Around 44,000 people died in a gun-related injury in the U.S. in 2024, according to a new report from Pew Research. Suicides make up a majority of those deaths at 62%. But in Oregon, that number is much higher, with 80% of all firearm deaths attributed to suicide. On top of that, previous reporting has also shown that some of the state’s most rural areas have the highest rates of gun-related suicides, especially for older men. Becca Valek is a research project coordinator at OHSU’s Gun Violence Prevention Center. Katie Iossi is an associate professor at OHSU’s department of medicine and a staff physician at VA Portland Health Care System. They both join us now to discuss these figures and what can be done to address them.
Note: This story contains a description of suicide. If you or someone you know may be considering suicide, contact the Suicide and Crisis Lifeline by dialing 988, or the Crisis Text Line by texting HOME to 741741.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: From the Gert Boyle studio at OPB this is Think Out Loud. I’m Dave Miller. Around 44,000 people died in a gun-related injury in the U.S. in 2024, according to a new report from Pew Research. Homicides get more attention, but suicides made up 62% of those deaths. In Oregon, that number was much higher – 80% of all firearm deaths were people who had taken their own lives. Becca Valek is a research project coordinator at OHSU’s Gun Violence Prevention Research Center. Katie Iossi is a member of the center’s faculty and a physician at the Portland VA. I should note before we start that if you or somebody that you know is struggling, you can call or text 988 to reach a national suicide and crisis lifeline. Help is available 24 hours a day, seven days a week. Becca Valek and Katie Iossi, welcome to Think Out Loud.
Becca Valek: Thanks for having us.
Katie Iossi: Thank you.
Miller: Becca, I mentioned the percentage of gun deaths in the U.S. and in Oregon that were suicides, and it’s very high in Oregon, 80%. But the other number that I said before, the break is just as stark. It’s that Oregon’s overall suicide rate is something like 50% higher than the national average. So I want to start there. What are the reasons for that?
Valek: Suicide is a complex public health issue. So I just want to start by noting that there’s no one cause, nor one solution. But research has identified some factors that contribute to elevated suicide rates, including elevated rates here in Oregon. For one, in particular with firearm suicide, Oregon has a high rate of gun ownership, similar to other Western states, and so there’s a correlation between firearm ownership rates and firearm suicide rates within states.
There are other factors. Oregon ranks pretty low in terms of mental health care access. In a 2024 report, I believe, 32 of our 36 counties had less than one mental health care provider per 1,000 residents in the county. So there’s really a limitation in terms of accessing needed mental health care that can also contribute to elevated suicide rates.
Miller: I wanna go back to the gun piece, and Dr. Iossi, how do you explain that? I mean, maybe it seems obvious, but it’s maybe a mistake to take anything at face value here. What’s the connection between access to firearms or the number of firearms that are in a certain place and that place’s suicide rate?
Iossi: Firearms are the most lethal method of suicide. So 90% of people who attempt suicide with a firearm will die by suicide with a firearm. So that is really the key piece. The other piece is that they are generally easily accessible, and when they are easily accessible, it can be a short amount of time between having that suicidal thought and then completing the action. That right there is how they end up being more lethal, and even though it’s not the highest method that is used in suicide attempts, it is the major cause of suicide death.
Miller: Because of the lethality.
Iossi: Exactly, exactly.
Miller: Becca, how much do suicide rates in Oregon vary by regions, and specifically, I’m wondering about cities versus more rural areas?
Valek: Rates in cities vs rural areas vary pretty significantly. Rural areas tend to have, both in Oregon and in the U.S. generally, rural areas tend to have higher rates of suicide and firearm suicide in particular.
Miller: Is that one of the things that you see? Because another huge stat that that jumps out that came from a recent study is that people who work in farming, fishing, and forestry have a suicide rate that’s five times higher than the already very high state average. How do you explain that?
Valek: I think that contributes to that rural-urban difference, and I think there are a variety of factors. For one, those working in those professions may be more likely to have firearms and have easy access to firearms. There is also the factor of some of those professions may be more associated with workplace injury or could lead to some chronic pain, and those physical health conditions can also increase risk for suicide.
Miller: Katie, what about gender? How does gender play into this?
Iossi: Men generally have a higher rate of suicide, and that, we think, is due to several reasons. One is that stereotypes still exist, for sure, around mental health and expressing emotion and vulnerability. I work with predominantly male patients who recognize that their health is important and also have a hard time sometimes talking about their mental health, so a sense of being able to ask for help or mention that things aren’t going as well as they’d want them to go can certainly contribute to that.
