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König D, Swoboda P, Cramer RJ, Krall C, Postuvan V, Kapusta ND. Austrian firearm legislation and its effects on suicide and homicide mortality: A natural quasi-experiment amidst the global economic crisis. Eur Psychiatry 2020; 52:104-112. [DOI: 10.1016/j.eurpsy.2018.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 12/22/2022] Open
Abstract
AbstractBackground:Restriction of access to suicide methods has been shown to effectively reduce suicide mortality rates.Aims:To examine how the global economic crisis of 2008 and the firearm legislation reform of 1997 affected suicide and homicide mortality rate within Austria.Methods:Official data for the years 1985–2016 for firearm certificates, suicide, homicide, unemployment rates and alcohol consumption were examined using auto regressive error and Poisson regression models.Results:Firearm certificates, total suicide mortality rate, suicide and homicides by firearms, and the fraction of firearm suicides/homicides among all suicides/homicides decreased after the firearm legislation reform in 1997. However, significant trend changes can be observed after 2008. The availability of firearm certificates significantly increased and was accompanied by significant changes in trends of firearm suicide and homicide rates. Concurrently, the total suicide mortality rate in 2008, for the first time since 1985, stopped its decreasing trend. While the total homicide rate further decreased, the fraction of firearm homicides among all homicides significantly increased.Conclusion:The initially preventative effect of the firearm legislation reform in Austria in 1997 seems to have been counteracted by the global economic downturn of 2008. Increased firearm availability was associated with corresponding increases in both firearm suicide and firearm homicide mortality. Restrictive firearm legislation should be an imperative part of a country’s suicide prevention programme. Although firearm legislation reform may have long-lasting effects, societal changes may facilitate compensatory firearm acquisitions and thus counteract preventive efforts, calling in turn again for adapted counter-measures.
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Anestis MD, Houtsma C. What I have is what I am: Differences in demographics, suicidal thoughts and behaviors, and firearm behavior and beliefs between firearm owners who do and do not primarily identify as firearm owners. J Psychiatr Res 2019; 116:157-165. [PMID: 31247359 DOI: 10.1016/j.jpsychires.2019.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/27/2019] [Accepted: 06/18/2019] [Indexed: 01/21/2023]
Abstract
Non-legislative forms of means safety (i.e., safe firearm storage practices) have been promoted as a way to reduce elevated suicide risk found among firearm owners. However, evidence suggests that some firearm owners are less willing than others to engage in these practices. The current study aimed to understand factors that differentiate firearm owners' beliefs and behaviors that are relevant to suicide risk by examining differences between individuals for whom firearm ownership represents a central aspect of identity (i.e., primary firearm owners) versus firearm owners who primarily identify with some other demographic or occupational characteristic. Results of main analyses revealed that primary firearm owners were more likely to be male, were less likely to have experienced suicidal ideation, were less likely to store their firearms safely across a number of storage methods, and were less open to means safety across all storage methods. These findings highlight demographically which firearm owners may be more likely to view firearm ownership as central to their identity and also suggest that this identification may be associated with beliefs and behaviors that increase suicide risk. Future firearm suicide prevention efforts should focus on culturally competent discussions and messaging to find common ground with firearm owners and to increase the salience of suicide among firearm owners.
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Jager-Hyman S, Benjamin Wolk C, Ahmedani BK, Zeber JE, Fein JA, Brown GK, Byeon YV, Listerud H, Gregor CA, Lieberman A, Beidas RS. Perspectives from firearm stakeholders on firearm safety promotion in pediatric primary care as a suicide prevention strategy: a qualitative study. J Behav Med 2019; 42:691-701. [PMID: 31367934 PMCID: PMC7603788 DOI: 10.1007/s10865-019-00074-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
The primary objective of the current study was to examine the perspective of firearm stakeholders, including firearm safety course instructors, members of law enforcement, and firearm retailers, with regard to the implementation of an evidence-based approach to firearm safety promotion, the Firearm Safety Check, as a universal suicide prevention strategy in pediatric primary care. Twelve firearm stakeholders participated in semi-structured interviews. Using an integrated analytic approach, several themes emerged from the interviews. With regard to acceptability of the intervention, participants generally found counseling caregivers to store firearms safely and the provision of firearm locking mechanisms to be acceptable, but expressed concern about screening for firearm ownership in health systems. Participants identified distinct roles of responsibility for firearm advocacy groups, firearm owners, healthcare clinicians, and caregivers with regard to the promotion and execution of safe firearm storage. Participants called for partnerships between healthcare systems and firearm stakeholders, and also identified potential threats to these partnerships, including lack of trust firearm owners may have in health systems and the government. Finally, participants suggested strategies for preventing firearm-related suicides. Findings support a growing body of literature suggesting the value in researchers, health systems, and firearm stakeholders partnering around a shared agenda of firearm safety promotion as a strategy to prevent suicide.
