year of the suicide, compared with 0.7 percent of controls. After the first year, the relative risk of suicide persisted, but at a much lower level; the median interval from first handgun purchase to suicide with a gun was 10.7 years.

The second study, by Wintemute et al. (1999), reported similar findings in a population-based study of individuals purchasing handguns in California in 1991. This study did not investigate the risk of suicide among the family members of gun purchasers, but the changes in suicide risk over time were presented in more detail. Age and sex-standardized mortality ratios for handgun purchasers were compared with the mortality of the general adult population of California. The risk of suicide in the first week after purchase was 57 times the risk of suicide in the general population, and the risk within the first year was 4.31 times the risk of suicide of the general population. The rates of suicide by firearm within the first six years after handgun purchase are presented graphically in Figure 7-2.

Taken together, these two studies provide strong evidence that some guns are indeed purchased for the purpose of carrying out a planned suicide, but this seems to represent only a small fraction of completed suicides: handguns purchased within the past year were used in about 5 percent of suicides in California, and about 3 percent of suicides in the Washington HMO. However, the focus on legal handgun purchases provides only a lower-bound estimate of the fraction of gun purchases that have occurred

FIGURE 7-2 Rates of suicide by firearm during the six years after purchase among persons who purchased in California in 1991.

NOTE: The horizontal line indicates the age- sex-adjusted average annual rate of suicide by firearms in California for 1991-1995 (10.7 per 100,000 persons per year).

SOURCE: Adapted from Wintemute et al. (1999).

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