Hardly a week goes by in the U.S. without a mass shooting, as the recent shooting at a high school in Georgia earlier this month reminds us of. In that tragedy, a 14-year-old student is suspected of killing two students and two teachers with a semiautomatic assault-style rifle which was legally purchased by his father. The National Rifle Association, along with some conservative lawmakers and the gun lobby argue that mental illness is to blame for mass shootings — not the easy access to firearms.
A new study by researchers at Oregon Health & Science University challenges that view. It compared the U.S. to 40 other countries for the prevalence of mental health disorders and deaths from firearms over a 20-year period, from 2000 to 2019. It found, for example, that the firearm death rate was 11 times greater in the U.S. compared to the other nations while the prevalence of mental health disorders in the U.S. was similar. It also found that the firearm death rate in the U.S. had increased, whereas it declined among the other nations. Joining us to share details about the study is Archie Bleyer, a pediatric and young adult oncologist at OHSU.
Note: The following transcript was created by a computer and edited by a volunteer.
Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. According to the Gun Violence Archive, there have been nearly 400 mass shootings in the U.S. so far this year. That’s hardly a complete tally of gun violence in this country. It excludes tens of thousands of other homicides and suicides. The National Rifle Association, along with many conservative lawmakers and the gun lobby often argue that mental illness is to blame.
But a new study by researchers at Oregon Health and Science University challenges that view. It compared the U.S. to 40 other countries, in terms of both the prevalence of mental health disorders and deaths from firearms. It found that over a recent 20-year period, rates of mental illness were relatively similar, but the rate of firearm deaths was over 11 times higher in the U.S. Archie Bleyer is a pediatric and young adult oncologist at OHSU, and he joins us now. It’s great to have you on Think Out Loud.
Archie Bleyer: My co-authors and I thank you for your interest in the problem. Thank you, Dave.
Miller: I just gave your bio there, your short one. You’re a doctor who treats and studies cancers in children and young adults. Folks may be surprised by that, given this is about guns and mental health. What motivated you to change your research focus in recent years?
Bleyer: Actually, more than 50 years ago, almost 55 years ago, I decided on pediatric cancer, pediatric oncology, as my profession. And over that half century, the results have been so excellent that the cure rate went from 10% to 90%. And in its place, instead of being the disease with the highest death rate – cancer in children – we now have bullets as their highest death rate. Higher than any other cause, and continuing to increase. So I had to switch, also for some personal reasons with the experience of other families, from what works so well to what’s not working at all, and go from cancer to firearms.
Miller: For this study, you compared the U.S. to 40 other countries for the prevalence of mental health disorders and firearm deaths. A really diverse set of countries: Kuwait, Sweden, Singapore, dozens of others. How did you choose these countries?
Bleyer: The Institute for Health Metrics and Evaluation at the University of Washington, over the last decade or two, developed an index to find the countries with the highest level of health care and public health in general. They have developed an index called the “Socio-Demographic Index” – SDI – and have found that 40 countries are matched, comparable in regard to the economy, their financial ability, the education of their people, the fertility rate and resources.
And even though it’s a diverse set of countries, including in the middle of the Pacific Ocean and some in South America, Central America, these countries are similar to each other because they have comparable capability to help their people. And that’s why, when the Institute for Health Metrics and Evaluation released its index … the recent data of which at the time we published our results was 2019, so it’s already five years old, although I have some updates we could potentially address. Anyway, when it published its data as of 2019, we were able to take all the countries that are comparable to the United States, and yes, we’re in the high category, and there are 40 other such countries that are very comparable to us in regard to all those parameters. In other words, they’re our peers, and if we compare ourselves with them, we can find out how we’re doing or not doing.
Miller: What kinds of mental health disorders did you focus on?
Bleyer: The index uses what’s well-known across the entire globe, in terms of disorders. There are nine specific mental health disorders that psychiatrists over the years, with all their foundations and governance, have developed as official legitimate diagnoses that can be submitted to the insurance industry and help pay for the patient’s disorder.
There are nine of them, and they span a whole variety from depression, anxiety, attention deficit disorders, behavior disorders, eating issues, etc. And there’s also an overall index that puts all those together, and it’s the sum of the total nine. So there’s 10 individual indices, one which is a composite.
Miller: And were there any significant disparities when you looked at the U.S. and the rest of these 40 countries, in terms of mental health disorders?
Bleyer: Well, if you listen to the majority of the country, including our people who have their belief systems, but also especially the lobbyists and the industry for firearms – including the one you mentioned at the beginning, the National Rifle Association – if you understand what they’re trying to attribute the problem to, you would have to believe that the mental health of our people are worse, because we have the worst firearm suicide, homicide and accidental death rate among our people, by far. Ten to 13 times higher, and for homicides, 18 times higher than all those other countries. If you average them, we’re at least a log [arithmic] factor higher, I mean 10-plus fold higher, in terms of the death rate. So we must have a higher mental disorder rate to explain that, based on the premise that I alluded to.
