Firearm Suicide Rates Research Articles

Examining the policy effects of Arizona’s 2016 pre-emption law on firearm suicide rates in the greater Tucson area: an observational study

ObjectiveIn 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...

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

Comparing and Contrasting Rates of Firearm Homicides and Suicides

Comparing and Contrasting Rates of Firearm Homicides and Suicides

Employing a Repeated Time Series Design to Evaluate Waiting Periods on Firearm Homicide and Suicide Rates

Employing a Repeated Time Series Design to Evaluate Waiting Periods on Firearm Homicide and Suicide Rates

Youth Gun and Weapon Carrying and Suicide Rates for Those Aged 24 Years and Younger, 2005–2017

PurposeGun access among youth may contribute to youth suicide deaths by increasing practical capability. The present work examines the association between youth gun and weapon carrying behavior and suicide rates among those aged 24 years and younger. MethodsUsing the 2005–2017 Youth Risk Behavior Surveillance System, the associations over time between youth gun and weapon carrying and youth suicide rates were examined. A series of generalized estimating equations were used to examine population-level associations between states and across time. ResultsAs anticipated youth gun carrying behavior was a significant contributor to the prediction of firearm suicide rates for those aged 24 years and younger, with higher rates of youth gun carrying associated with higher suicide rates. Youth gun carrying was not a significant predictor of overall suicide rates for those aged 24 years and younger. Youth weapon carrying (which includes guns, knives, and other weapons) was a significant predictor of both firearm-specific and overall suicide rates for those aged 24 years and younger. ConclusionsPrevious research has linked youth gun carrying behavior to past year suicide attempts. This study represents the first attempt at examining the associations between youth gun carrying behavior and suicide mortality among the young. In line with our expectations, states with higher percentages of youth reporting gun and weapon carrying behavior had greater rates of suicide among the young (those aged 24 years and younger). The present work points toward the importance of limiting youth access to firearms in reducing suicide mortality.

3.3 ONE EXAMPLE STATE: THE IMPACT OF MISSOURI’S FIREARM LAW CHANGES ON RATES OF YOUTH SUICIDE BY FIREARMS

Attendees will be able to: 1) describe a timeline of Missouri’s firearm laws; 2) discuss the impact of Missouri’s firearm law changes on adolescent and young adult suicide rates; and 3) understand the synthetic control method that is used to assess the impact of policies on public health outcomes. The presenter will: 1) describe the timeline of Missouri’s firearm laws from 1999 to 2018; 2) review the literature on impacts of Missouri’s permit-to-purchase (PTP) law and concealed carry law change on suicide rates; and 3) discuss results of her cross-sectional study assessing the impact of Missouri’s firearm law changes on adolescent and young adult suicide rates. In 2007, Missouri repealed its permit to purchase law, which removed an additional background check for prohibited persons to obtain firearms. Missouri lowered the legal age to obtain a concealed carry permit from 23 to 21 years in 2011 and further lowered the age to 19 years old in 2014. In 2017, Missouri enacted a law allowing gun owners to carry concealed firearms in most public places without a permit. Repeal of Missouri’s permit to purchase law was associated with a 21.8% increase in firearm suicide rates in young adults in Missouri. Lowering the minimum age of concealed carry to 19 years in Missouri was associated with a 32% increase in firearm suicide rates and a 29.7% increase in nonfirearm suicide rates in adolescents aged 14-18 years and a 7.2% increase in firearm suicide rates in young adults aged 19-24 years. Increases in rates of suicide by firearms in adolescents and young adults were seen following the repeal of Missouri’s PTP law and the lowering of the minimum age for concealed carry in 2014. Changes in Missouri’s firearm policies are likely an important contributor to rates of suicide by firearm in young Missouri residents. Missouri is one important example of how sequential weakening of firearm laws can impact statewide adolescent and young adult suicide rates.

Suicide, firearms, and legislation: A review of the Canadian evidence

Suicide accounts for approximately 4000 deaths a year in Canada, of which about 16% of those are suicide using a firearm. Canada has undertaken legislative efforts to regulate and control firearms, Bill C-51 in 1977 and Bills C-17 and C-68 in 1991 and 1995. Regulatory approaches that decrease the availability of firearms are hypothesized to reduce suicide by firearm however the substitution effect suggests it is possible that people may substitute other methods of suicide in place. Canadian studies on associations between legislation, regulation, and suicide rates have been published over the last three decades, and a search revealed thirteen that met the criteria. Seven studies examined the association between Bill C-51 and suicide rates and found that while rates of suicide by firearm appeared to have declined in association with regulations, there appears to be a substitution effect into other methods and no overall change in suicide rates. Six studies examining the effects of Bill C-17 and C-68 revealed a decrease in the rates of suicide by firearms, with a corresponding increase in non-firearms suicide rates and no decrease in overall suicide rates. One study even suggested no associated decrease in firearm suicide rates with an increasing rate of suicide by hanging possibly due to changes in preferences. These results suggest legislation has mixed effects on firearm suicide rates and may not alone reduce overall suicide in Canada.

