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Goldstein EV. Personal Circumstances Preceding Firearm Suicide Death Among Black Adults in the United States. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02136-4. [PMID: 39251500 DOI: 10.1007/s40615-024-02136-4] [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: 05/14/2024] [Revised: 07/21/2024] [Accepted: 08/09/2024] [Indexed: 09/11/2024]
Abstract
Despite an alarming rise in firearm suicide rates within Black communities, there has been little research on the contributors that precede firearm suicide deaths among Black adults. To fill this knowledge gap, this study was guided by an overarching research question: What are the recurring and salient personal circumstances experienced by Black adults prior to dying by firearm suicide in the US? This basic, interpretive qualitative study analyzed narrative text data for 843 Black adult firearm suicide decedents from the National Violent Death Reporting System. The analysis began with an initial cycle of open coding, followed by a second coding cycle, organizing the circumstances into major categories using a focused coding process. The analysis then moved back and forth between description and interpretation, and major themes were developed. Five themes emerged from this analysis: (1) Decedents often experienced poor health prior to death - but not always poor mental health. (2) Romantic relationships were often deteriorating, leading to frequent interpersonal arguments. (3) Alcohol and substance use were common before a suicide attempt. (4) Decedents frequently experienced financial and legal difficulties prior to death. (5) Decedents had many pathways to accessing firearms, and limiting firearm availability before death was challenging. Additional research on potential intervention pathways will be critical, given recent evidence indicating dramatic increases in firearm ownership among Black adults over the past 5 years.
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Affiliation(s)
- Evan V Goldstein
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building Room 1N502, Salt Lake City, UT, 84108, USA.
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2
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Sescleifer AM, Onufer EJ, Greenspon J, Keller MS. A Decade of Firearm Injuries: Children Caught in the Crossfire. J Surg Res 2024; 301:259-268. [PMID: 38972263 DOI: 10.1016/j.jss.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 05/16/2024] [Accepted: 06/16/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Firearm injuries (FIs) are the leading cause of preventable morbidity and mortality in pediatric patients. In this study, we aim to define evolving trends and avenues for prevention. METHODS Following institutional review board approval, medical records of patients presenting to our two State-Designated Level 1 Pediatric Trauma Centers for treatment of FIs from 2010 to 2019 were retrospectively reviewed. Data was analyzed with Chi-Squared and Student's t-test; P-value <0.05 was significant. RESULTS 1037 FI encounters from 1005 unique patients aged 0-21 y were included. 70.4% (n = 730) were determined to be assaults, 26.1% (n = 271) unintentional, and 1.7% (n = 18) self-inflicted injuries. Overall mortality was 4.5% (n = 45). FI victims were most commonly African American (n = 836, 80.6%), male (n = 869, 83.8%), aged 13-17 (n = 753, 72.6%), and from single-parent families (n = 647, 62.4%). The incidence of FIs increased significantly over the last 5 y of the study (2010-2014, 6.8 FIs/month), compared to 2015-2019 (averaging 10.6 FIs/month, P < 0.0001). Concurrently, FI related fatality increased from an average of 2.6 deaths/year (2010-2014) to 6.4 deaths/year (2015-2019, P = 0.064). Results were subanalyzed for pediatric patients aged 0-14 y. For the entire cohort, 12.1% (n = 116) recidivists were identified. Geographic patterns of injury were identified, with 75% of all FIs clustered in a single urban region. CONCLUSIONS Incidence of pediatric FIs is increasing in recent years, with high mortality rates. Violence and recidivism are geographically concentrated, offering an opportunity for targeted interventions.
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Affiliation(s)
- Anne M Sescleifer
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Emily J Onufer
- Division of Pediatric Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Jose Greenspon
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Martin S Keller
- Division of Pediatric Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
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Bauder CR, Rooney EA, Hay JM, Long CM, Bryan CJ. Associations Between PTSD Features and Firearm Ownership and Storage: Results From the PRImary Care Screening Methods (PRISM) Study. Mil Med 2024:usae342. [PMID: 38970431 DOI: 10.1093/milmed/usae342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/16/2024] [Accepted: 06/24/2024] [Indexed: 07/08/2024] Open
Abstract
INTRODUCTION Veterans and active duty service members are significantly more likely to die by suicide using firearms compared to the general population. Not-secure firearm storage (e.g., keeping guns loaded/in an unlocked location) is associated with greater risk for suicide and a third of veteran firearm owners store at least 1 personal firearm unsecured. Veterans and active duty service members are also significantly more likely to be diagnosed with posttraumatic stress disorder (PTSD) than the general population. Symptoms of PTSD are divided into 4 criteria: reexperiencing, avoidance, negative affect, and hyperarousal. Research has suggested that endorsement of hyperarousal symptoms is positively associated with unsecure firearm storage and that avoidance symptoms might be negatively associated with unsecure storage practices. The present study examined the relationship between self-reported firearm ownership and storage practices among each item from the Primary Care PTSD Screening for DSM-IV-TR (PC-PTSD-IV) to explore associations between PTSD features and firearm ownership and storage. MATERIALS AND METHODS Participants were recruited from primary care clinics across 5 military installations in the United States as part of a larger study (Mage = 45.4, SD = 16.9). Among participants (n = 2,685), most of our sample identified as male (51.3%) and white (67.3%) with 61.6% currently serving in the military, 16.8% retirees, and 21.6% family members. PTSD symptoms were assessed using the PC-PTSD-IV and a quarter met the clinical threshold for PTSD. Binomial and multinomial logistic regression analyses were used. RESULTS Among completed responses, 989 (38.1%) people reported owning guns; among gun owners, 386 (39.0%) reported that they were loaded, and 352 (35.6%) reported they were loaded and unlocked. Endorsement of specific items on the PC-PTSD-IV, including those specific to hyperarousal and avoidance, was not significantly associated with storing firearms loaded and/or in nonsecure locations when controlling for military service. Non-responses to items around firearm storage practices were significantly associated with those individuals meeting the clinical threshold for PTSD according to the PC-PTSD-IV and participants currently serving had higher odds of storing at least 1 personal firearm loaded and both loaded and unlocked. CONCLUSIONS Results from our study highlight similarities and departures from the previous literature on the connection between PTSD and non-secure firearm storage practices. Further research may examine (1) the relation between PTSD symptoms and firearm storage between active duty service members, retirees, and family members and (2) whether non-response to items regarding firearm ownership is systematic.
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Affiliation(s)
| | - Emily A Rooney
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Chennapragada L, Osterberg T, Strouse M, Sullivan SR, Silver C, LaMarca M, Boucher C, Fonseca E, Goodman M. A PRISMA Scoping Review to Explore Interventions to Prevent Firearm-Related Injury and Suicide in Older Adults. Clin Gerontol 2024; 47:519-535. [PMID: 38626064 DOI: 10.1080/07317115.2024.2339366] [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: 04/18/2024]
Abstract
OBJECTIVES This scoping review aims to examine existing research into firearm safety interventions designed to prevent firearm injury and suicide in older adults. METHODS Select databases were searched in 5/2023. Included articles involved an/a 1. aim to develop or investigate firearm safety interventions, 2. focus on adults 50 years and older, and 3. primary analysis. RESULTS The search yielded 10 articles which primarily focused on firearm safety counseling with older adults with suicide risk or emerging impairment. The review found that older adults may be open to receiving firearm safety counseling but that providers feel ill-equipped to have these conversations and to reliably identify suicide risk. Two studies presented promising data on the impact and acceptability of training providers in a firearm safety intervention. The review also identified the importance of building trust between older patients and providers to have helpful discussions regarding firearms, and highlighted specific approaches that facilitate openness to participate in these exchanges. CONCLUSIONS Further research into adapting interventions to meet the clinical needs of older adults and treatment efficacy trials is necessary. CLINICAL IMPLICATIONS Training healthcare providers to conduct firearm safety interventions with older adults may be an acceptable and impactful avenue to prevent suicide.
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Affiliation(s)
- Lakshmi Chennapragada
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Terra Osterberg
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Madison Strouse
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Sarah R Sullivan
- Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA
- Department of Psychology, Hunter College, City University of New York, New York, NY, USA
| | - Chana Silver
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Mary LaMarca
- Executive Division, National Center for PTSD Department of Veterans Affairs, White River Junction, Vermont, USA
| | - Caroline Boucher
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Emilia Fonseca
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ross R, Prater LC, Cole A, Mustafa A, Pham K, Gallagher A, Rowhani-Rahbar A, Phelan EA. Provider Perspectives on Addressing Firearm Safety with Older Adults in Primary Care. Clin Gerontol 2024; 47:555-570. [PMID: 37791738 PMCID: PMC10991080 DOI: 10.1080/07317115.2023.2264291] [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] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Chronic conditions, including mild cognitive impairment and depression, place older adults at high risk of firearm suicide. Approximately 40% of older adults have access to a firearm, and many do not store their firearms safely. However, firearm counseling occurs infrequently in clinical settings. Using by the Ottawa Decision Support Framework (ODSF) to conceptualize the decisional support needed by patients and their providers to facilitate firearm counseling, we explore provider perspectives on desired resources for addressing firearm safety with older adult patients. METHODS From March - August 2022, we conducted 21 semi-structured interviews with primary care providers caring for older adults. We report deductive concepts as well as emergent themes. RESULTS Major themes were identified from the three components of the ODSF; decisional needs, decision support and decisional outcomes. Themes included: provider self-efficacy to conduct firearm counseling, clinical workflow considerations, stories for change, patient diagnosis implications, and caregiver involvement. CONCLUSIONS There is a need for decision aids in the clinical setting that facilitate firearm counseling and promotes shared decision-making about firearm storage. CLINICAL IMPLICATIONS Implementing a decision aid in the clinical setting can improve provider self-efficacy to conduct firearm counseling and help reduce risk factors associated with firearm-related harm among older adults.
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Affiliation(s)
- Rachel Ross
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Laura C. Prater
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
- Department of Psychiatry & Behavorial Sciences, University of Washington, Seattle, WA, USA
| | - Allison Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Ayah Mustafa
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Kiet Pham
- School of Psychology, University of Washington, Seattle, WA, USA
| | - Amy Gallagher
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Elizabeth A. Phelan
- School of Medicine, Division of Gerontology and Geriatric Medicine, School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
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Knod JL, Sathya C, Griggs CL, Henry MC, Froehlich M, Zallen G, Coakley BA, Masiakos PT, Gow KW, Naik-Mathuria B. Promoting Firearm Injury Prevention and Advocacy as Pediatric Surgeons: A Call to Action From the APSA/AAP Advocacy Committee. J Pediatr Surg 2024; 59:1135-1141. [PMID: 38160188 DOI: 10.1016/j.jpedsurg.2023.11.013] [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: 09/07/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Firearm injuries have become the leading cause of death among American children. Here we review the scope of the problem, and the pivotal role pediatric surgeons have in preventing pediatric firearm injury. Specific methods for screening and counseling are reviewed, as well as how to overcome barriers. Community and hospital resources as well as organizational efforts are discussed. Finally, a path for surgeon advocacy is outlined as is a call to action for the pediatric surgeon, as we are uniquely poised to identify pediatric patients and deliver timely interventions to reduce the impact of firearm violence. LEVEL OF EVIDENCE: Level IV.
