As we all attempt to find our new normal after years of pandemic living, it’s evident that this will involve an immense societal need to focus on individual mental health. With nearly one in five adults living with a mental illness, finding innovative new approaches to diagnosis, treatment, and prevention are crucial to improving the lives of millions of people. Investigators at the Mass General Research Institute are working to do just that. 

This week, we talked to Roy Perlis, MD MSc, the Director of the Center for Quantitative Health at Mass General Hospital as well as Associate Chief for Research in the Department of Psychiatry, and a Professor of Psychiatry at Harvard Medical School.

While most of the conversations on gun safety come down to the harm that guns can do to other people, the evidence shows that guns are just as deadly—if not more deadly—to gun owners themselves.

In 2020 alone, 54% of all firearm-related deaths were suicides. During the pandemic, there was also an increase in first-time firearm purchases, helping to push record-breaking sales of guns in the U.S.

But it’s not just access to guns that should be alarming. According to Dr. Perlis and other mental health researchers, depression is becoming more common among Americans.

“Rates of depression are about three times greater among adults, and probably even more so among children and adolescents compared to pre-pandemic,” Perlis states.

According to the World Health Organization, the pandemic contributed to a 25% increase in the prevalence of depression worldwide, but results of surveys conducted by Dr. Perlis and colleagues spanning more than 100,000 US adults suggest that rates of depression may have doubled or even tripled at times during the pandemic.

The concurrent rise in gun ownership and rates of depression is particularly alarming when it comes to suicide prevention—while only four percent of suicide attempts without a gun end in death, 85% of suicide attempts that involve a gun are fatal.

So how has the mental health crisis during the pandemic influenced gun purchases, and what could this mean for suicide risk if depression rates continue to rise?

In a recent study, Dr. Perlis and team used an online survey to explore the prevalence of firearm ownership among individuals with major depressive symptoms.

The study was conducted as part of the COVID States survey, an academic consortium that has fielded a survey approximately every six to eight weeks beginning in April 2020, asking questions about COVID-19, mental health, and society to a study population representative of the United States population.

The survey on gun ownership included 24,770 respondents, 65% of which were female, and 74% were white. The mean age was 45.8 years old.

Respondents were asked questions including whether they had purchased a firearm during the pandemic; if it was the individual’s first purchase and why they decided to obtain a gun. Participants were also asked to complete a nine-item patient health questionnaire as a validated measure of major depressive symptoms.

The researchers found that current and planned firearm ownership was common among individuals with major depressive symptoms, and that the presence of depressive symptoms was associated with a greater likelihood of first-time firearm purchase during the pandemic.

Results also showed that the most common reason for purchase during the pandemic was protection against crime, target shooting, and hunting. However, those with depressive symptoms were significantly less likely to report purchasing for protection, but more likely to report purchasing because of COVID-19 and for protection against someone known to them.

What are the implications of these findings, and how can we protect we protect Americans from suicide-related gun death?

Perlis believes that prevention could start with physicians consistently asking their patients about their access to guns and encouraging those with access to take safety measures—such as keeping guns in a safe or leaving them unloaded-— that can reduce the risk of acting impulsively.

“When you see a primary care doctor, they ask you whether you smoke because they know if they can get you to quit smoking your risk of heart disease and bunch of different cancers will go down,” Perlis says.

“Your doctor also asks if you wear a seatbelt, because seatbelts are another very clear public health strategy that will decrease your risk of dying or being injured if you’re in a car crash. Do you wear a bike helmet when you ride your bike? Same thing.”

“So as far as guns it’s not so much just knowing if someone owns a gun, but making sure that they keep the gun locked up and unloaded.”

While these questions by themselves can’t prevent all bad outcomes of gun ownership, with the current legislative stalemate on gun regulations, even small steps can be important.

“There’s a huge opportunity to address suicide with sensible gun regulation. What working on this survey has made me consider is that even as a scientist who has primarily been focused on understanding disease, when I see things that can drive policy, I have an obligation to speak up.”

Roy Perlis, MD, MSc

“It’s not just doing the science and then leaving it somewhere and hoping someone pays attention to it,” Perlis says. “It’s doing the science and then talking about what the implications might be.”

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About the Mass General Research Institute
Research at Massachusetts General Hospital is interwoven through more than 30 different departments, centers and institutes. Our research includes fundamental, lab-based science; clinical trials to test new drugs, devices and diagnostic tools; and community and population-based research to improve health outcomes across populations and eliminate disparities in care.
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