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

In the U.S., state-level household firearm ownership is strongly associated with firearm suicide mortality rates. Whether the recent increases in firearm suicide are explained by state-level household firearm ownership rates and trends remains unknown. Mortality data from the U.S. National Vital Statistics System and an estimate of state-level household firearm ownership rate were used to conduct hierarchical age-period-cohort (random-effects) modeling of firearm suicide mortality between 2001 and 2016. Models were adjusted for individual-level race and sex and for state-level poverty rate, unemployment rate, median household income in U.S. dollars, population density, and elevation. Between 2001 and 2016, the crude national firearm suicide mortality rate increased from 6.8 to 8.0 per 100,000, and household firearm ownership rate remained relatively stable, at around 40%. Both variables were markedly heterogeneous and correlated at the state level. Age-period-cohort models revealed period effects (affecting people across ages) and cohort effects (affecting specific birth cohorts) underlying the recent increases in firearm suicide. Individuals born after 2000 had higher firearm suicide rates than most cohorts born before. A 2001-2006 decreasing period effect was followed, after 2009, by an increasing period effect that peaked in 2015. State-level household firearm ownership rates and trends did not explain cohort effects and only minimally explained period effects. State-level firearm ownership rates largely explain the state-level differences in firearm suicide but only marginally explain recent increases in firearm suicide. Although firearms in the home increase firearm suicide risk, the recent national rise in firearm suicide might be the result of broader, more distal causes of suicide risk.

Preventing Adolescent and Young Adult Suicide: Do States With Greater Mental Health Treatment Capacity Have Lower Suicide Rates?

PurposeYouth suicide is increasing at a significant rate and is the second leading cause of death for adolescents. There is an urgent public health need to address the youth suicide. The objective of this study is to determine whether adolescents and young adults residing in states with greater mental health treatment capacity exhibited lower suicide rates than states with less treatment capacity. MethodsWe conducted a state-level analysis of mental health treatment capacity and suicide outcomes for adolescents and young adults aged 10–24 spanning 2002–2017 using data from Centers for Disease Control and Prevention, U.S. Bureau of Labor Statistics, Federal Bureau of Investigation, and other sources. Multivariable linear fixed-effects regression models tested the relationships among mental health treatment capacity and the total suicide, firearm suicide, and nonfirearm suicide rates per 100,000 persons aged 10–24. ResultsWe found a statistically significant inverse relationship between nonfirearm suicide and mental health treatment capacity (p = .015). On average, a 10% increase in a state’s mental health workforce capacity was associated with a 1.35% relative reduction in the nonfirearm suicide rate for persons aged 10–24. There was no significant relationship between mental health treatment capacity and firearm suicide. ConclusionsGreater mental health treatment appears to have a protective effect of modest magnitude against nonfirearm suicide among adolescents and young adults. Our findings underscore the importance of state-level efforts to improve mental health interventions and promote mental health awareness. However, firearm regulations may provide greater protective effects against this most lethal method of firearm suicide.

The Impact of Firearm Legislation on Firearm Deaths, 1991-2017.

Firearm violence is a major public health concern in the USA with firearm suicide and homicide accounting for the majority of gun deaths. The present work seeks to explore the role of firearm legislation in reducing suicide and homicide rates. Using the State Firearm Law Database (www.statefirearmlaws.org), suicide and homicide rates were compared across the 50US states from 1991 to 2017. A firearm regulations index was computed to represent the total number of state firearm laws. Generalized estimating equations were used to explore population-level increases or decreases in firearm regulations and their association with state suicide and homicide rates after controlling for several state-level covariates. Even after accounting for several key covariates (US region; time; gun ownership; percent of the state population that was White, Black, below the poverty line and 25years or older with a bachelor's degree; incarceration rate, unemployment rate and divorce rate), we found that firearm laws significantly predicted state firearm suicide and homicide rates. States with greater numbers of laws had reduced suicide and homicide rates compared with those with fewer laws. The present findings point to the role of firearm legislation in curbing rates of gun violence across the USA.

