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Anestis MD, Bryan CJ, Bryan AO, Capron DW. Threat perceptions, defensive behaviors, and the perceived suicide prevention value of specific firearm storage practices. Suicide Life Threat Behav 2024. [PMID: 39188061 DOI: 10.1111/sltb.13123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/29/2024] [Accepted: 07/24/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION Secure firearm storage has been proposed as a suicide prevention method within the military; however, secure storage practices are uncommon. Service members may perceive limited value in secure storage as a suicide prevention tool and threat-related factors may influence such perceptions. METHOD A nationally representative sample of firearm-owning military service members (n = 719) was recruited between December 3, 2021 and January 4, 2022 to complete a self-report survey by Ipsos using their KnowledgePanel calibration approach to optimize representativeness. RESULTS Threat sensitivity was associated with less perceived suicide prevention value across all within-home storage practices as well as out-of-home storage. Defensive firearm ownership was associated with less perceived out-of-home storage value. Contrary to expectations, PTSD symptoms were associated with greater perceived suicide prevention value across all storage practices and intolerance of uncertainty was associated with greater perceived out-of-home storage value. DISCUSSION Perceptions of, sensitivity to, and reactions to threat represent a complicated confluence of factors that may influence firearm views and behaviors in disparate ways. Viewing the world as dangerous and other people as a threat may limit perceived suicide prevention value for secure storage and increase the drive for firearm access.
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Affiliation(s)
- Michael D Anestis
- New Jersey Gun Violence Research Center, School of Public Health, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
- Urban-Global Public Health, Rutgers, the State University of New Jersey, New Brunswick, New Jersey, USA
| | - Craig J Bryan
- Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - AnnaBelle O Bryan
- Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel W Capron
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
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Haasz M, Betz ME, Ambroggio L, Cafferty R, King CA, Wong S, Leonard J, Brooks-Russell A, Sigel E. Acceptability and feasibility of video-based firearm safety education in a Colorado emergency department for caregivers of adolescents in firearm-owning households. Inj Prev 2024:ip-2023-045204. [PMID: 39053924 DOI: 10.1136/ip-2023-045204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Easy firearm access increases injury risk among adolescents. We evaluated the acceptability and feasibility of improving knowledge of a 3 min safe firearm storage education video in the paediatric emergency department. METHODS We conducted a single-centre block trial in a large paediatric emergency department (August 2020-2022). Participants were caregivers of adolescents (10-17 years) in firearm-owning households. First block participants (control) completed a baseline survey about child safety behaviours (including firearms). Second block participants (intervention) completed a baseline survey, watched the safe firearm storage video and evaluated acceptability. Participants completed a 3-month follow-up survey about firearm safety behaviours and knowledge recall. Demographic and clinical variables were compared between the intervention and control groups using Fisher's exact and χ2 tests. McNemar's test was used to compare firearm storage behaviours at the initial and 3-month visit within each group. RESULTS Research staff approached 1264 caregivers; 371 consented to participate (29.4%) and 144 (38.8%) endorsed firearm ownership. There were 95 participants in the control group and 62 in the intervention group. Follow-up was lower in the intervention group (53.7% vs 37.1%, p=0.04). Among participants viewing the video, 80.3% liked the video and 50.0% felt they learnt something new from the video. CONCLUSIONS Video-based firearm education in a paediatric emergency department is acceptable among a population of caregivers of adolescents with household firearms. This is a higher-risk group that may uniquely benefit from consistent education in the paediatric emergency department. Further study with larger populations is needed to evaluate intervention effectiveness. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov (NCT05168878).
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Affiliation(s)
- Maya Haasz
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lilliam Ambroggio
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rachel Cafferty
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cheryl A King
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shale Wong
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jan Leonard
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadephia, Philadelphia, Pennsylvania, USA
| | - Ashley Brooks-Russell
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric Sigel
- Department of Pediatrics, Section of Adolescent Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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Christian H, Crasta D, Lloyd-Lester G, True G, Goodman M, Bass B, Coric K, Ruetten T, Lane R, Khazanov G. Engaging suicide prevention and firearm stakeholders in developing a workshop promoting secure firearm storage for suicide prevention. Inj Epidemiol 2024; 11:26. [PMID: 38877541 PMCID: PMC11179275 DOI: 10.1186/s40621-024-00511-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND In the US, over 50% of suicide deaths are by firearm injury. Studies have found that limiting access to firearms, including storing them temporarily outside of the home or locking and unloading them securely at home, helps prevent suicide. Family members and other loved ones are in a unique position to encourage secure firearm storage. This paper describes the development of a workshop to empower loved ones of individuals at risk for suicide to discuss secure firearm storage in New York State. METHODS Using a multistakeholder engagement framework, we partnered with New York State county-level suicide prevention coalitions, local firearms experts, and other stakeholders to develop a 90-min workshop addressing secure firearm storage for suicide prevention. Pilot workshops were co-facilitated by a suicide prevention coalition member and a local firearms expert. Feedback gathered via surveys from workshop attendees and interviews with workshop co-facilitators were used to revise workshop content and inform dissemination. Following pilot workshops, a 1-day training event was held for potential future facilitators, and survey data were collected to assess trainee experiences and interest in facilitating future workshops. Data analysis included rapid qualitative analysis of interviews and statistical analysis of survey responses about acceptability of workshop. RESULTS Four pilot workshops included a total of 23 attendees. Pilot workshop attendees endorsed willingness and confidence to discuss secure firearm storage with a family member or loved one. The training event included 42 attendees, of which 26 indicated interest in facilitating a workshop within the next year. Co-facilitators agreed on several key themes, including the importance of having a "trusted messenger" deliver the firearms portion of the workshop, keeping the conversation focused on firearm safety for suicide prevention, and developing interventions that reflect firearm owning community's culture. CONCLUSIONS Consistent with a public health approach to suicide prevention, this study leveraged a multistakeholder engagement framework to develop a community-based workshop empowering loved ones of individuals at risk for suicide to discuss secure firearm storage. The workshop will be disseminated across New York State. We noted positive and collaborative relationships across stakeholder groups, and willingness to facilitate the workshop among both suicide prevention and firearm stakeholders.
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Affiliation(s)
- Hanna Christian
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Dev Crasta
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Gala True
- Veteran-Informed Safety Intervention and Outreach Network, New Orleans, LA, USA
| | - Marianne Goodman
- VISN 2 Mental Illness, Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, James J. Peters, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brett Bass
- University of Washington School of Social Work, Seattle, WA, USA
| | - Kathryne Coric
- Suicide Prevention Coalition of Erie County, VA Western New York Healthcare System, Buffalo, NY, USA
| | | | - Robert Lane
- VISN 2 Mental Illness, Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, James J. Peters, Bronx, NY, USA
| | - Gabriela Khazanov
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, USA
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Bock JE, Daruwala SE, Tucker RP, Foster SD, Bandel SL, Gunn JF, Anestis MD. Honor Endorsement and Increased Firearm Purchasing Behavior and Intentions During the COVID-19 Pandemic. Psychol Rep 2024:332941241255323. [PMID: 38802302 DOI: 10.1177/00332941241255323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
The surge in firearm sales from the onset of the COVID-19 pandemic have been linked to increases in firearm violence, which is of public concern given that having firearms in one's home is associated with increased risk for domestic violence and suicide. Consistent with pre-pandemic trends, individuals tended to purchase firearms for self-protection during COVID-19. Prior work indicates that protective firearm ownership is motivated not only by perceptions that the world (and one's local environment) is dangerous, but also by one's endorsement of masculinity norms found in U.S. cultures of honor (primarily southern and western states). Honor-based masculinity norms emphasis reputation defense, toughness, and an absolute intolerance of disrespect. The present research examined the relative motivating influences of various threat perceptions and masculine honor endorsement in predicting reasons for non-COVID-19 firearm ownership, firearm purchasing during COVID-19, and purchase intentions. Three separate samples (total N = 2483) of mostly White U.S. men completed online surveys during different months of the first year of the COVID-19 pandemic. Participants completed measures of their endorsement of masculine honor norms, factors associated with firearm purchasing (e.g., dangerous world beliefs, intolerance of uncertainty), and firearm purchasing behaviors. Results indicated that masculine honor endorsement was higher among (1) protective firearm owners compared to non-owners and non-protective owners, (2) firearm owners who purchased a firearm during COVID-19 compared to non-owners and non-purchasing owners, and (3) firearm owners with intentions to purchase firearms in the next year compared to those without intentions and undecided owners. Relative to other predictors (e.g., COVID-19 concerns, dangerous world beliefs), masculine honor endorsement was consistently the strongest predictor of these outcomes. Findings add to the literature by highlighting the strength of masculine honor endorsement in motivating (protective) firearm ownership. Implications for interpersonal violence and suicide are discussed.
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Affiliation(s)
- Jarrod E Bock
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Samantha E Daruwala
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | | | - Shelby L Bandel
- Department of Psychology, Rutgers University, New Brunswick, NJ, USA
- New Jersey Gun Violence Research Center, New Brunswick, NJ, USA
| | - John F Gunn
- New Jersey Gun Violence Research Center, New Brunswick, NJ, USA
- School of Public Health - Biostatistics and Epidemiology, Rutgers University, New Brunswick, NJ, USA
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, New Brunswick, NJ, USA
- Department of Urban-Global Public Health, Rutgers University, New Brunswick, NJ, USA
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Beachy S, Liang CT, Fizur P, Fu Q, Johnson NL. Disentangling the coping process in White rural men who carry guns. Psychol Rep 2024:332941241252771. [PMID: 38770861 DOI: 10.1177/00332941241252771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Affluent White rural men have the highest rates of gun ownership in the United States. However, few studies have specifically examined reasons and motivations for gun ownership and gun behaviors in this population. Therefore, this study sought to examine the relationship between stress variables, namely masculine gender role stress, adverse childhood experiences (ACEs), and income level, and subsequent pro-gun beliefs and amount of time an individual carried a gun within this population. Results indicated that only two measures of pro-gun beliefs (i.e., believing guns keep one safe, believing guns are present in one's social sphere) were correlated with percentage of time an individual carried. Additionally, ACEs were positively correlated with believing guns influence how others perceive oneself, levels of masculine gender role stress, and income. These results suggest that White rural gun owners who have increased ACEs have decreased income and tend to believe that owning guns impacts their social status with peers. However, increased ACEs do not influence belief about guns keeping one safe, believing guns are present in one's social sphere, or gun carriage. Instead, White rural gun owners without childhood adversity may be more susceptible to believing their safety depends on guns and belongingness within their social sphere. Future research should assess reasons why affluent White rural men find it important to maintain their safety in the context of gun ownership.
