Dear Editor:

Gun ownership is common in America. People report that they need them for safety and/or sport. However, having a firearm in the home actually increases the rate for suicide, homicide, domestic violence, and accidents.
The presumed security is questioned, especially since owner and family suicide vastly outnumbers self-protective events. Gun-related suicide in America accounts for most of the violent death occurrences. This high suicide rate is shockingly under appreciated. The deaths, injuries, and disabilities significantly escalate healthcare costs, insurance premiums, criminal justice system expenses, and taxes. Nevertheless, regulation of firearms has neither been popular with the public nor legislatures; perhaps the degree of carnage might now kindle discussion about the way we control these weapons.

The Second Amendment to the Constitution states that, “A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed.” Despite current gun regulations, firearms can be bought at gun shows or privately from unlicensed dealers with no background checks.

In 2005, out of a total of 541 firearm-related deaths in Kentucky, 375 were gun-shot suicides (69%), homicides accounted for 143, accidents claimed 11, nine died in police shootings, and three fatalities were unspecified.[1] During 2006 and 2007, again, approximately 70 percent of gun-shot deaths were suicides.[1] Most Americans are unaware that gun-shot suicide occurs much more often than all other shooting deaths combined. Suicide by gun fire is the fastest growing and most common means of suicide regardless of age, gender, race, or educational level. It is the leading cause of death in those who purchase firearms for the first time.[2] Despite being obtained for personal security, 83 percent of gun fatalities in a home are suicide.[3] Among 395 shooting deaths in Seattle during one year, 333 were by suicide, 41 were domestic violence incidents, 12 were accidents, and only nine involved an intruder.[3] Women commit suicide three times as often when firearms are present in a home than in domiciles without them.[4]

Despite mental illness being an important factor, most suicide attempts are impulsive and done under stress, when upset and/or intoxicated, but without psychopathology. Awareness about the frequency of such unplanned acts is limited. Having firearms readily available increases the lethality of such impulsivity.

Guns are the most frequently used means involved in deaths by domestic violence, increasing the rate of killing an intimate partner. Five times as many women are shot to death in homes where such weaponry is available in contrast to households without them.[4] Family member homicide is much more likely than stopping a trespasser. Sadly, many American children are shot to death every day.

Gun violence has a negative impact on society. Beyond death and disability, survivors of a shooting endure psychological trauma and grief. Violence-exposed children experience developmental consequences and adults also evidence personal compromise. Living in communities where fear of getting shot is common has detrimental effects on people and teaches inappropriate role modeling about responsible behavior to future generations.

Hospitals, trauma centers, and rehabilitation or nursing home facilities are flooded with victims of shootings. Acute healthcare expenditures for injured individuals are enormous and most of these patients are uninsured. The economic impact extends well beyond emergency treatment and continues with chronic dysfunction, rehabilitation, and long-term disability. Medical expense outlays increase for everyone, covered largely by government and ultimately affecting tax-payers. These costs inflate the price of medical, disability, and life insurance; escalating premiums are paid by companies, governments, and private individuals. Acute care medical bills for gun violence in the United States reportedly is over $4 billion per year, and it exceeds $100 billion annually, when including follow up and long-term care.5 A serious attempt to reduce healthcare costs, would include consideration at limiting gun usage.

Firearm use also adds to the expenses of police work, court prosecutions, legal involvements, and incarcerations, again borne by tax-payers. Loss of productivity, disability payments, and emotional or physical dysfunction all add to the cost. Guns are so much a part of our culture, that Americans have become accustomed to the resulting bloodshed and huge expenses.
Firearms have a negative impact on our society, both emotionally and physically. They heighten expenditures for us all in taxes and insurance premiums, but gun regulation still remains socially and politically controversial.

Americans can make choices. We should decide whether to accept our current status or whether a reassessment of our gun-regulation system is a potential legal alternative.

References
1. Kentucky Violent Death Reporting System. http://www.kvdrs.uky.edu/index.htm. Accessed February 24, 2010
2. Miller M, Hemenway D.Guns and suicide in the United States. NEJM. 2008;359(10):989–991.
3. Kellermann A. Guns for safety? Dream on Scalia. The Washington Post. June 29, 2008. Page B02. http://www.washingtonpost.com/wp-dyn/content/article/2008/06/27/AR2008062702864.html. Accessed February 24, 2010.
4. Bailey J, Kellermann A, Somes G, Rivara FP. Risk factors for violent death of women in the home. Arch Internal Med. 1997;157(7):777–782.
5. Wintemute JC. Guns, fear, the constitution, and the public health. New England J Med. 2008;358(14):1421–1424.

With regards,
Rupinder Johal, MD
Steven Lippmann, MD
University of Louisville School of Medicine, Department of Psychiatry and Behavioral Sciences

William Smock, MD
Cynthia Gosney, RN
University of Louisville School of Medicine, Department of Emergency Medicine