Firearm suicides and homicides in the United States: regional variations and patterns of gun ownership

Assessment of Firearm Storage Practices in the US, 2022

IMPORTANCE

Secure firearm storage may help reduce firearm injury and death. Broad implementation requires more granular assessments of firearm storage practices and greater clarity on circumstances that may prevent or promote the use of locking devices.

OBJECTIVE

To develop a more thorough understanding of firearm storage practices, obstacles to using locking devices, and circumstances in which firearm owners would consider locking unsecured firearms.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional, nationally representative survey of adults residing in 5 US states who owned firearms was administered online between July 28 and August 8, 2022. Participants were recruited via probability-based sampling.

MAIN OUTCOMES AND MEASURES

Firearm storage practices were assessed via a matrix provided to participants in which firearm-locking devices were described both via text and images. Locking mechanisms (key/personal identification number [PIN]/dial vs biometric) were specified for each type of device. Obstacles to the use of locking devices and circumstances in which firearm owners would consider locking unsecured firearms were assessed via self-report items developed by the study team.

RESULTS

The final weighted sample included 2152 adult (aged ≥18 years), English-speaking firearm owners residing in the US; the sample was predominantly male (66.7%). Among the 2152 firearm owners, 58.3% (95% CI, 55.9%-60.6%) reported storing at least 1 firearm unlocked and hidden, with 17.9% (95% CI, 16.2%-19.8%) reporting storing at least 1 firearm unlocked and unhidden. Gun safes were the most frequently used device both among participants who use keyed/PIN/dial locking mechanisms (32.4%; 95% CI, 30.2%-34.7%) and those who use biometric locking mechanisms (15.6%; 95% CI, 13.9%-17.5%). Those who do not store firearms locked most frequently noted a belief that locks are unnecessary (49.3%; 95% CI, 45.5%-53.1%) and a fear that locks would prevent quick access in an emergency (44.8%; 95% CI, 41.1%-48.7%) as obstacles to lock usage. Preventing access by children was the most often reported circumstance in which firearm owners would consider locking unsecured firearms (48.5%; 95% CI, 45.6%-51.4%).

CONCLUSIONS AND RELEVANCE

In this survey study of 2152 firearm owners, consistent with prior research, unsecure firearm storage was common. Firearm owners appeared to prefer gun safes relative to cable locks and trigger locks, indicating that locking device distribution programs may not match firearm owners' preferences. Broad implementation of secure firearm storage may require addressing disproportionate fears of home intruders and increasing awareness of the risks associated with household firearm access. Furthermore, implementation efforts may hinge on broader awareness of the risks of ready firearm access beyond unauthorized access by children.

Suicide in Switzerland: why gun ownership can be deadly

There is a great deal of empirical evidence that owning a firearm increases the risk of dying from suicide. Most suicides are impulsive. Nearly 50% of survivors of suicide attempts report that they took less than 10 minutes between the decision to die and their suicide attempt. The great majority of these suicide survivors never make another attempt and die of natural causes. Because nearly 90% of firearm suicide attempts have a deadly outcome, gun owners are unlikely to have such a second chance. These impulsive suicide attempts are typically carried out with the means at hand. Swiss men have much higher firearm suicide rates than men in other European countries and this excess is likely to be due to their easy access to guns, because army conscripts have to keep their guns at home. When the number of conscripts was nearly halved in 2003/4 as a result of the Swiss Army Reform XXI, the number of army-issued firearms was reduced by an estimated 20%. An analysis of suicide rates before and after the reform indicated that male (but not female) suicide rates decreased by 8%, with no evidence of substitution with other means of suicide. If the army would require that the remaining half of conscripts had to keep their weapons at their barracks rather than at home, a further decrease in male suicide rates could be expected.

County-Level Variation in Changes in Firearm Mortality Rates Across the US, 1989 to 1993 vs 2015 to 2019

IMPORTANCE

Firearm violence remains a critical public health challenge, disproportionately impacting some US regions. County-level variation may hold key insights into how firearm mortality rates vary across the US.

OBJECTIVE

To model county-level changes in firearm mortality rates (total, homicide, and suicide) from 1989 to 1993 vs 2015 to 2019 and identify and characterize hot spots showing unexpected changes over time.

DESIGN, SETTING, AND PARTICIPANTS

This is a cross-sectional study with 2 time points using a novel small area estimation method to analyze restricted access mortality microdata by cause of death and US county. The analysis included 3111 US counties from 49 states and the District of Columbia from January 1, 1989, to December 31, 2019. Bayesian spatial models were fitted to map geographical variation in changes in age-standardized firearm mortality rates (per 100 000 person-years) from 1989 to 1993 vs 2015 to 2019. County outliers (or hot spots) were defined as having observed rates that fell outside the 95% credible intervals of their expected posterior predictive distribution. These counties were characterized using visualization and descriptive statistics of their characteristics. Data were analyzed from June to December 2021.

EXPOSURES

County of residence.

MAIN OUTCOMES AND MEASURES

Five-year age-standardized mortality rates by US county, age, and cause of death for 1989 to 1993 and 2015 to 2019.

RESULTS

Between 1989 and 2019, 1 036 518 firearm deaths were recorded in counties across the US. Suicide was the most common cause of firearm mortality (589 285 deaths) followed by homicide (412 231 deaths). Age-standardized rates (deaths per 100 000 individuals) for firearm deaths and suicides increased from 1989 to 1993 vs 2015 to 2019 (mean [SD] change, 0.16 [8.78] for firearm deaths and 1.21 [6.91] for suicides), while firearm homicides decreased (mean [SD] change, -0.39 [3.96]). However, these national trends were not homogeneous across counties and often varied by geographical region. The West and Midwest showed the most pronounced increases in firearm suicide rates, whereas the Southeast showed localized increases in firearm homicide rates, despite the national decreasing trend. Critical hot spots were identified in urban counties of Alabama, and firearm homicide rates (per 100 000) in Baltimore City, Maryland, almost doubled from 29.71 to 47.43, and by 2015 to 2019 it accounted for 66.7% of all firearm homicide in Maryland. By contrast, District of Columbia showed promising improvements over time, decreasing from 56.5 firearm homicides per 100 000 in 1989 to 1993 to 14.45 in 2015 to 2019.

CONCLUSIONS AND RELEVANCE

There was substantial variation in rates and changes in firearm deaths among US counties. Geographical hot spots may be useful to inform targeted prevention efforts and local policy responses.

Role of Firearm Ownership on 2001-2016 Trends in U.S. Firearm Suicide Rates

INTRODUCTION

In the U.S., state-level household firearm ownership is strongly associated with firearm suicide mortality rates. Whether the recent increases in firearm suicide are explained by state-level household firearm ownership rates and trends remains unknown.