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Affiliation(s)
- Sara Beachy
- Department of Family and Community Medicine, Thomas Jefferson University Hospital System, Philadelphia, PA, USA
| | - Christopher Th Liang
- Department of Education and Human Services, College of Education, Lehigh University, Bethlehem, PA, USA
| | - Philip Fizur
- Department of Behavioral Medicine, Cooper University Hospital, Camden, NJ, USA
| | - Qiong Fu
- Department of Education and Human Services, College of Education, Lehigh University, Bethlehem, PA, USA
| | - Nicole L Johnson
- Department of Education and Human Services, College of Education, Lehigh University, Bethlehem, PA, USA
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Akinyemi O, Ogundare T, Wedeslase T, Hartmann B, Odusanya E, Williams M, Hughes K, Cornwell Iii E. Trends in Suicides and Homicides in 21st Century America. Cureus 2024; 16:e61010. [PMID: 38910703 PMCID: PMC11194035 DOI: 10.7759/cureus.61010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Violent deaths, including suicides and homicides, pose a significant public health challenge in the United States. Understanding the trends and identifying associated risk factors is crucial for targeted intervention strategies. AIM To examine the trends in suicides and homicides over the past two decades and identify demographic and contextual predictors using the Center for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System online database. METHODS A retrospective analysis of mortality records from 2000 to 2020 was conducted, utilizing multivariate regression analyses. Covariates included age, race, sex, education, mental health conditions, and time period. Age-adjusted rates were employed to assess trends. RESULTS Over the 20 years, there was an upward trajectory in suicide rates, increasing from approximately 10/100,000 to over 14/100,000 individuals, which is a notable increase among American Indians (100.8% increase) and individuals aged 25 years and younger (45.3% increase). Homicide rates, while relatively stable, exhibited a significant increase in 2019-2020, with African Americans consistently having the highest rates and a significant increase among American Indians (73.2% increase). In the multivariate regression analysis, Individuals with advanced education (OR= 1.74, 95% CI= 1.70 - 1.78), depression (OR = 13.47, 95% CI = 13.04 - 13.91), and bipolar disorder (OR = 2.65, 95% CI = 2.44 - 2.88) had higher odds of suicide. Risk factors for homicide include African Americans (OR = 4.15, 95% CI = 4.08 - 4.23), Latinx (OR = 2.31, 95% CI = 2.26 - 2.37), people aged 25 years and younger, and those with lower educational attainment. CONCLUSION This study highlights the changing demographic pattern in suicides and homicides in the United States and the need for targeted public health responses. Means restriction, universal suicide screening, addressing mental health stigma, and implementing broad interventions that modify societal attitudes toward suicide and homicides are essential components of a comprehensive strategy.
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Affiliation(s)
| | - Temitope Ogundare
- Psychiatry and Behavioral Sciences, Boston University School of Medicine, Boston, USA
| | | | - Brandon Hartmann
- Medicine and Surgery, Howard University College of Medicine, Washington, USA
| | - Eunice Odusanya
- Medicine and Surgery, Howard University College of Medicine, Washington, USA
| | | | - Kakra Hughes
- Surgery, Howard University College of Medicine, Washington, USA
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Nichter B, Hill ML, Fischer I, Panza KE, Kline AC, Na PJ, Norman SB, Rowcliffe M, Pietrzak RH. Firearm storage practices among military veterans in the United States: Findings from a nationally representative survey. J Affect Disord 2024; 351:82-89. [PMID: 38280567 DOI: 10.1016/j.jad.2024.01.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Unsafe storage of firearms is associated with increased risk of suicide.. However, contemporary population-based data on the prevalence and correlates of firearm storage practices among veterans are limited. METHODS Data were from the 2022 National Health and Resilience in Veterans Study, a nationally representative sample of 2441 veterans. Analyses examined: (1) the prevalence of firearm storage practices; (2) sociodemographic, psychiatric, and clinical characteristics associated with storing firearms loaded and/or in non-secure location; and (3) associations between types of potentially traumatic events and storage practices. RESULTS More than half of veterans reported owning one or more personal firearms (50.9%). Among firearm owners, 52.9% reported some form of unsafe firearm storage practice (i.e., loaded and/or non-secure location), with 39.9% reporting that they stored one or more firearms loaded. After adjusting for sociodemographic characteristics, major depressive, alcohol and drug use disorders, direct trauma exposures, future suicidal intent, and traumatic brain injury were associated with storing firearms loaded and/or in a non-secure location (ORs = 1.09-7.16). Veterans with a history of specific forms of direct trauma exposure (e.g., physical assault) were more likely to store firearms unsafely. LIMITATIONS Cross-sectional design precludes causal inference. CONCLUSIONS Half of U.S. veterans who own firearms store at least one personal firearm loaded and/or in a non-secure location, with approximately four-in-ten keeping a loaded firearm in the home. These high rates underscore the importance of nationwide training initiatives to promote safe firearm storage for all service members and veterans, regardless of risk status, as well as for healthcare professionals working with veterans.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Melanie L Hill
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Ian Fischer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kaitlyn E Panza
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Alexander C Kline
- Naval Health Research Center, San Diego, CA, USA; Leidos, Reston, VA, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA
| | - Mara Rowcliffe
- 321(st) Special Tactics Squadron, U.S. Air Force Special Operations Command, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Anestis MD. Firearm Access and Suicide Rates: An Unambiguously Robust Association. Arch Suicide Res 2024; 28:701-705. [PMID: 36987987 DOI: 10.1080/13811118.2023.2192753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Firearms account for approximately half of all suicide deaths within the United States each year. Recently, Lane and Kleck published pieces reporting conflicting results regarding the relationship between firearm access and suicide rates. In this commentary, I aim to contextualize the findings within the broader literature and to provide clarity for readers aiming to navigate the findings of the two studies. Ultimately, I conclude that the results of Lane more accurately represent the nature of the relationship and align with the extant literature on the topic.
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Manzler CA, Gorka SM, Tabares JV, Bryan CJ. Impact of handgun ownership and biological sex on startle reactivity to predictable and unpredictable threats. Int J Psychophysiol 2024; 197:112297. [PMID: 38185419 PMCID: PMC10922634 DOI: 10.1016/j.ijpsycho.2024.112297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/18/2023] [Accepted: 12/31/2023] [Indexed: 01/09/2024]
Abstract
Extant literature suggests that many individuals obtain firearms because they perceive the world as unsafe and believe that firearm ownership increases physical protection. Converging evidence suggests that firearm owners are vulnerable to uncertainty and experience chronic anticipatory anxiety in daily life; however, biological sex is thought to potentially moderate this association. Studies have yet to examine this hypothesis using objective markers of anticipatory anxiety. The present study therefore examined the impact of handgun ownership and biological sex on psychophysiological reactivity to predictable (P-) and unpredictable (U-) threat (N = 133). Male and female adult participants were classified into two groups: a) individuals who do not currently own any handguns (n = 52), and b) individuals who currently own one or more handguns (n = 81). Startle eyeblink potentiation was recorded as an index of aversive reactivity during a well-validated threat-of-shock paradigm designed to probe anticipatory anxiety (during U-threat) and fear (during P-threat). Results revealed no main effect of group on startle reactivity to P- or U-threat. Females displayed greater startle reactivity to threat (P- and U-) compared with males. The main effect was qualified by a significant group x biological sex interaction. Male handgun owners exhibited greater startle to U-threat, but not P-threat, relative to non-handgun owners. There was no effect of group on startle reactivity in females. Findings revealed that biological sex and threat type influenced threat reactivity. Male handgun owners displayed increased sensitivity to stressors that are uncertain, which may reflect an objective mechanism related to firearm ownership.
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Affiliation(s)
- Charles A Manzler
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA
| | - Stephanie M Gorka
- Suicide and Trauma Reduction InitiatiVE (STRIVE), Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210, USA; Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH 43210, USA.
| | - Jeffrey V Tabares
- Suicide and Trauma Reduction InitiatiVE (STRIVE), Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - Craig J Bryan
- Suicide and Trauma Reduction InitiatiVE (STRIVE), Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210, USA
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10
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Anestis MD, Bond AE, Moceri-Brooks J, Bandel SL, Semenza D. Perceptions of the utility of secure firearm storage methods as a suicide prevention tool among firearm owners who currently store their firearms loaded and unlocked. Suicide Life Threat Behav 2024; 54:122-128. [PMID: 38015108 DOI: 10.1111/sltb.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/03/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Although secure firearm storage can prevent firearm injury and death, secure storage is relatively rare. This tendency may be driven in part by a perceived lack of utility for secure storage in preventing suicide and other gun violence-related outcomes. METHOD We recruited a large (n = 3510) representative sample of residents from five US states and assessed the degree to which those who do and do not store their firearms securely perceive different utility in specific firearm storage practices for suicide prevention. To test for specificity, we examined if those differences hold when considering unintentional shooting and firearm theft prevention. RESULTS Those who currently store their firearms unsecured reported lower perceived utility in several firearm storage practices, particularly for suicide and theft prevention. CONCLUSIONS Our findings highlight that a lack of perceived utility in secure firearm storage may partially drive unsecure firearm storage. Efforts to promote secure storage must address this misperception.
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Affiliation(s)
- Michael D Anestis
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Allison E Bond
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | | | - Shelby L Bandel
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Daniel Semenza
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers-Camden, Camden, New Jersey, USA
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Bock JE, Tucker RP, Brown RP, Foster S, Anestis MD. Veteran suicide rates mirror, but do not account for, elevated suicide rates among the general population in US cultures of honor. Suicide Life Threat Behav 2023; 53:692-701. [PMID: 37427839 DOI: 10.1111/sltb.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Veteran total and firearm suicide rates are higher compared to the general population. Among the general population, total and firearm suicide rates are higher in US states deemed cultures of honor compared to non-honor states, likely because honor states have higher firearm ownership rates and fewer firearm laws. Considering that veterans tend to live in states with fewer firearm laws and that veteran population rates predict both statewide total and firearm suicide rates, it is possible that the elevated suicide rates seen in honor states in part due to those states having a greater presence of veterans compared to non-honor states. METHOD Publicly available databases were used to obtain total and firearm suicide rates (per 100 k) for veterans and non-veterans, as well as our covariates (e.g., rurality). RESULTS Veteran population proportions were higher in honor states than non-honor states. Veteran and non-veteran total and firearm suicide rates were higher in honor states compared to non-honor states. Statewide differences in all four suicide rates were indirectly explained by honor states having higher firearm ownership than non-honor states. CONCLUSIONS These findings add to a growing body of literature showing that enacting firearm regulations may be a viable public health approach for preventing suicide.
