The Association of Firearm Suicide With Mental Illness, Substance Use Conditions, and Previous Suicide Attempts.

Abstract

Letters15 August 2017The Association of Firearm Suicide With Mental Illness, Substance Use Conditions, and Previous Suicide AttemptsFREEJennifer M. Boggs, MSW, Gregory E. Simon, MD, MPH, Brian K. Ahmedani, PhD, Edward Peterson, PhD, Samuel Hubley, PhD, and Arne Beck, PhDJennifer M. Boggs, MSWFrom Kaiser Permanente Colorado—Institute for Health Research, Denver, Colorado; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Henry Ford Health System and Henry Ford Hospital, Detroit, Michigan; and University of Colorado at Denver, Denver, Colorado.Search for more papers by this author, Gregory E. Simon, MD, MPHFrom Kaiser Permanente Colorado—Institute for Health Research, Denver, Colorado; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Henry Ford Health System and Henry Ford Hospital, Detroit, Michigan; and University of Colorado at Denver, Denver, Colorado.Search for more papers by this author, Brian K. Ahmedani, PhDFrom Kaiser Permanente Colorado—Institute for Health Research, Denver, Colorado; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Henry Ford Health System and Henry Ford Hospital, Detroit, Michigan; and University of Colorado at Denver, Denver, Colorado.Search for more papers by this author, Edward Peterson, PhDFrom Kaiser Permanente Colorado—Institute for Health Research, Denver, Colorado; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Henry Ford Health System and Henry Ford Hospital, Detroit, Michigan; and University of Colorado at Denver, Denver, Colorado.Search for more papers by this author, Samuel Hubley, PhDFrom Kaiser Permanente Colorado—Institute for Health Research, Denver, Colorado; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Henry Ford Health System and Henry Ford Hospital, Detroit, Michigan; and University of Colorado at Denver, Denver, Colorado.Search for more papers by this author, and Arne Beck, PhDFrom Kaiser Permanente Colorado—Institute for Health Research, Denver, Colorado; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Henry Ford Health System and Henry Ford Hospital, Detroit, Michigan; and University of Colorado at Denver, Denver, Colorado.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0111 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Firearms account for one half of all suicide deaths in the United States (1), and reducing access to firearms among at-risk patients may reduce suicide mortality (2). Attempts to reduce access to firearms have focused on persons with a mental health condition or a history of suicidal behavior.Objective: To identify the proportion of suicide deaths that could be prevented by limiting firearm access for persons with a mental health condition or a history of suicidal behavior.Methods and Findings: The TUBS (Treatment Utilization Before Suicide) study identified 2674 adults and adolescents in 8 integrated health systems who died by suicide between 2000 and 2013 and were continuously enrolled for at least 10 of the 12 months before death (3). Using medical records and claims information, we identified 1 group who had a history of any mental health or substance use condition diagnosed at any medical or mental health visit in the year preceding death and another who had previous suicide attempts. These groups were not mutually exclusive. Persons who previously attempted suicide overlapped considerably with those who had a mental health condition, because a mental health condition is usually diagnosed in patients who have attempted suicide. Among persons who died by suicide, 54.7% had a mental health or substance use condition and 42.8% of persons with 1 of these conditions used a firearm (Table). In addition, only 10.9% of persons who died by suicide had previously attempted suicide and only 37.5% of these persons used a firearm in their death. In contrast, more persons without a mental health or substance use condition used firearms in their death than did persons with those conditions (671 vs. 627). Also, more persons without a previous suicide attempt used firearms in their death than did those with a previous attempt (1189 vs. 109). In fact, among persons who died by suicide, only 4.1% had previously attempted suicide and used a firearm; 23.5% had a mental health or substance use condition and used a firearm.Table. Suicide Deaths by Firearm in Those With a Mental Health or Substance Use Condition and Those With a Previous Suicide Attempt*Discussion: Our findings show that, even if successful, current efforts to limit firearm access only for persons with a mental health condition (including substance use disorders) or those who previously attempted suicide would prevent few suicide deaths by firearm. We suggest that prevention of firearm suicide should be expanded beyond the current focus on these patients to include other persons at risk for suicide. Suicide prevention resources are available to educate primary care providers about how to identify patients at risk, evaluate firearm access, engage patients in treatment, and transition patients to specialty care (4). Our findings also highlight the importance of expanding attention beyond an exclusive focus on firearms—especially for persons with mental health or substance use conditions—to include other common means of suicide, such as instruments used for suffocation (for example, rope for hanging) and poison (for example, medications, alcohol, and recreational drugs). Suicide prevention resources are also available to educate primary care providers about restricting access to common means of suicide and counseling at-risk patients and their families about how to implement restrictions (5).