Annual Research Review: Youth firearm violence disparities in the United States and implications for prevention.

Research has identified the United States (U.S.) as a global outlier in its firearm ownership rates, with a correspondingly higher risk of youth firearm violence compared to other countries. The relative extent of disparities in youth firearm violence within the U.S. has been less clear. Little is known about factors in the social ecology driving these disparities and whether current firearm violence prevention approaches sufficiently address them. Applying a health disparities framework, we synthesized epidemiological, sociological, and prevention science literatures, emphasizing structural inequalities in youth sociocultural positionality in life course developmental context. We also highlighted findings from national injury data and other studies regarding the magnitude and impacts of youth firearm violence disparities. The burden of firearm violence varied markedly at intersections of gender, race, place, developmental stage, and homicidal or suicidal intent. Firearm homicide among Black boys and young men (ages 15-24) was at outlier levels - many times greater than the rates of any other demographic group, developmental stage, or violence intent, particularly in urban settings. Recent research has operationalized structural racism and implicated historically racialized spaces as a root cause of this disparity. In contrast, elevated firearm suicide rates were found among Native and White boys and young men in rural settings; firearm-related cultural attitudes and gender socialization were points of consideration to explain these disparities. We highlighted research-based youth firearm violence preventive interventions, and emphasized gaps in efforts focused on structural and sociocultural factors. More explicit attention to reducing firearm homicide among Black boys and young men and firearm suicide among Native and rural White boys and young men is urgently needed and has potential to substantially lower overall rates of firearm violence in the U.S.

Association of state-level intoxicated driving laws with firearm homicide and suicide

ObjectivesTo determine if an association exists between the number of driving under the influence (DUI) convictions required to activate federal firearms prohibitions and annual firearm homicide and suicide rates by...

Time-series analyses of firearm-related Google searches and U.S. suicide rates 2004-2016.

The U.S. suicide rate has increased 35% since 1999. The role of the Internet has not been thoroughly investigated despite Internet use more than doubling from 1999 to present. The majority of U.S. suicide deaths are by firearm; however, there is no examination of the association between trends in firearm Internet searches and overall and firearm monthly suicide rates. We hypothesized that search strings related to firearm suicide would be significantly associated with monthly suicide rates (both all methods and firearm). Google Trends provides data on request frequencies of searches. Twenty-four search strings were examined representing possible searches by individuals considering firearm suicide and compared to U.S. suicide rates with time-series modeling. In the time series with higher search volumes, consistent associations were found of negative cross-correlation at lag +1. Several searches appeared at least sensitive enough to consistently show associations with overall and firearm suicide rates in the following month. This novel finding should be followed up as the potential exists to predict suicide trends.

Association of Changes in Missouri Firearm Laws With Adolescent and Young Adult Suicides by Firearms

Suicide by firearm is a major cause of mortality in young Missouri residents. Changes in statewide firearm policy may have contributed to changes in suicide rates. To evaluate if changes in Missouri permit-to-purchase (PTP) and concealed carry firearm laws were associated with changes in rates of suicide by firearms in young Missouri residents. This cross-sectional study examined rates of suicide by firearm in Missouri among adolescents (ages 14-18 years) and young adults (ages 19-24 years) from January 1999 to December 2018, following changes to state PTP and concealed carry law, in comparison with a donor state pool with existing firearm laws (13 states in PTP pool; 42 states in concealed carry pool) that did not make changes during this period. This study used a quasiexperimental, synthetic control design at the state level that defined Missouri as the treated state and treatment as changes in firearm laws. Legislative changes to Missouri's PTP and concealed carry firearm laws. Age-adjusted annual rates of firearm-related suicide mortality per 100 000 people for adolescents (aged 14-18 years) and young adults (aged 19-24 years). Repeal of the PTP law was associated with a 21.8% increase in firearm suicide rates in young adults aged 19 to 24 years in Missouri. Lowering the minimum age of concealed carry to 19 years in Missouri was associated with a 32.0% increase in firearm suicide rates and a 29.7% increase in nonfirearm suicide rates in adolescents aged 14 to 18 years, and a 7.2% increase in firearm suicide rates in young adults aged 19 to 24 years. Increases in rates of suicide by firearms in adolescents and young adults were seen following repeal of Missouri's PTP law and lowering of the minimum age for concealed carry in 2014. Changes in Missouri's firearm policies may be an important contributor to rates of suicide by firearm in young Missouri residents.