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Affiliation(s)
- Jarrod E Bock
- Department of Psychology, Towson University, Towson, Maryland, USA
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Ryan P Brown
- The Doerr Institute for New Leaders, Rice University, Houston, Texas, USA
| | - Stephen Foster
- Department of Psychology, Penn State York, York, Pennsylvania, USA
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, New Brunswick, New Jersey, USA
- Department of Urban-Global Public Health, Rutgers University, New Brunswick, New Jersey, USA
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12
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Bond AE, Brooks JR, Rodriguez TR, Bandel SL, Anestis MD. Examining characteristics and experiences of Black firearm owners. J Clin Psychol 2023. [PMID: 37190950 DOI: 10.1002/jclp.23532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/05/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The present study sought to better understand the characteristics of those who own firearms in the Black community; and to understand how Black firearm owners differ from nonfirearm owning Black individuals on a variety of variables related to safety, threat concerns, and suicide risk. METHODS Two samples were utilized in this study. The first was a subsample of those who identified as Black from a nationally representative sample (N = 502) seeking to understand firearm ownership within the United States. The second used a subsample of those who identified as Black (N = 1086) from a representative sample from New Jersey, Minnesota, and Mississippi. Variables related to safety and threat concerns were included in the second sample. RESULTS In both samples, multiple demographic variables, such as being a woman and having higher education, predicted firearm ownership. In the second sample, experiences of everyday discrimination and crime experiences were associated with firearm ownership. Additionally, Black firearm owners reported significantly more suicidal ideation than Black nonfirearm owners. CONCLUSION The findings demonstrate the unique characteristics and experiences of Black firearm owners and show that firearm ownership is associated with increased suicide risk factors for Black adults. Findings should be used to advocate for the creation of more culturally relevant suicide prevention and firearm means safety strategies.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Jasmin R Brooks
- Department of Psychology, The University of Houston, Houston, Texas, USA
| | - Taylor R Rodriguez
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Shelby L Bandel
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
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Soupene VA, Davis J, Fogner A, Casteel C. Circumstances Contributing to Installation, Maintenance, and Repair Worker Death by Suicide. J Occup Environ Med 2023; 65:394-400. [PMID: 36727910 PMCID: PMC10175102 DOI: 10.1097/jom.0000000000002789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine risk factors related to death by suicide among installation, maintenance, and repair (IMR) workers compared with workers in other occupational groups. METHODS The National Violent Death Reporting System (NVDRS) data for the years 2013 to 2018 was used to identify suicide deaths. Circumstance variables were used to examine differences between IMR workers and other workers. RESULTS Having a physical health problem (1.13; 95% confidence interval [CI], 1.03 to 1.23) or a diagnosis of posttraumatic stress disorder (1.24; 95% CI, 1.03 to 1.50) was more likely to contribute to IMR worker suicide compared with other occupations. Installation, maintenance, and repair workers were less likely to receive treatment for a mental health diagnosis or substance use disorder (0.88; 95% CI, 0.81 to 0.94). CONCLUSIONS Additional support for physical health problems, posttraumatic stress disorder diagnoses, and mental health care access among IMR workers may reduce suicide deaths.
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Affiliation(s)
- Victor A. Soupene
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Department of Epidemiology, Iowa City, IA, USA
| | - Jonathan Davis
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Department of Occupational and Environmental Health, Iowa City, IA, USA
| | - Andrew Fogner
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Department of Epidemiology, Iowa City, IA, USA
| | - Carri Casteel
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Department of Occupational and Environmental Health, Iowa City, IA, USA
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Mann JJ, Michel CA, Auerbach RP. Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:182-196. [PMID: 37201140 PMCID: PMC10172556 DOI: 10.1176/appi.focus.23021004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Objective The authors sought to identify scalable evidence-based suicide prevention strategies. Methods A search of PubMed and Google Scholar identi- fied 20,234 articles published between September 2005 and December 2019, of which 97 were randomized controlled trials with suicidal behavior or ideation as primary outcomes or epidemiological studies of limiting access to lethal means, using educational approaches, and the impact of antidepressant treatment. Results Training primary care physicians in depression rec- ognition and treatment prevents suicide. Educating youths on depression and suicidal behavior, as well as active out- reach to psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior. Meta-analyses find that antidepressants prevent suicide attempts, but individual randomized controlled trials appear to be underpowered. Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention. Cognitive-behavioral therapy and dialectical behavior therapy prevent suicidal behavior. Active screening for suicidal ideation or behavior is not proven to be better than just screening for depression. Education of gatekeepers about youth suicidal behavior lacks effectiveness. No randomized trials have been reported for gatekeeper training for prevention of adult suicidal behavior. Algorithm-driven electronic health record screening, Internet-based screening, and smartphone passive monitoring to identify high-risk patients are under-studied. Means restriction, including of firearms, prevents suicide but is sporadically employed in the United States, even though firearms are used in half of all U.S. suicides. Conclusions Training general practitioners warrants wider implementation and testing in other nonpsychiatrist physi- cian settings. Active follow-up of patients after discharge or a suicide-related crisis should be routine, and restricting firearm access by at-risk individuals warrants wider use. Combination approaches in health care systems show promise in reducing suicide in several countries, but evaluating the benefit attributable to each component is essential. Further suicide rate reduction requires evaluating newer approaches, such as electronic health record-derived algorithms, Internet-based screening methods, ketamine's potential benefit for preventing attempts, and passive monitoring of acute suicide risk change.Reprinted from Am J Psychiatry 2021; 178:611-624, with permission from American Psychiatric Association Publishing. Copyright © 2021.
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Affiliation(s)
- J John Mann
- Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuro- science, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach)
| | - Christina A Michel
- Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuro- science, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach)
| | - Randy P Auerbach
- Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuro- science, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach)
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Carlson KF, Gilbert TA, Maxim L, Hooker ER, Shull S, DeBeer B, DeFrancesco S, Denneson L. Associations between nonfatal firearm injuries and risk of subsequent suicide among Veteran VA users: A retrospective cohort study. Acad Emerg Med 2023; 30:278-288. [PMID: 36869632 DOI: 10.1111/acem.14711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/21/2023] [Accepted: 02/03/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Suicide is a leading cause of death in the United States, particularly among Veterans. Nonfatal firearm injuries may indicate subsequent risk of suicide and, thus, provide important opportunities for prevention in emergency departments and other health care settings. We used a retrospective cohort design to analyze associations between nonfatal firearm injuries and subsequent suicide among all Veterans who used U.S. Department of Veterans Affairs (VA) health care, nationally, between 2010 and 2019. METHODS We linked VA health care and mortality data to identify VA users, nonfatal firearm injuries, and deaths. International Classification of Diseases (ICD)-10th Revision cause-of-death codes were used to identify suicides. Veterans' firearm injuries and their intent were categorized using cause-of-injury codes from the ICD Clinical Modification-9th and 10th Revisions systems. Using bivariable and multivariable regression, we estimated risk of subsequent suicide among Veterans with, versus without, nonfatal firearm injuries. Among Veterans with nonfatal firearm injuries, we examined characteristics associated with subsequent suicide; electronic health record (chart) reviews explored documentation about firearm access among those who died. RESULTS Among 9,817,020 VA-using Veterans, 11,503 experienced nonfatal firearm injuries (64.9% unintentional, 12.3% intentional self-harm, 18.5% assault). Of these, 69 (0.6%) subsequently died by suicide (42 involving firearms). The odds of subsequent suicide among Veterans with, versus without, nonfatal firearm injuries were 2.4 (95% confidence interval 1.9-3.0); odds were only slightly attenuated in multivariable modeling. Among Veterans with nonfatal firearm injuries, those with depression or substance use disorder diagnoses had twice the odds of subsequent suicide than those without. Chart reviews identified small proportions of suicide decedents who were assessed for (21.7%), and/or counseled about (15.9%), firearm access. CONCLUSIONS Findings suggest that Veterans' nonfatal firearm injuries, regardless of injury intent, may be important but underutilized opportunities for suicide prevention. Future work should explore mechanisms to reduce risk among these patients.
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Affiliation(s)
- Kathleen F Carlson
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
- Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Tess A Gilbert
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
| | - Lauren Maxim
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
| | - Elizabeth R Hooker
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
| | - Sarah Shull
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
| | - Bryann DeBeer
- Department of Veterans Affairs, Rocky Mountain MIRECC for Suicide Prevention, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Susan DeFrancesco
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
- Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Lauren Denneson
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
- Department of Psychiatry, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Daruwala SE, Bandel SL, Anestis MD. Conformity to masculine role norms, firearm storage behaviors, and openness to means safety among two samples of firearm owners. J Psychiatr Res 2023; 158:365-372. [PMID: 36641973 DOI: 10.1016/j.jpsychires.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/06/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Understanding the sociocultural characteristics that are associated with US firearm owners' current storage practices and openness to means safety can inform suicide prevention initiatives. Masculinity, which is dominant within the US gun culture, may be a particularly salient factor that influences firearm ownership, storage practices, and openness to means safety. A recent study by McDermott et al. (2021) found that firearm ownership was associated with a combination of being White, male, politically conservative, and endorsing higher conformity to the masculine norms of violence, risk taking, and power over women. The current study builds upon McDermott and colleagues' (2021) research by examining the unique contribution of conformity to nine masculine norms as predictors of current firearm storage practices and openness to firearms means safety. METHODS Two samples of US firearm owners were recruited on Amazon's Mechanical Turk in 2019 (Sample 1; n = 200) and 2020 (Sample 2; n = 297). RESULTS Higher adherence to the norms of emotional control, violence, and power over women were associated with less secure storage practices, but only in Sample 2. The hypothesis that self-reliance, emotional control, and risk taking would be associated with openness to means safety was largely unsupported. Adherence to the violence norm was observed to have the greatest association with both current storage practices and openness to changing storage practices. CONCLUSIONS While several masculine norms were not consistently associated with our outcomes, the norm of violence may play a small role in firearm storage practices and openness to means safety for suicide prevention.
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Affiliation(s)
- Samantha E Daruwala
- The Ohio State University Wexner Medical Center, Columbus, OH, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, NY, USA.
| | - Shelby L Bandel
- Rutgers, The State University of New Jersey, New Brunswick, NJ, USA; New Jersey Gun Violence Research Center, Piscataway, NJ, USA
| | - Michael D Anestis
- Rutgers, The State University of New Jersey, New Brunswick, NJ, USA; New Jersey Gun Violence Research Center, Piscataway, NJ, USA
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Houtsma C, Powers J, Raines AM, Bailey M, Barber C, True G. Engaging stakeholders to develop a suicide prevention learning module for Louisiana firearm training courses. Inj Epidemiol 2023; 10:3. [PMID: 36631823 PMCID: PMC9832758 DOI: 10.1186/s40621-023-00413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Firearm suicide is a significant public health problem in the United States of America among the general and veteran populations. Broad-based preventive strategies, including lethal means safety, have been emphasized as a key approach to suicide prevention. Prior research has identified ways to improve the reach and uptake of lethal means safety messages. However, few resources have been created with these lessons in mind. METHODS Louisiana firearm owners and instructors were recruited through a larger project, Veteran-Informed Safety Intervention and Outreach Network, as well as a publicly available database of firearm instructors to participate in focus groups to provide feedback on an existing suicide prevention learning module (developed in Utah) for use by firearm instructors. Their feedback was used to adapt the module, which included a brief video and PowerPoint presentation. Firearm owners and instructors were then invited back for another round of focus groups to provide feedback on this adapted learning module. Team-based rapid qualitative analysis was conducted to identify themes across transcripts from these four focus groups. RESULTS Firearm owners and instructors agreed on several key themes, including the importance of messenger relatability and aligning the lethal means safety message with firearm owner values. Feedback suggested these themes were adequately addressed in the adapted learning module and contributed to overall module acceptability. The final theme, present across the original and adapted learning modules (i.e., Utah and Louisiana), was openness to further information and training on firearm suicide prevention. CONCLUSION Consistent with a public health approach to suicide prevention, the current study used stakeholder engagement to develop a suicide prevention learning module perceived as representative, accurate, and acceptable to Louisiana firearm owners and instructors. These findings can be used to inform firearm suicide prevention efforts in other states.