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Affiliation(s)
- J Leslie Knod
- Division of Pediatric Surgery, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, United States.
| | - Chethan Sathya
- Center for Gun Violence Prevention, Northwell Health, Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, 1111 Marcus, Suite M15, New Hyde Park, NY 11042, United States
| | - Cornelia L Griggs
- Harvard Medical School, Division of Pediatric Surgery, Massachusetts General Hospital, 55 Fruit Street GRB-11, Boston MA 02114, United States
| | - Marion C Henry
- University of Chicago, 5839 S. Maryland Ave/MC 4062/Suite A-426, Chicago, IL 60637, United States
| | - Mary Froehlich
- Kirk Kerkorian School of Medicine at UNLV, Department of General Surgery, 4505 South Maryland Pkwy, Las Vegas, NV 89154, United States
| | - Garret Zallen
- PeaceHealth Medical Center Springfield Oregon and Shriner's Hospital, Portland, OR, United States
| | - Brian A Coakley
- The Icahn School of Medicine at Mount Sinai, Division of Pediatric Surgery, Department of Surgery, 5 East 98th Street, 15th Floor, New York, NY 10029, United States
| | - Peter T Masiakos
- Harvard Medical School, Division of Pediatric Surgery, Massachusetts General Hospital, 55 Fruit Street GRB-11, Boston MA 02114, United States
| | - Kenneth W Gow
- University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, University of Texas Medical Branch, 301 University Blvd, Research Building 6, Suite 3.220, Galveston, TX 77555, United States
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Uspal NG, Nichols J, Strelitz B, Bradford MC, Rutman LE. Improving Identification of Firearm Access in Children With Mental Health Complaints. Hosp Pediatr 2024; 14:348-355. [PMID: 38572566 DOI: 10.1542/hpeds.2023-007451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To determine if electronic medical record (EMR) changes and implementation of a study on firearm storage practices changed identification of firearm exposure in children presenting to a pediatric emergency department (PED) with mental health complaints. We also sought to determine the accuracy of information collected on firearm storage practices. METHODS Retrospective study of EMR documentation of firearm exposure in PED patients with mental health complaints from January 20, 2015 until November 20, 2017. EMR changes occurred on January 20, 2016 and the firearms study began on February 13, 2016. The primary outcome was documentation of firearm exposure. Secondary outcomes were documentation of unsafe firearm storage practices. We also examined differences between clinical and research documentation of unsafe firearm storage practices post-intervention. We compared groups using descriptive statistics and chi-squared tests. We used statistical process control to examine the relationship between interventions and changes in outcomes. RESULTS 5582 encounters were examined. Identification of firearm exposure increased from 11 to 17% postintervention. Identification of unsafe storage practices increased from 1.9% to 4.4% across all encounters. Special cause variation in both metrics occurred concurrently with the interventions. Postintervention, unsafe firearms storage practices in firearm owning families were under-identified (39% identified as not triple-safe in clinical data vs 75% in research data). CONCLUSIONS EMR changes and implementation of a firearms study improved identification of firearm exposure and unsafe storage practices in families of PED patients being evaluated for mental health complaints. However, unsafe storage practices continued to be under-identified in firearm-owning families.
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Affiliation(s)
- Neil G Uspal
- Division of Emergency Medicine, Department of Pediatrics
| | - Julia Nichols
- School of Informatics, University of Washington, Seattle, Washington
| | - Bonnie Strelitz
- Center for Clinical and Translational Research, Seattle Children's Hospital
| | - Miranda C Bradford
- Biostatistics, Epidemiology and Analytics in Research (BEAR) Core, Seattle Children's Research Institute
| | - Lori E Rutman
- Division of Emergency Medicine, Department of Pediatrics
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8
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Tharp D, Goldstein EV, Medina RM, Brewer SC, Bakian AV, Coon H. Utah Latina/o/x suicide decedents less likely to die by firearm, even in rural areas: examining population-wide data from the Utah Office of the Medical Examiner. Front Public Health 2024; 12:1358043. [PMID: 38660351 PMCID: PMC11040675 DOI: 10.3389/fpubh.2024.1358043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Suicide death remains a significantly rarer event among Latina/o/x populations compared to non-Latina/o/x populations. However, the reasons why Latina/o/x communities experience relatively lower suicide rates are not fully understood. Critical gaps exist in the examination of Latina/o/x suicide death, especially in rural settings, where suicide death by firearm is historically more common within non-Latina/o/x populations. Method We tested whether the prevalence of Latina/o/x firearm suicide was meaningfully different in urban and rural environments and from non-Latino/a/x decedents when controlling for age, sex, and a social deprivation metric, the Area Deprivation Index. Suicide death data used in this analysis encompasses 2,989 suicide decedents ascertained in Utah from 2016 to 2019. This included death certificate data from the Utah Office of the Medical Examiner on all Utah suicide deaths linked to information by staff at the Utah Population Database. Results Compared to non-Latina/o/x suicide decedents, Latina/o/x suicide decedents had 34.7% lower adjusted odds of dying by firearm. Additionally, among the firearm suicide decedents living only in rural counties, Latina/o/x decedents had 40.5% lower adjusted odds of dying by firearm compared to non-Latina/o/x suicide decedents. Discussion The likelihood of firearm suicide death in Utah differed by ethnicity, even in rural populations. Our findings may suggest underlying factors contributing to lower firearm suicide rates within Latina/o/x populations, e.g., aversion to firearms or less access to firearms, especially in rural areas, though additional research on these phenomena is needed.
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Affiliation(s)
- Douglas Tharp
- Department of Geography, University of Utah, Salt Lake City, UT, United States
| | - Evan V. Goldstein
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Richard M. Medina
- Department of Geography, University of Utah, Salt Lake City, UT, United States
| | - Simon C. Brewer
- Department of Geography, University of Utah, Salt Lake City, UT, United States
| | - Amanda V. Bakian
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, United States
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Hilary Coon
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, United States
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Lambe G, Dempsey P, Bolger M, Bolster F. Self-harm, suicide and brain death: the role of the radiologist. Clin Radiol 2024; 79:239-249. [PMID: 38341342 DOI: 10.1016/j.crad.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
Suicide is a leading cause of death worldwide and takes many forms, which include hanging, jumping from a height, sharp force trauma, ingestion/poisoning, drowning, and firearm injuries. Self-harm and suicide are associated with particular injuries and patterns of injury. Many of these patterns are apparent on imaging. Self-harm or suicidal intent may be overlooked initially in such cases, particularly when the patient is unconscious or uncooperative. Correct identification of these findings by the radiologist will allow a patient's management to be tailored accordingly and may prevent future suicide attempts. The initial role of the radiologists in these cases is to identify life-threatening injuries that require urgent medical attention. The radiologist can add value by drawing attention to associated injuries, which may have been missed on initial clinical assessment. In many cases of self-harm and suicide, imaging is more reliable than clinical assessment. The radiologist may be able to provide important prognostic information that allows clinicians to manage expectations and plan appropriately. Furthermore, some imaging studies will provide essential forensic information. Unfortunately, many cases of attempted suicide will end in brain death. The radiologist may have a role in these cases in identifying evidence of hypoxic-ischaemic brain injury, confirming a diagnosis of brain death through judicious use of ancillary tests and, finally, in donor screening for organ transplantation. A review is presented to illustrate the imaging features of self-harm, suicide, and brain death, and to highlight the important role of the radiologist in these cases.
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Affiliation(s)
- G Lambe
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - P Dempsey
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - M Bolger
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - F Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
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Shirai T, Okazaki S, Tanifuji T, Otsuka I, Miyachi M, Okada S, Shindo R, Horai T, Mouri K, Takahashi M, Kondo T, Ueno Y, Hishimoto A. Association study of a single nucleotide polymorphism in the hypoxia response element of the macrophage migration inhibitory factor gene promoter with suicide completers in the Japanese population. Neuropsychopharmacol Rep 2024; 44:262-266. [PMID: 38267013 PMCID: PMC10932791 DOI: 10.1002/npr2.12410] [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: 09/18/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND More than 800 000 people die by suicide annually. The heritability of suicide is 30%-50%. We focused on the hypoxia response element (HRE), which promotes the expression of macrophage migration inhibitory factor (MIF) via the hypoxia-inducible factor (HIF) pathway, important in neurogenesis and neuroprotection. We examined a genetic polymorphism of rs17004038, a single-nucleotide polymorphism (SNP), in suicide completers and controls. METHODS The study population included 1336 suicide completers and 814 unrelated healthy controls. All participants were Japanese. We obtained peripheral blood, extracted DNA, and genotyped the patients for SNP rs17004038 (C > A). RESULTS No significant differences were observed between the two groups in either the allele or genotype analyses. Subgroup analyses by sex, age (<40 or ≥40), and suicide method (violent or nonviolent suicide) were performed with similar results. CONCLUSION No association was observed between SNP rs17004038 and suicide completion. Although it is challenging to collect a large number of samples from suicide completers, further MIF-related genetic studies, including those of rs17004038, are necessary with larger sample sizes.
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Affiliation(s)
- Toshiyuki Shirai
- Department of PsychiatryKobe University Graduate School of MedicineKobeJapan
| | - Satoshi Okazaki
- Department of PsychiatryKobe University Graduate School of MedicineKobeJapan
| | - Takaki Tanifuji
- Department of PsychiatryKobe University Graduate School of MedicineKobeJapan
| | - Ikuo Otsuka
- Department of PsychiatryKobe University Graduate School of MedicineKobeJapan
| | - Masao Miyachi
- Department of PsychiatryKobe University Graduate School of MedicineKobeJapan
| | - Shohei Okada
- Department of PsychiatryKobe University Graduate School of MedicineKobeJapan
| | - Ryota Shindo
- Department of PsychiatryKobe University Graduate School of MedicineKobeJapan
| | - Tadasu Horai
- Department of PsychiatryKobe University Graduate School of MedicineKobeJapan
| | - Kentaro Mouri
- Department of PsychiatryKobe University Graduate School of MedicineKobeJapan
| | - Motonori Takahashi
- Division of Legal Medicine, Department of Community Medicine and Social Health ScienceKobe University Graduate School of MedicineKobeJapan
| | - Takeshi Kondo
- Division of Legal Medicine, Department of Community Medicine and Social Health ScienceKobe University Graduate School of MedicineKobeJapan
| | - Yasuhiro Ueno
- Division of Legal Medicine, Department of Community Medicine and Social Health ScienceKobe University Graduate School of MedicineKobeJapan
| | - Akitoyo Hishimoto
- Department of PsychiatryKobe University Graduate School of MedicineKobeJapan
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11
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Miller AB, Oppenheimer CW, Chew RF, Weitzel KJ, D'Arcangelo B, Barnes A, Lowe A, Yaros AC. Exploring whether mental health crisis text conversations that include discussion of firearms differ from those without firearms. Prev Med 2023; 177:107783. [PMID: 37980956 PMCID: PMC10783174 DOI: 10.1016/j.ypmed.2023.107783] [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: 04/07/2023] [Revised: 10/10/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Firearm violence represents a public health crisis in the United States. Yet, there is limited knowledge about how firearms are discussed in the context of mental health emergencies representing a major gap in the current research literature. This study addresses this gap by examining whether the content of mental health crisis text conversations that mention firearms differ from those that do not mention firearms in a large, unique dataset from a national crisis text line. METHODS We examined data from over 3.2 million conversations between texters to Crisis Text Line and volunteer crisis counselors between September 2018 and July 2022. We used a study developed text classification machine learning algorithm that builds on natural language processing to identify and label whether crisis conversations mentioned firearms. We compared the frequency of psychosocial factors between conversations that mention firearms with those that did not. RESULTS Results from a generalized linear mixed-effects model demonstrated that. conversations mentioning firearms more frequently were associated with suicide, racism, physical, sexual, emotional, and unspecified abuse, grief, concerns about a third party, substance use, bullying, gender and sexual identity, relationships, depression, and loneliness. Further, conversations mentioning firearms were less likely to be related to self-harm and eating/body image. CONCLUSIONS These results offer an initial glimpse of how firearms are mentioned in the context of acute mental health emergencies, which has been completely absent in prior literature. Our results are preliminary and help sharpen our understanding of contextual factors surrounding mental health emergencies where a firearm is mentioned.
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Affiliation(s)
| | | | | | | | | | | | - Ashley Lowe
- RTI International, Research Triangle Park, NC, USA
| | - Anna C Yaros
- RTI International, Research Triangle Park, NC, USA
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Jasperson RA, Sullivan E, Goldstein EV. Employee attitudes toward suicide prevention and Counseling on Access to Lethal Means: initial findings from an academic medical center implementing the Zero Suicide framework. Front Public Health 2023; 11:1268300. [PMID: 38026388 PMCID: PMC10654743 DOI: 10.3389/fpubh.2023.1268300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Zero Suicide is a strategic framework designed to transform a healthcare system's suicide prevention activities. In 2020, University of Utah Health launched a Zero Suicide program and Counseling on Access to Lethal Means (CALM) training for its employees. In 2022, the healthcare system surveyed its workforce's attitudes toward suicide prevention and CALM. We sought to evaluate employees' attitudes and behaviors toward suicide prevention and CALM training following the launch of the Zero Suicide program. Methods A Zero Suicide Workforce Survey was administered online through REDCap to all University of Utah Health employees. The analytic sample included 3,345 respondents. We used two-portion z-tests to compare the proportions of respondents who (1) completed CALM training and (2) did not yet complete the CALM training because they felt it was irrelevant to their position by different employee characteristics. Results More than half of the respondents in the analytic sample were directly interacting with patients who may be at risk for suicide (57.6%). About 8.4% of the respondents had completed CALM training. Among those who had not yet completed CALM training, 9.5% indicated they did not think CALM was relevant to their job. Respondents knowledgeable about warning signs for suicide and respondents who were confident in their ability to respond when suspecting elevated suicide risk were significantly more likely to complete CALM training. Discussion This evaluation provides important insights from the workforce of a large academic medical center implementing a Zero Suicide program, including insights on opportunities for improving program implementation and evaluation.