METHODS

Mortality data from the U.S. National Vital Statistics System and an estimate of state-level household firearm ownership rate were used to conduct hierarchical age-period-cohort (random-effects) modeling of firearm suicide mortality between 2001 and 2016. Models were adjusted for individual-level race and sex and for state-level poverty rate, unemployment rate, median household income in U.S. dollars, population density, and elevation.

RESULTS

Between 2001 and 2016, the crude national firearm suicide mortality rate increased from 6.8 to 8.0 per 100,000, and household firearm ownership rate remained relatively stable, at around 40%. Both variables were markedly heterogeneous and correlated at the state level. Age-period-cohort models revealed period effects (affecting people across ages) and cohort effects (affecting specific birth cohorts) underlying the recent increases in firearm suicide. Individuals born after 2000 had higher firearm suicide rates than most cohorts born before. A 2001-2006 decreasing period effect was followed, after 2009, by an increasing period effect that peaked in 2015. State-level household firearm ownership rates and trends did not explain cohort effects and only minimally explained period effects.

CONCLUSIONS

State-level firearm ownership rates largely explain the state-level differences in firearm suicide but only marginally explain recent increases in firearm suicide. Although firearms in the home increase firearm suicide risk, the recent national rise in firearm suicide might be the result of broader, more distal causes of suicide risk.

Patterns and Trends of Gun Violence Against Women in the United States

OBJECTIVE

To examine patterns and trends of firearm injuries in a nationally representative sample of US women.

SUMMARY OF BACKGROUND DATA

Gun violence in the United States exceeds rates seen in most other industrialized countries. Due to the paucity of data little is known regarding demographics and temporal variations in firearm injuries among women.

METHODS

Data were extracted from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System (2001-2017) for women 18 years and older. Number of nonfatal firearm assaults and homicide per year were extracted and crude population-based injury rates were calculated. Sub-stratification by age-group and time period were performed.

RESULTS

Between 2001 and 2017, there were 88,823 nonfatal firearm assaults involving women and 29,106 firearm homicides. There were 4116 victims of nonfatal firearm assault in 2001 (3.8 per 105) and 12,959 by 2017 (10.0 per 105). Homicide rates were 1.5 per 105 in 2001 and 1.7 per 105 in 2017. Sub-stratification by age-group and time period showed that there were no significant changes in nonfatal firearm assault rates between 2001 and 2010 (P-trend = 0.132 in 18-44 yo; 0.298 in 45-64 yo). However between 2011 and 2017, nonfatal assault rates increased from 7.10 per 105 to 19.24 per 105 in 18-44 yo (P-trend = 0.013) and from 1.48 per 105 to 3.93 per 105 in 45-64 yo (P-trend = 0.003). Similar trends were seen with firearm homicide among 18-44 yo (1.91 per 105 to 2.47 per 105 in 2011-2017, P-trend = 0.022). However, the trends among 45-64 yo were not significant in both time periods.

CONCLUSIONS

Female victims of gun violence are increasing and more recent years have been marked with higher rates of firearm injuries, particularly among younger women. These data suggest that improved public health strategies and policies may be beneficial in reducing gun violence against US women.

From Regression Analysis to Deep Learning: Development of Improved Proxy Measures of State-Level Household Gun Ownership

In the absence of direct measurements of state-level household gun ownership (GO), the quality and accuracy of proxy measures for this variable are essential for firearm-related research and policy development. In this work, we develop two highly accurate proxy measures of GO using traditional regression analysis and deep learning, the former accounting for non-linearities in the covariates (portion of suicides committed with a firearm [FS/S] and hunting license rates) and their statistical interactions. We subject the proxies to extensive model diagnostics and validation. Both our regression-based and deep-learning proxy measures provide highly accurate models of GO with training R² of 96% and 98%, respectively, along with other desirable qualities-stark improvements over the prevalent FS/S proxy (R² = 0.68). Model diagnostics reveal this widely used FS/S proxy is highly biased and inadequate; we recommend that it no longer be used to represent state-level household gun ownership in firearm-related studies.

A descriptive medico-legal study of female deaths in cairo governorate, Egypt

BACKGROUND

Mortality is conditioned by biological, political and social factors, as well as by culturally defined behaviors and attitudes that historically characterize the stage of development of a country or a region. Women are often in great danger, where they should be safest. Violence against women is the most pervasive yet the least recognized human rights violation in the world. It is a profound health problem and femicide, is often the tragic end-point of violence. Females represent more than half of the Egyptian population, however, they remain vulnerable.

AIM OF THE STUDY

To describe and analyze data obtained from Zeinhom Morgue records in Cairo, regarding female deaths, throughout two years. To evaluate female deaths regarding age, cause, manner of death, location, perpetrator and motive. To describe the incidence of female homicides and their related injury patterns. To identify the risk factors and nature of violence from victimologic point of view. Finally, to describe the manner of death whether natural, homicidal, suicidal or accidental aiming for early identification of vulnerable females so that actions can be taken to prevent further mortality.

SUBJECTS AND METHODS

This is a national two year retrospective descriptive mortuary based study. The study population comprised of all adult females, aged 18 years and older, whose death was suspicious and medico-legal examination was ordered. Each investigation included a detailed case history, investigation, gross examination, histo-pathological and toxicological examinations. Data was collected from autopsy reports, hospital records and police records. From the available data the victim profile was made.

RESULTS

All female deaths aged 18 years and older were retrospectively reviewed for 2 years at Zeinhom morgue of Medico-legal Authority from a total of 1858 autopsy cases. The most common manner of death was homicide. The commonest cause of death in homicides was due to sharp traumatic injuries. Natural death was the least common manner of death and ischemic heart disease constituted the commonest cause. Falling from height was the most common method of suicidal related deaths. Regarding poisoned cases, insecticides and carbon monoxide were the most common detected poisons. According to the cause of death (trauma), blunt trauma injuries were the most common. Falling from height constituted the largest percent of cases under this group.

CONCLUSION AND RECOMMENDATIONS

Females in the third decade of life with blunt injuries to the head and neck were the majority of adult female autopsies. Homicide was the most common manner of female death using sharp instruments after domestic arguments mainly by a spouse or relative. Accidental death came second mainly due to post-operative complications. In cases of suicide, falling from height was the commonest cause followed by poisoning. These findings could be useful for forensic pathologists and healthcare promoters in predicting and preventing female deaths. Moreover, this emphasizes the need for raising public awareness about the scale of female violence problem in our society. The results of this study indicates that, by not only a strong legal support network, but also by opportunities for economic independency, essential education and awareness, alternative accommodation and a change in attitude and mindset of society, judiciary, legislature, executive, men and most importantly women themselves can lower or even prevent such deaths specially suicidal.