Well, when we did our analysis, we couldn’t find a single entity out of the nine specific disorders, mental disorders, or the overall rate, in which we were worse. Depending on the index, whether it’s one of those 10, we were somewhere between five and 35 of the 40 countries, and on average, we were no worse than their average. In fact, we were not statistically significantly worse off in any of the 10 categories than any other country among those 40. We were within that group of 40.
Our mental health in the United States may be worse in some states and areas of the country than the average, of course. And it may also be slightly worse in certain categories, or even really worse, although not significantly statistically worse in any category. So, we’re similar to the other 40 countries, but we have the problem and none of them do. None of the 40 have the suicide, homicide and accidental death rate like we have – not even close. In fact, every one of them, with one exception of the 40, has had a decreasing death rate, statistically significant in most cases. We’re going the other direction.
Miller: How do you explain that? Not our increase, because clearly you’re saying it’s because there are ever more guns on the street and in homes here, but the decreases in other countries. What have they done that you think could actually lead to a decrease in deaths from guns?
Bleyer: Well, one of the premises, although, even though you mentioned it as proof, I guess we haven’t proven any of this, but it’s almost likely or certainly statistically … one of the premises is that they don’t have the problem we have because they don’t have access to guns. My grandson spent a year in England. My granddaughter spent some time in Italy, and they just don’t have the guns or prevalence or access to them. It’s amazing they can’t even find the police forces, in general, equipped with firearms. So that’s one obvious explanation.
But they’ve also improved the public health of their country. They’ve helped them in terms of resources, financial, and that’s why they’re in the top 40 countries of the 205 countries and territories of the world. So that’s 40 out of 200. They’re in the top 20-30%. Anyway, the reason they’re up there is because they’re helping their people, they’re reducing public health issues, disease, improving diagnosis and treatment. And they’re having a reduction in their mental health categories, too. That’s because they’re capable of doing it. We should be just like them and capable, too, because we do have public health. In fact, they used to look up to us as how to do better for their people. But then we have the access to what causes bullet injury and death.
Miller: Now that you have this data, what do you want policymakers to do with it?
Bleyer: Well, first of all, because of the premise, stop blaming the country’s mental health problem, and instead of spending effort, time and a lot of the budget to cause the financial issue on helping our people with mental health, or preventing the mental health disorders just so we could reduce the firearm rate. We need to do that anyway, just like the other countries have done it so well, and continue to do better, year to year. We need to do that. No question about that. But to blame the problem, and not to take care of the actual problem, it’s not the mental health that’s causing our increasing death and violence and injury. It’s the access to and the prevalence of our firearms.
So what we want is to reduce the access, safe storage, essentially locked, and being certain that family members know that everybody in their family is aware of that, and so forth. And also the number of guns. We have – this is hard to believe – more than half of the world’s firearms in civilian homes, in civilians’ hands here in the United States. We’re only 4% of the entire world population, yet we have more than half of all the firearms; and when it comes to assault weapons, we have even more than that. We have something like 60, 70% of the world’s assault weapons – if not more, in our homes … not comparing the military or the armed forces of our countries, talking about the homes. We have more than half, almost two-thirds, and yet there’s no other country in the world like that.
Miller: Do you believe that the politics of gun ownership, gun access in this country, can be changed significantly with the introduction of new data?
Bleyer: Yes and no. Unfortunately, our country’s ability to understand numerical, quantitative scientific issues is limited, and it’s become, unfortunately, less. In fact, a colleague here in Oregon has shown that one-third of our population is functionally innumerate and has this inability to understand the science and these results. So even though we’ve published this, I don’t expect – except for you, and Think Out Loud and others to bring this to the attention of our people and our teachers and parents and the governorships of our states, counties, cities and so forth – until we can really make the point by being so public about this, maybe we can indent the problem of understanding science.
So yeah, research reports have become less effective. That’s why I really appreciate this, Dave, and anything that those out there can help, or listening today, with their own local family, community, neighborhood, interactions, would be outstanding.
Miller: Archie Bleyer, thank you very much for your time.
Bleyer: Hey, thank you, Dave, and thank you for bringing this to the attention, just like we discussed at the end here.
Miller: Archie Bleyer is a pediatric and young adult oncologist at the OHSU Knight Cancer Institute. He is a part of a study that disproved the notion, or argued against the notion, that mental illness is a reason the U.S. has a much higher rate of deaths from guns than other countries.
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