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Affiliation(s)
- Rachael A. Jasperson
- Zero Suicide Program, University of Utah Health, Salt Lake City, UT, United States
| | - Emily Sullivan
- Zero Suicide Program, University of Utah Health, Salt Lake City, UT, United States
- Hunstman Mental Health Institute, University of Utah, Salt Lake City, UT, United States
| | - Evan V. Goldstein
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
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13
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Barnard LM, Knoepke CE, McCarthy M, Rowhani-Rahbar A, Siry-Bove BJ, Betz ME. Views of voluntary, temporary out-of-home firearm storage among individuals living in a firearm-owning home: results from a qualitative study in two states. Inj Prev 2023; 29:431-436. [PMID: 37451860 PMCID: PMC10529183 DOI: 10.1136/ip-2023-044868] [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: 02/03/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Firearms account for the majority of suicide deaths in the USA. A recommended approach for suicide prevention is reducing access to firearms by temporarily removing them from the home. We sought to understand how firearm owners and those who reside with them view and might use voluntary, temporary out-of-home firearm storage. METHODS From July to November 2021, we interviewed English-speaking adults in Colorado and Washington who own firearms or reside with them, using semistructured interviews. We used a team-based mixed deductive and inductive approach to code transcripts and identify themes. RESULTS Half of the 38 interviewees were men (53%) aged 35-54 years (40%); 92% identified as white. The average age that participants reported first having a firearm was 20.4 years; 16% reported never owning a firearm themselves, only living in homes with firearms. Qualitative findings fell into broad themes: (1) storage with family members/friends, (2) concerns/challenges with storing a firearm with a business/organization, (3) importance of trust (4) outreach methods for out-of-home storage programmes. CONCLUSION Programmes for voluntary, temporary out-of-home firearm storage will not be impactful unless such storage is desired and used. Understanding views of potential storage users can help support development of acceptable and feasible programmes.
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Affiliation(s)
- Leslie M Barnard
- Epidemiology, University of Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christopher E Knoepke
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Cardiology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan McCarthy
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Marian E Betz
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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14
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Paul ME, Coakley BA. State Gun Regulations and Reduced Gun Ownership are Associated with Fewer Firearm-Related Suicides Among Both Juveniles and Adults in the USA. J Pediatr Surg 2023; 58:1796-1802. [PMID: 36797108 DOI: 10.1016/j.jpedsurg.2023.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/27/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Few studies have investigated the relationship between specific gun regulations and gun ownership with the firearm-related suicide rate among juveniles and adults across U.S. states. Therefore, this study seeks to determine if gun ownership rates and gun restrictions are related to the firearm-related suicide rate in both the pediatric and adult populations. METHODS Fourteen measures of state gun law restrictions and gun ownership were collected. These included Giffords Center ranking, gun ownership percentages, and 12 specific firearm laws. Unadjusted linear regressions modeled the relationship between each individual variable and the rate of firearm-related suicides for adults and children across states. This was repeated using a multivariable linear regression adjusting for poverty, poor mental health, race, gun ownership, and divorce rates by state. P values of <0.004 were considered significant. RESULTS In the unadjusted linear regression, 9 of 14 firearm-related measures were statistically associated with fewer firearm-related suicides in adults. Similarly, 9 of 14 measures were found to be associated with fewer firearm-related suicides in the pediatric population. In the multivariable regression, 6 of 14 vs. 5 of 14 measures were statistically associated with fewer firearm-related suicides in the adult and pediatric populations, respectively. CONCLUSIONS Ultimately, this study found that increased state gun restrictions and lower gun ownership rates were associated with fewer firearm related suicides among juveniles and adults in the US. This paper provides objective data to help lawmakers as they create gun control legislation that can potentially decrease the rate of fire-arm related suicide. LEVELS OF EVIDENCE II.
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Affiliation(s)
- Megan E Paul
- The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Brian A Coakley
- Division of Pediatric Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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15
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Goldstein EV, Mooney SJ, Takagi-Stewart J, Agnew BF, Morgan ER, Haviland MJ, Zhou W, Prater LC. Characterizing Female Firearm Suicide Circumstances: A Natural Language Processing and Machine Learning Approach. Am J Prev Med 2023; 65:278-285. [PMID: 36931986 DOI: 10.1016/j.amepre.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Since 2005, female firearm suicide rates increased by 34%, outpacing the rise in male firearm suicide rates over the same period. The objective of this study was to develop and evaluate a natural language processing pipeline to identify a select set of common and important circumstances preceding female firearm suicide from coroner/medical examiner and law enforcement narratives. METHODS Unstructured information from coroner/medical examiner and law enforcement narratives were manually coded for 1,462 randomly selected cases from the National Violent Death Reporting System. Decedents were included from 40 states and Puerto Rico from 2014 to 2018. Naive Bayes, Random Forest, Support Vector Machine, and Gradient Boosting classifier models were tuned using 5-fold cross-validation. Model performance was assessed using sensitivity, specificity, positive predictive value, F1, and other metrics. Analyses were conducted from February to November 2022. RESULTS The natural language processing pipeline performed well in identifying recent interpersonal disputes, problems with intimate partners, acute/chronic pain, and intimate partners and immediate family at the scene. For example, the Support Vector Machine model had a mean of 98.1% specificity and 90.5% positive predictive value in classifying a recent interpersonal dispute before suicide. The Gradient Boosting model had a mean of 98.7% specificity and 93.2% positive predictive value in classifying a recent interpersonal dispute before suicide. CONCLUSIONS This study developed a natural language processing pipeline to classify 5 female firearm suicide antecedents using narrative reports from the National Violent Death Reporting System, which may improve the examination of these circumstances. Practitioners and researchers should weigh the efficiency of natural language processing pipeline development against conventional text mining and manual review.
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Affiliation(s)
- Evan V Goldstein
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah.
| | - Stephen J Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington; Harborview Injury Prevention & Research Center, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Julian Takagi-Stewart
- Harborview Injury Prevention & Research Center, Harborview Medical Center, University of Washington, Seattle, Washington; College of Medicine, Drexel University, Philadelphia, Pennsylvania; Department of Anesthesiology & Pain Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Brianna F Agnew
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California
| | - Erin R Morgan
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington; Harborview Injury Prevention & Research Center, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Miriam J Haviland
- Harborview Injury Prevention & Research Center, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Weipeng Zhou
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington
| | - Laura C Prater
- Harborview Injury Prevention & Research Center, Harborview Medical Center, University of Washington, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington
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16
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Whiteman PJ, Macias-Konstantopoulos WL, Relan P, Knopov A, Ranney ML, Riviello RJ. Violence and Abuse: A Pandemic Within a Pandemic. West J Emerg Med 2023; 24:743-750. [PMID: 37527378 PMCID: PMC10393453 DOI: 10.5811/westjem.58405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, as society struggled with increasing disease burden, economic hardships, and with disease morbidity and mortality, governments and institutions began implementing stay-at-home or shelter-in-place orders to help stop the spread of the virus. Although well-intentioned, one unintended adverse consequence was an increase in violence, abuse, and neglect. METHODS We reviewed the literature on the effect the pandemic had on domestic violence, child and elder abuse and neglect, human trafficking, and gun violence. In this paper we explore common themes and causes of this violence and offer suggestions to help mitigate risk during ongoing and future pandemics. Just as these forms of violence primarily target at-risk, vulnerable populations, so did pandemic-related violence target marginalized populations including women, children, Blacks, and those with lower socioeconomic status. This became, and remains, a public health crisis within a crisis. In early 2021, the American College of Emergency Physicians (ACEP) Public Health and Injury Committee was tasked with reviewing the impact the pandemic had on violence and abuse as the result of a resolution passed at the 2020 ACEP Council meeting. CONCLUSION Measures meant to help control the spread of the COVID-19 pandemic had many unintended consequences and placed people at risk for violence. Emergency departments (ED), although stressed and strained during the pandemic, remain a safety net for survivors of violence. As we move out of this pandemic, hospitals and EDs need to focus on steps that can be taken to ensure they preserve and expand their ability to assist victims should another pandemic or global health crisis develop.
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Affiliation(s)
| | - Wendy L Macias-Konstantopoulos
- Center for Social Justice and Health Equity, Boston, Massachusetts
- MGH Freedom Clinic, Boston, Massachusetts
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Pryanka Relan
- Emory Healthcare Network, Atlanta, Georgia
- World Health Organization, Emergency, Trauma and Acute Care Programme, Geneva, Switzerland
| | - Anita Knopov
- Brown University, Warren Alpert Medical School, Providence, Rhode Island
| | - Megan L Ranney
- Yale School of Public Health, Yale University, New Haven, Connecticutt
| | - Ralph J Riviello
- University of Texas Health San Antonio, Lozano Long School of Medicine, Department of Emergency Medicine, San Antonio, Texas
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17
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Goldstein EV, Brenes F, Wilson FA. Critical gaps in understanding firearm suicide in Hispanic communities: demographics, mental health, and access to care. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad016. [PMID: 38770408 PMCID: PMC11103729 DOI: 10.1093/haschl/qxad016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 05/22/2024]
Abstract
Suicide rates increased by 26.7% among Hispanics from 2015 to 2020, driven at least in part by highly lethal firearm suicide deaths. However, there are critical gaps in characterizing firearm suicide risks and prevention opportunities in Hispanic communities. We examined Hispanic adult firearm suicide decedents reported through the National Violent Death Reporting System from 2013-2019, focusing on demographic characteristics, firearm choices, suicidal thoughts/behaviors, mental health, and mental health treatment, compared with non-Hispanic adult firearm suicide decedents. Only 13.8% of Hispanic firearm suicide decedents were known to be undergoing treatment for a mental health or substance use problem prior to death, compared to 18.8% of non-Hispanic firearm suicide decedents. On average, Hispanic firearm suicide decedents were significantly less likely than non-Hispanic firearm suicide decedents known to have been treated for a mental health or substance use problem. These results may underscore the critical need for public health agencies and policymakers to promote initiatives integrating mental health screening into medical care, reducing mental health stigma among Hispanics, and expanding mental health treatment capacity in Hispanic communities.
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Affiliation(s)
- Evan V Goldstein
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Francisco Brenes
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL 33199, United States
| | - Fernando A Wilson
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
- Department of Economics, University of Utah, Salt Lake City, UT 84112, United States
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT 84112, United States
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18
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Anestis MD, Bond AE, Capron DW, Bryan AO, Bryan CJ. Differences in firearm storage practices among United States military servicemembers who have and have not disclosed suicidal thoughts or attended behavioral health sessions. Suicide Life Threat Behav 2023; 53:262-269. [PMID: 36622136 DOI: 10.1111/sltb.12940] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/24/2022] [Accepted: 12/09/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Two-thirds of military suicides are by firearm, and unsafe storage increases the risk of suicide. Understanding who is at risk for suicide, their interactions with behavioral healthcare, and their firearm storage habits have implications for suicide prevention. METHOD Probability-based sampling was used. Inclusion criteria were current military service and firearm ownership. Analyses focused on those who endorsed past year (n = 180) or past month suicidal ideation (n = 85). RESULTS Servicemembers with undisclosed past year ideation stored firearms at home more often and with a locking device less often. Servicemembers with past year ideation who did not attend recent behavioral health sessions stored firearms with a locking device and loaded less often. Servicemembers with undisclosed suicidal ideation in the past month stored firearms with a locking device less often. Servicemembers with past month ideation who have not attended recent behavioral health sessions stored firearms with a locking device and loaded less often. CONCLUSIONS Servicemembers experiencing undisclosed suicidal ideation and who are not receiving treatment generally have more ready access to firearms. Safe firearm storage messaging needs to be disseminated in a manner that shifts social norms around firearm storage, whether or not suicide risk is known.
