Abstract
BackgroundSuicide rates vary more than 3-fold across the fifty states. Previous ecological studies have pointed, separately, to covariation of suicide mortality with rates of a) household firearm ownership, and b) antidepressant prescriptions.MethodsAn ecologic study using panel data from 2001-2005 was used to evaluate the joint and separate association of household firearm ownership and antidepressant prescription rates with the distribution of suicide rates across the United States. Key exposures were household firearm ownership prevalence (using data from the 2004 Behavioral Risk Factor Surveillance System) and antidepressant prescription rates (using data supplied by IMS health). Negative binomial mixed-effect models were used to estimate the association between household firearm ownership prevalence and antidepressant prescriptions rates and state level suicide rates (using data from the National Vital Statistics System), overall and by method of suicide (firearm vs. non-firearm). Sensitivity analyses examined analogous county-level data for those counties for which firearm ownership measures were available. All analyses were adjusted for median income, unemployment rate, and percent of population in urban areas.ResultsIn adjusted analyses, household firearm prevalence is significantly associated with overall suicide rates (adjusted incidence rate ratio (IRRa) = 1.28, 95% confidence interval (CI): 1.18, 1.38) and firearm suicides rates (IRRa = 1.61, CI: 1.45, 1.80), but not with non-firearm suicide rates (IRRa = 1.05, 95% CI: 0.95, 1.16). By contrast, adjusted analyses find no relationship between suicide rates and antidepressant prescription rates. Findings from county-level analyses were consistent with state-level results.ConclusionThe prevalence of household firearm ownership is strongly and significantly associated with overall suicide rates, due to its association with firearm suicide rates. This association is robust to consideration of the role of antidepressant prescription rates. A relationship between antidepressant prescription rates and suicide rates was not observed before or after adjusting for firearm ownership.
Highlights
Suicide rates vary more than 3-fold across the fifty states
On an average day in 2010, the last year for which national data are available, more than 100 Americans died by suicide; half used firearms (Centers for Disease Control and Prevention (CDC))
The tenth leading cause of death among Americans in 2010 (Centers for Disease Control and Prevention (CDC)), occurs at substantially higher rates in rural compared with urban areas, largely due to higher rates of firearm suicide in rural areas (Singh and Siahpush 2002)
Summary
Suicide rates vary more than 3-fold across the fifty states. Previous ecological studies have pointed, separately, to covariation of suicide mortality with rates of a) household firearm ownership, and b) antidepressant prescriptions. As reviewed previously (Miller and Hemenway 1999; Miller et al 2012; Brent 2001) ecologic studies in the U.S have linked variation in suicide rates with the distribution of household firearm ownership. These studies have evaluated variation across states, census divisions, and cities, as well as over time, and have found overall suicide rates and firearm suicide rates are positively associated with firearm ownership prevalence. At least one early US study that found an inverse association between antidepressant prescription rates and overall suicide (Olfson et al 2003) noted that future studies should account for gun ownership if and when such measures became available
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