Much debate on Maine’s Question 3 — expanding firearm background checks — centered on how to keep firearms from people who wish to harm others. Yet the issue has another, less discussed side: people who want to harm themselves.

The overwhelming majority of gun fatalities in Maine are suicides, according to CDC data. In Lincoln County, for example, every firearm death between 2010 and 2014 was a suicide. In Hancock County, which had the lowest rate of suicides by gun, self-inflicted gun deaths still accounted for 75 percent.

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This is why many viewed Question 3, the failed bid to expand background checks to private gun sales and transfers, as a public health issue.

Voters rejected the measure, but this fact remains: Guns, overall, are clearly the deadliest method of suicide. While they aren’t the most common method by which people attempt suicide, firearms are the most common way people complete suicide.

In Maine, more than half of overall suicides are by gun. Most of those deaths are among men, who are particularly likely to turn to a firearm.

Veterans are also likelier than civilians to take their own lives using a firearm. Nationally, 67 percent of all veteran suicide deaths in 2014 resulted from firearm injuries, according to the U.S. Department of Veterans Affairs.

A suicidal person who overdoses or slits their wrists might still be able to call for help. With a gun, however, pulling the trigger makes death more certain.

Advocates of Question 3 argued that fewer guns in circulation would mean fewer in the hands of suicidal people. Opponents pointed out that safeguards are already in place to keep guns out of the hands of the mentally ill.

Before we dive further into that debate, let’s first examine how background checks work in regard to the mentally ill. To better understand that, I visited the Cabela’s in Scarborough for an educational exercise: running through a federal background check myself.

There are two questions about mental health on a current gun background check.

Have you ever been adjudicated mentally defective OR have you ever been committed to a mental institution?

If you answer yes to either, you generally can’t buy a gun, though there are exceptions.

People found by the courts as mentally defective include those deemed incompetent to stand trial or not guilty by reason of insanity.

A firearms retailer can check if you’ve answered truthfully to the first part of this question, since brushes with the court system show up in the federal database. Gun control advocates point out there’s often a lag between when those records get reported by the courts and when they show up in the federal system, though Maine has made progress in this reporting in recent years.

(In 2015, Maine courts reported 468 mental health cases that would prohibit individuals from buying a gun. That’s down from 581 in 2014 and 499 in 2013, but an increase from 364 in 2012.)

As for the second part of the question, it’s not easy for even a doctor to view your mental health records, much less a gun retailer. Someone who has been committed could lie and potentially still purchase a gun, though they could get in trouble later for falsifying a federal form.

Are you an unlawful user of, or addicted to, marijuana or any depressant, stimulant, narcotic drug, or any other controlled substance?

Answer “yes” and you can’t buy a gun. (Again, this question relies on the honor system.) I learned at Cabela’s that it’s not uncommon for individuals with medical marijuana cards to try to purchase firearms, unaware that marijuana remains illegal to the federal government. Those cards amount to a “do not pass go” for anyone who wants to buy a gun legally.

Background checks don’t identify suicidal people.

The background check form does not ask if the gun buyer is depressed or suicidal. Even if Question 3 had passed, it would not have changed that. It didn’t seek to alter or add any questions to the existing background check.

It’s fair to assume that many, if not most, people who are suicidal have never been deemed insane by a court or involuntarily committed to a mental institution. Those individuals will continue to pass a background check.

Advocates of Question 3 contended that even the few minutes it takes to complete the form could be the difference for someone contemplating taking their own life. It might slow the downward spiral just enough that they reconsider or get help, they said.

Opponents pointed out that even people with a history of severe depression shouldn’t lose their Second Amendment rights to bear arms. Think of the veteran who has recovered from post-traumatic stress disorder and wants a gun to go hunting, they say.

In the middle of this debate is the gun seller, who can deny a gun sale if they suspect an individual is suicidal. This kind of diagnosis is no small feat, though, even for a mental health professional under such circumstances.

Given all this, research is mixed on the relationship between background checks and suicide.

Advocates of Question 3 argued that there are 48 percent fewer gun suicides in states requiring background checks for private handgun sales, according to an analysis by Everytown for Gun Safety, a national gun control group.

Whether background checks are the cause of this trend is debatable, though, and Everytown even acknowledges that “the mechanism by which background checks affect overall suicide rates is not entirely clear.”

However, research supports the general idea that suicides are more common in places where guns are more common. A 2013 study found a strong relationship between higher suicides rates and higher rates of gun ownership.

“Cut it however you want: In places where exposure to guns is higher, more people die of suicide,” Deborah Azrael, associate director of the Harvard Youth Violence Prevention Center, said in a special report on guns published by the university’s magazine.

Yet opponents of Question 3 pointed to a 2000 study published in the Journal of the American Medical Association, which found that the 1994 Brady Act — a law instituting background checks and, initially, waiting periods — did not reduce overall suicide rates.

It did suggest that the Brady Act was associated with a drop in the gun suicide rate for people aged 55 years and older, but whether that was due to background checks, the waiting period or both was again unclear.

That’s just some of the research, and there’s still plenty we don’t know about the relationship between background checks and suicide. For example, how many guns used in suicides were purchased through private sales versus firearms retailers? Do the guns used in suicides typically belong to the victim, or to someone else in the family?

These are questions that require much more research to answer. In the meantime, in Maine, guns remain an inarguable part of how and why someone dies by suicide every 39 hours.

We can’t know whether expanding background checks would have slowed that clock, but it will keep ticking long after the debate over Question 3 fades.

Jackie Farwell

I'm the health editor for the Bangor Daily News, a Bangor native, a UMaine grad, and a weekend crossword warrior. I never get sick of writing about Maine people, geeking out over health care data, and...