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Affiliation(s)
- Claire Houtsma
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
- South Central Mental Illness Research, Education and Clinical Center, New Orleans, LA USA
- Louisiana State University Health Sciences Center, New Orleans, LA USA
| | - Jeffrey Powers
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
- Louisiana State University, Baton Rouge, LA USA
| | - Amanda M. Raines
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
- South Central Mental Illness Research, Education and Clinical Center, New Orleans, LA USA
- Louisiana State University Health Sciences Center, New Orleans, LA USA
| | - Matthew Bailey
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
| | | | - Gala True
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119 USA
- South Central Mental Illness Research, Education and Clinical Center, New Orleans, LA USA
- Louisiana State University Health Sciences Center, New Orleans, LA USA
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Pritchard C, Hansen L, Dray R, Sharif J. USA Suicides Compared to Other Western Countries in the 21st Century: Is there a Relationship with Gun Ownership? Arch Suicide Res 2023; 27:135-147. [PMID: 35068366 DOI: 10.1080/13811118.2021.1974624] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES Causes of suicide are complex indicating a nation's psycho-socio-economic well-being hence this population-based study explores whether USA suicides worsened compared to nineteen Other Western Countries (OWC) being possibly related to gun ownership in the 21st Century. METHODS Total suicide data are drawn from the latest WHO Age-Standardised-Death-Rates per million (pm) controlled for age, sex, and population, along with suicides in the five age- bands 15-34 years to 75 + years. National gun ownership data from the international Small Arms Survey. Chi-square tests any significant difference between American and OWC suicides during the century. Spearman Rank Order correlations are used to determine comparability of suicides and gun ownership per thousand person rates over the period 2000-15. RESULTS USA had the highest gun ownership, treble the rate of the next highest country. American Total suicides rose 27%, significantly more than eight other countries (p < 0.05). The USA had significantly worse suicide outcomes for Older (75+) people than three OWC; eleven for Mature Adults 55-74; eight for Adults 34-54 and for ten countries for Young Adults 15-34. Young Adult suicides numbered 12,438, 6,702 gun-related in 2015, exceeding recent USA military losses. Only Young Adult suicides positively correlated with gun ownership (<0.025). CONCLUSIONS The key finding is whilst most countries reduced suicides American rates rose substantially this century, raising questions about US society. Importantly the easy access to firearms in the USA makes Young Adult suicide more likely when facing psycho-social stress. This study exposes the vulnerability of distressed young American adults in a permissive gun culture, with its sequel, life-long grieving parents.HighlightsDuring 21st Century USA suicides rose substantially more than other Western nations.Only USA suicides rose >20% amongst Total suicides and in those aged 15-to-74years.USA Young Adult suicides 150,099 in 21st century, 12,438 in 2015, 6,702 were gun-related.
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Logan TK, Lynch KR. Increased Risks or Peace of Mind? Exploring Fear, Victimization, and Safety Strategies Among Women Planning to Get a Gun. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP18032-NP18059. [PMID: 34376085 DOI: 10.1177/08862605211035865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Much of the research on firearm owners implies that the U.S. population can be divided into two groups-those that own guns and those that do not; however, there is a third group-those thinking of getting a gun and almost nothing is known about this group. A survey on gun ownership, experiences, and behaviors was deployed online via Prolific in June and July 2020 to recruit women from the general U.S. population who were planning on getting a gun (n = 187), who owned a gun (n = 288) and who did not own or plan to own guns (n = 968). Results show that women planning on getting a gun worried more about their personal safety and more had experienced recent interpersonal violence victimization compared to the other two groups. Almost all of the women planning on getting a gun believed that carrying a gun would make them safer. Even though women planning on getting a gun had limited experience with guns, they expressed fewer gun related worries than nongun owners. Additionally, women planning on getting a gun had more depression symptoms and more of them indicated they had thoughts of self-harm in the past two weeks than current gun owners. Depression symptoms were significantly associated with plans to get a gun in the multivariate model. Given the risks associated with having firearms in the household, interventions could target those considering getting a gun as well as educating friends and family about what to say when someone close is considering obtaining a firearm for safety.
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Affiliation(s)
- T K Logan
- University of Kentucky, Lexington, KY, USA
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Bond AE, Anestis MD. Firearm Type and Number: Examining Differences among Firearm Owning Suicide Decedents. Arch Suicide Res 2022; 26:1624-1631. [PMID: 33570007 DOI: 10.1080/13811118.2021.1885536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The present study sought to determine if among a sample of firearm owning suicide decedents, the type and number of firearms owned was associated with dying by suicide using a firearm compared to another method. METHOD Data were collected as part of a larger online study that gathered information on suicide decedents and the context surrounding their death from family members and friends. The present study used data from those who owned at least one firearm (n = 121). Participants in the present study were mostly male and white. RESULTS Among firearm owners, handgun ownership was significantly associated with dying by suicide using a firearm compared to using another method. The number of firearms owned was inversely associated with using a firearm compared to another method in a suicide death. The average number of firearms owned was higher among those who owned shotguns compared to handguns. CONCLUSIONS Handgun ownership, not shotgun ownership, was associated with having died from a self-inflicted gunshot wound. The finding regarding number of firearms should be interpreted with caution. Overall, findings provide insight into what differentiates firearm owners who die by suicide using a firearm compared to another method.
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Lane TJ. Associations Between Firearm and Suicide Rates: A Replication of Kleck (2021). Arch Suicide Res 2022:1-16. [PMID: 35686601 DOI: 10.1080/13811118.2022.2083535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Using data from n = 194 nation-states, Kleck found that firearm availability was only associated with firearm suicide rates, but not total or non-firearm suicides. He thus concluded that while firearm availability influences how people commit suicide, it does not affect total numbers. However, the study contains numerous logical and methodological issues and is at odds with the evidence base. Therefore, I attempt to reproduce the original results. METHOD I reproduce the original study's methods: ordinary least squares regression, weighted by the square root of the population, with log-transformed suicide rates and three separate firearm availability measures: global estimates from the Small Arms Survey, proportion of suicides committed with firearms, and a European Union survey of firearm ownership. I also test several methodological variations and include U.S. suicide data. RESULTS In contrast to Kleck, global analyses with Small Arms Survey data found a significant and positive association between firearm availability and total suicides, as did U.S. analyses. Analyses with other firearm availability measures comported with the original study, finding no association. CONCLUSION The main result in Kleck failed to reproduce, finding instead a significant association between firearm availability and suicide rates, as did U.S. analyses. While reproductions of Kleck's other analyses continued to show no association, they were based on unreliable methods. I therefore reject Kleck's conclusion that that firearm availability does not influence suicide rates. HighlightsUsing data global data, I find firearm availability is positively associated with suicide rates.I identify serious flaws in the logic and methods of Kleck and an earlier review.For transparency, data and code have been archived on a public repository.
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Logan TK, Cole J. Firearm-related threat exposure and associated factors among men and women entering a supportive housing substance use disorder recovery program. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:367-377. [PMID: 35157534 DOI: 10.1080/00952990.2021.2007259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Exposure to firearm victimization has often been overlooked as a sequela of substance use disorders (SUD).Objectives: The overall objective of this study was to explore firearm-related victimization and associated factors among men and women entering a supportive housing SUD recovery program.Methods: This study used program intake information from men (n = 1,758) and women (n = 1,066) clients entering a SUD recovery program.Results: Results found that almost half (49.3%) of the clients entering the program had ever been threatened with a firearm or held at gunpoint, and one-quarter of those clients had experienced firearm-related threats in the 6 months before entering the program. Economic vulnerability, mental health problems, polysubstance use, interpersonal victimization, and early use of drugs and alcohol were associated with firearm-related threat exposure. Many of the factors associated with firearm-related threat exposure were similar for men and women. Multivariate results found that polysubstance use (OR 1.16 men and 1.13 women), number of adverse childhood events (OR 1.13 men and 1.09 women), and interpersonal victimization (OR 3.41 men and 2.05 women) in the 6 months before program entry were significantly associated with ever being threatened with a firearm. Suicidality (OR 1.53 men and 1.80 women) and interpersonal victimization (OR 6.38 men and 6.08 women) were associated with being threatened with a firearm in the 6 months before program entry for both men and women.Conclusion: Results suggest there is a need for firearm-related risk reduction interventions for individuals in SUD recovery programs.
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Affiliation(s)
- T K Logan
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Jennifer Cole
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
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Temko JE, Grigorian A, Barrios C, Lekawa M, Nahmias L, Kuza CM, Nahmias J. Race, Age, and Lack of Insurance Increase Risk of Suicide Attempt in Trauma Patients. Arch Suicide Res 2022; 26:846-860. [PMID: 33186511 DOI: 10.1080/13811118.2020.1838370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The overall rate of suicide between 1999 and 2017 increased by 33% in the United States. We sought to examine suicide attempts in the trauma patient population, hypothesizing that in adult trauma patients race and lack of insurance status would be predictors of suicide attempt. METHOD The Trauma Quality Improvement Program (2010-2016) was queried for trauma patients ≥18 years old. The primary outcome was suicide attempt. A multivariable logistic regression model was performed including covariates that influence risk of suicide attempt. RESULTS From 1,403,466 adult trauma admissions, 16,263 (1.2%) patients attempted suicide. Death after suicide attempt occurred in 30.2% of patients. Independent predictors of suicide attempt were age < 40 years old (odds ratio [OR] = 1.46, 95% confidence interval [CI] [1.41, 1.51], p < .001) and no insurance (OR = 1.92, 95% CI [1.85, 2.00], p < .001). Black (vs. White) race was associated with decreased risk of suicide attempt (OR = 0.63, 95% CI [0.60, 0.67], p < .001). Hispanic (versus non-Hispanic) patients demonstrated lower associated risk of suicide attempt by gun (OR = 0.50, 95% CI [0.45, 0.54], p < .001), while Asian (vs. White) patients exhibited higher risk of suicide attempt overall (OR = 1.25, 95% CI [1.12, 1.39], p < .001) and more specifically by knife (OR = 2.55, 95% CI [2.16, 3.00], p < .001). CONCLUSIONS Age younger than 40 years and lack of insurance were associated with higher risk of suicide attempt in adult trauma patients. Asian race was associated with the highest risk of suicide, with >2.5 times increased risk of attempt by knife. Awareness of these demographic-specific risk factors for suicide attempt, and in particular violent mechanisms of suicide attempt, is critical to implementation of effective suicide prevention efforts.HighlightsAge younger than 40 and no insurance were associated with risk of suicide attempt.Black (vs. White) race was associated with decreased risk of suicide attempt.Asian race was associated with an increased risk of suicide attempt with a knife.
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Phillips JA, Hempstead K. The role of context in shaping the relationship between physical health and suicide over the life course. SSM Popul Health 2022; 17:101059. [PMID: 35257025 PMCID: PMC8897577 DOI: 10.1016/j.ssmph.2022.101059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 11/28/2022] Open
Abstract
U.S. suicide rates are at a thirty-year high while physical health, as measured by life expectancy and pain, has declined, particularly for those without a college degree. We investigate how these patterns may be related by exploring the role of physical health problems in suicide deaths using 2019 data from the National Violent Death Reporting System. We estimate multilevel logistic regression models to examine (1) how individual risk factors are associated with the likelihood of a physical health circumstance underlying a suicide over the life course and (2) how context – the socioeconomic, health and policy environment of the state in which a decedent resides – may play a role. Physical health circumstances were present in about 20% of all suicides and in over half of suicide deaths for the older population in 2019. A gender crossover effect exists, in which women are more likely to have a physical health problem contribute to a suicide prior to age 60, but men surpass women after age 60 in that probability. Net of individual characteristics, we find significant variation across states in the likelihood of physical health circumstances. For all age groups, physical health circumstances are more likely in states that are less densely populated with weaker gun control laws and higher suicide rates. Among decedents younger than 65, the likelihood is elevated in states with limited health care access. This study highlights the critical interaction between physical and mental well-being, the ways in which that interaction may be experienced differently by gender, and the important role of social safety nets in prevention. Poor physical health is an important risk factor for suicide. Overall, women and older suicide decedents are more likely to have a physical health circumstance. A gender crossover effect exists, with older men more likely to have a physical health circumstance. State health and policy environment affects the likelihood of a physical health circumstance. Improving physical health and social support is an avenue to suicide prevention.