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Affiliation(s)
- Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA
| | - Brian K Ahmedani
- Henry Ford Health System, Center for Health Policy and Health Services Research and Behavioral Health Services, One Ford Place, Suite 3A, Detroit, MI, 48202, USA
| | - John E Zeber
- School of Public Health, University of Massachusetts at Amherst, 317 Arnold House, Amherst, MA, 01003, USA
- Department of Research, Central Texas Veterans Health Care System, 1901 1st Street, Temple, TX, 76502, USA
| | - Joel A Fein
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, The Perelman School of Medicine at The University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Gregory K Brown
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA
| | - Y Vivian Byeon
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA
| | - Hannah Listerud
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA
| | - Courtney A Gregor
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA
| | - Adina Lieberman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA.
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Youth exposure to violence involving a gun: evidence for adverse childhood experience classification. J Behav Med 2019; 42:646-657. [PMID: 31367930 DOI: 10.1007/s10865-019-00053-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/30/2019] [Indexed: 01/13/2023]
Abstract
Adverse childhood experiences (ACEs) have historically included child maltreatment, household dysfunction, and other critical issues known to impact children negatively. Although youth experiences with violence are broadly captured in some ACE measures, youth exposure to violence involving a gun has not been included specifically in the operationalizing, and therefore scientific study, of ACEs. There are numerous implications of this omission, including limiting access to ACE interventions that are currently available and resources for individuals who have been exposed to gun violence. Thus, and given the persistent prevalence of gun violence in the US, we conducted a systematic review of the literature over the past two decades on the assessment of and response to ACEs and gun violence. Eighty-one journal articles across four search engines met our inclusion criteria. Our findings provide evidence that youth gun violence exposure should be classified as an ACE. In addition to increasing access to resources for youth affected by gun violence, these findings may improve the likelihood of funding and research into gun violence, with direct implications for prevention and intervention efforts.
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Ghiani M, Hawkins SS, Baum CF. Associations Between Gun Laws and Suicides. Am J Epidemiol 2019; 188:1254-1261. [PMID: 30874719 DOI: 10.1093/aje/kwz069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 01/08/2023] Open
Abstract
We examined the impact of a state gun law environment on suicides overall and within demographic subgroups. We linked 211,766 firearm suicides and 204,625 nonfirearm suicides in the 50 states of the United States for 2005-2015 to the population in each state, year, race/ethnicity, sex, and age, as well as to an index of state-level gun control. Difference-in-differences, zero-inflated, negative-binomial models were used to evaluate the impact of strengthening gun control on firearm and nonfirearm suicides. We subsequently stratified by sex and tested for interactions with race/ethnicity and age. We found 25 states strengthened gun control by an average of 6 points. Such an increase may result in a 3.3% (incidence rate ratio = 0.967; 95% confidence interval: 0.938, 0.996) decrease in firearm suicides. Although no impact on nonfirearm suicides was found overall, interaction models showed an increase in nonfirearm suicides among black men, white women, black women, and older individuals. Strengthening gun control may reduce firearm suicides overall but may increase nonfirearm suicides in some populations. The results indicate stricter gun laws should be advocated for and that additional policies are needed for populations who shifted to nonfirearm suicides.
