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Articles   |    
Change in Suicide Rates in Switzerland Before and After Firearm Restriction Resulting From the 2003 “Army XXI” Reform
Thomas Reisch, M.D.; Timur Steffen, M.A.; Astrid Habenstein, M.D.; Wolfgang Tschacher, Ph.D.
Am J Psychiatry 2013;170:977-984. doi:10.1176/appi.ajp.2013.12091256
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The authors report no financial relationships with commercial interests.

Supported by grant 32003B_133070/1 from the Swiss National Science Foundation.

From University Hospital of Psychiatry Bern and Hospital of Psychiatry Muensingen, Switzerland.

Address correspondence to Dr. Reisch (thomas.reisch@gef.be.ch).

Copyright © 2013 by the American Psychiatric Association

Received September 28, 2012; Revised January 20, 2013; March 13, 2013; May 15, 2013; May 28, 2013; Accepted May 29, 2013.


Objective  Firearms are the most common method of suicide among young men in Switzerland. From March 2003 through February 2004, the number of Swiss soldiers was halved as a result of an army reform (Army XXI), leading to a decrease in the availability of guns nationwide. The authors investigated the patterns of the overall suicide rate and the firearm suicide rate before and after the reform.

Method  Using a naturalistic study design, the authors compared suicide rates before (1995–2003) and after the intervention (2004–2008) in the affected population (men ages 18–43) and in two comparison groups (women ages 18–44 and men ages 44–53). Data were received from the Swiss Federal Statistical Office. Interrupted time series analysis was used to control for preexisting temporal trends. Alternative methods (Poisson regression, autocorrelation analysis, and surrogate data tests) were used to check validity.

Results  The authors found a reduction in both the overall suicide rate and the firearm suicide rate after the Army XXI reform. No significant increases were found for other suicide methods overall. An increase in railway suicides was observed. It was estimated that 22% of the reduction in firearm suicides was substituted by other suicide methods. The attenuation of the suicide rate was not compensated for during the follow-up years. Neither of the comparison groups showed statistically significant changes in firearm suicide rate and overall suicide rate.

Conclusions  The restriction of firearm availability in Switzerland resulting from the Army XXI reform was followed by an enduring decrease in the general suicide rate.

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firearms ; suicide ; army
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FIGURE 1. Effect of the 2003 Army XXI Legislation on Number of Soldiers in Switzerlanda

a Data from the Swiss Federal Department of Defense, 2008.

FIGURE 2. Suicide Rates in Switzerland Before and After Implementation of the 2003 Army XXI Reforma

a The Army XXI reform was implemented during the period from March 1, 2003, to the end of February 2004. Each depicted year reflects the overall suicide rate of a 12-month period starting in March and ending in February of the following year. In 2008, data could be included until December 31, 2008; the suicide rate for 2008 was adjusted accordingly.

***p<0.001. n.s.=not significant.

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TABLE 1.Poisson Regression Analysis for the Factual Time of the Intervention and Surrogate Versions of Intervention Timing
Table Footer Note

a Difference: reduced model minus full model.

Table Footer Note

* p<0.05. **p<0.01. ***p<0.001.



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