More than half of Ont. gun deaths are from self-harm, majority in older men in rural areas, study finds

TORONTO -- A new study has found that more than half of gun-related deaths in Ontario are from self-harm, and most often occur to older men living in rural areas.

The study, published Monday in medical journal CMAJ, found that 68 per cent of gun deaths between 2002 and 2016 were from self-harm, and were predominantly among men aged 45 and older across all income levels.

The study also found that gun injuries and deaths were higher per capita in rural areas compared to urban centres, pointing to higher rates of self-harm outside the cities.

According to the study, 92 per cent of the gun injuries stemming from self-harm resulted in death.

Dr. David Gomez, co-author of the study and a trauma surgeon at St. Michael's Hospital in Toronto, said in the study that this is "equivalent to a firearm-related injury … every 3 days" in the province.

The study's authors say their data shows that "targeted initiatives" are needed to address the different causes of injuries in rural and urban regions.

"Our findings highlight the need for suicide-prevention strategies in rural Ontario targeted at men aged 45 or older. Restricting access to lethal methods by such means as safe-storage campaigns and reduction in firearm ownership must go hand-in-hand with depression screening and treatment," the study said.

• Mental health care in Canada: Where to find help

While gun-related injuries and deaths can be a "major burden to the health care system," researchers say non-fatal firearm injuries have been largely unmeasured in Canada.

To better understand injuries and deaths from firearms, researchers looked at data on Ontario residents with a valid OHIP number who were injured or died of gun injuries between 2002 and 2016. Non-profit health research company ICES provided data that was linked to other databases, including the Office of the Registrar General Deaths database, which captured deaths without a hospital visit.

They categorized injuries as a result of assault, unintentional or accidental, self-harm and undetermined intent.

Researchers found that gun injuries related to assault accounted for 40 per cent of non-fatal injuries and 25 per cent of deaths. Young men living in low income neighborhoods were overrepresented in this group, according to the study.

The study reported that five of 10 census divisions with the highest injury rate from assault were in the Greater Toronto Area and Hamilton.

The study says injury patterns varied by age with assault most common in people aged 15–34, and self-harm the most common injury among those aged 45 or older.

The study found that firearm injury rates also varied over time. Researchers reported that in 2005-2006 there was a high of 4.71 gun-related injures per every 100,000 Ontarians. Rates then declined until the last two years of the study (2015, 2016) which saw 3.51 firearm injures per every 100,000.

Researchers concluded that both peaks were related to injuries from assault, as self-harm rates showed less variability.

ADDRESSING FIREARMS IN SELF-HARM PREVENTION

Wendy Cukier, founder of the Coalition for Gun Control, told CTVNews.ca that the new study adds to growing calls to restrict access to firearms as part of self-harm preventions.

"Firearms are one of the principal means of suicides in Canada, and yet, when we look at the suicide prevention strategies, when we look at the big campaigns they focus on mental health, which is of course important, but they completely ignore the issues of firearms," Cukier said in a telephone interview on Monday.

Cukier said one of the issues in developing comprehensive suicide prevention strategies that include firearms is that the highest opposition to gun control is in the regions with the most guns, such as rural Ontario and the Prairies.

"In rural communities, suicide rates, domestic violence and murders of police officers are very much driven by the availability of firearms, [but] it's often seen as a big city issue because so much of the focus is on gang related violence," she said.

Despite having gun laws in place, Cukier said health-care professionals and others who interact with people who may be suicidal need to take action to have firearms removed from the home such as reporting to authorities if they suspect someone who has access to a gun may be at risk.

"If you have someone who's at risk of suicide and you control access to the means by removing firearms, you actually can save their life," Cukier said.

Co-chair of the Canadian Doctors for Protection from Guns, Dr. Najma Ahmed, says treatment for gun violence has to be targeted to those demographics most at risk as a "one-size-fits-all approach will not work."

"We have to address the social determinants of health that put [people] at risk for interpersonal violence... We have to think about and provide better access to mental health and we have to try and understand what is driving this depression and these mental health issues in this cohort of people," Ahmed said in a telephone interview on Monday.

Ahmed said this study is important amid the uncertainty of the COVID-19 pandemic. She explained that the health crisis and subsequent economic crisis has heightened depression and anxiety for some and may lead to increase acts of self-harm.

To help combat this, Ahmed said there also needs to be a corresponding increase in the understanding of the risks of having firearms around those struggling with their mental health.

"We need to help the public understand that a gun in a home increases the risk of suicide dramatically. Suicide can often be an impulsive act, and the thing about guns and suicide is that they are lethal 90 per cent of the time," Ahmed said.

She explained that other means of self-harm are less lethal and if the patient survives, there is an opportunity for mental health intervention. She added that the lethalness of guns does not present the same situation.

"The majority of people who attempt suicide and survive… do not go on to die by suicide. Mental health interventions can be very effective in treating their mental health crises and preventing death from suicide," Ahmed said.

"Deaths from suicide is a highly tragic thing for the family -- the whole family and the whole community are affected for decades. There's a sense of guilt, there's a sense of anger and all of this is avoidable if lethal means are not in the home," she said.

GUN-RELATED INJURIES, DEATHS ACROSS CANADA

According to Canada's Department of Justice, there have been an average of 1,300 firearm-related deaths per year, over the past 25 years.

Self-inflicted injuries account for three-quarters of gun deaths, according to data from Statistics Canada.

In total, suicides accounted for 9,919 of the 13,168 gun deaths in Canada from 2000 to 2016. Homicides accounted for 20 per cent while accidental shootings caused two per cent of deaths during this time.

Statistics Canada reported that the frequency of accidental shootings -- both fatal and non-fatal -- varies between cities.

Canadians tend to be accidentally injured by firearms most often in Saskatchewan, followed by Manitoba and Alberta, while Quebec has the lowest rate.

StatsCan says Calgary and Toronto lead Canada's cities in violent gun crimes resulting in homicides.

From 2013 to 2016, Edmonton had the highest rate of firearm deaths by intent, but gun crime in the city has since been on a decline.

Vancouver, which had the highest rate back in 2012, has also seen a steady decline in gun crime, and reported the lowest rate across Canada in 2017.

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If you or someone you know is in crisis, here are some resources that are available.

Kids Help Phone [phone])

Canada Suicide Prevention Helpline (1-833-456-4566)

Centre for Addiction and Mental Health (1 800 463-2338)

Crisis Services Canada (1-833-456-4566 or text 45645)

If you need immediate assistance call 911 or go to the nearest hospital.