Household Gun Ownership and Youth Suicide Rates at the State Level, 2005-2015

INTRODUCTION

Determining whether the prevalence of gun ownership is associated with youth suicide is critical to inform policy to address this problem. The objective of this study is to investigate the relationship between the prevalence of household gun ownership in a state and that state's rate of youth suicide.

METHODS

This study, conducted in 2018, involved a secondary analysis of state-level data for the U.S. using multivariable linear regression. The relationship between the prevalence of household gun ownership and youth (aged 10-19 years) suicide rates was examined in a time-lagged analysis of state-level household gun ownership in 2004 and youth suicide rates in the subsequent decade (2005-2015), while controlling for the prevalence of youth suicide attempts and other risk factors.

RESULTS

Household gun ownership was positively associated with the overall youth suicide rate. For each 10 percentage-point increase in household gun ownership, the youth suicide rate increased by 26.9% (95% CI=14.0%, 39.8%).

CONCLUSIONS

Because states with high levels of household gun ownership are likely to experience higher youth suicide rates, these states should be especially concerned about implementing programs and policies to ameliorate this risk.

Adult Firearm-Related Traumatic Brain Injury in United States Trauma Centers

Civilian firearm injury is an important public health concern in the United States. Gunshot wounds to the head (GSWH) remain in need of update and systematic characterization. We identify predictors of prolonged hospital length of stay (HLOS), intensive care unit length of stay (ICU LOS), medical complications, mortality, and discharge disposition from a population-based sample using the National Sample Program (NSP) of the National Trauma Data Bank (NTDB), years 2003-2012. Statistical significance was assessed at α < 0.001 to correct for multiple comparisons. In total, 8148 adult GSWH patients were included extrapolating to 32,439 national incidents. Age was 36.6 ± 16.4 years and 64.4% were severe traumatic brain injury (TBI; Glasgow Coma Scale [GCS] score 3-8). Assault (49.2%), handgun (50.3%), and residential injury (43.2%) were of highest incidence. HLOS and ICU LOS were 7.7 ± 14.2 and 5.7 ± 13.4 days, respectively. Overall mortality was 54.6%; suicide/self-injury was associated with the highest mortality rate (71.6%). GCS, Injury Severity Score, and hypotension were significant predictors for outcomes overall. Medicare/Medicaid patients had longer HLOS compared to private/commercial insured (mean increase, 4.4 days; 95% confidence interval [2.6-6.3]). Compared to the Midwest, the South had longer HLOS (mean increase, 3.7 days; [2.0-5.4]) and higher odds of complications (odds ratio [OR], 1.7 [1.4-2.0]); the West had lower odds of complications (OR, 0.6; [0.5-0.7]). Versus handgun, shotgun (OR, 0.3; [0.2-0.4]) and hunting rifle (OR, 0.5; [0.4-0.8]) resulted in lower mortality. Patients with government/other insurance had higher odds of discharging home compared to private/commercially insured (OR, 1.7; [1.3-2.3]). In comparison to level I trauma centers, level II trauma centers had lower odds of discharge to home (OR, 0.7; [0.5-0.8]). Our results support hypotension, injury severity, injury intent, firearm type, and U.S. geographical location as important prognostic variables in firearm-related TBI. Improved understanding of civilian GSWH is critical to promoting increased awareness of firearm injuries as a public health concern and reducing its debilitating injury burden to patients, families, and healthcare systems.

A decompositional analysis of firearm-related mortality in the United States, 2001-2012

Prior literature reporting increased rates of firearm-related homicide and suicide with increasing firearm availability is limited by only examining the availability of firearms, which is only one component of firearm-related mortality. The objective of the current study is to separate the rates into their respective components and determine which components contribute to mortality rate changes. To address the objective, nationally representative data from 2001 to 2012 was collected from a variety of publicly-available sources. Utilizing decompositional methodology, a negative binomial regression was used to estimate rate ratios for the association between the components and year category, and relative contributions of each component were calculated. From 2001 to 2012, the homicide and unintentional mortality rate decreased while the suicide rate increased. The suicide rate was only the firearm prevalence rate. The unintentional mortality rate was a factor of firearm prevalence, injury incidence, and case fatality rate. The homicide rate was a factor of firearm prevalence, violent crime rate, injury incidence, and case fatality rate. The current results suggest that the contributors of changes in firearm-related mortality are multi-faceted. Future studies should perform a decompositional analysis utilizing more granular data to examine whether the currently reported results are true associations or a factor of ecologic fallacy.

Green pastures: Do US real estate prices respond to population health?

We investigate whether communities with improving population health will subsequently experience rising real estate prices. Home price indices (HPIs) for 371 MSAs from 1990 to 2010 are regressed against life-expectancy five years prior. HPIs come from the Federal Housing Finance Agency. Life expectancy estimates come from the Institute of Health Metrics. Our analysis uses random and fixed effect models with a comprehensive set of controls. Life expectancy predicted increases in the HPI controlling for potential confounders. We found that, this effect varied spatially. Communities that invest their revenue from property taxes in public health infrastructure could benefit from a virtuous cycle of better health leading to higher property values. Communities that do not invest in health could enter vicious cycles and this could widen geospatial health and wealth disparities.

A longitudinal ecological study of household firearm ownership and firearm-related deaths in the United States from 1999 through 2014: A specific focus on gender, race, and geographic variables

Firearms have a longstanding tradition in the United States (US) and are viewed by many with iconic stature with regards to safety and personal freedom. Unfortunately, from a public health point of view, firearm-related deaths (FRDs) in the US have reached a crisis point with an estimated > 31,000 deaths and 74,000 nonfatal injuries resulting from firearms each year. This longitudinal ecological study analyzed variations in FRDs following firearm assaults (FAs) and law enforcement incidents involving a firearm (LEIF) in comparison to variations in household firearm ownership (HFO) among different geographic and demographic groups in the US from 1999 to 2014. The Underlying Cause of Death database was examined on the CDC Wonder online interface. Records coded with ICD-10 codes: FA (X93 – assault by handgun discharge, X94 – assault by rifle, shotgun, and larger firearm discharge, or X95 – assault by other and unspecified firearm discharge) and LEIF (Y35.0) were examined, and the prevalence of HFO was determined using the well-established proxy of the percentage of suicides committed with a firearm. Gender, ethnicity, Census Division, and urbanization significantly impacted the death rates from FA and LEIF. Significant direct correlations between variations in HFO and death rates from FAs and LEIF were observed. Understanding the significant impacts of gender, race, Census Division, and urbanization status may help shape future public health policy to promote increased firearm safety.

