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, 25 (5), 366-76

Mental Illness and Reduction of Gun Violence and Suicide: Bringing Epidemiologic Research to Policy


Mental Illness and Reduction of Gun Violence and Suicide: Bringing Epidemiologic Research to Policy

Jeffrey W Swanson et al. Ann Epidemiol.


Purpose: This article describes epidemiologic evidence concerning risk of gun violence and suicide linked to psychiatric disorders, in contrast to media-fueled public perceptions of the dangerousness of mentally ill individuals, and evaluates effectiveness of policies and laws designed to prevent firearms injury and mortality associated with serious mental illnesses and substance use disorders.

Methods: Research concerning public attitudes toward persons with mental illness is reviewed and juxtaposed with evidence from benchmark epidemiologic and clinical studies of violence and mental illness and of the accuracy of psychiatrists' risk assessments. Selected policies and laws designed to reduce gun violence in relation to mental illness are critically evaluated; evidence-based policy recommendations are presented.

Results: Media accounts of mass shootings by disturbed individuals galvanize public attention and reinforce popular belief that mental illness often results in violence. Epidemiologic studies show that the large majority of people with serious mental illnesses are never violent. However, mental illness is strongly associated with increased risk of suicide, which accounts for over half of US firearms-related fatalities.

Conclusions: Policymaking at the interface of gun violence prevention and mental illness should be based on epidemiologic data concerning risk to improve the effectiveness, feasibility, and fairness of policy initiatives.

Keywords: Firearms; Guns; Law; Mental illness; Policy; Psychiatric disorder; Risk; Stigma; Suicide; Violence.


Fig. 1
Fig. 1
Average prevalence of minor to serious violence among persons with serious mental illness by setting of study: meta-analysis of many studies.
Fig. 2
Fig. 2
Violence risk varies among people with serious mental illness who are involuntarily committed: characteristics of violent behavior in 4 months before involuntary hospital admission (Duke Mental Health Study; n = 331).
Fig. 3
Fig. 3
Accumulation of MH records in National Instant Check System.
Fig. 4
Fig. 4
Mean monthly predicted probabilities of first violent crime for persons with serious mental illness with and without a gun-disqualifying mental health record, before and after NICS reporting began in Connecticut (n = 23,282). Note: analysis excludes persons with disqualifying criminal records.

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