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Affiliation(s)
- Michael D Anestis
- New Jersey Gun Violence Research Center, Piscataway, USA.,Rutgers, The State University of New Jersey, Piscataway, USA
| | - Allison E Bond
- New Jersey Gun Violence Research Center, Piscataway, USA.,Rutgers, The State University of New Jersey, Piscataway, USA
| | | | | | - Craig J Bryan
- The Ohio State University College of Medicine, Columbus, USA
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19
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Stulz N, Hepp U, Kupferschmid S, Raible-Destan N, Zwahlen M. Trends in suicide methods in Switzerland from 1969 to 2018: an observational study. Swiss Med Wkly 2022; 152:40007. [PMID: 36592392 DOI: 10.57187/smw.2022.40007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Suicide is a serious societal and health problem. We examined changes in rates of completed suicides in Switzerland between 1969-2018 with particular regard to different methods of suicide used in different subgroups of the resident population. METHODS We used data of the Swiss cause of death statistics and Poisson regression models to analyse annual incidence rates and calendar time trends of specific suicide methods used in population subgroups by sex (men vs women), age (10-29, 30-64, >64 years), and nationality (Swiss vs other citizenship). RESULTS There were 64,996 registered suicides between 1969 and 2018. Across these 5 decades, the overall suicide rate was higher in men than in women (incidence rate ratio [IRR] 2.62, 95% confidence interval [CI] 2.58-2.67), in Swiss citizens than in foreigners (IRR 2.02; 95% CI 1.97-2.07), and in older residents (>64 years) than in the age groups 30-64 years (IRR 1.35, 95% CI 1.32-1.37) and 10-29 years (IRR 2.37, 95% CI 2.32-2.43). After peaking in the 1980s, the overall suicide rate had declined in all of these population subgroups, with flattening trends over most recent years. The most common specific methods of suicide were hanging (accounting for 26.7% of all suicides) and firearms (23.6%). The rates of the specific suicide methods were usually higher in men, in Swiss citizens and in older residents, and they had typically declined over most recent decades in the population subgroups examined. However, some methods diverged from this general pattern, at least in some population subgroups. For instance, railway suicides most recently increased in younger and in male residents whereas suicides by gas and by drowning were only at a low level after rapid declines in the last millennium. CONCLUSIONS Restricting access to lethal means (e.g., detoxification of domestic gas), improvements in health care and media guidelines for responsible reporting of suicides are possible explanations for the generally declining suicide rates in Switzerland. Whereas some methods (e.g., poisoning by gases or drowning) had become rare, others continue to account for many suicides every year, at least in some population subgroups (e.g., firearms in older Swiss men or railway suicides in younger and in male residents). As different methods of suicide are chosen by different people or subgroups of the population, preventive efforts should include differentiated strategies and targeted measures to further reduce suicides in Switzerland and elsewhere.
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Affiliation(s)
- Niklaus Stulz
- Integrated Psychiatric Services Winterthur - Zurcher Unterland, Switzerland
| | - Urs Hepp
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Switzerland.,Meilener Institute Zurich, Switzerland
| | | | | | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
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Prater LC, Ellyson AM, Shawon RA, Lyons VH, Cheung A, Rivara F, Rowhani-Rahbar A, Zatzick D. Suicide, Firearms, and Terminal Illness: A Latent Class Analysis Using Data From the National Violent Death Reporting System. Psychiatr Serv 2022:appips202100733. [PMID: 36475825 DOI: 10.1176/appi.ps.202100733] [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: 12/12/2022]
Abstract
OBJECTIVE Firearms are highly lethal when used for suicide and are used more frequently as a suicide method by persons of older age. Individuals with terminal illness are at high risk for suicide, yet little research has explored how firearms may be used for self-harm in this population. The authors sought to understand the patterns of psychiatric diagnoses, substance use disorders diagnoses, and suicide mechanisms for individuals with terminal illness who died by suicide as well as their demographic and circumstantial characteristics. METHODS A latent class analysis using data from the National Violent Death Reporting System was undertaken to better understand typologies of individuals with terminal illness who died by suicide in 2003-2018 (N=3,072). To develop the classes, the authors considered diagnoses of mental illness and of alcohol or substance use disorders, suicidal thoughts and behaviors, and mechanism of suicide (firearm or no firearm). Demographic and circumstantial variables were examined across classes. RESULTS The analysis revealed four classes of persons with terminal illness who died from suicide: depression and nonfirearm methods (N=375, 12%), suicidal intent and firearm use (N=922, 30%), alcohol or substance use disorder and nonfirearm methods (N=70, 2%), and firearm use only (N=1,705, 56%). CONCLUSIONS Firearm access is an important consideration for terminally ill persons at risk for suicide. Screening for psychiatric and substance use disorders may not identify terminally ill persons who are at increased suicide risk because of the presence of a firearm in the home. This population may benefit from tailored interventions in specialty care settings to address firearm safety.
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Affiliation(s)
- Laura C Prater
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Alice M Ellyson
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Riffat Ara Shawon
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Vivian H Lyons
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Angel Cheung
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Frederick Rivara
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Ali Rowhani-Rahbar
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
| | - Douglas Zatzick
- Departments of Psychiatry and Behavioral Health (Prater, Zatzick), Pediatrics (Ellyson, Rivara), and Epidemiology (Shawon, Cheung, Rowhani-Rahbar), University of Washington, Seattle; Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle (Prater, Ellyson, Rivara); Social Development Research Group, School of Social Work, University of Washington, Seattle (Lyons)
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21
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Karnick AT, Bond AE, Kaufman EJ, Anestis MD, Capron DW. Injury characteristics and circumstances of firearm trauma: Assessing suicide survivors and decedents. Suicide Life Threat Behav 2022; 52:1217-1225. [PMID: 36056539 DOI: 10.1111/sltb.12916] [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: 04/26/2022] [Revised: 07/25/2022] [Accepted: 08/10/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Despite representing fewer than 5% of suicide attempts, firearms account for over half of deaths. Yet there is little clinical information regarding firearm attempts, particularly survivors. We assessed clinical factors differentiating firearm suicide survivors from decedents, firearm attempters from other methods, and firearm attempters from similarly injured trauma patients. METHODS We used clinical data from the National Trauma Data Bank (2017) to assess firearm suicide attempts using cross-sectional and case-control designs. We used logistic and multinomial regression to compare groups and assess firearm type and discharge destination. RESULTS Older age, being uninsured, and injury location were associated with increased mortality among firearm attempters. Older age, White race, male sex, and being uninsured were associated with firearm attempts. Major psychiatric disorders were associated with firearm attempts and using a rifle or shotgun. Major psychiatric disorders, female sex, and smoking were associated with psychiatric discharge. Black and other race were associated with law enforcement discharge, and Black race was associated with lower odds of psychiatric discharge. Uninsured patients had lower odds of discharge to long-term care, psychiatric, or rehabilitation facilities. CONCLUSIONS This study identifies factors associated with firearm suicide and includes indicators of disparities in health services for patients at high risk of suicide death.
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Affiliation(s)
- Aleksandr T Karnick
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Allison E Bond
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA.,New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
| | - Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael D Anestis
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA.,New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
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22
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Lee LK, Fleegler EW, Goyal MK, Doh KF, Laraque-Arena D, Hoffman BD, Injury Violence And Poison Prevention CO. Firearm-Related Injuries and Deaths in Children and Youth. Pediatrics 2022; 150:189687. [PMID: 36207778 DOI: 10.1542/peds.2022-060071] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. In 2020, firearms resulted in 10,197 deaths (fatality rate 9.91/100,000 youth 0-24 years old). Firearms are the leading mechanism of death in pediatric suicides and homicides. Increased access to firearms is associated with increased rates of firearm deaths. Substantial disparities in firearm injuries and deaths exist by age, gender, race, ethnicity, and sexual orientation and gender identity and for deaths related to legal intervention. Barriers to firearm access can decrease the risk to youth for firearm suicide, homicide, or unintentional shooting injury and death. Given the high lethality of firearms and the impulsivity associated with suicidal ideation, removing firearms from the home or securely storing them-referred to as lethal means restriction of firearms-is critical, especially for youth at risk for suicide. Primary care-, emergency department-, mental health-, hospital-, and community-based intervention programs can effectively screen and intervene for individuals at risk for harming themselves or others. The delivery of anticipatory guidance coupled with safety equipment provision improves firearm safer storage. Strong state-level firearm legislation is associated with decreased rates of firearm injuries and death. This includes legislation focused on comprehensive firearm licensing strategies and extreme risk protection order laws. A firm commitment to confront this public health crisis with a multipronged approach engaging all stakeholders, including individuals, families, clinicians, health systems, communities, public health advocates, firearm owners and nonowners, and policy makers, is essential to address the worsening firearm crisis facing US youth today.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Kiesha Fraser Doh
- Division of Pediatrics and Emergency Medicine, Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | - Danielle Laraque-Arena
- New York Academy of Medicine, Mailman School of Public Health at Columbia University, Departments of Epidemiology and Pediatrics, New York, NY
| | - Benjamin D Hoffman
- Division of General Pediatrics, Oregon Health and Science University, Portland, OR
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Anestis MD, Bryan CJ, Capron DW, Bryan AO. Evaluation of Safe Firearm Storage Messaging in a Sample of Firearm-Owning US Military Service Members. JAMA Netw Open 2022; 5:e2235984. [PMID: 36219445 PMCID: PMC9554700 DOI: 10.1001/jamanetworkopen.2022.35984] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Nearly two-thirds of military suicides involve firearms, and safe firearm storage is rare. OBJECTIVE To examine whether US military service members endorse greater openness to safe firearm storage depending on the content of the visual message they are randomly assigned to view. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study used a 3 × 2 × 2 factorial design to randomize US military service members to view 1 of 12 visual messages on safe firearm storage. Willingness to use safe firearm storage practices was assessed immediately before and after exposure to the message. Participants were recruited using the KnowledgePanel Calibration approach. Inclusion criteria included current membership in the US military and current firearm ownership. The KnowledgePanel sample was fielded from December 3 to 27, 2021, with a 76% completion rate and 45 individuals determined to be qualified (28% qualification rate). The opt-in sample was fielded December 7, 2021, through January 4, 2022, with 699 individuals (3%) qualified and 674 included in the final data set. EXPOSURES Messages shared the same image and text on safe firearm storage but varied in messenger occupation (eg, primary care physician, security forces, or combat controller), the presence of text validating the perspective of firearm owners, and the presence of text validating the drive for home protection. MAIN OUTCOMES AND MEASURES Outcomes included changes in willingness to use 4 at-home (unloaded, separate from ammunition, in a locked location, and with a locking device) and 3 away-from-home (with family or friend, at a firearm retailer, or at a law enforcement agency) firearm storage practices. All analyses, including sample descriptives, are based on weighted data. RESULTS Of the 719 individuals in the data set, 367 (median [range] age, 33.64 [18-86] years; 80.4% male; 71.4% White) who endorsed not currently storing firearms using the methods assessed were included in analyses. In a multivariate analysis of variance, a significant interaction was found among time, messenger profession, gun-friendly text, and home protection text across all outcomes (Wilks' λ F = 2.09; P = .01; pη2 = 0.040); however, in a post hoc repeated-measures analysis of variance, the interaction was statistically significant only for storing firearms away from home with a trusted family member or friend (F = 5.42; P = .005; pη2 = 0.030). The profession of the messenger was more consistently associated with shifts in willingness than was the message content, although this varied across storage options. CONCLUSIONS AND RELEVANCE The findings of this comparative effectiveness study suggest that several combinations of messenger and content may be associated with willingness to endorse safe firearm storing practices, with particularly consistent positive findings for messages featuring security forces. The scalability and dosage potential of this intervention may render visual messaging valuable for promoting safe firearm storage at the population level.
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Affiliation(s)
- Michael D. Anestis
- New Jersey Gun Violence Research Center, Piscataway
- Rutgers, the State University of New Jersey, Piscataway
| | - Craig J. Bryan
- The Ohio State University Wexner Medical Center, Columbus
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Hogan AH, Gadun A, Borrup K, Hunter AA, Campbell BT, Knod JL, Downs J, Rogers SC. Assessing the Effect of Electronic Medical Record Note Template on Firearm Access Screening in High-Risk Children. Hosp Pediatr 2022; 12:e278-e282. [PMID: 35794213 DOI: 10.1542/hpeds.2022-006515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children who survive a suicide attempt are at greater risk of later dying by suicide. Firearm screening and provision of lethal means restriction counseling may improve the safety of this high-risk cohort. Our objective was to determine firearm screening rates among children hospitalized after suicide attempts. We also assessed the effects of templating firearm screening questions into the psychiatric consultation note. METHODS This retrospective pre- and postintervention study identified children <19 years old admitted after a suicide attempt from January 1, 2016 to March 1, 2020. In mid-2017, the psychiatry consult note incorporated a previously available optional firearm screening tool as an embedded field (intervention). The intervention effect on proportion of children at high risk screened for firearm access was assessed by interrupted time series analysis. RESULTS Of 26 088 total admissions, 357 met inclusion criteria. The majority were teenagers (15 years old, interquartile range 14 to 16), 275 were female (77%), and 167 were White (47%). Overall, 286 (80%) of patients had firearm access screening documentation. Of the 71 (20%) without screening, 21 (30%) were discharged from the hospital; 50 (70%) were transferred to psychiatric facilities. There was no significant difference in screening rates after the intervention (Intervention shift P = .74, slope P = .85). CONCLUSIONS Many children were not screened for firearm access after a suicide attempt requiring hospitalization despite the screening tool integration. Multidisciplinary quality improvement efforts are needed to ensure that this critical risk reduction intervention is implemented for all patients after a suicide attempt.