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Affiliation(s)
- Julie A. Phillips
- Rutgers, the State University of New Jersey, 26 Nichol Avenue, New Brunswick, NJ, 08901, USA
- Corresponding author.
| | - Katherine Hempstead
- Robert Wood Johnson Foundation, 50 College Road East, Princeton, NJ, 08540-6614, USA
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Logan TK, Cole J, Schroeder M. Examining Recovery Status and Supports before and after Substance Abuse Disorder Treatment Among Clients Who Experienced Lifetime and Recent Firearm-Related Threats. JOURNAL OF DRUG ISSUES 2021. [DOI: 10.1177/00220426211056601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Firearm-related risks have often been overlooked in the sequela of substance use and substance use disorders. This study compares adult substance abuse disorder treatment (SADT) clients who experienced recent ( n = 274) and lifetime ( n = 889) firearm threats to adults who were not threatened with a firearm ( n = 2029) before and 12 months after program entry. More men experienced firearm threats (38.8%) than women (34.2%). However, among those with any firearm threats, more women (27.2%) experienced firearm threats in the year before program entry than men (20.2%). Being threatened with a firearm was associated with increased economic vulnerability, criminal justice system involvement, mental health problems, and victimization both before and after SADT program entry. A higher number of adverse childhood experiences were associated with firearm threats and particularly recent firearm threats. Results of this study underscore the importance of screening for firearm-related risks in substance abuse disorder treatment programs.
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Affiliation(s)
- TK Logan
- University of Kentucky, Lexington, KY, USA
| | | | - Maggie Schroeder
- Kentucky Department of Behavioral Health, Developmental and Intellectual Disabilities, Frankfort, KY, USA
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26
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Stack S. Contributing factors to suicide: Political, social, cultural and economic. Prev Med 2021; 152:106498. [PMID: 34538366 DOI: 10.1016/j.ypmed.2021.106498] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/10/2021] [Accepted: 02/27/2021] [Indexed: 11/16/2022]
Abstract
This review summarizes recent research in four environmental areas affecting risk of deaths by suicide. Politically, the weight of the evidence suggests that laws increasing social welfare expenditures and other policies assisting persons with low incomes (e.g., minimum wage) tend to lower suicide rates. Other legal changes such as those restricting firearms and alcohol availability can also prevent suicides. The social institutions of marriage, as well as parenting, continue to serve as protective factors against suicide, although the degree of protection is often gendered. Religiousness tends to be inversely associated with suicide deaths at the individual level of analysis, but the mediators need exploration to determine what accounts for the association: social support, better mental health, better physical health, less divorce, or other covariates. Cultural definitions of the traditional male role (e.g., breadwinner culture) continue to help explain the high male to female suicide ratio. New work on the "culture of suicide" shows promise. The degree of approval of suicide is sometimes the single most important factor in predicting suicide. At the individual level of analysis, two of the strongest predictors of suicide are economic ones: unemployment and low socio-economic status. Attention is drawn to enhancing the minimum wage as a policy known to lower state suicide rates. Limitations of research include model mis-specification, conflicting results especially when ecological data are employed, and a need for more research exploring moderators of established patterns such as that between religiousness and suicide.
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27
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Anestis JC, Anestis MD, Preston OC, Rodriguez TR. Dispositional characteristics in firearm ownership and purchasing behavior during the 2020 purchasing surge. Soc Sci Med 2021; 289:114408. [PMID: 34653931 DOI: 10.1016/j.socscimed.2021.114408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 01/29/2023]
Abstract
RATIONALE In 2020 the U.S. saw a firearm purchasing surge that was synchronous with the onset of the SARS-CoV-2 (COVID-19) pandemic and notable community unrest. Extant literature has highlighted a potential cohort effect among 2020 firearm purchasers and the importance of characterizing these individuals to inform policy and interventions. Dispositional traits have received minimal attention in the firearm literature overall, despite research that indicates dispositional traits impact intervention interest, access, and effectiveness. OBJECTIVE The current study examined two dispositional traits indicated as important in firearm research - threat sensitivity (THT) and disinhibition (DIS). We hypothesized that 1) firearm owners overall would have lower THT and higher DIS relative to non-firearm owners, 2) mean levels of DIS (but not THT) would be higher among firearm owners who purchased during the 2020 purchasing surge relative to firearm owners who did not and non-firearm owners, and 3) DIS (but not THT) would be related to future plans for purchasing such that mean levels of DIS would be highest amongst those who have plans. METHODS This study used an online-recruited sample (N = 3500) matched to 2010 US Census data. RESULTS Firearm owners demonstrated lower THT and higher DIS than non-firearm owners. 2020 firearm purchasers had higher DIS compared to non-firearm owners and non-purchasing firearm owners, while firearm owners who did not purchase had lower THT compared to non-owners and 2020 purchasers. Plans to purchase in the next 12 months was associated with higher DIS relative to those undecided or without plans. CONCLUSIONS In combination with prior research, findings suggest elevated DIS may drive purchasing as a danger and distress management strategy, while low THT may protect against emotion-based firearm purchasing. Further research is needed to clarify the directionality of these relationships and to identify other dispositional characteristics of those purchasing firearms in 2020.
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Affiliation(s)
- Joye C Anestis
- Department of Health Behavior, Society, & Policy, School of Public Health, Rutgers, The State University of New Jersey, USA.
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, Rutgers, the State University of New Jersey, USA; Department of Urban-Global Public Health, School of Public Health, Rutgers, the State University of New Jersey, USA
| | | | - Taylor R Rodriguez
- New Jersey Gun Violence Research Center, Rutgers, the State University of New Jersey, USA; Department of Psychology, School of Arts & Sciences, Rutgers, the State University of New Jersey, USA
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28
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Kivisto AJ, Kivisto KL, Gurnell E, Phalen P, Ray B. Adolescent Suicide, Household Firearm Ownership, and the Effects of Child Access Prevention Laws. J Am Acad Child Adolesc Psychiatry 2021; 60:1096-1104. [PMID: 32971189 DOI: 10.1016/j.jaac.2020.08.442] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/17/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study has 3 objectives: to examine the association between state-level firearm ownership and suicide among adolescents of high school age; to compare the strength of the firearm ownership-suicide association among adolescents relative to adults; and to evaluate the relationship between 11 child access prevention (CAP) laws and suicide. METHOD Using an ecological time series cross-sectional design, we modeled suicide rates from January 1, 1991, to December 31, 2017, as a function of household firearm ownership and states' implementation of CAP provisions using fixed effect negative binomial models. RESULTS There were 37,652 suicides among adolescents between the ages of 14 and 18 years during the study period, and more than half of all suicides (51.5%, n = 19,402) involved firearms. Each 10 percentage-point increase in states' firearm ownership was associated with a 39.3% (35.1%-43.5%) increase in firearm suicide, which in turn contributed a 6.8% (2.5%-11.1%) increase in all-cause suicide. The association between firearm ownership and suicide was approximately 2 times stronger among adolescents relative to adults. Policies mandating locks and safe storage were associated with a 13.1% (2.7%-22.3%) reduction in adolescent firearm suicide and an unexplained 8.7% (1.2%-15.7%) reduction in non-firearm suicide. CAP provisions were associated with reduced firearm suicide across the lifespan, but effects were stronger among adolescents. CONCLUSION There is an increased risk of adolescent suicide associated with household firearm ownership, and safe storage provisions are associated with decreased adolescent firearm suicide.
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Affiliation(s)
| | | | | | - Peter Phalen
- University of Maryland, Baltimore, and VA Capitol Health Care Network, Baltimore, Maryland
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Mann JJ, Michel CA, Auerbach RP. Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review. Am J Psychiatry 2021; 178:611-624. [PMID: 33596680 PMCID: PMC9092896 DOI: 10.1176/appi.ajp.2020.20060864] [Citation(s) in RCA: 206] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to identify scalable evidence-based suicide prevention strategies. METHODS A search of PubMed and Google Scholar identified 20,234 articles published between September 2005 and December 2019, of which 97 were randomized controlled trials with suicidal behavior or ideation as primary outcomes or epidemiological studies of limiting access to lethal means, using educational approaches, and the impact of antidepressant treatment. RESULTS Training primary care physicians in depression recognition and treatment prevents suicide. Educating youths on depression and suicidal behavior, as well as active outreach to psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior. Meta-analyses find that antidepressants prevent suicide attempts, but individual randomized controlled trials appear to be underpowered. Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention. Cognitive-behavioral therapy and dialectical behavior therapy prevent suicidal behavior. Active screening for suicidal ideation or behavior is not proven to be better than just screening for depression. Education of gatekeepers about youth suicidal behavior lacks effectiveness. No randomized trials have been reported for gatekeeper training for prevention of adult suicidal behavior. Algorithm-driven electronic health record screening, Internet-based screening, and smartphone passive monitoring to identify high-risk patients are understudied. Means restriction, including of firearms, prevents suicide but is sporadically employed in the United States, even though firearms are used in half of all U.S. suicides. CONCLUSIONS Training general practitioners warrants wider implementation and testing in other nonpsychiatrist physician settings. Active follow-up of patients after discharge or a suicide-related crisis should be routine, and restricting firearm access by at-risk individuals warrants wider use. Combination approaches in health care systems show promise in reducing suicide in several countries, but evaluating the benefit attributable to each component is essential. Further suicide rate reduction requires evaluating newer approaches, such as electronic health record-derived algorithms, Internet-based screening methods, ketamine's potential benefit for preventing attempts, and passive monitoring of acute suicide risk change.
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Affiliation(s)
- J. John Mann
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, and Department of Psychiatry and Radiology, Columbia University, New York, NY
| | - Christina A. Michel
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY
| | - Randy P. Auerbach
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, and Department of Psychiatry, Columbia University, New York, NY,Division of Clinical Developmental Neuroscience, Sackler Institute
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30
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Capron DW, Andel R, Voracek M, Till B, Niederkrotenthaler T, Bauer BW, Anestis MD, Tran US. Time-series analyses of firearm-related Google searches and U.S. suicide rates 2004-2016. Suicide Life Threat Behav 2021; 51:554-563. [PMID: 33426750 DOI: 10.1111/sltb.12728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/28/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The U.S. suicide rate has increased 35% since 1999. The role of the Internet has not been thoroughly investigated despite Internet use more than doubling from 1999 to present. The majority of U.S. suicide deaths are by firearm; however, there is no examination of the association between trends in firearm Internet searches and overall and firearm monthly suicide rates. We hypothesized that search strings related to firearm suicide would be significantly associated with monthly suicide rates (both all methods and firearm). METHODS Google Trends provides data on request frequencies of searches. Twenty-four search strings were examined representing possible searches by individuals considering firearm suicide and compared to U.S. suicide rates with time-series modeling. RESULTS In the time series with higher search volumes, consistent associations were found of negative cross-correlation at lag +1. CONCLUSIONS Several searches appeared at least sensitive enough to consistently show associations with overall and firearm suicide rates in the following month. This novel finding should be followed up as the potential exists to predict suicide trends.