Firearm Ownership and Suicide Rates Among US Men and Women, 1981-2013

OBJECTIVES

To examine the relationship between state-level firearm ownership rates and gender-specific, age-adjusted firearm and total suicide rates across all 50 US states from 1981 to 2013.

METHODS

We used panel data for all 50 states that included annual overall and gender-specific suicide and firearm suicide rates and a proxy for state-level household firearm ownership. We analyzed data by using linear regression and generalized estimating equations to account for clustering.

RESULTS

State-level firearm ownership was associated with an increase in both male and female firearm-related suicide rates and with a decrease in nonfirearm-related suicide rates. Higher gun ownership was associated with higher suicide rates by any means among male, but not among female, persons.

CONCLUSIONS

We found a strong relationship between state-level firearm ownership and firearm suicide rates among both genders, and a relationship between firearm ownership and suicides by any means among male, but not female, individuals.

POLICY IMPLICATIONS

For male persons, policies that reduce firearm ownership will likely reduce suicides by all means and by firearms. For female persons, such policies will likely reduce suicides by firearms.

Characteristics of Chinese rural young suicides by pesticides

BACKGROUND

The major suicide method in rural China today is ingestion of agricultural pesticides.

AIM

This study is to investigate the characteristics of Chinese rural young suicides who died of pesticide ingestion.

METHODS

A sample of 392 suicides from rural China was studied using the psychological autopsy method, and data were analysed for demographic characteristics, the suicide method used, mental disorder and psychological characteristics.

RESULTS

Suicides by pesticide ingestion were enacted more because of impulsiveness and tended to demonstrate less mental illness than those suicides using other means in rural China.

CONCLUSIONS

Accessibility, high toxicity and lethality of the pesticides were risk factors for the suicides of people without a mental disorder in rural China. The use of pesticides is a rational choice and the safe storage of these kinds of farming chemicals should be controlled to prevent certain suicides.

The relationship between gun ownership and firearm homicide rates in the United States, 1981-2010

OBJECTIVES

We examined the relationship between levels of household firearm ownership, as measured directly and by a proxy-the percentage of suicides committed with a firearm-and age-adjusted firearm homicide rates at the state level.

METHODS

We conducted a negative binomial regression analysis of panel data from the Centers for Disease Control and Prevention's Web-Based Injury Statistics Query and Reporting Systems database on gun ownership and firearm homicide rates across all 50 states during 1981 to 2010. We determined fixed effects for year, accounted for clustering within states with generalized estimating equations, and controlled for potential state-level confounders.

RESULTS

Gun ownership was a significant predictor of firearm homicide rates (incidence rate ratio = 1.009; 95% confidence interval = 1.004, 1.014). This model indicated that for each percentage point increase in gun ownership, the firearm homicide rate increased by 0.9%.

CONCLUSIONS

We observed a robust correlation between higher levels of gun ownership and higher firearm homicide rates. Although we could not determine causation, we found that states with higher rates of gun ownership had disproportionately large numbers of deaths from firearm-related homicides.

Using the unmatched count technique to improve base rate estimates of risky driving behaviours among veterans of the wars in Iraq and Afghanistan

BACKGROUND

Few studies have investigated base rate estimates of risky driving behaviours among veterans of the wars in Afghanistan and Iraq despite evidence suggesting such behaviours result in increased death rates. In addition, published estimates of driving behaviours may be subject to a significant response bias via the impact of perceived mental health stigma on honest self-reporting.

AIM

The present study compared the unmatched count technique, a form of randomised response technique used to mitigate biased responding, with traditional anonymous self-report to gain information about base rates of risky driving behaviours among combat veterans.

METHODS

Cross-sectional data gathered as part of a study of attitudes and behaviours related to military service provided estimates of target activities. Six facets of risky driving (horn honking, carrying firearms in the vehicle, drinking and driving, screaming at other drivers, following other drivers to complain, and tailgating) were assessed.

RESULTS

In our sample of 1351 combat veterans, the unmatched count technique revealed significantly higher rates relative to traditional anonymous assessment specifically for horn honking in anger (22.1% vs 13.6%), carrying firearms (51.1% vs 32.2%), and drinking and driving (77.8% vs 54.0%). There were no significant differences for the remaining three items.

CONCLUSIONS

The high level of morbidity associated with risky driving and motor vehicle crashes is a significant concern in the combat veteran population. These data suggest the presence of a strong response bias associated with endorsing certain risky driving behaviours, potentially leading to serious underestimation of these problem behaviours in standard anonymous questionnaires.

Gender differences in suicide methods

INTRODUCTION

Gender differences in suicide completion rates have been attributed to the differences in lethality of suicide methods chosen by men and women, but few empirical studies have investigated factors other than demographic characteristics that might explain this differential.

METHODS

Data from the 621 suicides in Summit County, Ohio during 1997-2006 were disaggregated by gender to compare known correlates of suicide risk on three methods of suicide-firearm, hanging and drug poisoning.

RESULTS

Compared to women, men who completed suicide with firearms were more likely to be married and committed the act at home. Unmarried men were likelier to hang themselves than married men, but unmarried women were less likely to hang themselves than married women. Men with a history of depression were more likely to suicide by hanging, but women with depression were half as likely to hang themselves compared to the women without a history of depression. Men with a history of substance abuse were more likely to suicide by poisoning than men without such history, but substance abuse history had no influence on women's use of poisoning to suicide. For both sexes, the odds of suicide by poisoning were significantly higher for those on psychiatric medications.

Losses of expected lifetime in the United States and other developed countries: methods and empirical analyses

Patterns of diversity in age at death are examined using e (†), a dispersion measure that equals the average expected lifetime lost at death. We apply two methods for decomposing differences in e (†). The first method estimates the contributions of average levels of mortality and mortality age structures. The second (and newly developed) method returns components produced by differences between age- and cause-specific mortality rates. The United States is close to England and Wales in mean life expectancy but has higher life expectancy losses and lacks mortality compression. The difference is determined by mortality age structures, whereas the role of mortality levels is minor. This is related to excess mortality at ages under 65 from various causes in the United States. Regression on 17 country-series suggests that e (†) correlates with income inequality across countries but not across time. This result can be attributed to dissimilarity between the age- and cause-of-death structures of temporal mortality reduction and intercountry mortality variation. It also suggests that factors affecting overall mortality decrease differ from those responsible for excess lifetime losses in the United States compared with other countries. The latter can be related to weaknesses of health system and other factors resulting in premature death from heart diseases, amenable causes, accidents and violence.

