With the homicide rate down sharply since the early 1990s, the number of Americans who commit suicide with guns each year far surpasses those who are killed by others with firearms, government statistics show.
In 1997, the last year for which there are statistics available, guns were used in 17,566 suicides, compared with 13,522 homicides, according to the National Vital Statistics Report.
This difference is helping focus new attention on suicide, a subject that has long been taboo for many Americans and whose toll was partly hidden from view by the violent crime wave of the 1980s.
Next week, a Senate committee is scheduled to hold the first congressional hearings on suicide. The surgeon general, Dr. David Satcher, recently made preventing suicide one of his priorities, the first time a surgeon general has put suicide so prominently on the public health agenda.
Also, a new book by a best-selling writer, Dr. Kay Redfield Jamison, "Night Falls Fast: Understanding Suicide" (Knopf), provides a comprehensive and authoritative look at the subject, which mental health advocates hope will have a major impact on public thinking about suicide.
Jamison, a professor of psychiatry at the Johns Hopkins School of Medicine, concludes that 90 percent to 95 percent of people who commit suicide had a diagnosable psychiatric illness and that the number of young people who kill themselves in the United States has tripled since the 1950s. She found that 60 percent of the 30,000 Americans who on average take their own lives each year do so with guns -- about 18,000.
"Suicide is a public health tragedy," said Jamison, who was the writer of "An Unquiet Mind: A Memoir of Moods and Madness" (Knopf, 1995), an account of her own struggle with manic-depressive illness and suicide attempts. "You don't hear the outrage about suicide" that is voiced about crime, she said, "because I think families have been so stigmatized and reluctant to talk about it."
In her new book, Jamison notes a series of studies in recent years indicating that having a gun in the home increases the risk of suicide. "For young people in particular, who have a very impulsive element to their suicide, having access to a means of suicide that is quick and irrevocable like a gun is an unnecessary risk," she said.
Laurie Flynn, executive director of the National Alliance for the Mentally Ill, which is made up of relatives of the emotionally disturbed, said the easy access to guns in the United States had compounded the suicide problem, especially as states have dismantled their treatment system for the mentally ill and health insurers have made it increasingly difficult for the emotionally troubled to get treatment.
"It is easier and cheaper to get a gun and kill yourself than to get treatment," Flynn said.
One recent study that looked at all people who legally bought handguns in California in 1991 found that their risk of gun suicides in the first week after purchase was more than 50 times higher than for the population of the state as a whole.
The risk of committing suicide with a gun remained at least twice as high for the handgun buyers as for the general population of California during the next five years, said Dr. Garen Wintemute, who presented a paper on the study last year at a meeting of the American Public Health Association.
The Senate hearings will be held Oct. 28 before the Labor, Health and Human Services subcommittee of the Senate Appropriations Committee and were arranged by Sen. Harry Reid, D-Nev. Reid's father, Harry Reid, a miner in the desert town of Searchlight, Nev., shot and killed himself in 1972 while suffering from depression.
Among those expected to testify are Satcher, the surgeon general; Jamison; and writer Danielle Steele, whose daughter committed suicide.
Over the past decade, the annual number of suicides and the number committed with guns have remained remarkably consistent. The number of suicides was 30,232 in 1989, rose to a high of 31,284 in 1995 and then fell to 29,264 last year, according to the National Vital Statistics Report, which is published by the National Center for Health Statistics in Washington. The number involving firearms in the same period has ranged from a high of 18,940 in 1993 to a low of 17,566 in 1997.
Satcher said that one alarming development was that the suicide rate for black youths ages 10 to 19, which had traditionally been lower than that of young whites, had more than doubled since 1980, to 4.5 per 100,000 in 1995 from 2.1 per 100,000 in 1980.
"I believe the problems that give rise to suicide among African-American young people are related to the problems that give rise to homicide, like hopelessness," said Satcher, who is black and a former emergency room doctor. "This is certainly something we are going to study."