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© 2006 American Public Health Association
DOI: 10.2105/AJPH.2006.087965
LETTER |
Susan B. Sorenson is with the Department of Community Health Sciences, School of Public Health, University of California, Los Angeles. Matthew Miller is with the Harvard Injury Control Research Center and the Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass.
Correspondence: Requests for reprints should be sent to Susan B. Sorenson, PhD, UCLA School of Public Health, 650 C.E. Young Dr S, Los Angeles, CA 90095–1772 (e-mail: sorenson{at}ucla.edu).
Knox and Caine, authors of the recent article "Establishing Priorities for Reducing Suicide and Its Antecedents in the United States," admonish the public health community for neglecting the toll of suicide among men in their middle years.1 We find no fault with the article as a piece of descriptive epidemiology. However, in an article claiming to establish priorities for reducing suicide in the United States, the authors’ disregard of the central role of firearms in American suicides is a stunning oversight. Nowhere is it noted, for example, that firearms are the mechanism involved in more than half of all US suicides, including those among middle-aged men.2 Knox and Caine are right to claim that population-based approaches to preventing suicide have been neglected. Their decision to put forward certain observations and skirt others, however, is an example of just such a failing.
Consider the ink Knox and Caine devote to workplace programs and the ink they devote to firearms. Although they acknowledge that there are no published reports of effective workplace interventions for suicide prevention, the authors suggest workplace interventions in 2 paragraphs. Firearms in the home, an established risk factor for suicide, is mentioned once, and not as a risk factor but as an International Classification of Diseases, 10th Revision (ICD–10)3 classification. In fact, the authors’ sole reference to firearms—"Suicide is presently limited to 2 ICD–10 codes that categorize suicide as either attributable to a firearm or to other unspecified means"1(p1901)—is inaccurate. The ICD–10 has 25 major category codes to document the multiple ways by which people commit suicide; firearms constitute 1 of the major categories. The failure to give proper weight to the role of firearms is especially ironic when one realizes that the message the authors put forward is that the public health community has ignored the obvious for various political reasons.
Suicide experts from 15 countries recently concluded that restriction of lethal means is one of only 2 effective suicide prevention strategies.4 Firearms should not be ignored in efforts to improve the health of the nation.
References
1. Knox KL, Caine ED. Establishing priorities for reducing suicide and its antecedents in the United States. Am J Public Health. 2005;95:1898–1903.
2. Welcome to WISQARS. Available at: http://www.cdc.gov/ncipc/wisqars. Accessed February 3, 2006.
3. International Classification of Diseases, 10th Revision. Geneva, Switzerland: World Health Organization; 1992. Also available at: http://www3.who.int/icd/vol1htm2003/fr-icd.htm. Accessed April 17, 2006.
4. Mann JJ, Apter A, Bertolote J, et al. Suicide prevention strategies: a systematic review. JAMA. 2005; 294:2064–2074.
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