291 Firearm Presence and Storage in Rural Youth Homes

The firearm suicide rate in children/teens has increased 65% in the past decade. Over 80% of youth firearm suicides involve a gun belonging to a family member. Safe firearm storage can be a major factor in preventing these tragedies. The objective of this study was to determine firearm exposure and storage practices in the homes of rural youth. Attendees of the 2019 Iowa Future Farmers of America (FFA) Leadership Conference were surveyed at the University of Iowa Stead Family Children’s Hospital safety booth. Data was collected regarding the presence of firearms in the home, and their storage. Demographic data obtained included age, sex, race, and where the FFA member lived. Descriptive and comparative analyses were performed. A total of 1,382 FFA members 13-18 years old completed the survey. Just over half (53%) lived on a farm, nearly two-fifths (18%) lived in the country, but not on a farm, and 29% lived in town. Over four-fifths (84%) of FFA members were aware of having at least one rifle/shotgun in their home, while nearly three-fifths (58%) had at least one handgun. Over one-half (56%) had both rifles/shotguns and handguns at their homes. The proportion of homes with firearms varied significantly by where FFA members lived (p<0.001): farm (91%) > country/not farm (86%) > town (70%) for rifles/shotguns; and farm (63%) > country/not farm (57%) > town (50%) for handguns. Caucasians had higher proportions with rifles/shotguns in the home (95%) than those of other races (66%, p<0.001). Of those with rifles/shotguns in their home, over half (51%) stated the they were stored unlocked, 29% stated they were stored loaded, and 17% stated they were stored both unlocked and loaded at least some of the time. For those who reported there were rifles/shotguns unlocked at least part of the time in their home (51%), almost one-half (46%) also had ammunition that was stored unlocked. Higher proportions living on a farm > country/not farm > town reported having rifles/shotguns not properly stored (p=0.019). Of those with handguns in their home, over two-fifths (43%) stated they were stored unlocked, two-fifths (40%) said they were stored loaded, and about a quarter (24%) reported they were stored both unlocked and loaded at least some of the time. For those who reported there were handguns unlocked at least part of the time in their home (43%), 38% also had ammunition that was stored unlocked. Of those who were aware of how both rifles/shotguns and handguns were stored in the home, 82% reported that they had at least one firearm stored either unlocked or loaded at least some of the time. The vast majority of Iowa FFA members have firearms in their home and a large proportion of them are not stored safely. This puts these adolescents at increased risk for firearm-related suicide. Widespread efforts are needed to educate rural families regarding the importance of proper storage of firearms and ammunition.

Firearm suicide mortality among emergency department patients with physical health problems

PurposeIndividuals with poor physical and mental health may face elevated risk for suicide, particularly suicide by firearm. MethodsThis retrospective cohort study used statewide, longitudinally linked emergency department (ED) patient record and mortality data to examine 12-month incidence of firearm suicide among ED patients presenting with a range of physical health problems. Participants included all residents presenting to a California ED in 2009–2013 with nonfatal visits for somatic diagnoses hypothesized to increase suicide risk, including myocardial infarction, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes, cancer, back pain, headache, joint disorder, and injuries. For each patient diagnostic group, we calculated rates of firearm suicide per 100,000 person-years and standardized mortality ratios (SMRs) relative to the demographically matched California population. ResultsFirearm suicide rates per 100,000 person-years ranged from 9.6 (among patients presenting with unintentional injury) to 55.1 (patients with cancer diagnoses), with SMRs from 1.48 to 7.45 (all p < 0.05). SMRs for patients with cardiovascular conditions ranged from 2.45 to 5.10. Men and older individuals had higher firearm suicide rates, and there was substantial between-group variability in the proportion of suicide decedents who used a firearm. ConclusionsED patients presenting with deliberate self-harm injuries, substance use, and cancer were especially at risk for firearm suicide. To avoid missed suicide prevention opportunities, EDs should implement evidence-based suicide interventions as a best practice for their patients.