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Affiliation(s)
| | - Rita Andel
- Wiener Werkstaette for Suicide Research, Vienna, Austria
| | - Martin Voracek
- Wiener Werkstaette for Suicide Research, Vienna, Austria.,Department of Cognition, Emotion, and Methods of Psychology, School of Psychology, University of Vienna, Vienna, Austria
| | - Benedikt Till
- Wiener Werkstaette for Suicide Research, Vienna, Austria.,Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Thomas Niederkrotenthaler
- Wiener Werkstaette for Suicide Research, Vienna, Austria.,Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Brian W Bauer
- University of Southern Mississippi, Hattiesburg, MS, USA
| | | | - Ulrich S Tran
- Wiener Werkstaette for Suicide Research, Vienna, Austria.,Department of Cognition, Emotion, and Methods of Psychology, School of Psychology, University of Vienna, Vienna, Austria
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Quenzer F, Givner A, Dirks R, Coyne CJ, Ercoli F, Townsend R. Self-Inflicted Gun Shot Wounds: A Retrospective, Observational Study of U.S. Trauma Centers. West J Emerg Med 2021; 22:518-524. [PMID: 34125021 PMCID: PMC8203010 DOI: 10.5811/westjem.2021.4.49315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 04/03/2021] [Accepted: 04/03/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Intentional self-harm (suicide) by firearms is a growing problem in the United States. Currently, there are no large studies that have identified risk factors for patients who die from self-inflicted gunshot wounds. Our objectives are to 1) identify risk factors for patients with the highest morbidity and mortality from self-inflicted gunshot wounds (SIGSWs) at trauma centers 2) present the outcomes of victims of SIGSW by handguns (HG) versus all other specified guns (AOG) and 3) compare the presentations and outcomes of victims with head or face (HF) injuries to other regions of the body. METHODS We performed a retrospective analysis from the National Trauma Database (NTDB) data between 2012 and 2013 of all SIGSW patients who presented to trauma centers. Categorical data included patient characteristics upon presentation and outcomes which were compared between patients with HG injury versus AOG injury using the Chi-Squared test, where AOG includes shotguns, hunting rifles, and military firearms. Additionally, analysis of head and face (HF) injuries versus other bodily injuries (OBI) were compared between the HG group versus AOG group using Chi-squared test. RESULTS There were 7,828 SIGSWs, of those, 78% (6,115) were white and 84.3% (6,600) were male. There were 5,139 HG injuries, 1,130 AOG injuries, and 1,405 unidentified gun injuries. The HG group was likely to be older (>55 years old), hypotensive (systolic blood pressure < 90), have a lower Glasgow Coma Score (GCS < 9), use illegal, or use prescription drugs. In comparing HF injuries (4,799) versus other bodily injuries (OBI) (3,028), HF group was more likely to use handguns, expire in ED, require ICU, and have a higher percent of overall mortality. Of the total OBI, the thorax, upper extremities, and abdomen were the most commonly injured. CONCLUSION In our retrospective study of SIGSWs, we were able to demonstrate that SIGSW by handguns are associated with higher rates of mortality versus all other types of firearms. SIGSWs in older white males with handguns are the most at-risk for severe complications. Future efforts should improve screening methods for handguns in suicidal patients and at developing prevention programs.
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Affiliation(s)
- Faith Quenzer
- University of California, San Diego, Department of Emergency Medicine, San Diego, California
| | - Andrew Givner
- Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California
| | - Rachel Dirks
- University of California, San Francisco-Fresno, Department of Emergency Medicine, Fresno, California
| | - Christopher J. Coyne
- University of California, San Diego, Department of Emergency Medicine, San Diego, California
| | - Frank Ercoli
- Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California
- Desert Regional Medical Center, Desert Trauma Surgeons, Palm Springs, California
| | - Ricard Townsend
- Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California
- Desert Regional Medical Center, Desert Trauma Surgeons, Palm Springs, California
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32
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An examination of preferred messengers on firearm safety for suicide prevention. Prev Med 2021; 145:106452. [PMID: 33577775 DOI: 10.1016/j.ypmed.2021.106452] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 11/23/2022]
Abstract
This study sought to determine differences in preferred messengers on the topic of safe firearm storage and suicide prevention between firearm owners and non-firearm owners, and among firearm owners of different racial groups and sexes. Participants were 6200 United States residents recruited via Qualtrics Panels to complete an online survey. Data were collected during March 2020. The total sample and all subsamples ranked law enforcement, current military personnel, and military veterans as the top three most credible sources to discuss firearm safety for suicide prevention. Significant differences existed among the mean ranking of sources between firearm owners and non-firearm owners as well as between several subgroups of firearm owners. The identical ranking of the top three sources indicates that these groups agree on the relative credibility of multiple sources, although the average level of credibility for particular sources may vary. These findings highlight that the effectiveness of messaging on safe firearm storage may hinge on the identity of the individual delivering the message and provide an initial roadmap for how to consider packaging specific messages.
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33
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Hinnant A, Boman CD, Hu S, Ashley RR, Lee S, Dodd S, Garbutt JM, Cameron GT. The Third Rail of Pediatric Communication: Discussing Firearm Risk and Safety in Well-Child Exams. HEALTH COMMUNICATION 2021; 36:508-520. [PMID: 31833783 PMCID: PMC7771016 DOI: 10.1080/10410236.2019.1700883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This research endeavors to understand how pediatricians and parents discuss - or do not discuss - firearm risks for children during well-child visits. Through individual semi-structured interviews with 16 pediatric providers and 20 parents, the research explores discursive barriers to open conversation, perspectives on anticipatory guidance, and new ideas for culturally competent messaging. The research focuses particularly on how parents' and providers' perspectives on firearm risk communication are tied to cultural norms and expectations. One salient theme that emerged is that the American Academy of Pediatrics recommendation that pediatricians ask parents about ownership status is deemed undesirable by pediatricians and parents because of the delicate intercultural setting. Born out of pediatric and parent experiences, and mindful of culturally salient barriers, this study offers alternative strategies for discussing firearm risk in well-child exams.
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Affiliation(s)
| | | | - Sisi Hu
- School of Journalism, University of Missouri
| | | | | | - Sherry Dodd
- Department of Pediatrics, Washington University School of Medicine
| | - Jane M Garbutt
- Departments of Medicine and Pediatrics, Washington University School of Medicine
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Anestis MD, Bond AE, Daruwala SE, Bandel SL, Bryan CJ. Suicidal Ideation Among Individuals Who Have Purchased Firearms During COVID-19. Am J Prev Med 2021; 60:311-317. [PMID: 33358551 DOI: 10.1016/j.amepre.2020.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Given the increase in firearm purchases during the COVID-19 pandemic, this study seeks to determine the extent to which COVID-19 firearm purchasers differ in terms of suicide risk from nonfirearm owners and firearm owners who did not make a purchase during COVID-19. METHODS Participants (N=3,500) were recruited through Qualtrics Panels to participate in an online survey examining methods for self-protection. ANCOVAs were utilized to assess suicidal ideation. Multivariate ANCOVAs were used to examine firearm storage practices and storage changes during COVID-19. Data were collected in late June and early July 2020, and analyses were conducted in July 2020. RESULTS Individuals who purchased a firearm during COVID-19 more frequently reported lifetime, past-year, and past-month suicidal ideation than nonfirearm owners and firearm owners who did not make a purchase during COVID-19. COVID-19 purchasers with lifetime ideation were less likely to hide loaded firearms in a closet than those without lifetime ideation. COVID-19 purchasers with past-year or past-month ideation were more likely to use locking devices than COVID-19 purchasers without past-month ideation. CONCLUSIONS In contrast to firearm owners more generally, COVID-19 firearm purchasers appear far more likely to have experienced suicidal ideation and appear less likely to use certain unsafe firearm storage methods but also report a greater number of storage changes during COVID-19 that made firearms less secure. Future research should seek to further understand those who purchased a firearm during COVID-19 and determine ways to increase secure storage among firearm owners.
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Affiliation(s)
- Michael D Anestis
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey; Department of Urban-Global Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey.
| | - Allison E Bond
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi
| | - Samantha E Daruwala
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi
| | - Shelby L Bandel
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Anestis MD, Bryan CJ, Capron DW, Bryan AO. Lethal Means Counseling, Distribution of Cable Locks, and Safe Firearm Storage Practices Among the Mississippi National Guard: A Factorial Randomized Controlled Trial, 2018-2020. Am J Public Health 2021; 111:309-317. [PMID: 33351652 PMCID: PMC7811068 DOI: 10.2105/ajph.2020.306019] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/04/2022]
Abstract
Objectives. To examine whether lethal means counseling and provision of cable locks prompt safe firearm storage relative to control among firearm-owning members of the Mississippi National Guard.Methods. This randomized controlled trial utilized a 2 × 2 factorial design (lethal means counseling vs control, provision of cable locks vs no cable locks). Follow-up assessments took place at 3 and 6 months after baseline. Data were collected (n = 232; 87.5% male; mean age = 35.01 years; 77.2% White) from February 2018 through July 2020.Results. Relative to control, lethal means counseling and provision of cable locks resulted in greater adoption of several safe storage methods over time. Lethal means counseling outperformed control (3 months: 55.0% vs 39.0%; odds ratio [OR] = 1.91). Cable locks outperformed control at 3 and 6 months on number of storage methods (1.41 vs 1.11; d = 0.29 and 1.34 vs 1.16; d = 0.15, respectively) and locking devices (59.8% vs 29.9%; OR = 3.49 and 58.4% vs 35.8%; OR = 2.52, respectively)Conclusions. Lethal means counseling and cable locks can result in sustained changes in firearm storage.Public Health Implications. The military may benefit from lethal means counseling, perhaps administering at point of entry.Trial Registration. Clinical Trials.gov identifier: NCT03375099.
