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San Antonio Combat PTSD conference shifts its focus toward preventing firearm injuries

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U.S. Air Force photo illustration By Senior Airman Erica Fowler, 375th Air Mobility Wing Public Affairs
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Months after a lone gunman killed 21 people at Robb Elementary School in Uvalde, firearms have become a hot-button issue in midterm races in Texas and around the country. But the shooting has also created opportunities for dialogue about the relationship between guns and other forms of harm – like suicide.

Gun safety was a major topic of conversation at San Antonio’s annual Combat PTSD Conference this year. Experts from around the country gathered to share the latest research on the treatment and prevention of post-traumatic stress among service members and veterans. But the conversation didn’t stop at mental health.

Dr. Craig Bryan of Ohio State University spoke about firearm access, something he and others consider the third rail of suicide prevention.

“When we do talk about gun violence, it oftentimes is within the context of mass shootings, mass violence, and homicide, which is incredibly important to talk about,” Bryan said. “At the same time, this is mostly a suicide issue.”

Two thirds of all gun deaths in the United States are suicides, and over half of all suicides involve guns. Bryan said he believes that researchers need to devote more time to studying lethal means and how they influence behavior.

“Within our society, we have for so long messaged that suicide is a symptom or outcome of mental illness and psychological distress that we've completely ignored the ‘how’ of suicide,” Bryan explained.

His research found that 67% of servicemembers who die by suicide use a firearm while more than half of servicemembers who die by suicide don’t have a mental illness. On top of that, the majority of military personnel with firearms in their home don’t practice safe storage.

“Locking devices and other secure storage practices can slow a person down when they're experiencing a suicidal crisis. That extra few seconds or minutes could be enough to save their lives.”

Bryan said he believes Americans are becoming more open to understanding the role of firearms in suicide – and that gun owners should think of safe storage as just another way of protecting themselves and their families.

Trauma and gun violence

A San Antonio surgeon who treated victims of the Uvalde and Sutherland Springs shootings spoke out about the relationship between trauma and gun violence. To prevent suicide and other forms of intentional harm, he said we need to develop a broader understanding of what trauma is — and how it cycles.

“Part of the risk for PTSD is the perception of a life threatening event. So for people with severe injuries, it's very common that they also have psychological trauma that may result in PTSD. It may result in anxiety, may result in depression,” said Dr. Ronald Stewart, chair of the department surgery at UT Health San Antonio and University Health.

He pointed out that physical trauma and psychological trauma are two sides of the same coin.

“Trauma is a physical or emotional injury that potentially has a lifelong impact on the person's wellbeing… Physical trauma often leads to psychological trauma, and psychological trauma often predisposes one to lifelong physical injury later on.”

Stewart has served as part of the American College of Surgeons Committee on Trauma, which develops programs that support injury prevention and best practices for trauma patients.

“One of its highest goals was firearm injury prevention: working on preventing injury, disability, and death related to firearms. If you look at all intentional injuries, firearms make up about 60 to 65 percent of those.”

Stewart advocates a community-based approach to the problem of gun violence, one that considers the conditions in which people are born, grow, live, work and age. Socioeconomic status, education, neighborhood and physical environment, employment, social support networks, and access to health care are all part of that equation.

Stewart believes it’s possible to come up with a common narrative with respect to firearm injury prevention that acknowledges that constitutionally-protected nature of firearm ownership, as well as the epidemic of violence and firearm-related injury and death.

“In the United States, everyone — myself included — we own the culture of violence. We own it and we all have the ability to influence pieces of it.”

The Military Desk at Texas Public Radio is made possible in part by North Park Lincoln and Rise Recovery.

Carson Frame can be reached carson@tpr.org and on Twitter at @carson_frame