
ADDED because it is relevant to some of the discussion below:
Sometimes, a person shows up at a gun range, checks out a gun ostensibly to use in target practice on the range, but instead uses the gun to commit suicide. In one case not long ago, a woman brought her teenage son to the range, and checked out two pistols. They took turn shooting for a while, then, while he was aiming his firearm at the target, she shot him in the back of the head and then shot herself. So that was murder-suicide. Now and then a person goes to the shooting range, and while shooting end up shooting themselves dead but it is not clear if it was an accident or suicide.
CASSELBERRY, Fla. — A central Florida woman who fatally shot her son then killed herself at a shooting range wrote in suicide notes to her boyfriend that she was trying to save her son.
“I’m so sorry,” Marie Moore wrote several times. “I had to send my son to heaven and myself to Hell.” … She signed two of the notes “Failed Queen.”
ENGLEWOOD, Colo. — A photocopy of a magazine cover about the Columbine school shooting was found among the belongings of Australian twin sisters who shot themselves in a suicide pact at a Colorado shooting range, authorities said Friday.
However, it remained unclear why Kristin and Candice Hermeler, both 29, had the cover of Time headlined “The Monsters Next Door/What Made Them Do It?” and why the sisters made the plan to kill themselves, authorities said. One of the women survived.
A 52-year-old Tamarac man killed himself Saturday morning at a Broward shooting range, according to a Broward’s Sheriff’s Office release. When police went to notify his wife at home, they found her dead in a possible murder-suicide.
Police report that the man rented a gun at the Arizona Shooting Range & Emporium in Lauderdale Lakes at 10:18 a.m. He then went into the target-shooting area and shot himself in the head at 10:33 a.m., according to the release.
COLONIAL HEIGHTS, Va. (WTVR)–The owner of The Smoking Gun pistol range didn’t want to appear on TV, but he did want to set the record straight about the suicide inside his business five days ago.
It began with the sound of gunshots inside a shooting range. It’s safe to say it’s common to hear that sound there, but a shot last week still haunts the range owner. “I yelled, ‘Lieutenant!” he said. “’You have five minutes,’ but he didn’t acknowledge me.”… Second Lieutenant James Cho, an Army Reserve officer was dead. The gunshot wound to the head was later determined to be a suicide. The Smoking Gun’s owner says Cho was in a position that he’ll never forget
KENT COUNTY, MI – As family of Mark Sobie grieve his death after a self-inflicted gunshot wound last week at a Wyoming shooting range, they question why no laws prevented him from renting a firearm.
A background check, they say, would have shown the 43-year-old’s felony bank robbery conviction, an offense that led him to serve 30 months in federal prison. The criminal record prevents him from purchasing or possessing a gun.
On July 9th, 2012, Anoka High School student Justin Aaberg committed suicide. Here in Minnesota, when a kid commits suicide we don’t talk about it; often the other kids in the school are never told. There’s just a funeral service and a yearbook page but no discussion, no action, no response. But, Justin was one of several kids who successfully took their own lives in the Anoka Hennepin School District, the largest school district in Minnesota, and they were among a much larger group who came close to doing so, because they were gay or thought to be so, and were thus bullied and shunned and treated poorly by people from across the entire community, including students, teachers, school administrators, public officials, parents, and members of the general public. Putting this a slightly different way, the Anoka-Hennepin School District, which considerably overlaps with anti-gay Congressperson Michele Bachmann’s school district, is one of the most actively homophobic geographical entities in the country. Homeless youth in this area are often, by some estimates about half the time and certainly more than 35% of the time, homeless because their parents discovered that they were gay and threw them out, or bullied them into leaving. The attempted and successful suicide rates and related problems in the Anoka County School district were reached such a severe level that the US Center for Disease Control declared the problem a serious health emergency and launched an investigation. The first response of the education community, including many teachers and administrators, was to enact a policy in which no one would be allowed to say anything about anything. Ya. Here in Minnesota, when a bunch of kids commit suicide we just don’t talk about it.
Anoka, the city, which is in Anoka County and part of this school district, is the Halloween Capitol of the world. You probably already knew that. I’m not sure why this is the case and at the moment I’m not too interested to find out, even though it is the next town over from where I live. The thing is, Anoka has a big huge parade for Halloween, and all the usual groups march in it. Everyone is welcome and everyone has a great time.
Unless of course you are some kinda gay thing. Justin’s Gift is a non profit that formed after Justin’s death to raise money to help at risk youth and address bullying in the district. Justin’s gift and allied organizations have been organizing things like the annual Youth Gay Pride festival. And 30 Kids linked to Justin’s Gift wanted to march in the parade, but of course, they were refused. The reason given? “Too many people already marching in the parade. Can’t fit the 30 kids.”
Which, of course, is bullshit.
So, one off the moms in the district has gotten peeved and instead of being Minnesota nice and merely walking away after passing around a stern look, she has started a petition on Change.org, and we need you to sign it. Click here to sign it, and please pass it around.
Most firearm deaths in Canada are suicides (over 75 per cent). Only 24 per cent are homicides. Suicides in Canada will go up if the Prime Minister isn’t careful about what he repeals.
… Suicides dropped dramatically in Canada thanks to the federal gun registry. Not only do statistics prove as much, it stands to reason that with improved gun safety comes decreased gun fatalities; with fewer tools-of-choice for suicides available, fewer suicides occur. It just makes sense.
… A home where there are firearms is five times more likely to be the scene of a suicide than a home without a gun: Canada Safety Council. The Institut national de sante publique du Québec has assessed that the coming into force of the Firearms Act is associated, on average, with a reduction of 250 suicides (and 50 homicides) each year in Canada. That’s nearly one life saved per day. …
Lithium has long been used as a psychotherapeutic drug, and treatment with lithium demonstrably reduces incidence of suicide. Lithium also occurs naturally in groundwater to varying degrees. This study explores the relative amount of Lithium in groundwater and suicide in 18 municipalities in Oita prefecture, Japan over a period running from 2002 to 2006. There are two principle findings:
… there is no way to turn way from it, but we are often poorly prepared to deal with it, especially when it involves teenagers. Face it: adults like it when teenagers finally learn to hide some of their emotions. Maturity = knowing how to leave other people out of your bad shit. We reward this behavior and we model it by building and maintaining a Barbified and Kenified culture. But every now and then a kid goes too far for their own good and, not to shock you or anything, but the morgue is not the appropriate place to have “that conversation” about life.
I’ve been lucky. I was never particularly suicidal, nor were any of my relatives as far as I know. As I was growing up, only two people I knew killed themselves and a few tried, but they were not people I was close to. I once had to drag my roommate off the roof of a building. I have a very close friend now who was very depressed and suicidal as a teenager. There have been times in the past when we would go somewhere and he’d point out a spot that he had sat for a long time contemplating suicide. It was always a high place, over a road or a train track. It is rather chilling to hear such a thing while standing there looking at the spot.
So now, today, a friend of mine has someone in her life who is in a state of depression and need but who is living in a setting where there clearly is not enough support, so she is intervening, or at least, trying to. She, my friend, happens to be a blogger. So like I was saying to Lizzie the other day at dinner, “If you hang around with a blogger, you’re going to get blogged.” (She gave me a dirty look.)
OK, so this blogger has decided to share this with others for obvious, and good reasons. I want you to do me a favor and take some time off from reading my blog, and visit this post: