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The Missing Link Between Mental Health and Guns

The evidence is sparse but suggests mental health issues don’t lead to gun violence. (Volume 9, Issue 3)

The crime rate in the United States has decreased despite public perception. However, the death rate from firearms – especially for suicides – has not seen as great a reduction.

Source: Iorna (Flickr/CC)

Source: Iorna (Flickr/CC)

Researchers at Duke and the University of South Florida studied over 80,000 people in Florida with schizophrenia, bipolar disorder, or major depressive disorder from 2002 – 2011. They observed whether the people were arrested for violent crime or committed suicide and whether or not guns were involved.

Among the study population, the average rate of arrest for violent crime was almost double the rate of the general public over the same period. However, the study population arrested for violent crime used guns only half as often as those individuals committing violent crime without a mental health history. Many of those arrested for gun-related violent crime were not legally allowed to have a gun at the time.

Among the study population, the average suicide rate was noticeably higher than among people without a mental health history. Yet, the study population was less likely to use guns to commit suicide compared to the general population. About a quarter of the people who committed suicide by firearms were barred from gun ownership by law.

In contrast, 38% of the people arrested for gun-related violent crime and 72% of the people who committed gun-related suicides were legally allowed to purchase firearms.

Identifying people at risk for committing violent crime or suicide is extremely challenging. High quality research is needed to determine whether other gun-disqualifying regulations could save lives.

Unfortunately, Congress consistently has barred federal funding of gun violence research since 1996. With limited research dollars available, it is hard to provide researchers with resources to study effective ways to reduce gun violence.

Similar to other public health problems such as motor vehicle safety and infectious diseases, examining this issue could provide valuable information to work towards prevention and control. It may be difficult, but not impossible. Nevertheless, the Congressional ban on federal funding should end.

commentary by Bich-May Nguyen


Gun violence kills about ninety people every day in the United States, a toll measured in wasted and ruined lives and with an annual economic price tag exceeding $200 billion. Some policy makers suggest that reforming mental health care systems and improving point-of-purchase background checks to keep guns from mentally disturbed people will address the problem. Epidemiological research shows that serious mental illness contributes little to the risk of interpersonal violence but is a strong factor in suicide, which accounts for most firearm fatalities. Meanwhile, the effectiveness of gun restrictions focused on mental illness remains poorly understood. This article examines gun-related suicide and violent crime in people with serious mental illnesses, and whether legal restrictions on firearm sales to people with a history of mental health adjudication are effective in preventing gun violence. Among the study population in two large Florida counties, we found that 62 percent of violent gun crime arrests and 28 percent of gun suicides involved individuals not legally permitted to have a gun at the time. Suggested policy reforms include enacting risk-based gun removal laws and prohibiting guns from people involuntarily detained in short-term psychiatric hospitalizations. PMID: 27269024 

Swanson JW. Health Affairs. 2016; 35 (6): 1067-1075.

Bich-May Nguyen, MD, MPH
About Bich-May Nguyen, MD, MPH

Dr. Nguyen Bich-May Nguyen, MD, MPH cares for patients at a patient-centered medical home and teaches medical students and residents in the clinic and hospital setting. She received an MD in the Underserved Track from Baylor College of Medicine and an MPH with a concentration in health policy from Harvard School of Public Health. She completed her residency training in Family Medicine at Boston University. Dr. Nguyen is involved with the National Physicians Alliance and serves on the Executive Committee of the New Leaders Council Houston. You can follow her at @bicmay. She began contributing to Policy Prescriptions™ in 2013. Contact: Website | Facebook | Twitter | Google+ | More Posts