Suicide mortality in the United States: the importance of attending to method in understanding population-level disparities in the burden of suicide

Suicide mortality varies widely across age, sex, race, and geography, far more than does mortality from the leading causes of natural death. Unlike the tight correlation between cancer mortality and the incidence of cancer, suicide mortality is only modestly correlated with the incidence of suicidal acts and other established risk factors for suicidal behavior, such as major psychiatric disorders. An implication of this modest correlation is that the proportion of all suicidal acts that prove fatal (the case fatality ratio) must account for a substantial portion of the (nonrandom) variation observed in suicide mortality. In the United States, the case fatality ratio is strongly related to the availability of household firearms. Findings from ecologic and individual-level studies conducted over the past two decades illustrate the importance of accounting for the availability of highly lethal suicide methods in efforts to understand (and ultimately reduce) disparities in suicide mortality across populations.

Culture of Honor and Violence Against the Self

Cultures of honor facilitate certain forms of interpersonal violence. The authors suggest that these cultures might also promote values and expectations that could heighten suicide risk, such as strict gender-role standards and hypersensitivity to reputational threats, which could lead people living in such cultures to consider death as an option when failure occurs or reputation is threatened sufficiently. Study 1 shows that, controlling for a host of statewide covariates, honor states in the United States have significantly higher male and female suicide rates than do nonhonor states, particularly in nonmetropolitan areas among Whites. Study 2 shows that statewide levels of antidepressant prescriptions (an indicator of mental health resource utilization) are lower in honor states, whereas levels of major depression are higher, and statewide levels of depression are associated with suicide rates only among honor states. Finally, Study 3 shows that individual endorsement of honor ideology is positively associated with depression.

An approach to the patient in crisis: assessments of the risk of suicide and violence

Suicide is one of the leading causes of death in the United States and is defined as intentional self-harm with the intent of causing death. Various mental disorders may be a cause for increased violence. This article outlines the elements of the risk assessment (for harm to self and/or others) in patients in crisis and addresses which contributing factors may be modifiable. This article also proposes a practical framework for the management of risk regarding suicide and violence.

Characteristics of Black and White suicide decedents in Fulton County, Georgia, 1988-2002

OBJECTIVES

We compared the prevalence of risk factors for Black and White suicide decedents in Fulton County, Georgia, from 1988-2002.

METHODS

We used data from the Fulton County Medical Examiner's Office to compile information on suicides that occurred in Fulton County between 1988 and 2002. We used the chi(2) test and logistic regression to identify associations between suicide risk factors and race.

RESULTS

Black suicide decedents were more likely than White suicide decedents to be male (odds ratio [OR]=2.06; 95% confidence interval [CI]=1.38, 3.09), to be younger, (>or=24 y [OR = 4.74; 95% CI = 2.88, 7.81]; 25-34 y [OR = 2.79; 95% CI = 1.74, 4.47]; 35-44 y [OR = 1.86; 95% CI = 1.13, 3.07]), and to hurt others in a suicide (OR = 4.22; 95% CI = 1.60, 11.15) but less likely to report depression (OR=0.63; 95% CI=0.48, 0.83), to have a family history of suicide (OR=0.08; 95% CI=0.01, 0.61), or to leave a suicide note (OR=0.37; 95% CI=0.26, 0.52).

CONCLUSIONS

Future research should consider that Black suicide decedents are less likely to report depression than White suicide decedents. This suicide risk difference is important when developing effective suicide prevention programs.

Changes in suicide methods in Quebec between 1987 and 2000: the possible impact of bill C-17 requiring safe storage of firearms

This study presents the changes in the overall and firearm suicide rates for Québec (Canada) before and after Bill C-17, which was implemented to secure safe storage of firearms. It covers 20,009 suicide cases reported to the coroner's office. Interrupted time series analysis is used to compare suicide rates in the two periods. Firearm suicide rates have dropped among males and females, but the downward trends were not significant when compared to those prior to the law. Hanging suicide rates have risen considerably among men and women, but those upward trends did not increase significantly when compared with those preceding the law. The decline in suicide rates involving firearms has not resulted in a parallel decline in overall suicide rates. The analyses suggest that Bill C-17 neither improved the downward trend in firearm suicide, which had already begun before the enactment of the law, nor reduced the upward trend of the overall suicide rate. Correlation analyses between firearm suicide, hanging suicide, and the overall suicide rate suggest that firearm suicide is replaced by hanging suicide among males.

Household Firearm Ownership and Rates of Suicide Across the 50 United States

BACKGROUND

The current investigation explores the association between rates of household firearm ownership and suicide across the 50 states. Prior ecologic research on the relationship between firearm prevalence and suicide has been criticized for using problematic proxy-based, rather than survey-based, estimates of firearm prevalence and for failing to control for potential psychological risk factors for suicide. We address these two criticisms by using recently available state-level survey-based estimates of household firearm ownership, serious mental illness, and alcohol/illicit substance use and dependence.

METHODS

Negative binomial regression was used to assess the relationship between household firearm ownership rates and rates of firearm, nonfirearm, and overall suicide for both sexes and for four age groups. Analyses controlled for rates of poverty, urbanization, unemployment, mental illness, and drug and alcohol dependence and abuse.

RESULTS

US residents of all ages and both sexes are more likely to die from suicide when they live in areas where more households contain firearms. A positive and significant association exists between levels of household firearm ownership and rates of firearm and overall suicide; rates of nonfirearm suicide were not associated with levels of household firearm ownership.

CONCLUSION

Household firearm ownership levels are strongly associated with higher rates of suicide, consistent with the hypothesis that the availability of lethal means increases the rate of completed suicide.

The association between changes in household firearm ownership and rates of suicide in the United States, 1981-2002

OBJECTIVE

To explore whether recent declines in household firearm prevalence in the United States were associated with changes in rates of suicide for men, women, and children.

METHODS

This time series study compares changes in suicide rates to changes in household firearm prevalence, 1981-2002. Multivariate analyses adjust for age, unemployment, per capita alcohol consumption, and poverty. Regional fixed effects controlled for cross sectional, time invariant differences among the four census regions. Standard errors of parameter estimates are adjusted to account for serial autocorrelation of observations over time.