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Affiliation(s)
- Marco Ghiani
- Department of Economics, Boston College, Chestnut Hill, Massachusetts
| | | | - Christopher F Baum
- Department of Economics, Boston College, Chestnut Hill, Massachusetts
- Department of Macroeconomics, German Institute for Economic Research
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Anestis MD, Houtsma C, Daruwala SE, Butterworth SE. Firearm legislation and statewide suicide rates: The moderating role of household firearm ownership levels. BEHAVIORAL SCIENCES & THE LAW 2019; 37:270-280. [PMID: 31087580 DOI: 10.1002/bsl.2408] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
Firearm legislation is associated with statewide suicide rates; however, prior research has often relied upon older data and categorical legislative grades while also failing to consider the nuanced role of firearm ownership. Therefore, the robust literature base on legislation and suicide has not directly examined regarding the extent to which the value of legislation hinges upon the rate of firearm ownership in a given state. The current study examined 2015 US statewide firearm legislation strength scores from Giffords Law Center to Prevent Gun Violence and 2016 statewide suicide rates from the Centers for Disease Control and Prevention. Firearm legislation strength was inversely associated with statewide overall and firearm suicide rates, but not with non-firearm suicide rates. Firearm ownership rates moderated the association between firearm legislation strength and statewide overall suicide rates. Specifically, firearm legislation strength was inversely associated with statewide overall suicide rates at mean and high levels of firearm ownership. Findings support the potential utility of firearm legislation as part of a national effort to decrease US suicide deaths, particularly in areas with higher firearm ownership rates.
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Affiliation(s)
- Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Claire Houtsma
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Samantha E Daruwala
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Sarah E Butterworth
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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Affiliation(s)
- Eric Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Reeping PM, Cerdá M, Kalesan B, Wiebe DJ, Galea S, Branas CC. State gun laws, gun ownership, and mass shootings in the US: cross sectional time series. BMJ 2019; 364:l542. [PMID: 30842105 PMCID: PMC6402045 DOI: 10.1136/bmj.l542] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether restrictiveness-permissiveness of state gun laws or gun ownership are associated with mass shootings in the US. DESIGN Cross sectional time series. SETTING AND POPULATION US gun owners from 1998-2015. EXPOSURE An annual rating between 0 (completely restrictive) and 100 (completely permissive) for the gun laws of all 50 states taken from a reference guide for gun owners traveling between states from 1998 to 2015. Gun ownership was estimated annually as the percentage of suicides committed with firearms in each state. MAIN OUTCOME MEASURE Mass shootings were defined as independent events in which four or more people were killed by a firearm. Data from the Federal Bureau of Investigation's Uniform Crime Reporting System from 1998-2015 were used to calculate annual rates of mass shootings in each state. Mass shooting events and rates were further separated into those where the victims were immediate family members or partners (domestic) and those where the victims had other relationships with the perpetrator (non-domestic). RESULTS Fully adjusted regression analyses showed that a 10 unit increase in state gun law permissiveness was associated with a significant 11.5% (95% confidence interval 4.2% to 19.3%, P=0.002) higher rate of mass shootings. A 10% increase in state gun ownership was associated with a significant 35.1% (12.7% to 62.7%, P=0.001) higher rate of mass shootings. Partially adjusted regression analyses produced similar results, as did analyses restricted to domestic and non-domestic mass shootings. CONCLUSIONS States with more permissive gun laws and greater gun ownership had higher rates of mass shootings, and a growing divide appears to be emerging between restrictive and permissive states.
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Affiliation(s)
- Paul M Reeping
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University, Langone School of Medicine, New York, NY, USA
| | - Bindu Kalesan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Douglas J Wiebe
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
| | - Charles C Branas
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
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Joseph K, Turner P, Barry L, Cooper C, Danner O, Enumah S, Hayanga JWA, James I, Oppong B, Gibson CQ, Stanford A, Thomas Y, Weaver WL, Williams M, Young C, Britt L. Reducing the impact of violence on the health status of African-Americans: Literature review and recommendations from the Society of Black Academic Surgeons. Am J Surg 2018; 216:393-400. [DOI: 10.1016/j.amjsurg.2018.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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