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Affiliation(s)
- Michael D Anestis
- Michael D. Anestis is with the New Jersey Gun Violence Research Center and the Department of Urban-Global Public Health, School of Public Health, Rutgers, The State University of New Jersey, Piscataway. Craig J. Bryan and AnnaBelle O. Bryan are with the Department of Psychiatry and Behavioral Health, the Ohio State University Wexner Medical Center, Columbus. Daniel W. Capron is with the School of Psychology, University of Southern Mississippi, Hattiesburg
| | - Craig J Bryan
- Michael D. Anestis is with the New Jersey Gun Violence Research Center and the Department of Urban-Global Public Health, School of Public Health, Rutgers, The State University of New Jersey, Piscataway. Craig J. Bryan and AnnaBelle O. Bryan are with the Department of Psychiatry and Behavioral Health, the Ohio State University Wexner Medical Center, Columbus. Daniel W. Capron is with the School of Psychology, University of Southern Mississippi, Hattiesburg
| | - Daniel W Capron
- Michael D. Anestis is with the New Jersey Gun Violence Research Center and the Department of Urban-Global Public Health, School of Public Health, Rutgers, The State University of New Jersey, Piscataway. Craig J. Bryan and AnnaBelle O. Bryan are with the Department of Psychiatry and Behavioral Health, the Ohio State University Wexner Medical Center, Columbus. Daniel W. Capron is with the School of Psychology, University of Southern Mississippi, Hattiesburg
| | - AnnaBelle O Bryan
- Michael D. Anestis is with the New Jersey Gun Violence Research Center and the Department of Urban-Global Public Health, School of Public Health, Rutgers, The State University of New Jersey, Piscataway. Craig J. Bryan and AnnaBelle O. Bryan are with the Department of Psychiatry and Behavioral Health, the Ohio State University Wexner Medical Center, Columbus. Daniel W. Capron is with the School of Psychology, University of Southern Mississippi, Hattiesburg
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36
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Bojanić L, Pitman A, Kapur N. Suicide prevention through means restriction: the example of firearms control in Croatia. J Public Health (Oxf) 2021; 44:402-407. [PMID: 33429426 DOI: 10.1093/pubmed/fdaa251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/13/2020] [Accepted: 12/11/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health, Division of Psychology and Mental Health, University of Manchester, M13 9PL, Manchester, UK
| | - A Pitman
- Division of Psychiatry, University College London, W1T 7NF, London, UK.,Camden and Islington NHS Foundation Trust, NW1 0PE, London, UK
| | - N Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health, Division of Psychology and Mental Health, University of Manchester, M13 9PL, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, M25 3BL, Manchester, UK
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Bleyer A, Siegel SE, Thomas CR. Increasing Rate of Unintentional Firearm Deaths in Youngest Americans: Firearm Prevalence and Covid-19 Pandemic Implication. J Natl Med Assoc 2021; 113:265-277. [PMID: 33446333 DOI: 10.1016/j.jnma.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The United States has had, by far, the world's greatest civilian ownership of firearms. An even greater ownership occurred during the Covd-19 pandemic, mostly of handguns and including many new owners. The U.S. has also had the least progress of the 41 highest sociodemographic countries ranked by the Institute for Health Metrics and Evaluation in reducing the unintentional firearm mortality rate in young children. This study characterized the unintentional firearm mortality trends in American 1-4 year-olds by sex and race/ethnicity and evaluated the trends in the context of firearm prevalence in the U.S. METHODS Mortality data for 1999-2018 were obtained from the U.S. Centers for Disease Control and Prevention and the Institute for Health Metrics and Evaluation, firearm injury and mortality data for 2016-2020 from Everytown for Gun Safety #NotAnAccident database, firearm background check data for 1999-2020 from the National Instant Criminal Background Check System, and civilian firearm prevalence for 2017 from the Small Arms Survey. RESULTS In American 1-4 year-olds, the rate of unintentional firearm deaths during 1999-2018 increased exponentially at an average annual percent rate of 4.9 (p < 0.001) and was greatest in non-Hispanic black children. Unintentional firearm deaths had the most rapid increase of all evaluable causes of death in the age group. The unintentional firearm death rate increase was correlated with the concurrent rate of firearm background checks and handgun permits issued (each p < 0.001) and in non-Hispanic white children with handgun prevalence in their families (p = 0.03). Globally, the unintentional firearm death rate was also correlated with firearm prevalence (p = 0.02). CONCLUSIONS An increase in fatal firearm accidents in the United States death rate among 1-4 year-olds is directly associated with the steadily increasing prevalence of firearms. The acceleration of firearm deaths and injuries among young Americans, especially among non-Hispanic black children, requires urgent solutions to address firearm prevalence and access. The problem is expected to become even more urgent as a result of the record high firearm sales that occurred in the United States during the 2020 coronavirus pandemic.
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Affiliation(s)
- Archie Bleyer
- Knight Cancer Institute and Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA; McGovern Medical School, University of Texas, Houston, TX, USA.
| | | | - Charles R Thomas
- Department of Radiation Medicine and Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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Anestis MD, Bryan CJ. Threat perceptions and the intention to acquire firearms. J Psychiatr Res 2021; 133:113-118. [PMID: 33338733 DOI: 10.1016/j.jpsychires.2020.12.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/09/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Firearm sales have surged during COVID-19, raising concerns about a coming wave of suicide deaths. Little is known, however, about the individuals considering acquiring firearms during the pandemic. Recent research has highlighted that individuals considering acquiring firearms may be motivated by exaggerated threat expectancies. In a sample of 3,500 Americans matched to 2010 United States Census data, we compared individuals intending to buy firearms in the coming 12 months (assessed in late June and early July 2020) to those undecided or not planning to acquire firearms on a range of demographic, anxiety, and firearm ownership variables. Our results indicated that those intending to acquire a firearm in the next twelve months are less tolerant of uncertainty, endorse exaggerated threat expectancies, and are experiencing more severe COVID-19 specific fears. Individuals intending to purchase firearms were also more likely to have experienced suicidal ideation in the past year, to have worked in law enforcement, and to have been considered essential workers during COVID-19. Furthermore, such individuals were more likely to already own firearms and to have purchased firearms during the opening months of the COVID-19 pandemic. Those intending to purchase firearms did not endorse lower perceived neighborhood safety, however, indicating that their intent to purchase firearms is unlikely to be driven by tangible threats in their immediate environment. These findings highlight that exaggerated fears may be motivating individuals to purchase firearms to diminish anxiety and that this trend may be particularly common among individuals who already own firearms.
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Affiliation(s)
- Michael D Anestis
- New Jersey Gun Violence Research Center, United States; Rutgers, the State University of New Jersey, United States.
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, United States
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Gomez DB, Xu Z, Saleh JH. From Regression Analysis to Deep Learning: Development of Improved Proxy Measures of State-Level Household Gun Ownership. PATTERNS 2020; 1:100154. [PMID: 33336203 PMCID: PMC7733878 DOI: 10.1016/j.patter.2020.100154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/05/2020] [Accepted: 11/03/2020] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- David Benjamin Gomez
- School of Aerospace Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Zhaoyi Xu
- School of Aerospace Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Joseph Homer Saleh
- School of Aerospace Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Kongkaewpaisan N, El Hechi M, El Moheb M, Orlas CP, Ortega G, Mendoza MA, Parks J, Saillant NN, Kaafarani HMA, Mendoza AE. No place like home: A national study on firearm-related injuries in the American household. Am J Surg 2020; 220:1599-1604. [PMID: 32409008 DOI: 10.1016/j.amjsurg.2020.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/11/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND We aimed to examine the prevalence of, and describe factors associated with, firearm-related injuries in American households. METHODS Using the 2010-2016 ACS-TQIP database, all ICD-9/10 external causes of injury for firearm-related injuries were queried with the place of occurrence designated as "home". Causes of injury were identified as assault, intentional self-injury, and unintentional injury. Univariate then multivariable regression analyses were performed to identify factors associated with each injury type. RESULTS 12,657 firearm-related injuries in households were identified. Of those, 49.9% were victims of assault, 35.7% were intentional self-injury, and 14.4% were unintentional. Mortality was highest among self-inflicted injuries (52.4%), followed by assault (12.9%), and unintentional injuries (5.9%). On multivariable analysis, age <45 years, African-American race, and drug use were independently associated with an injury secondary to assault. Age >65 years, White race, psychiatric illness, and alcohol use disorder were independently associated with intentional self-injury. White and American-Indian race were independently associated with unintentional injuries. CONCLUSIONS Assault is the most common cause of home-related firearm injury requiring hospitalization, while intentional self-injury is the most lethal.
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Affiliation(s)
- Napaporn Kongkaewpaisan
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Acute Care and Ambulatory Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Majed El Hechi
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohamad El Moheb
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Claudia P Orlas
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Melissa A Mendoza
- Louisiana State University Health Science Center New Orleans, School of Public Health, Health Policy & Systems Management, New Orleans, LA, USA
| | - Jonathan Parks
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Noelle N Saillant
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - April E Mendoza
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Bhatt A, Wang X, Cheng AL, Morris KL, Beyer L, Chestnut A, Steigerwalt K, Metzner J. Association of Changes in Missouri Firearm Laws With Adolescent and Young Adult Suicides by Firearms. JAMA Netw Open 2020; 3:e2024303. [PMID: 33146733 PMCID: PMC7643031 DOI: 10.1001/jamanetworkopen.2020.24303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Suicide by firearm is a major cause of mortality in young Missouri residents. Changes in statewide firearm policy may have contributed to changes in suicide rates. OBJECTIVE To evaluate if changes in Missouri permit-to-purchase (PTP) and concealed carry firearm laws were associated with changes in rates of suicide by firearms in young Missouri residents. DESIGN, SETTINGS, AND PARTICIPANTS This cross-sectional study examined rates of suicide by firearm in Missouri among adolescents (ages 14-18 years) and young adults (ages 19-24 years) from January 1999 to December 2018, following changes to state PTP and concealed carry law, in comparison with a donor state pool with existing firearm laws (13 states in PTP pool; 42 states in concealed carry pool) that did not make changes during this period. This study used a quasiexperimental, synthetic control design at the state level that defined Missouri as the treated state and treatment as changes in firearm laws. EXPOSURES Legislative changes to Missouri's PTP and concealed carry firearm laws. MAIN OUTCOMES AND MEASURES Age-adjusted annual rates of firearm-related suicide mortality per 100 000 people for adolescents (aged 14-18 years) and young adults (aged 19-24 years). RESULTS Repeal of the PTP law was associated with a 21.8% increase in firearm suicide rates in young adults aged 19 to 24 years in Missouri. Lowering the minimum age of concealed carry to 19 years in Missouri was associated with a 32.0% increase in firearm suicide rates and a 29.7% increase in nonfirearm suicide rates in adolescents aged 14 to 18 years, and a 7.2% increase in firearm suicide rates in young adults aged 19 to 24 years. CONCLUSIONS AND RELEVANCE Increases in rates of suicide by firearms in adolescents and young adults were seen following repeal of Missouri's PTP law and lowering of the minimum age for concealed carry in 2014. Changes in Missouri's firearm policies may be an important contributor to rates of suicide by firearm in young Missouri residents.
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Affiliation(s)
- Apurva Bhatt
- University of Missouri-Kansas City/Center for Behavioral Medicine, Kansas City
- Truman Medical Centers, Kansas City, Missouri
| | - Xi Wang
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City
| | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City
- University of Missouri-Kansas City School of Medicine, Kansas City
| | - Kalee L. Morris
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri
| | - Luke Beyer
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri
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Fochtmann LJ, Medicus J, Hong SH. Performance in Practice: Practice Assessment Tool for the Care of Patients With Schizophrenia. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:402-423. [PMID: 33343252 PMCID: PMC7725154 DOI: 10.1176/appi.focus.20200034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Schizophrenia is associated with significant health, social, occupational, and economic burdens, including increased mortality. Despite extensive and robust research on the treatment of individuals with schizophrenia, many individuals with the illness do not currently receive evidence-based pharmacological and nonpharmacological treatments. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia, Third Edition, aims to enhance knowledge and increase the appropriate use of interventions for schizophrenia, thereby improving the quality of care and treatment outcomes. To this end, this evidence-based Performance in Practice tool can facilitate the implementation of a systematic approach to practice improvement for the care of individuals with schizophrenia. This practice assessment activity can also be used in partial fulfillment of Continuing Medical Education and Maintenance of Certification, part IV, requirements, which can also satisfy requirements for the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System program.