RESULTS

Over the 22 year study period household firearm ownership rates declined across all four regions. In multivariate analyses, each 10% decline in household firearm ownership was associated with significant declines in rates of firearm suicide, 4.2% (95% CI 2.3% to 6.1%) and overall suicide, 2.5% (95% CI 1.4% to 3.6%). Changes in non-firearm suicide were not associated with changes in firearm ownership. The magnitude of the association between changes in household firearm ownership and changes in rates of firearm and overall suicide was greatest for children: for each 10% decline in the percentage of households with firearms and children, the rate of firearm suicide among children 0-19 years of age dropped 8.3% (95% CI 6.1% to 10.5%) and the rate of overall suicide dropped 4.1% (2.3% to 5.9%).

CONCLUSION

Changes in household firearm ownership over time are associated with significant changes in rates of suicide for men, women, and children. These findings suggest that reducing availability to firearms in the home may save lives, especially among youth.

Suicide by shooting is correlated to rate of gun licenses in Austrian counties

OBJECTIVES

Shooting as method of suicide has increased considerably in Austria over recent decades and represented 23.5% of all suicides among men during the period 1990-2000. It is thought that the availability of guns could lead to their use in acts of suicide, and therefore we investigated the numbers of gun licenses (which constitutes ownership of guns and permission to carry a gun) in the nine Austrian counties and their correlation with suicides by shooting and other methods.

METHODS

We studied registered suicides, including the method used, between 1990 and 2000 in Austria and the numbers of gun licenses held in the nine counties of Austria in the same period.

RESULTS

We found a strong correlation between the average gun license rate for the period 1990-2000 and suicides by shooting (r = 0.967), and only very weak correlation, and for some of the years under investigation a negative correlation, with other methods of committing suicide (r = 0.117) and the suicide rate in general (r = 0.383).

CONCLUSIONS

As shooting as a method of suicide has increased in Austria in recent decades, and is a highly lethal method, the finding that the shooting suicide rate is related to the extent of gun ownership deserves attention, especially as there is evidence that restriction of gun ownership is an important factor in suicide prevention.

State-level homicide victimization rates in the US in relation to survey measures of household firearm ownership, 2001-2003

Two of every three American homicide victims are killed with firearms, yet little is known about the role played by household firearms in homicide victimization. The present study is the first to examine the cross sectional association between household firearm ownership and homicide victimization across the 50 US states, by age and gender, using nationally representative state-level survey-based estimates of household firearm ownership. Household firearm prevalence for each of the 50 states was obtained from the 2001 Behavioral Risk Factor Surveillance System. Homicide mortality data for each state were aggregated over the three-year study period, 2001-2003. Analyses controlled for state-level rates of aggravated assault, robbery, unemployment, urbanization, per capita alcohol consumption, and a resource deprivation index (a construct that includes median family income, the percentage of families living beneath the poverty line, the Gini index of family income inequality, the percentage of the population that is black and the percentage of families headed by a single female parent). Multivariate analyses found that states with higher rates of household firearm ownership had significantly higher homicide victimization rates of men, women and children. The association between firearm prevalence and homicide victimization in our study was driven by gun-related homicide victimization rates; non-gun-related victimization rates were not significantly associated with rates of firearm ownership. Although causal inference is not warranted on the basis of the present study alone, our findings suggest that the household may be an important source of firearms used to kill men, women and children in the United States.

Characteristics of black and white suicide decedents in Fulton County, Georgia, 1988-2002

OBJECTIVES

We compared the prevalence of risk factors for Black and White suicide decedents in Fulton County, Georgia, from 1988-2002.

METHODS

We used data from the Fulton County Medical Examiner's Office to compile information on suicides that occurred in Fulton County between 1988 and 2002. We used the chi2 test and logistic regression to identify associations between suicide risk factors and race.

RESULTS

Black suicide decedents were more likely than White suicide decedents to be male (odds ratio [OR]=2.06; 95% confidence interval [CI]=1.38, 3.09), to be younger, (< or =24 y [OR = 4.74; 95% CI = 2.88, 7.81]; 25-34 y [OR = 2.79; 95% CI = 1.74, 4.47]; 35-44 y [OR = 1.86; 95% CI = 1.13, 3.07]), and to hurt others in a suicide (OR = 4.22; 95% CI = 1.60, 11.15) but less likely to report depression (OR=0.63; 95% CI=0.48, 0.83), to have a family history of suicide (OR=0.08; 95% CI=0.01, 0.61), or to leave a suicide note (OR=0.37; 95% CI=0.26, 0.52).

CONCLUSIONS

Future research should consider that Black suicide decedents are less likely to report depression than White suicide decedents. This suicide risk difference is important when developing effective suicide prevention programs.

Implications of National Suicide Trends for Social Work Practice with Black Youth

Although homicide is the leading cause of death for African-Americans aged 15-24, suicide is silently claiming the lives of many African-American youth, males in particular. Given the disproportionate number of African-American adolescents in many of the primary human service institutions, it is important to increase social workers' understanding of the nature and trends in self-destructive behaviors of this population. This paper presents the descriptive epidemiological trend data on African-American adolescent suicide completion and parasuicidal behavior, reviews current explanatory hypotheses, highlights important risk and protective factors, and outlines several culturally-congruent practice guidelines for working with suicidal African-Americans adolescents.

Explaining Changes in the Patterns of Black Suicide in the United States From 1981 to 2002: An Age, Cohort, and Period Analysis

To explore the different trends of suicide incidence among Blacks and possible contributing factors, the current study compared national epidemiologic data of suicide in the United States from 1981 to 2002. For the first time, period and birth-cohort effects on the incidence trends of Black suicide were evaluated using an age-period-cohort analysis. Cohort effects were found for males and females, suggesting that younger generations of Blacks are at higher risk. If younger cohorts carry their increased suicide risk into later life, then the recent decline in Black suicide rates will be reversed. The results of the current study are only interpretable in terms of group-level characteristics and population suicide rates and not individual-level characteristics. The possible explanation and the implications for prevention and future research are discussed.

Firearm suicide in New York City in the 1990s

OBJECTIVE

Across the US, firearms are used in approximately 60% of all suicide deaths. Little research has assessed the role and determinants of firearms in suicide in major urban areas.

METHODS

The authors collected data on all suicide deaths between 1990 and 2000 from the Office of the Chief Medical Examiner of New York City (NYC) and assessed trends and correlates of firearm related suicide deaths.

RESULTS

During the period studied, there were a total of 6008 suicides in NYC; 1200 (20.0%) were firearm related suicides. There was a decrease in total suicides, total firearm suicides, and the proportion of firearm related suicides. In multivariable modeling, characteristics of suicide decedents associated with a greater likelihood of firearm suicide were: male, black race, residing in the outer boroughs, and use of cannabis.