Miller: How much training did you get? When you were, say, doing rotations in med school or doing your residency, specifically about this, about talking to patients about suicidal ideation and about really serious mental health issues, and I should say again you’re an internist?
Iossi: Yes, I’m an internist, and I don’t recall learning much about talking about firearms in particular in medical school or residency. We certainly talked about suicidal ideation and how to assess risk, but I really learned about how to do lethal means safety counseling, which is an intervention that reduces suicide risk in individuals, while working at the VA and recognizing that it was such an important piece of taking great care of my patients.
Miller: Is that at this point a standard part of training or clinical work at the VA, or is this something that just some people there recognize was good and so some people there do it?
Iossi: It is a part of standard training at the VA, and it is a universal screen that we do for all patients now at the VA, is to ask people about thoughts of suicide. The U.S. Preventive Services Task Force has found insufficient evidence for universal screening for suicide elsewhere, and I think there will be more data coming out on this in the future, but clinicians all should be able to identify warning signs and risk factors for suicide and then appropriately counsel patients on how to help manage and mitigate that risk.
Miller: What does that second part look like? Because you had said earlier that part of this, to the extent that it’s gendered, one of the pieces of it is this idea that men should just tough it out and figure out their own ways of dealing with challenges without having to maybe talk to somebody else, but here you come along and start asking questions. So how do you navigate that?
Iossi: Yeah, it can be challenging, especially when patients are asked about firearms, it can feel very personal because firearms are such a huge part of many people’s identity and because that topic has been unfortunately politicized. So I always ground the conversation in care about health and safety and often about their family members and how much they’re cared about and what an effect of not doing well personally would have on their family.
So I will root the conversation in health and safety and say, hey, we know that people going through hard times may develop crises where they might think about suicide. And in those moments, we know that keeping people safe really matters, that reducing access to lethal means, like maybe not having your firearms right nearby when you’re having a crisis can actually help keep you alive and save your life. So if we do some talking right now and brainstorming around how we might keep you safe in a crisis moment that might actually help save your life if you are to develop a crisis moment.
Miller: What you’ve just been describing sounds very voluntary, and we can talk in a little bit about red flag laws, Extreme Risk Protection Orders, which, now we’re one of many states that have that in Oregon. But I’m curious, before we get to that, where a judge is saying, for some period of time we’re going to remove your guns.
What you’re saying seems different. I mean, what would the method be, let’s say, as you were just outlining in a pretty careful, kind way, you’re going through challenges, I care about your life, and maybe it’s not a great idea to have guns around right now. What do people say and what are you actually asking them to do?
Iossi: Yes, people will sometimes be surprised by that. And other times they’re not at all surprised. So then we talk about, you know, a lot of my patients own firearms. If you own them, how do you store them? How do you use them? Tell me more. Then the patient is telling me about what matters to them and why they might own firearms.
And then I share my medical experience and say, you know, we do know this from studies that having these around can be hard. So what do you think we can do together collaboratively, you and I, to help mitigate your risk, to lower your risk? And some patients will agree that it really isn’t safe to have their firearms in their home. So maybe they’ll give them to a friend or a family temporarily, while they’re going through this hard time.
Other times that doesn’t work for patients, and that’s OK. Then we brainstorm about other ideas that we could take. Securely storing firearms is also a really fantastic way to put time and space between that thought and the lethal action. Secure storage involves storing the firearm unloaded, locked up and separate from ammunition, and that can give you time to rethink a fleeting thought of suicide that someone might have.
Miller: Even if we’re just talking about, say, a couple minutes of finding the key or maybe two different keys to get access to ammunition and the gun itself, that can make a difference?
Iossi: It can. Twenty minutes, ten minutes, thought to be a critical window, not for every person, but it can definitely reduce harm.
Miller: Becca, I’m curious, we have been talking about removing people’s access to firearms. How much is that the focus right now, meaning the means of suicide, as opposed to addressing people’s underlying causes, not that it’s either/or, but if we’re talking about where you’re focusing your energy right now?
Valek: Like you said, it can’t be either/or. There’s really a need for upstream interventions, and I think that those are happening pretty widely. But in terms of my energy, because my research focus is firearm injury, I focus more on firearm suicide in particular and lethal means.
And I think that is a really effective mechanism because there’s a lot of work that needs to happen more upstream.
As a public health professional, I care a lot about the upstream interventions, and we have people that are dying now. And so we know that reducing access to lethal means during a time of crisis can save lives now.