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Affiliation(s)
- Laura J Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
| | - Jennifer Medicus
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
| | - Seung-Hee Hong
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
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43
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Anestis MD, Bandel SL, Butterworth SE, Bond AE, Daruwala SE, Bryan CJ. Suicide risk and firearm ownership and storage behavior in a large military sample. Psychiatry Res 2020; 291:113277. [PMID: 32886959 DOI: 10.1016/j.psychres.2020.113277] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
Firearms account for the majority of suicide deaths in the United States military and access to firearms is a risk factor for suicide. Prior research has shown service members tend to store firearms unsafely, with some research indicating this is particularly true among those with elevated suicide risk. Existing research has focused on individuals at known risk for suicide; however, those who die by suicide using a firearm are prone to avoiding mental healthcare and underreporting suicidal ideation, thereby necessitating an understanding of this phenomenon among firearm owners outside of the mental healthcare system. The present study examined firearm storage and suicide risk in a large nonclinical sample of service members (total sample n = 953; firearm owning sample = 473). Lifetime suicidal ideation, current depressive symptoms, and perceived likelihood of making a future suicide attempt were associated with unsafe firearm storage. In contrast, lifetime suicidal ideation was not associated with a greater likelihood to own firearms. These findings suggest those at risk of suicide are more likely to store firearms unsafely, which increases ease of access to firearms. These findings reiterate the importance of means safety as a suicide prevention strategy.
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Affiliation(s)
- Michael D Anestis
- New Jersey Gun Violence Research Center, United States; School of Public Health, Rutgers, The State University of New Jersey, United States.
| | - Shelby L Bandel
- School of Psychology, University of Southern Mississippi, United States
| | | | - Allison E Bond
- School of Psychology, University of Southern Mississippi, United States
| | | | - Craig J Bryan
- Department of Psychiatry & Behavioral Health, The Ohio State University, United States
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44
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Choi KR, Saadi A, Takada S, Easterlin MC, Buchbinder LS, Johnson DC, Zimmerman FJ. Longitudinal Associations Between Healthcare Resources, Policy, and Firearm-Related Suicide and Homicide from 2012 to 2016. J Gen Intern Med 2020; 35:2043-2049. [PMID: 31898128 PMCID: PMC7352015 DOI: 10.1007/s11606-019-05613-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/06/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Firearm-related violence is a leading cause of mortality in the United States (US). Prior research suggests that public policy plays a role in firearm mortality, but the role of healthcare resources (physicians, insurance coverage) within the US policy context has not yet been studied. OBJECTIVE To examine how healthcare resources and social/firearm policy affect firearm-related suicide and homicide rates in the US. DESIGN Longitudinal, ecological study. SETTING US. PARTICIPANTS US states from 2012 to 2016 (N = 242). MEASUREMENT The outcome variables were age-adjusted, firearm-related suicide and homicide rates. Predictor variables were healthcare resources (physicians, Medicaid benefits generosity) and policy context (social policy, firearm policy) with covariates for sociodemographic factors. RESULTS Healthcare provider variables did not have significant associations to firearm-related suicide or homicide. In fully saturated models, more worker protection laws, greater average population density, more alcohol regulation, and more firearm prohibition policies were associated with fewer firearm-related suicides. Higher generosity of Medicaid benefits was associated with fewer firearm-related homicides. Poverty rate was a predictor of both outcomes. LIMITATIONS This state-level study cannot make individual-level inferences. Only proxy variables were available for measuring gun ownership and actual gun ownership rates may not have been ideally captured at the state level. CONCLUSIONS At the state level, there are protective associations of certain social, healthcare, and firearm policies to firearm-related suicide and homicide rates. Healthcare resources play a role in population-level firearm outcomes but alone are not sufficient to decrease firearm-related homicide or suicide.
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Affiliation(s)
- Kristen R Choi
- National Clinician Scholars Program, Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA.
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, 90095, USA.
| | - Altaf Saadi
- National Clinician Scholars Program, Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, 90095, USA
| | - Sae Takada
- National Clinician Scholars Program, Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
- U.S. Department of Veterans Affairs, Health Services Research & Development, Center for the Study of Healthcare Innovation, Implementation, & Policy, Los Angeles, CA, USA
| | - Molly C Easterlin
- National Clinician Scholars Program, Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
- Department of Pediatrics, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Liza S Buchbinder
- National Clinician Scholars Program, Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
- U.S. Department of Veterans Affairs, Health Services Research & Development, Center for the Study of Healthcare Innovation, Implementation, & Policy, Los Angeles, CA, USA
| | - David C Johnson
- National Clinician Scholars Program, Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
- U.S. Department of Veterans Affairs, Health Services Research & Development, Center for the Study of Healthcare Innovation, Implementation, & Policy, Los Angeles, CA, USA
| | - Frederick J Zimmerman
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, 90095, USA
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Butterworth SE, Daruwala SE, Anestis MD. The Role of Reason for Firearm Ownership in Beliefs about Firearms and Suicide, Openness to Means Safety, and Current Firearm Storage. Suicide Life Threat Behav 2020; 50:617-630. [PMID: 32011028 DOI: 10.1111/sltb.12619] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 10/30/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Firearm means safety strategies, such as safe storage, are effective in reducing suicide rates but are not widely implemented in the United States. This study examined the association between reason for firearm ownership, beliefs about firearm ownership and storage and suicide risk, willingness to engage in means safety, and current firearm storage practices. METHOD A sample of 300 American firearm owners (53.0% male; 82.3% White; Mage = 36.11, age range = 20-69) completed an online survey via Amazon's Mechanical Turk (mTurk) program. RESULTS Firearm owners who own a firearm for protection, compared to owning a firearm for other reasons, (1) endorsed decreased belief in the relationship between firearm ownership and storage and suicide risk, (2) were less willing to engage in the means safety measures of storing firearms safely and allowing a trusted individual to temporarily remove firearms from the home, and (3) were more likely to store their firearms loaded. CONCLUSIONS Reason for firearm ownership influences views regarding firearms and suicide, willingness to engage in firearm means safety, and firearm storage practices. It is essential to understand how differences in reason for firearm ownership impact these outcomes so appropriate, efficacious messaging can be developed and implemented.
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Affiliation(s)
- Sarah E Butterworth
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Samantha E Daruwala
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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Monteith LL, Wendleton L, Bahraini NH, Matarazzo BB, Brimner G, Mohatt NV. Together With Veterans: VA National Strategy Alignment and Lessons Learned from Community-Based Suicide Prevention for Rural Veterans. Suicide Life Threat Behav 2020; 50:588-600. [PMID: 31950557 DOI: 10.1111/sltb.12613] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rural veterans are at increased risk for dying by suicide compared with urban veterans, yet interventions for preventing suicide among rural veterans have been limited. OBJECTIVES (1) Describe how Together With Veterans (TWV), a community-based intervention to prevent suicide among veterans in rural communities, aligns with the VA National Strategy for Preventing Veteran Suicide; (2) share lessons learned while beginning to implement TWV in rural communities. METHODS Together With Veterans is being implemented in four rural communities and comprises six suicide prevention best practices: (1) reducing stigma and promoting help-seeking; (2) lethal means safety, with an emphasis on firearms; (3) gatekeeper training; (4) training primary care providers; (5) improving access to crisis services; and (6) enhancing support for high-risk veterans. RESULTS Together With Veterans best practices align with most, but not all, of the strategies in the VA National Strategy for Preventing Veteran Suicide. Community veteran partners have shown a willingness to collaborate and provide local leadership, enthusiasm, and a sense of duty. CONCLUSIONS By supporting and facilitating local veteran leaders and their community partners in increasing suicide prevention knowledge, public awareness, and resources, we propose that TWV offers an acceptable and feasible approach that builds on the strengths of rural communities. Systematic evaluation is warranted.
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Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Leah Wendleton
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, Colorado, USA
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bridget B Matarazzo
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gina Brimner
- Western Interstate Commission for Higher Education Behavioral Health Program, Boulder, Colorado, USA
| | - Nathaniel V Mohatt
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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47
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The relationship of nursing practice laws to suicide and homicide rates: a longitudinal analysis of US states from 2012 to 2016. BMC Health Serv Res 2020; 20:176. [PMID: 32143696 PMCID: PMC7059356 DOI: 10.1186/s12913-020-5025-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing resources can have a protective effect on patient outcomes, but nurses and nursing scope of practice have not been studied in relation to injury outcomes. The purpose of this study was to examine whether scope of practice and ease of practice laws for nurse practitioners and registered nurses are associated with suicide and homicide rates in the United States. METHODS This state-level analysis used data from 2012 to 2016. The outcome variables were age-adjusted suicide and homicide rates. The predictor variables were NP scope of practice by state (limited, partial, or full) and RN ease of practice (state RN licensure compact membership status). Covariates were state sociodemographic, healthcare, and firearm/firearm policy context variables that have a known relationship with the outcomes. RESULTS Full scope of practice for NPs was associated with lower rates of suicide and homicide, with stronger associations for suicide. Likewise, greater ease of practice for RNs was associated with lower suicide and homicide rates. CONCLUSIONS Findings suggest that nurses are an important component of the healthcare ecosystem as it relates to injury outcomes. Laws supporting full nursing practice may have a protective effect on population health in the area of injuries and future studies should explore this relationship further.
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48
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Goldberg SB, Tucker RP, Abbas M, Schultz ME, Hiserodt M, Thomas KA, Anestis MD, Wyman MF. Firearm Ownership and Capability for Suicide in Post-Deployment National Guard Service Members. Suicide Life Threat Behav 2019; 49:1668-1679. [PMID: 31002425 DOI: 10.1111/sltb.12551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/25/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE National Guard service members demonstrate increased suicide risk relative to the civilian population. One potential mechanism for this increased risk may be familiarity with and access to firearms following deployment. This study examined the association between firearm ownership, reasons for ownership, and firearm familiarity with a widely studied suicide risk factor-capability for suicide-among National Guard service members. METHOD Data were drawn from a cross-sectional survey of National Guard service members conducted immediately post-deployment in 2010. Service members (n = 2,292) completed measures of firearm ownership, firearm familiarity, and capability for suicide. RESULTS Firearm ownership and increased firearm familiarity were associated with capability for suicide (d = 0.47 and r = .25, for firearm ownership and familiarity, respectively). When examined separately based on reason for ownership, owning a firearm for self-protection (d = 0.33) or owning a military weapon (d = 0.27) remained significantly associated with capability for suicide. In contrast, owning a firearm for hobby purposes did not (d = -0.07). CONCLUSION Our findings support theories emphasizing practical aspects of suicide (e.g., three-step theory) and suggest that owning firearms, in particular for self-protection, along with familiarity using firearms may be associated with greater capability for suicide.
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Affiliation(s)
- Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin - Madison, Madison, WI, USA
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Maleeha Abbas
- Department of Counseling Psychology, University of Wisconsin - Madison, Madison, WI, USA.,VA Puget Sound Health Care System, Seattle, WA, USA
| | - Megan E Schultz
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Michele Hiserodt
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Kathryn A Thomas
- Department of Counseling Psychology, University of Wisconsin - Madison, Madison, WI, USA.,William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | | | - Mary F Wyman
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,School of Medicine & Public Health, University of Wisconsin - Madison, Madison, WI, USA
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Kaplan MS, Mueller-Williams AC. The Hidden Epidemic of Firearm Suicide in the United States: Challenges and Opportunities. HEALTH & SOCIAL WORK 2019; 44:276-279. [PMID: 31651029 DOI: 10.1093/hsw/hlz029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 06/10/2023]
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Suicidal Ideation in Adolescence: The Role of In-Home Firearm Access and Childhood Maltreatment. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09522-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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