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Affiliation(s)
| | | | - Kevin Borrup
- Department of Pediatrics.,Injury Prevention Center, Hartford, Connecticut
| | - Amy A Hunter
- Department of Pediatrics.,Department of Public Health Sciences.,Trinity College, Hartford, Connecticut
| | - Brendan T Campbell
- Department of Pediatrics and Surgical Subspecialties, University of Connecticut School of Medicine, Farmington, Connecticut.,Department of Pediatric Surgery
| | - J Leslie Knod
- Department of Pediatrics and Surgical Subspecialties, University of Connecticut School of Medicine, Farmington, Connecticut.,Department of Pediatric Surgery
| | - Jennifer Downs
- Department of Psychiatry, Connecticut Children's Medical Center, Hartford, Connecticut.,Department of Pediatrics.,Institute of Living, Hartford, Connecticut
| | - Steven C Rogers
- Department of Pediatrics.,Division of Emergency Medicine, Connecticut Children's Medical Center, Hartford, Connecticut and
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Monteith LL, Holliday R, Dichter ME, Hoffmire CA. Preventing Suicide Among Women Veterans: Gender-Sensitive, Trauma-Informed Conceptualization. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2022; 9:186-201. [PMID: 35730002 PMCID: PMC9198614 DOI: 10.1007/s40501-022-00266-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review There is growing concern regarding suicide among women veterans, who have experienced an increase in suicide rates that has exceeded that reported for other US adult populations. Recent research has bolstered understanding of correlates of suicide risk specific to women veterans. Yet most existing suicide prevention initiatives take a gender-neutral, rather than gender-sensitive, approach. We offer clinical considerations and suggestions for suicide prevention tailored to the needs, preferences, and experiences of women veterans. Discussion is framed around the White House strategy for preventing suicide among military service members and veterans. Recent Findings Considering high rates of trauma exposure among women veterans, we propose that a trauma-informed lens is essential for taking a gender-sensitive approach to suicide prevention with this population. Nonetheless, research to inform evidence-based assessment and intervention remains largely focused on veteran men or gender-neutral. Integral next steps for research are posited. Summary Extant research provides an initial foundation for beginning to understand and address suicide among women veterans in a gender-sensitive, trauma-informed manner. Additional research that is specific to women veterans or that examines gender differences is critical to ensure women veterans receive optimal, evidence-based care to prevent suicide.
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Affiliation(s)
- Lindsey L. Monteith
- Rocky Mountain MIRECC for Veteran Suicide Prevention, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling St, Aurora, CO 80045 USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Ryan Holliday
- Rocky Mountain MIRECC for Veteran Suicide Prevention, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling St, Aurora, CO 80045 USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Melissa E. Dichter
- VA Center for Health Equity Research and Promotion, Philadelphia, PA USA
- Temple University School of Social Work, Philadelphia, PA USA
| | - Claire A. Hoffmire
- Rocky Mountain MIRECC for Veteran Suicide Prevention, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling St, Aurora, CO 80045 USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, CO Aurora, USA
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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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27
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Miller CDM, Rudolphi JM. Characteristics of suicide among farmers and ranchers: Using the CDC NVDRS 2003-2018. Am J Ind Med 2022; 65:675-689. [PMID: 35671362 PMCID: PMC9541098 DOI: 10.1002/ajim.23399] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Suicide is among the top 10 causes of premature death in the United States. This study provides details on farmer and rancher suicide decedents, including demographic information, mental health status, history of suicidal thoughts and attempts, and circumstances associated with death. METHODS Data for this study were obtained from the Centers for Disease Control and Prevention's National Violent Death Reporting System Restricted Access Database for the years 2003-2018. Descriptive statistics and adjusted odds ratios are presented for farm and nonfarm populations in addition to farm populations by age groups and sex. RESULTS This study found that almost half of the farmer suicide decedents were over 65 years old. Firearms were the most widely used method for farmers and ranchers regardless of age and sex. Young farmers and ranchers that died by suicide were more likely to have had relationship problems and older farmers and ranchers that died by suicides were more likely to have had a physical health problem. Male farmer and rancher suicide decedents were more likely to die by firearm than females, and female farmer and rancher suicide decedents were likely to have resided in a small metropolitan area, however, due to small numbers and suppression in the data, most sex comparisons were not able to be presented. CONCLUSIONS While no clear risk factor for suicide among farmers and ranchers emerged, results underscore the complex nature of suicide and the need for multifaceted, culturally competent interventions and campaigns that address suicide risk and prevention at the individual and community levels.
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Affiliation(s)
| | - Josie M Rudolphi
- Rural Development Innovation Center, Data Analytics Division, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
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28
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Morgan ER, Rivara FP, Ta M, Grossman DC, Jones K, Rowhani-Rahbar A. Incarceration and subsequent risk of suicide: A statewide cohort study. Suicide Life Threat Behav 2022; 52:467-477. [PMID: 35092087 DOI: 10.1111/sltb.12834] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/26/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Increasing suicide rates across the United States are disproportionate among populations most impacted by mass incarceration. We sought to determine if incarceration is associated with risk of suicide and firearm suicide after release from prison. METHODS Using a population-based Washington cohort from Department of Corrections and vital statistics administrative records 1990-2017, individuals were compared to the sex-, age-, and race-matched population of Washington using Poisson regression. Among previously incarcerated individuals, we included incarceration history characteristics to calculate sub-hazard ratios using Cox proportional-hazards models. RESULTS Of 140,281 individuals released from prison, 484 died by suicide. Suicide risk was 62% higher among previously incarcerated individuals compared with the general population (RR: 1.62; 95% CI: 1.46-1.79). Suicide risk was higher among individuals convicted of firearm-involved crimes (RR: 2.27; 95% CI: 1.79-2.89). Individuals released prior to age 18 had substantially higher risk of firearm suicide than those whose first release occurred between ages 18-24 (sHR: 11.91; 95% CI: 4.30-32.96). CONCLUSION Our findings highlight the need for improved mental health resources and lethal means safety in this population. Mental health and substance use treatment have been proposed as effective alternatives to incarceration-continuing to study their impacts may reveal additional benefits of reducing suicide.
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Affiliation(s)
- Erin Renee Morgan
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Frederick P Rivara
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Myduc Ta
- Assessment, Policy Development and Evaluation Unit, Public Health - Seattle & King County, Seattle, Washington, USA
| | - David C Grossman
- Kaiser Permanente Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Karl Jones
- Washington State Department of Corrections, Tumwater, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
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29
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Goldstein EV, Prater LC. Examining the policy effects of Arizona's 2016 pre-emption law on firearm suicide rates in the greater Tucson area: an observational study. BMJ Open 2022; 12:e058196. [PMID: 35534056 PMCID: PMC9086613 DOI: 10.1136/bmjopen-2021-058196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE In 2016, Arizona enacted SB 1487 to nullify Tucson's ordinance permitting the municipality to destroy confiscated and forfeited firearms and instead require the firearms to be resold to the public through an auctioneer. Our objective was to examine whether firearm suicide rates increased in Pima County (greater Tucson area) relative to other Arizona counties following the enactment of Arizona's 2016 pre-emption law. DESIGN An observational study of a natural policy experiment. We used a difference-in-differences approach to estimate the effects of Arizona enacting SB 1487 on firearm suicide rates in Pima County. Our statistical analyses adjusted for county-level differences in population demographics (age, gender and race) and unemployment rates, as well as a proxy for firearm availability and mental health professional shortage area status. SETTING 9 Arizona counties from 2014 to 2019. PARTICIPANTS A policy group was constructed using Pima County (Tucson area) observations. A comparison group was created using data from eight other Arizona counties. 54 county-year observations were analysed. INTERVENTION SB 1487, which pre-empted Tucson law and allowed firearms that were seized/surrendered to law enforcement to be recirculated instead of destroyed. OUTCOMES AND MEASURES Annual rates of firearm and non-firearm suicides per 100 000 persons extracted from the Centers for Disease Control and Prevention WONDER system. RESULTS Over the study period, comparison group counties had an average of 14.87 firearm suicides per 100 000 persons per year, compared with 11.56 firearm suicides per 100 000 persons per year in Pima County. A 1.13 increase in Pima County's firearm suicides per 100 000 persons coincided with the enactment of Arizona's 2016 pre-emption law, relative to comparison group counties over the same period. CONCLUSIONS SB 1487 was associated with higher firearm suicide rates in Pima County relative to other areas not targeted by the law, assuming fewer firearms were destroyed and more firearms re-entered the greater Tucson area through 2019.
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Affiliation(s)
- Evan V Goldstein
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Laura C Prater
- Department of Psychiatry and Behavioral Health Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Firearm Injury Prevention and Research Program, Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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30
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Cai Z, Junus A, Chang Q, Yip PSF. The lethality of suicide methods: A systematic review and meta-analysis. J Affect Disord 2022; 300:121-129. [PMID: 34953923 DOI: 10.1016/j.jad.2021.12.054] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The use of suicide methods largely determines the outcome of suicide acts. However, no existing meta-analysis has assessed the case fatality rates (CFRs) by different suicide methods. The current study aimed to fill this gap. METHODS We searched Scopus, Web of Science, PubMed, ProQuest and Embase for studies reporting method-specific CFRs in suicide, published from inception to 31 December 2020. A random-effect model meta-analysis was applied to compute pooled estimates. RESULTS Of 10,708 studies screened, 34 studies were included in the meta-analysis. Based on the suicide acts that resulted in death or hospitalization, firearms were found to be the most lethal method (CFR:89.7%), followed by hanging/suffocation (84.5%), drowning (80.4%), gas poisoning (56.6%), jumping (46.7%), drug/liquid poisoning (8.0%) and cutting (4.0%). The rank of the lethality for different methods remained relatively stable across study setting, sex and age group. Method-specific CFRs for males and females were similar for most suicide methods, while method-CFRs were specifically higher in older adults. CONCLUSIONS This study is the first meta-analysis that provides significant evidence for the wide variation of the lethality of suicide methods. Restricting highly lethal methods based on local context is vital in suicide prevention.
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Affiliation(s)
- Ziyi Cai
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Alvin Junus
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Qingsong Chang
- School of Sociology and Anthropology, Xiamen University, Xiamen, China.
| | - Paul S F Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China; Hong Kong Jockey Club Center for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China.
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Karnick AT, Boska RL, Caulfield NM, Winchell R, Capron DW. Suicide and self-injury outcomes for patients with comorbid psychiatric and physical health conditions. Psychiatry Res 2022; 308:114345. [PMID: 34954501 DOI: 10.1016/j.psychres.2021.114345] [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: 07/16/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 11/29/2022]
Abstract
Suicide is a transdiagnostic public health issue that affects nearly all psychiatric disorders, individuals without a mental health diagnosis, and individuals with physical health issues. We assessed the relationship between these variables and suicide outcomes using a novel epidemiological research paradigm. Data were collected from the National Trauma Data Bank. Participants included patients admitted to trauma units for suicide and self-injury (n = 13,422). Patients were classified to one of four comorbid condition groups: no comorbidity, comorbid physical condition, comorbid major psychiatric condition, or multimorbidity (comorbid physical and psychiatric conditions). Multivariable logistic regression measured associations between comorbid condition and mortality and multivariable linear regression measured associations between comorbidity and injury severity. Mortality in patients with physical health comorbidity was not significant, but patients with psychiatric comorbidity or multimorbidity had significantly lower mortality than patients without either. No association between injury severity and comorbidity was detected. There were no differences in suicide mortality for individuals with a physical health comorbidity, but mortality was lower for individuals with a comorbid major psychiatric illness or multimorbidity. Since physical health conditions and psychiatric illness are associated with eventual suicide mortality, prevention strategies could target these populations at trauma units for suicide and self-injury admissions.