Miller: I just want to give the number again. The number to reach the National Suicide Crisis Lifeline is 988. Help is available 24 hours a day, seven days a week.
Becca, for as long as we’ve been talking about suicide on this show, which is close to 20 years, since the beginning of this show, we’ve been giving out some version of a phone number, but it was only about four years ago or so that it became that three digit number. Has that made a difference?
The hope was, I remember hearing this, that, like 911, this is an easier to remember number. And part of the thinking was, it would make it easier for people to call in. Has that happened?
Valek: It certainly has. We’ve seen increased call volumes. In addition to having that easier number, there’s also text options and an ability to message online. So I think by expanding the different ways that individuals can reach out and seek help, it has made it more accessible and more people have been using this resource.
Miller: I’m curious about another societal shift. Katie, I feel like I’ve seen a shift in societal norms about the way suicide is talked about in the last 20 years or so. Basically, people seem more comfortable talking about suicide head on, including in places like obituaries where, I mean there’s still sometimes, maybe still frequently, a euphemism like “so and so died suddenly.” But I feel like I see more often families and loved ones saying, “So and so died by suicide after a long struggle with mental illness,” something like that. What effect do you think the normalization of talking about suicide has had?
Iossi: I think the normalization has generally been helpful, as long as it is helping people to open up about what they’re going through and then be able to seek resources or have people help connect them with resources to get the help they need. We do worry about folks who have been impacted by suicide then having their own mental health crises. So postvention resources are also really important when a community has been impacted by suicide, to ensure that others are not then in a new crisis. But I do think that having that conversation is important.
And one thing that’s also really important to know is that asking about suicide does not cause a person to have suicidal behavior. So exploring someone who’s feeling down, and finding out if they’re having thoughts of wanting to end their life, is really important just to figure it out, open up, and get them connected to resources.
Miller: I want to go back to the non-voluntary piece of this. So we were talking about, hey, how would you feel about locking your guns up or giving them to a safe loved one for a little while, as you work through what you’re working through, but there are also these red flag laws. In the big picture, how are they working? How is it working in Oregon?
Valek: Research has found in some of the states that have red flag laws or Extreme Risk Protection Order laws, that they are effective at reducing firearm suicide. In a four-state study, it was found that one suicide was prevented for every about 17 ERPOs issued, which is a really impressive number.
In Oregon, our team has done research looking at the court records, speaking with law enforcement and judges and other professionals who are involved in ERPO implementation, and talking to some of the family and household members who have filed for ERPOs. And what we found is that for these family and household members, they’re offering a sense of relief. They’re offering time and space so that an individual can receive other interventions; because it won’t solve the underlying problems, it won’t solve the underlying crisis, but it can create a safer home environment in which an individual can get help.
Miller: Are there other policies that you’d like to see in Oregon? Because we’ve been talking to some extent about local interventions or doctor-patient conversations or a family reaching out for their own loved one. But what about at the societal level?
Valek: Certainly. Before we move fully away from the local interventions though, I’d just like to note that in addition to the healthcare setting and family and friends, many of the local prevention activities are really being spearheaded by firearm owners.There are examples of gun shops that will store your firearms during a crisis, and gun shops that distribute secure storage information and talk about suicide or have coffee chats. And I think that really contributes to normalizing the conversation and to reaching out to those who may be more vulnerable.
Miller: And the idea there is this is a gun shop owner, so this is not someone who you think is out there to take your guns away from you.This is a second amendment supporter who’s on your side.
Valek: Certainly, it’s a trusted messenger. It’s someone you may be more comfortable having that conversation with, and it shifts the culture because it shows this person who I agree with broadly, who I have a connection with, also cares about firearm suicide prevention and it is willing to have that conversation.
But on the societal level, I think there’s a lot that can be done. Every few years, the Oregon Health Authority creates youth and adult suicide prevention plans that outline the overall strategic plan for the state. And the youth suicide prevention plan has general fund funding from the legislature, but the adult plan does not. So it’s funded through grants – federal, state and local grants – which can create instability or uncertainty. So there’s really a need for more dedicated resources to support that.
Miller: Becca Valek and Katie Iossi, thanks very much.
Valek: Thank you so much.
Iossi: Thank you.
Miller: Becca Valek is research project coordinator at OHSU’s Gun Violence Prevention Research Center. Katie Iossi is a member of that center’s faculty. She is an internal medicine physician at the Portland VA.
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