Investigating the association between household firearm ownership and suicide rates in the United States using spatial regression models

Past studies have rather consistently shown a significant positive association between firearm ownership and suicide rates (particularly firearm-related) in the United States. However, the impact of spatial dependence of suicide rates has not been considered in the existing research that took an ecological studies approach. To bridge this gap in the literature, we estimated and compared the association using Ordinary Least Square (OLS), spatial autoregressive (SAR), and hierarchical spatial autoregressive (HSAR) regression models. The outcome variable was the average age-adjusted and smoothed suicide rate (all, firearm, and non-firearm) at the county level in the United States between 2008 and 2014. The covariates included the state-level firearm ownership and several key demographic, geographic, religious, psychopathological, and suicide-related variables at both the state and county levels. Our main findings were: 1) the spatially-informed models (SAR and HSAR) were significantly outperformed the OLS model. The SARlag model was a better choice than the SARerr model in fitting our data. However, the HSAR model was not statistically better than the SAR model; 2) based on the results from the three final SARlag models, firearm ownership was significantly associated with firearm suicide rates, but not with all or non-firearm suicide rates, and such relationships were also observed in the SARlag models using contiguity-based spatial weight matrix; and 3) The final SARlag models explained 82.6%, 84.9%, and 76.1% of the total variance in all, firearm, and non-firearm suicide rates, respectively. In conclusion, the SARlag model provided more robust evidence supporting the positive relationship between firearm suicide rate and firearm ownership. Results from this study confirmed that access to household firearms was a significant risk factor of firearm suicide in the United States and hence means reduction should be included in the suicide prevention strategy in the United States. In the future, the effect of state firearm laws and regulations on suicide rate should also be investigated using spatially informed models to gain insights on the connection among firearm ownership, firearm laws and regulations, and population-based suicide rates.

Purchaser Licensing, Point-of-Sale Background Check Laws, and Firearm Homicide and Suicide in 4 US States, 1985-2017.

Objectives. To estimate and compare the effects of state background check policies on firearm-related mortality in 4 US states.Methods. Annual data from 1985 to 2017 were used to examine Maryland and Pennsylvania, which implemented point-of-sale comprehensive background check (CBC) laws for handgun purchasers; Connecticut, which adopted a handgun purchaser licensing law; and Missouri, which repealed a similar law. Using synthetic control methods, we estimated the effects of these laws on homicide and suicide rates stratified by firearm involvement.Results. There was no consistent relationship between CBC laws and mortality rates. There were estimated decreases in firearm homicide (27.8%) and firearm suicide (23.2%-40.5%) rates associated with Connecticut's law. There were estimated increases in firearm homicide (47.3%), nonfirearm homicide (18.1%), and firearm suicide (23.5%) rates associated with Missouri's repeal.Conclusions. Purchaser licensing laws coupled with CBC requirements were consistently associated with lower firearm homicide and suicide rates, but CBC laws alone were not.Public Health Implications. Our results contribute to a body of research showing that CBC laws are not associated with reductions in firearm-related deaths unless they are coupled with handgun purchaser licensing laws.

Age, period and cohort effects in firearm homicide and suicide in the USA, 1983–2017

BackgroundRates of firearm homicide and suicide have varied over time. These variations are due to a number of factors including temporal trends, age, birth year and gender. We sought to...

Intersections of Firearm Suicide, Drug-Related Mortality, and Economic Dependency in Rural America

BackgroundRural counties in the United States have higher firearm suicide rates and opioid overdoses than urban counties. We sought to determine whether rural counties can be grouped based on these “diseases of despair.” MethodsAge-adjusted firearm suicide death rates per 100,000; drug-related death rates per 100,000; homicide rate per 100,000, opioid prescribing rate, %black, %Native American, and %veteran population, median home price, violent crime rates per 100,000, primary economic dependency (nonspecialized, farming, mining, manufacturing, government, and recreation), and economic variables (low education, low employment, retirement destination, persistent poverty, and persistent child poverty) were obtained for all rural counties and evaluated with hierarchical clustering using complete linkage. ResultsWe identified five distinct rural county clusters. The firearm suicide rates in the clusters were 5.9, 6.8, 6.4, 8.5, and 3.8 per 100,000, respectively. The counties in cluster 1 were poor, mining dependent, with population loss, cluster 2 were nonspecialized economies, with high opioid prescription rates, cluster 3 were manufacturing and government economies with moderate unemployment, cluster 4 were recreational economies with substantial veterans and Native American populations, high median home price, drug death rates, opioid prescribing, and violent crime, and cluster 5 were farming economies, with high population loss, low median home price, low rates of drug mortality, opioid prescribing, and violent crime. Cluster 4 counties were spatially adjacent to urban counties. ConclusionsMore than 300 counties currently face a disproportionate burden of diseases of despair. Interventions to reduce firearm suicides should be community-based and include programs to reduce other diseases of despair.