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Affiliation(s)
- Aleksandr T Karnick
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA.
| | - Rachel L Boska
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort hill Avenue, Canandaigua, NY, 14424; Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Blvd., Rochester, NY, 14642
| | - Nicole M Caulfield
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA
| | - Robert Winchell
- Department of Surgery, Weill Cornell Medicine, 525 E. 68th Street, New York, NY, USA
| | - Daniel W Capron
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA
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32
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Ramesh P, Taylor PJ, McPhillips R, Raman R, Robinson C. A Scoping Review of Gender Differences in Suicide in India. Front Psychiatry 2022; 13:884657. [PMID: 35669273 PMCID: PMC9165759 DOI: 10.3389/fpsyt.2022.884657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Much of the published literature on suicide comes from high income countries. In countries such as India, female suicide rates exceed the global suicide rate and suicide rates found in their male counterparts. Results from previous studies indicate that factors related to suicide among men and women in India are different from those seen in high-income countries. To date, no reviews have considered the relationship between gender and suicide in India. Therefore, the aim of this scoping review is to provide a comprehensive understanding of existing literature reporting gender differences in suicide rates, methods, risk factors and antecedent factors in India by reviewing published studies. METHOD A scoping review was conducted to map the existing literature on gender differences in suicide in India. To identify peer-reviewed publications, online databases PsycINFO and Embase were searched. The search terms were [suicid* AND India*]. The searches took place in November 2020 and May 2021, with no language restrictions. Articles published from 2014 onwards from India were included. Reference lists of selected studies were searched for studies that could meet the inclusion criteria. RESULTS This review identified 17 studies that met the inclusion criteria. The ratio between women and men who die by suicide in India is much lower than in high-income countries. Hanging was found to be a more commonly used method of suicide among both men and women, in comparison to high-income countries where hanging is more common among men. This review also identified several gaps in the literature. There were few studies that examined suicide among transgender Indians. There was limited literature on gender differences in risk and protective factors for suicide. Limitations such as the omission of a lack of gender-based analyses in several studies and under-reporting of suicide rates were identified. CONCLUSION Understanding suicide within the context of individual countries is essential in designing culture-appropriate suicide prevention strategies. This review identified an urgent need to establish and evaluate suicide surveillance systems in India. Furthermore, additional research is warranted to understand suicide among individuals who identify outside the gender binary, and gender-specific risk and protective factors.
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Affiliation(s)
- Parvathy Ramesh
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Peter J Taylor
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Rebecca McPhillips
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Rajesh Raman
- Department of Psychiatry, JSS Medical College, JSS University, Mysore, India
| | - Catherine Robinson
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
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Uspal NG, Jensen J, Sanchez-Erebia L, Strelitz B, Schloredt K, Gallagher C, Bradford MC, Bennett E, Paris CA. Emergent Mental Health Visits to a Pediatric Hospital: Impact on Firearm Storage Practices. Pediatr Emerg Care 2021; 37:e1382-e1387. [PMID: 32205798 DOI: 10.1097/pec.0000000000002056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aims of this study were to describe firearm storage practices in homes of patients evaluated for mental health (MH) complaints at a tertiary care children's hospital and to describe storage practice changes after treatment. METHODS We surveyed families of children with MH complaints presenting to the emergency department or psychiatry unit who stored firearms in their homes between February 12, 2016, and January 14, 2017. Patients and families received standard care, including routine counseling on limiting access to methods of suicide. Participants completed surveys at baseline, 7, and 30 days after discharge. The primary outcome was triple safe firearm storage-storage of firearms unloaded, locked, and with ammunition stored and locked separately. RESULTS Ninety-one household members of MH patients who stated they had firearms were enrolled at baseline. Seventy-seven (85%) completed at least 1 follow-up survey, and 63 (69%) completed both. At baseline, 21% (19/91) of participants reported engaging in triple safe firearm storage, 26% had an unlocked firearm, 23% had a loaded firearm, and 65% stored ammunition either unlocked or with their firearm. Triple safe storage rates increased to 31% at both 7 days and 30 days. Ten (17%) of 59 (P < 0.01) participants who did not report triple safe storage at baseline and completed a follow-up survey changed to reporting triple safe storage on follow-up. CONCLUSIONS The majority of firearm-storing family members of children with MH complaints do not follow triple safe storage practices. Storage practices modestly improved after an emergent MH visit, but over two thirds of participants reported unsecured or partially secured firearms 7 and 30 days later.
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Affiliation(s)
- Neil G Uspal
- From the Department of Pediatrics, University of Washington
| | - Jennifer Jensen
- Center for Clinical and Translational Research, Seattle Children's Hospital
| | | | - Bonnie Strelitz
- Center for Clinical and Translational Research, Seattle Children's Hospital
| | | | | | - Miranda C Bradford
- Children's Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
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Prater LC, Ellyson A, Fihn SD. Incentivizing Firearm Safety and Storage Counseling in the US Health Care System: a Path Forward. J Gen Intern Med 2021; 36:3568-3570. [PMID: 33904041 PMCID: PMC8075276 DOI: 10.1007/s11606-021-06800-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/01/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Laura C Prater
- Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, 401 Broadway Suite 2075, Seattle, WA, 98104, USA. .,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Alice Ellyson
- Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, 401 Broadway Suite 2075, Seattle, WA, 98104, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Stephan D Fihn
- Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
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Osborne MC, Self-Brown S, Lai BS. Child maltreatment, suicidal ideation, and in-home firearm availability in the U.S.: findings from the longitudinal studies of child abuse and neglect. Int J Inj Contr Saf Promot 2021; 29:56-65. [PMID: 34711135 DOI: 10.1080/17457300.2021.1996397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Suicide is the second leading cause of death among adolescents in the U.S., and risk factors include child maltreatment (CM), especially physical and emotional abuse, and in-home firearm availability ('availability'). However, research examining availability among adolescent populations at-risk for CM is limited. This study examines availability in this population, the association between CM and availability, and availability among adolescents experiencing suicidal ideation. A multivariable modified Poisson regression model assessed the relationship between CM by age 12 and availability at age 14 using data from the Longitudinal Studies of Child Abuse and Neglect (n = 1,354 families). Approximately 11.61% of adolescents reported availability, and physical abuse increased the risk of availability (aRR = 1.94; 95% CI [1.22, 3.08]). Over one-quarter (27.50%) of adolescents with suicidal ideation at age 16 reported availability. Child welfare-involved families are often referred to interventions. Future research and prevention efforts should explore augmentation of these programmes with firearm safe storage guidance.
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Affiliation(s)
- Melissa C Osborne
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | | | - Betty S Lai
- Counseling, Developmental and Educational Psychology, Lynch School of Education and Human Development, Boston College, Boston, MA, USA
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K R, Ananda Rao A, D K, Vaishnav PP, Davis S, T A, J DK, Suresh A, Nadig C. Patients With Suicidal Patterns in the Emergency Room: A Clinical and Social Reflection. Cureus 2021; 13:e18570. [PMID: 34765347 PMCID: PMC8575329 DOI: 10.7759/cureus.18570] [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] [Accepted: 10/07/2021] [Indexed: 11/27/2022] Open
Abstract
Background and objective Emergency physicians come across a myriad of medical afflictions resulting from suicide attempts. The Indian contribution to global suicide deaths is alarming; the social construct of India is unique, and so are the problems and challenges. This study aims to describe the social background, demographic parameters and correlate the clinical profile and outcomes of all patients presenting with an attempted or completed suicide. Materials and methods The present study is a hospital-based prospective observational study conducted by the Department of Emergency Medicine at RL Jalappa Hospital and Research Centre, a rural tertiary-care center in Karnataka, India, from June 2020 to February 2021. After stabilizing the patient, a detailed socio-demographic history was recorded. Details of the suicide attempt and findings of the clinical examination were noted. Results The final study sample consisted of 89 patients who presented to the emergency room (ER). Fifty-three patients were female, and thirty-six were males; the average age of the sample was 28.4 ± 11 years. A higher proportion of men who completed pre-university education (p= 0.0005, c2= 11.98) or had a graduate degree (p= 0.009, c2= 6.71) attempted suicide. Amongst all women who attempted suicide, 73.6% (n=39) were married at the time of the event (p= 0.0006, c2= 11.79). Poisoning (n=59) was the most common method of attempting suicide. We also observed that it was primarily men who attempted suicide when under the influence of alcohol (p= 0.006, c2= 7.57). The most common reason for attempting suicide was familial disharmony, including domestic violence. A Glasgow Coma Scale (GCS) score of 9/15 and less at the time of presentation resulted in a mortality rate of 28.6%, whereas patients with a GCS score of 10 and above had a mortality rate of 6.1% (p= 0.04, c2= 4.14). Discussion Marriage appears to be less protective for Indian women than Indian men. Poisoning was the most common method of attempted suicide in our study, followed by tablet overdose. The reason for the above could be ease of access to household poisons. Insecticides have been a preferred method in the Indian population over the years. Aluminum phosphide poisoning, a common constituent of rodenticides, is associated with a high mortality rate. However, in the West, firearm-related incidents have the highest mortality. Multiple correspondence analysis (MCA) of the National Crime Records Bureau (NCRB), India, data showed that adult males succumb majorly to romantic relations, unemployment, and failure in examinations. The use of alcohol was more in the illiterate and unskilled workers; however, high school educated persons and students used alcohol intentionally to facilitate suicide. Lower Glasgow Coma Scale values are associated with higher fatality; however, some studies found that Full Outline of Unresponsiveness (FOUR) and Acute Physiology and Chronic Health Evaluation Score (APACHE) II scores are better mortality indicators. Conclusion Besides the presentation and GCS score, cognizance of the lethality of different methods in attempting suicide provides clues in anticipating the patient's clinical course. The social patterns of suicide must be considered while designing awareness campaigns and focused outreach programs to decrease suicides. A strict policy must be made and enforced to limit the availability of household poisons.
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Affiliation(s)
- Rajesh K
- Emergency Medicine, Sri Devaraj Urs Medical College and Research Hospital, Kolar, IND
| | - Amogh Ananda Rao
- Internal Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
| | - Krishna D
- Emergency Medicine, Sri Devaraj Urs Medical College and Research Hospital, Kolar, IND
| | - Pratyaksh P Vaishnav
- Internal Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
| | - Sissmol Davis
- Internal Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
| | - Abhinov T
- Emergency Medicine, Sri Devaraj Urs Medical College and Research Hospital, Kolar, IND
| | - Devendraprasad K J
- Emergency Medicine, Sri Devaraj Urs Medical College and Research Hospital, Kolar, IND
| | - Ashutosh Suresh
- Internal Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
| | - Chiranth Nadig
- Internal Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
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O'Dwyer ST, Janssens A, Sansom A, Biddle L, Mars B, Slater T, Moran P, Stallard P, Melluish J, Reakes L, Walker A, Andrewartha C, Hastings RP. Suicidality in family caregivers of people with long-term illnesses and disabilities: A scoping review. Compr Psychiatry 2021; 110:152261. [PMID: 34332205 DOI: 10.1016/j.comppsych.2021.152261] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/26/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022] Open
Abstract
An emerging body of international research suggests family caregivers may be a high-risk group for suicide, but the evidence has not been synthesised. Forty-eight peer-reviewed journal articles were included in this review, spanning low-, middle-, and high-income countries and a variety of illnesses and disabilities. The proportion of caregivers experiencing suicidal ideation ranged from 2.7% to 71%, with evidence of suicide attempts, deaths by suicide, and deaths by homicide-suicide also reported. Risk and protective factors varied across studies and there was little consideration of differences by caregiving relationship, type of illness/disability, or country. There is sufficient evidence to warrant concern for caregivers around the world and prompt action in policy and practice, but more rigorous research is required to draw clear, nuanced conclusions about risk and inform evidence-based prevention and intervention.
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Affiliation(s)
- Siobhan T O'Dwyer
- University of Exeter Medical School, College of Medicine and Heath, University of Exeter, Heavitree Rd, Exeter EX1 2LU, United Kingdom; National Institute for Health Research Applied Research Collaboration South West Peninsula (NIHR PenARC), United Kingdom.
| | - Astrid Janssens
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, J.B. Winslows Vej 9B, 1(st) Floor, 5000 Odense C, Denmark; Centre for Innovative Medical Technology, Odense University Hospital, Denmark
| | - Anna Sansom
- University of Exeter Medical School, College of Medicine and Heath, University of Exeter, Heavitree Rd, Exeter EX1 2LU, United Kingdom
| | - Lucy Biddle
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Research Foundation, United Kingdom; Bristol Medical School, University of Bristol, Oakfield House, Bristol BS8 2BN, United Kingdom
| | - Becky Mars
- National Institute for Health Research (NIHR), Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, United Kingdom; Bristol Medical School, University of Bristol, Oakfield House, Bristol BS8 2BN, United Kingdom
| | - Thomas Slater
- School of Social Sciences, Cardiff University, 2.14B Glamorgan Building, King Edward VII Avenue, Cardiff CF10 3WT, United Kingdom
| | - Paul Moran
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom; The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Research Foundation, United Kingdom
| | - Paul Stallard
- Department of Health, University of Bath, Bath BA2 7AY, United Kingdom
| | | | | | | | | | - Richard P Hastings
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom; Centre for Developmental Psychiatry and Psychology, Monash University, Australia
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Impact of a Firearm Safety Device Distribution Intervention on Storage Practices After an Emergent Mental Health Visit. Acad Pediatr 2021; 21:1209-1217. [PMID: 33945885 DOI: 10.1016/j.acap.2021.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine if providing firearm storage devices with training during clinical care improves safe storage practices in household members of children who present to a pediatric hospital with an emergent mental health complaint. METHODS Prospective, pre-post study. Enrollment occurred in the emergency department or the inpatient psychiatric unit. Participants in the observation phase received usual care. Participants in the intervention phase were randomized to be offered a firearm storage device at either no or low ($5) cost and trained in its use. We surveyed participants at enrollment, 7, & 30 days post visit. Our primary outcome was triple-safe storage (TSS) - storing firearms unloaded, locked, and with ammunition stored and locked separately. RESULTS About 256 participants enrolled. In the observation phase TSS increased from 21% (95% confidence interval [CI] 14%-30%) at baseline to 31% (95% CI 21%-42%) at 7 and 31% (95% CI 21%-43%) at 30 days. In the intervention phase, TSS increased from 32% (95% CI 25%-39%) at baseline to 56% (95% CI 48%-64%) at 7 and 56% (95% CI 47%-64%) at 30 days. Among those not practicing TSS at baseline, 7-day TSS was higher in the intervention (38%) versus the observation phase (14%, P = .001). CONCLUSIONS Distribution and training in the use of firearm storage devices increased TSS in the study population, improves pediatric safety and should be part of the routine care of these high-risk patients.
