• Jeffrey W Swanson, E Elizabeth McGinty, Seena Fazel, and Vickie M Mays.
• Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC. Electronic address: jeffrey.swanson@duke.edu.
• Ann Epidemiol. 2015 May 1;25(5):366-76.

PurposeThis article describes epidemiologic evidence concerning risk of gun violence and suicide linked to psychiatric disorders, in contrast to media-fueled public perceptions of the dangerousness of mentally ill individuals, and evaluates effectiveness of policies and laws designed to prevent firearms injury and mortality associated with serious mental illnesses and substance use disorders.MethodsResearch concerning public attitudes toward persons with mental illness is reviewed and juxtaposed with evidence from benchmark epidemiologic and clinical studies of violence and mental illness and of the accuracy of psychiatrists' risk assessments. Selected policies and laws designed to reduce gun violence in relation to mental illness are critically evaluated; evidence-based policy recommendations are presented.ResultsMedia accounts of mass shootings by disturbed individuals galvanize public attention and reinforce popular belief that mental illness often results in violence. Epidemiologic studies show that the large majority of people with serious mental illnesses are never violent. However, mental illness is strongly associated with increased risk of suicide, which accounts for over half of US firearms-related fatalities.ConclusionsPolicymaking at the interface of gun violence prevention and mental illness should be based on epidemiologic data concerning risk to improve the effectiveness, feasibility, and fairness of policy initiatives.Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

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