CONCLUSIONS

The proportion of suicides caused by firearms in NYC is low compared to other parts of the US; differential access to means of committing suicide and the differential importance of firearms in different racial and ethnic groups may contribute to this observation. Innovative, local population based interventions that target non-firearm related suicide may contribute to lower suicide mortality overall in urban areas.

Gender, place, and method of suicide

BACKGROUND

The goal of the study was to investigate whether women use less lethal methods in committing suicide than men. A related objective was to determine whether place of committing suicide influences method of suicide.

METHOD

Data on all completed suicides occurring in Riverside County from 1998 to 2001 were derived from original death certificates obtained from records of the County Coroner. Descriptive statistics on method and place of suicide by sex were computed and graphically presented. Multivariate logistic regression models were fitted to data on 643 suicide victims to estimate the unique effects of sex and place of suicide on the three most common methods observed: firearms, hanging, and drug poisoning.

RESULTS

Women were over 73% less likely to use firearms than men (OR = 0.267, CI = 0.172, 0.413). There were no sex differentials in hanging. Female victims were over 4 times more likely to die from drug poisoning than male victims (OR = 4.828, CI = 3.047, 7.650). When place of committing suicide was added to the equation, it was found that victims killing themselves at home were over 2.5 times as likely to use firearms as those dying in outdoor settings (OR = 2.501, CI = 1.078, 6.051). Persons committing suicide at home were over 3 times more likely to hang themselves than those killing themselves outdoors or on railway tracks (CI = 3.118, CI = 1.447, 6.718). Victims committing suicide at home were also 3 times as likely to use drugs as those dying outdoors or on railway tracks (OR = 3.118, CI = 1.242, 7.828). Hotel or motel suicides were 4.9 times more likely to use drug poisoning than outdoor or railway suicides (OR = 4.924, CI = 1.409, 17.206).

CONCLUSIONS

The proposition that women use less lethal methods of committing suicide than men was only partially supported by the data. It appears that the situation is more complex than a simple dichotomy between more lethal and less lethal methods. In past research, hanging has been considered a very lethal method. However, women were just as likely to hang themselves as men. Furthermore, firearm use was the second mode of suicide among women. The overall policy implication of this study is that suicide prevention efforts should concentrate not only on dissuading potential suicide victims, but also limiting access to firearms and promoting responsible firearm storage practices.

Firearm-related personal and clinical characteristics of US medical students

BACKGROUND

Firearm injuries are the second leading cause of fatal injury in the US, and several medical specialty societies encourage patient counseling about firearm injury prevention. Because personal choices. influence physicians' willingness to counsel, it would be valuable to know how frequently guns are kept in the homes of physicians-in-training, as well as their perceptions and current rates of counseling about firearm injury prevention.

METHODS

At a nationally representative sample of 16 medical schools, we surveyed the class of 2003 at freshman orientation, entrance to wards, and during senior year.

RESULTS

A total of 2,316 students provided data (response rate = 80.3%). Among freshmen, 16% reported living in a home with a firearm, 13% did so at entry to wards, as did 14% of seniors (14% overall, women = 9%, men = 19%). Only 34% of seniors reported counseling their patients more often than "never/rarely" about firearm possession and storage.

CONCLUSIONS

US medical students reported substantially lower rates of household gun ownership than the general population, but their participation in firearm-related counseling is also low.

Suicide prevention through means restriction: assessing the risk of substitution. A critical review and synthesis

The effectiveness of restricting access to certain means of committing suicide has been demonstrated, at least as regards toxic domestic gas, firearms, drugs and bridges. At the individual level, studies tend to indicate that many persons have a preference for a given means, which would limit the possibility of substitution or displacement towards another method. Similarly, the fact that suicidal crisis are very often short-lived (and, what is more, influenced by ambivalence or impulsiveness) suggests that an individual with restricted access to a given means would not put off his plans to later or turn to alternative methods. This has been more difficult to demonstrate scientifically in population studies. Nevertheless, it appears that, should such a shift occur towards other means, it would be put into effect only in part and over a longer term.

Was an increase in cocaine use among injecting drug users in New South Wales, Australia, accompanied by an increase in violent crime?

Background

A sharp reduction in heroin supply in Australia in 2001 was followed by a large but transient increase in cocaine use among injecting drug users (IDU) in Sydney. This paper assesses whether the increase in cocaine use among IDU was accompanied by increased rates of violent crime as occurred in the United States in the 1980s. Specifically, the paper aims to examine the impact of increased cocaine use among Sydney IDU upon police incidents of robbery with a weapon, assault and homicide.

Methods

Data on cocaine use among IDU was obtained from the Illicit Drug Reporting System (IDRS). Monthly NSW Police incident data on arrests for cocaine possession/use, robbery offences, homicides, and assaults, were obtained from the Bureau of Crime Statistics and Research. Time series analysis was conducted on the police data series where possible. Semi-structured interviews were conducted with representatives from law enforcement and health agencies about the impacts of cocaine use on crime and policing.

Results

There was a significant increase in cocaine use and cocaine possession offences in the months immediately following the reduction in heroin supply. There was also a significant increase in incidents of robbery where weapons were involved. There were no increases in offences involving firearms, homicides or reported assaults.

Conclusion

The increased use of cocaine among injecting drug users following the heroin shortage led to increases in violent crime. Other States and territories that also experienced a heroin shortage but did not show any increases in cocaine use did not report any increase in violent crimes. The violent crimes committed did not involve guns, most likely because of its stringent gun laws, in contrast to the experience of American cities that have experienced high rates of cocaine use and violent crime.

Race and method of suicide: culture and opportunity

The present study assesses the link between choice of violent methods of suicide and race from the standpoint of two perspectives: differential socio-acceptability and differential availability. To the extent that African Americans form a subculture of violence, and are more exposed to violence, we would expect them to choose violent methods of suicide. Data are from the 1990 mortality detail file of the U.S. Public Health Service and correspond to 19,580 male suicides. The results of a multivariate logistic regression analysis indicate that African Americans are 2.24 times more likely than Caucasians to choose violent methods of suicide. Although they are less likely to own firearms, African Americans are more likely than Caucasians to choose violent methods of suicide.

Safer storage of firearms at home and risk of suicide: a study of protective factors in a nationally representative sample

OBJECTIVE

To estimate the protective effect of storing firearms locked or unloaded, or both, on the risk of suicide by firearms among people with relatively low intention to die.

DESIGN AND SETTING

Cross sectional survey. The 1993 National Mortality Followback Survey of 22 957 deaths in the United States, representing 2.2 million people, conducted by the National Center for Health Statistics.