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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: 41] [Impact Index Per Article: 13.7] [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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Zuriaga A, Kaplan MS, Choi NG, Hodkinson A, Storman D, Brudasca NI, Hirani SP, Brini S. Association of mental disorders with firearm suicides: A systematic review with meta-analyses of observational studies in the United States. J Affect Disord 2021; 291:384-399. [PMID: 34098496 DOI: 10.1016/j.jad.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
In the United States (US), 61% of all suicide cases may involve firearms, and some evidence suggests that mental disorders may play a role in suicide by firearm. We performed the first systematic review and meta-analyses to investigate: (i) whether mental disorders are associated with suicide by firearm, and (ii) whether the risk of using a firearm compared with alternative means is associated with higher levels of suicide in individuals with a mental disorder METHODS AND FINDINGS: We searched twelve databases from inception to the 24th of May 2020. We retrieved 22 observational studies conducted in the US. Random-effects meta-analyses showed individuals who had a diagnosis of a mental disorder had lower odds (odds ratios (OR)= 0.50, 95% CI: 0.36 to 0.69; I2=100 (95% CI: 87 to 100%), of dying by suicide with a firearm than those who did not have a diagnosis of a mental disorder. Secondary analysis showed that decedents who had a mental health diagnosis resulted in lower odds of dying by suicide by using firearms than using other means LIMITATIONS: Risk of bias revealed a heterogeneous and poor definition of mental disorders as well as lack of control for potential demographic confounding factors. In the meta-analyses, studies were combined in the same analytic sample as 77% of these studies did not specify the type of mental disorder CONCLUSION: While our results seem to suggest that having a mental disorder may not be consistently associated with the odds of dying by suicide using a firearm, the presence of substantial heterogeneity and high risk of bias precludes any firm conclusions.
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Affiliation(s)
- Ana Zuriaga
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom.
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, United States
| | - Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, United States
| | - Alexander Hodkinson
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Nicoleta I Brudasca
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Shashivadan P Hirani
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Stefano Brini
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
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41
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Taylor JS, Madhavan S, Han RW, Chandler JM, Tenakoon L, Chao S. Financial burden of pediatric firearm-related injury admissions in the United States. PLoS One 2021; 16:e0252821. [PMID: 34161341 PMCID: PMC8221502 DOI: 10.1371/journal.pone.0252821] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/22/2021] [Indexed: 11/18/2022] Open
Abstract
Pediatric firearm-related injuries pose a significant public health problem in the United States, yet the associated financial burden has not been well described. This is the first study examining national data on the cost of initial hospitalization for pediatric firearm-related injuries. In this retrospective review, the Healthcare Cost and Utilization Project Kids' Inpatient Database from the years 2003, 2006, 2009, and 2012 was used to identify all patients 18 years of age and under who were admitted with firearm-related injuries. We compared demographic and discharge-level data including injury severity score, hospital length of stay, income quartile, injury intent, and inflation-adjusted hospital costs across age groups (0-5, 6-9, 10-15, 16-18 years). There were approximately 4,753 pediatric firearm-related admissions each year, with a median hospitalization cost of $12,984 per patient. Annual initial hospitalization costs for pediatric firearm injuries were approximately $109 million during the study period. Pediatric firearm-related injuries predominately occured among older teenagers (74%, 16-18 years), males (89%), black individuals (55%), and those from the lowest income quartile (53%). We found significant cost variation based on patient race, income quartile, injury severity score, intent, hospital length of stay, disposition, and hospital region. Inflation-adjusted hospitalization costs have increased significantly over the study period (p < 0.001). Pediatric firearm-related injuries are a large financial burden to the United States healthcare system. There are significant variations in cost based on predictable factors like hospital length of stay and injury severity score; however, there are also substantial discrepancies based on hospital region, patient race, and income quartile that require further investigation.
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Affiliation(s)
- Jordan S. Taylor
- Department of Surgery, Division of Pediatric Surgery, Stanford University, Stanford, California, United States of America
| | - Sriraman Madhavan
- Department of Statistics, Stanford University, Stanford, California, United States of America
| | - Ryan W. Han
- Department of Computer Science, Stanford University, Stanford, California, United States of America
| | - Julia M. Chandler
- Department of Surgery, Division of Pediatric Surgery, Stanford University, Stanford, California, United States of America
| | - Lakshika Tenakoon
- Department of Surgery, Division of General Surgery, Stanford University, Stanford, California, United States of America
| | - Stephanie Chao
- Department of Surgery, Division of Pediatric Surgery, Stanford University, Stanford, California, United States of America
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Gomez D, Saunders N, Greene B, Santiago R, Ahmed N, Baxter NN. Firearm-related injuries and deaths in Ontario, Canada, 2002-2016: a population-based study. CMAJ 2021; 192:E1253-E1263. [PMID: 33077520 DOI: 10.1503/cmaj.200722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Firearm-related injury is an important and preventable cause of death and disability. We describe the burden, baseline characteristics and regional rates of firearm-related injury and death in Ontario. METHODS We conducted a population-based cross-sectional study using linked data from health administrative data sets held at ICES. We identified residents of Ontario of all ages who were injured or died as a result of a firearm discharge between Apr. 1, 2002, and Dec. 31, 2016. We included injuries classified as assault, unintentional, self-harm or undetermined intent secondary to handguns, rifles, shotguns and larger firearms. The primary outcome was the incidence of nonfatal and fatal injuries resulting in an emergency department visit, hospital admission or death. We also describe regional and temporal rates. RESULTS We identified 6483 firearm-related injuries (annualized injury rate 3.54 per 100 000 population), of which 2723 (42.3%) were fatal. Assault accounted for 40.2% (1494/3715) of nonfatal injuries and 25.5% (694/2723) of deaths. Young men, predominantly in urban neighbourhoods, within the lowest income quintile were overrepresented in this group. Injuries secondary to self-harm accounted for 68.0% (1366/2009) of injuries and occurred predominantly in older men living in rural Ontario across all income quintiles. The case fatality rate of injuries secondary to self-harm was 91.7%. Self-harm accounted for 1842 deaths (67.6%). INTERPRETATION We found that young urban men were most likely to be injured in firearm-related assaults and that more than two-thirds of self-harm-related injuries occurred in older rural-dwelling men, most of whom died from their injuries. This highlights a need for suicide-prevention strategies in rural areas targeted at men aged 45 or older.
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Affiliation(s)
- David Gomez
- Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Natasha Saunders
- Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Brittany Greene
- Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Robin Santiago
- Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Najma Ahmed
- Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Nancy N Baxter
- Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
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Leibbrand C, Rivara F, Rowhani-Rahbar A. Gun Violence Exposure and Experiences of Depression Among Mothers. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:523-533. [PMID: 33439439 PMCID: PMC7805261 DOI: 10.1007/s11121-020-01202-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/26/2022]
Abstract
Gun violence is a uniquely prevalent issue in the USA that disproportionately affects disadvantaged families already at risk of health disparities. Despite the traumatic nature of witnessing gun violence, we have little knowledge of whether exposure to local gun violence is associated with higher risks of depression among mothers, whose symptoms of depression are likely to have spillover effects for kin. We examined the association between exposure to gun violence in mothers' neighborhoods and their experiences of depression using longitudinal Fragile Families and Child Wellbeing Study data (n = 4587) in tandem with lagged outcome and fixed effect models. We find that mothers who witness at least one shooting in their neighborhoods or local communities exhibit more symptoms of depression and are 32-60% more likely to meet criteria for depression than mothers who do not witness a shooting. We also find that witnessing a shooting is associated with increases in parental aggravation, which is partially mediated by maternal depression. Given this and other previously documented spillover effects of mothers' mental health on children and family members, these findings have important implications for mothers' wellbeing and their kin. Further, we observe substantial racial and socioeconomic disparities in exposure to gun violence, suggesting that gun violence may heighten health disparities and drawing attention to the importance of providing mental health resources in communities that are most affected by gun violence.
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Affiliation(s)
- Christine Leibbrand
- Center for Studies in Demography and Ecology, University of Washington, 218 Raitt Hall, Seattle, WA, 98195, USA.
| | - Frederick Rivara
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
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Price JH, Khubchandani J. Firearm Suicides in the Elderly: A Narrative Review and Call for Action. J Community Health 2021; 46:1050-1058. [PMID: 33547617 PMCID: PMC7864138 DOI: 10.1007/s10900-021-00964-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 01/07/2023]
Abstract
Firearm suicides are one of the leading causes of death for older Americans. The purpose of this review is to explore the risk factors associated with suicides in the elderly, provide an overview of the epidemiology of firearm-related suicides in older Americans, and explore methods of preventing firearm suicides in the elderly. The vast majority (70 %) of elderly suicides in the U.S were committed using a firearm. Elderly firearm suicides have increased by 49 % between 2010 and 2018, disproportionately affecting white males. Yearly firearm suicides in the elderly ranged from 4,276 in 2010 to 6,375 in 2018. In 2018, the rate of elderly male firearm suicides was 24.96/100,000 compared to a rate of 1.92/100,000 for elderly females, a rate ratio of 13 to 1 for males compared to females. The primary risk factors for elderly firearm suicides seem to be physical illnesses, mental illnesses, and social factors. Older Americans engage in suicidal behaviors with greater planning and lethality of intent than do young adults. Of all the strategies to prevent suicides with firearms, the most efficacious measures based on current research seem to be state firearm legislation and improving mental healthcare, but these effects are not specific to the elderly. Strengthening state firearm laws and improving mental healthcare for the elderly may have promise in preventing elderly firearm-related suicides. Additional implications for practice and research are discussed in this review.
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Affiliation(s)
- James H Price
- School of Population Health, University of Toledo, 43606, OH, Toledo, USA.
| | - Jagdish Khubchandani
- Department of Public Health Sciences, New Mexico State University, NM, 88003, Las Cruces, USA
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Janeway MG, Zhao X, Rosenthaler M, Zuo Y, Balasubramaniyan K, Poulson M, Neufeld M, Siracuse JJ, Takahashi CE, Allee L, Dechert T, Burke PA, Li F, Kalesan B. Clinical diagnostic phenotypes in hospitalizations due to self-inflicted firearm injury. J Affect Disord 2021; 278:172-180. [PMID: 32961413 DOI: 10.1016/j.jad.2020.09.067] [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: 12/15/2019] [Revised: 07/07/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND . Hospitalized self-inflicted firearm injuries have not been extensively studied, particularly regarding clinical diagnoses at the index admission. The objective of this study was to discover the diagnostic phenotypes (DPs) or clusters of hospitalized self-inflicted firearm injuries. METHODS . Using Nationwide Inpatient Sample data in the US from 1993 to 2014, we used International Classification of Diseases, Ninth Revision codes to identify self-inflicted firearm injuries among those ≥18 years of age. The 25 most frequent diagnostic codes were used to compute a dissimilarity matrix and the optimal number of clusters. We used hierarchical clustering to identify the main DPs. RESULTS . The overall cohort included 14072 hospitalizations, with self-inflicted firearm injuries occurring mainly in those between 16 to 45 years of age, black, with co-occurring tobacco and alcohol use, and mental illness. Out of the three identified DPs, DP1 was the largest (n=10,110), and included most common diagnoses similar to overall cohort, including major depressive disorders (27.7%), hypertension (16.8%), acute post hemorrhagic anemia (16.7%), tobacco (15.7%) and alcohol use (12.6%). DP2 (n=3,725) was not characterized by any of the top 25 ICD-9 diagnoses codes, and included children and peripartum women. DP3, the smallest phenotype (n=237), had high prevalence of depression similar to DP1, and defined by fewer fatal injuries of chest and abdomen. LIMITATIONS . Claims data. CONCLUSIONS . There were three distinct diagnostic phenotypes in hospitalizations due to self-inflicted firearm injuries. Further research is needed to determine how DPs can be used to tailor clinical care and prevention efforts.
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Affiliation(s)
- Megan G Janeway
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Xiang Zhao
- Department of Medicine and Mathematics and Statistics, Boston University School of Medicine and Graduate School of Arts and Sciences, Boston, MA, USA
| | - Max Rosenthaler
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Yi Zuo
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Michael Poulson
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Miriam Neufeld
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Jeffrey J Siracuse
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | | | - Lisa Allee
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Tracey Dechert
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Peter A Burke
- Department of Surgery, Boston University Medical Center, Boston, MA, USA
| | - Feng Li
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Bindu Kalesan
- Department of Medicine and Community Health Sciences, Boston University, 72 E Concord St L-516, Boston, MA 02118, USA.
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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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Raifman J, Larson E, Barry CL, Siegel M, Ulrich M, Knopov A, Galea S. State handgun purchase age minimums in the US and adolescent suicide rates: regression discontinuity and difference-in-differences analyses. BMJ 2020; 370:m2436. [PMID: 32699008 PMCID: PMC7374798 DOI: 10.1136/bmj.m2436] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the association between US state policies that establish age 18 or 21 years as the minimum purchaser age for the sale of handguns and adolescent suicide rate. DESIGN Regression discontinuity and difference-in-differences analyses. SETTING 46 US states without policy changes between 2001 and 2017; Missouri and South Carolina, which lowered the age for handgun sales in 2007 and 2008, respectively; and West Virginia and Wyoming, which increased the age for handgun sales in 2010. PARTICIPANTS Adolescents aged 13 to 20 years(554 461 961 from 2001 to 2017) in the regression discontinuity analysis, and adolescents aged 18 to 20 years (168 934 041 from 2002 to 2014) in the main difference-in-differences analysis. MAIN OUTCOME MEASURE Suicide rate per 100 000 adolescents. RESULTS In the regression discontinuity analysis, state policies that limited the sale of handguns to those aged 18 or older (relative to 21 or older) were associated with an increase in suicide rate among adolescents aged 18 to 20 years equivalent to 344 additional suicides in each state where they were in place between 2001 and 2017. In the difference-in-differences analysis, state policies that limited the sale of handguns to those aged 21 or older were associated with 1.91 fewer suicides per 100 000 adolescents aged 18 to 20 years (95% confidence interval -3.13 to -0.70, permutation adjusted P=0.025). In the difference-in-differences analysis, there were 1.83 fewer firearm related suicides per 100 000 adolescents (-2.66 to -1.00, permutation adjusted P=0.002), with no association between age 21 handgun sales policies and non-firearm related suicides. Separate event study estimates indicated increases in suicide rates in states that lowered the age of handgun sales, with no association in states that increased the age of handgun sales. CONCLUSIONS A clear discontinuity was shown in the suicide rate by age at age 18 in states that limited the sale of handguns to individuals aged 18 or older. State policies to limit the sale of handguns to individuals aged 21 or older were associated with a reduction in suicide rates among adolescents. Increases in suicide rates were observed after states lowered the age of handgun sales, but no effect was found in states that increased the age of handgun sales.
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Affiliation(s)
- Julia Raifman
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA 02118, USA
| | - Elysia Larson
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Colleen L Barry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Siegel
- Boston University School of Public Health, Boston, MA, USA
| | - Michael Ulrich
- Boston University School of Public Health, Boston, MA, USA
| | - Anita Knopov
- Brown University Department of Emergency Medicine, Providence, RI, USA
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
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Studdert DM, Zhang Y, Swanson SA, Prince L, Rodden JA, Holsinger EE, Spittal MJ, Wintemute GJ, Miller M. Handgun Ownership and Suicide in California. N Engl J Med 2020; 382:2220-2229. [PMID: 32492303 DOI: 10.1056/nejmsa1916744] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Research has consistently identified firearm availability as a risk factor for suicide. However, existing studies are relatively small in scale, estimates vary widely, and no study appears to have tracked risks from commencement of firearm ownership. METHODS We identified handgun acquisitions and deaths in a cohort of 26.3 million male and female residents of California, 21 years old or older, who had not previously acquired handguns. Cohort members were followed for up to 12 years 2 months (from October 18, 2004, to December 31, 2016). We used survival analysis to estimate the relationship between handgun ownership and both all-cause mortality and suicide (by firearm and by other methods) among men and women. The analysis allowed the baseline hazard to vary according to neighborhood and was adjusted for age, race and ethnic group, and ownership of long guns (i.e., rifles or shotguns). RESULTS A total of 676,425 cohort members acquired one or more handguns, and 1,457,981 died; 17,894 died by suicide, of which 6691 were suicides by firearm. Rates of suicide by any method were higher among handgun owners, with an adjusted hazard ratio of 3.34 for all male owners as compared with male nonowners (95% confidence interval [CI], 3.13 to 3.56) and 7.16 for female owners as compared with female nonowners (95% CI, 6.22 to 8.24). These rates were driven by much higher rates of suicide by firearm among both male and female handgun owners, with a hazard ratio of 7.82 for men (95% CI, 7.26 to 8.43) and 35.15 for women (95% CI, 29.56 to 41.79). Handgun owners did not have higher rates of suicide by other methods or higher all-cause mortality. The risk of suicide by firearm among handgun owners peaked immediately after the first acquisition, but 52% of all suicides by firearm among handgun owners occurred more than 1 year after acquisition. CONCLUSIONS Handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm. (Funded by the Fund for a Safer Future and others.).
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Affiliation(s)
- David M Studdert
- From the Stanford Law School (D.M.S.), School of Medicine (D.M.S, Y.Z., L.P., E.E.H.), and Department of Political Science (J.A.R.), Stanford University, Stanford, and the School of Medicine, University of California at Davis, Sacramento (G.J.W.) - all in California; the Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (S.A.S.); the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (M.J.S.); and the Bouvé College of Health Sciences, Northeastern University, Boston (M.M.)
| | - Yifan Zhang
- From the Stanford Law School (D.M.S.), School of Medicine (D.M.S, Y.Z., L.P., E.E.H.), and Department of Political Science (J.A.R.), Stanford University, Stanford, and the School of Medicine, University of California at Davis, Sacramento (G.J.W.) - all in California; the Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (S.A.S.); the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (M.J.S.); and the Bouvé College of Health Sciences, Northeastern University, Boston (M.M.)
| | - Sonja A Swanson
- From the Stanford Law School (D.M.S.), School of Medicine (D.M.S, Y.Z., L.P., E.E.H.), and Department of Political Science (J.A.R.), Stanford University, Stanford, and the School of Medicine, University of California at Davis, Sacramento (G.J.W.) - all in California; the Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (S.A.S.); the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (M.J.S.); and the Bouvé College of Health Sciences, Northeastern University, Boston (M.M.)
| | - Lea Prince
- From the Stanford Law School (D.M.S.), School of Medicine (D.M.S, Y.Z., L.P., E.E.H.), and Department of Political Science (J.A.R.), Stanford University, Stanford, and the School of Medicine, University of California at Davis, Sacramento (G.J.W.) - all in California; the Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (S.A.S.); the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (M.J.S.); and the Bouvé College of Health Sciences, Northeastern University, Boston (M.M.)
| | - Jonathan A Rodden
- From the Stanford Law School (D.M.S.), School of Medicine (D.M.S, Y.Z., L.P., E.E.H.), and Department of Political Science (J.A.R.), Stanford University, Stanford, and the School of Medicine, University of California at Davis, Sacramento (G.J.W.) - all in California; the Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (S.A.S.); the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (M.J.S.); and the Bouvé College of Health Sciences, Northeastern University, Boston (M.M.)
| | - Erin E Holsinger
- From the Stanford Law School (D.M.S.), School of Medicine (D.M.S, Y.Z., L.P., E.E.H.), and Department of Political Science (J.A.R.), Stanford University, Stanford, and the School of Medicine, University of California at Davis, Sacramento (G.J.W.) - all in California; the Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (S.A.S.); the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (M.J.S.); and the Bouvé College of Health Sciences, Northeastern University, Boston (M.M.)
| | - Matthew J Spittal
- From the Stanford Law School (D.M.S.), School of Medicine (D.M.S, Y.Z., L.P., E.E.H.), and Department of Political Science (J.A.R.), Stanford University, Stanford, and the School of Medicine, University of California at Davis, Sacramento (G.J.W.) - all in California; the Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (S.A.S.); the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (M.J.S.); and the Bouvé College of Health Sciences, Northeastern University, Boston (M.M.)
| | - Garen J Wintemute
- From the Stanford Law School (D.M.S.), School of Medicine (D.M.S, Y.Z., L.P., E.E.H.), and Department of Political Science (J.A.R.), Stanford University, Stanford, and the School of Medicine, University of California at Davis, Sacramento (G.J.W.) - all in California; the Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (S.A.S.); the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (M.J.S.); and the Bouvé College of Health Sciences, Northeastern University, Boston (M.M.)
| | - Matthew Miller
- From the Stanford Law School (D.M.S.), School of Medicine (D.M.S, Y.Z., L.P., E.E.H.), and Department of Political Science (J.A.R.), Stanford University, Stanford, and the School of Medicine, University of California at Davis, Sacramento (G.J.W.) - all in California; the Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (S.A.S.); the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (M.J.S.); and the Bouvé College of Health Sciences, Northeastern University, Boston (M.M.)
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Ammerman BA, Reger MA. Evaluation of Prevention Efforts and Risk Factors Among Veteran Suicide Decedents Who Died by Firearm. Suicide Life Threat Behav 2020; 50:679-687. [PMID: 32017233 DOI: 10.1111/sltb.12618] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Veterans die by suicide at a higher rate than the U.S. population, and veterans more frequently use a firearm as the suicide method. Consequently, firearm accessibility and storage represent important prevention considerations. This project aimed to explore the implementation of suicide prevention efforts among veterans who went on to die by suicide, with and without the use of a firearm, and to identify factors that differentiated veteran suicide decedents to help inform suicide prevention efforts. METHODS Data from the Veteran Health Administration Behavior Health Autopsy Program was analyzed for 97 veteran suicide decedents. RESULTS Results demonstrated that veterans who used a firearm for suicide were less likely to have engaged in suicide prevention efforts overall and were less likely to have received lethal means safety counseling / safety planning. Veterans who died by firearm had lower levels of notable risk factors (e.g., prior suicide attempt, no-shows for appointments), however were more likely to have a documented unsecured firearm in their home. CONCLUSION These findings support the benefit of broadening the reach of suicide prevention efforts, especially for high-risk veterans with access to firearms.
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Affiliation(s)
| | - Mark A Reger
- VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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50
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Goldstein EV, Prater LC, Bose-Brill S, Wickizer TM. The Firearm Suicide Crisis: Physicians Can Make a Difference. Ann Fam Med 2020; 18:265-268. [PMID: 32393564 PMCID: PMC7213998 DOI: 10.1370/afm.2522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/01/2019] [Accepted: 10/14/2019] [Indexed: 11/09/2022] Open
Abstract
Firearm suicide receives relatively little public attention in the United States, however, the United States is in the midst of a firearm suicide crisis. Most suicides are completed using a firearm. The age-adjusted firearm suicide rate increased 22.6% from 2005 to 2017, and globally the US firearm suicide rate is 8 times higher than the average firearm suicide rate of 22 other developed countries. The debate over how to solve the firearm suicide epidemic tends to focus on reducing the firearm supply or increasing access to behavioral health treatment. Ineffectual federal firearm control policies and inadequate behavioral health treatment access has heightened the need for primary care physicians to play a more meaningful role in firearm suicide prevention. We offer suggestions for how individual physicians and the collective medical community can take action to reduce mortality arising from firearm suicide and firearm deaths.
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Affiliation(s)
- Evan V Goldstein
- Division of Health Services Management & Policy, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Laura C Prater
- Division of General Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Seuli Bose-Brill
- Division of General Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Thomas M Wickizer
- Division of Health Services Management & Policy, College of Public Health, The Ohio State University, Columbus, Ohio
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