PARTICIPANTS

Decedent's next of kin answered questions regarding various aspects of decedent's life to supplement information from death certificates.

MAIN RESULTS

Compared with decedents who stored their firearm unlocked or loaded, those who stored their firearms locked or unloaded, or both, were less likely to commit suicide by firearms (locked: OR = 0.39, 95% CI = 0.24 to 0.66; unloaded OR = 0.30, 95% CI = 0.18 to 0.49).

CONCLUSIONS

This study further supports the utility of devices and practices intended to reduce the likelihood of unauthorised or impulsive use of firearms.

Association of selected risk factors with variation in child and adolescent firearm mortality by state

This study examined relationships between variation in child and adolescent firearm mortality by state and the following variables: childhood poverty rate, percent single parent families, percent population that is African American, percent population that is Hispanic, percent students carrying a gun, percent students carrying a weapon, percent students feeling unsafe, percent students feeling sad/hopeless, percent students academically at-risk, percent students involved infighting, percent students engaging in binge drinking behavior, violent crime rate for youths, individual gun laws in each state, prevalence of firearm ownership, and percent residing in urban area. Stepwise regression was calculated and one independent variable, prevalence of firearm ownership in the state, emerged as a significant predictor of child and adolescent firearm mortality. This variable predicted 47% of the variance from state to state in the child and adolescent firearm mortality. Schools need to address firearm safety and advocate for elimination of firearms accessible to youth.

Factors associated with state variations in homicide, suicide, and unintentional firearm deaths

This study examined the relationship of 16 variables with homicide, suicide, and unintentional firearm deaths. This cross-sectional analysis, using adjusted partial correlation coefficients, found that state-level firearm homicide rates significantly varied by the prevalence of firearms and by percent of the population which was African American. Whereas, state-level variations in firearm suicide mortality significantly varied by firearm prevalence, per capita alcohol consumption, percent of the population which was African American, and level of urbanization. None of the variables were significantly (p < or = .05) related to state-level variations in unintentional firearm mortality. Furthermore, state gun laws had only a limited effect on firearm-related homicide deaths. Although the current study cannot determine causation, firearm mortality in its various forms is most commonly related to the prevalence of firearms and the percent of the population that is African American.

Testing three competing hypotheses for explaining lethal violence

This study tests three competing hypotheses for explaining lethal violence that is conceptualized as the combination of both suicide and homicide. These three hypotheses differ on how lethal violence can be expressed as either suicide or homicide. Suicide and homicide data, from 1989 to 1991, were obtained from the Multiple Cause of Death study conducted by the National Center for Health Statistics. A bivariate analysis shows that there is a positive correlation between suicide and homicide rates for 458 large counties in the US. A weighted least square regression analysis reveals that the attribution hypothesis is supported by the results. Counties with a higher degree of others-blame-worthiness are more likely to express violence as homicide. Neither the socialization nor the social disorder hypotheses is supported by the analysis. Results of this study suggest that it is fruitful to study both suicide and homicide under the same theoretical and empirical framework.

Uncovering the mystery: factors of African American suicide

Traditionally, African Americans have registered lower rates of suicide than other ethnic groups. In the last 20 years this pattern has changed, particularly among young African Americans. To date, the research conducted regarding this phenomenon has been limited for a variety of reasons and previous research has been inconclusive in determining risk factors of African American suicide. The purpose of this paper is to identify risk and protective factors specific to African American suicide. To determine the factors, the 1993 National Mortality Follow-back Survey was analyzed. The risk factors identified include being under age 35, southern and northeastern residence, cocaine use, firearm presence in home, and threatening others with violence. Some of the protective factors associated with African American suicide include rural residence and educational attainment. These results provide valuable information about completed African American suicides in relation to Whites. Several of these factors are unique to African Americans.

Gun control and suicide: possible impact of Canadian legislation to ensure safe storage of firearms

In 1992, the Canadian Firearms Act aimed at ensuring safe storage of firearms was promulgated. This study compares suicide methods 6 years prior to the enactment of the law and 5 years after its enactment. The study encompassed 426 suicide cases from Abitibi-Témiscamingue (Northern Quebec), the region with the highest suicide rate and the highest firearm suicide rate in Quebec. Suicide by firearms decreased in the male and female population. Suicide by hanging increased among youths of both sexes, and suicide by poisoning doubled in the female population. A decrease in firearm suicides was most noticeable in the under-25 age group, although it was in this same age group that the general suicide rate increased the most. The reduction of firearm suicides was not accompanied by a decrease in overall suicide rates.

Lethality of firearms relative to other suicide methods: a population based study

OBJECTIVES

(1) To quantify lethality of firearms relative to other suicide methods, (2) to quantify the extent to which suicide mortality may be reduced by limiting access to firearms.

METHODS

Data on suicides and hospitalised para-suicides that occurred in the state of Illinois from 1990 to 1997 were combined. Total number of episodes for each suicide method was estimated as the sum of the number of suicides and the number of para-suicides for that method. Gender and suicide method were used as proxies for intention to die, and estimated lethality of suicide methods within method-gender groups (for example, male firearm users). Logistic regression was used to quantify the lethality of firearms relative to other suicide methods. Excess mortality associated with the use of firearms was estimated by conservatively assuming that in the absence of firearms the next most lethal suicide method would be used.

RESULTS

From January 1990 to December 1997, among individuals 10 years or older in the state of Illinois, there were 37,352 hospital admissions for para-suicide and 10,287 completed suicides. Firearms are the most lethal suicide method. Episodes involving firearms are 2.6 times (95% CI 2.1 to 3.1) more lethal than those involving suffocation-the second most lethal suicide method. Preventing access to firearms can reduce the proportion of fatal firearms related suicides by 32% among minors, and 6.5% among adults.

CONCLUSIONS

Limiting access to firearms is a potentially effective means of reducing suicide mortality.

Rates of household firearm ownership and homicide across US regions and states, 1988-1997

OBJECTIVES

In this study we explored the association between rates of household firearm ownership and homicide across the United States, by age groups.

METHODS

We used cross-sectional time-series data (1988-1997) to estimate the association between rates of household firearm ownership and homicide.

RESULTS

In region- and state-level analyses, a robust association between rates of household firearm ownership and homicide was found. Regionally, the association exists for victims aged 5 to 14 years and those 35 years and older. At the state level, the association exists for every age group over age 5, even after controlling for poverty, urbanization, unemployment, alcohol consumption, and nonlethal violent crime.

CONCLUSIONS

Although our study cannot determine causation, we found that in areas where household firearm ownership rates were higher, a disproportionately large number of people died from homicide.