Suicide Decedents Research Articles

Pain in Prison: A Risk Factor Analysis of 57 Prisoners' Deaths by Suicide in Illinois, United States.

United States prisons have elevated rates of suicide deaths compared to the general population. Thus, this manuscript aims to identify suicide risk factors, using data collected in Illinois (IL) state prisons between 2013-2021. First, we present comprehensive demographic, psychological, and prison-related descriptive statistics regarding 57 suicide decedents. Next, we compared this subset to IL state population-level prison reports to identify suicide-specific risk factors. Suicide decedents were predominately male, White, serving their first sentence, had a psychiatric diagnosis, and had no work assignment. Lethal attempts frequently occurred during evening off-hours, on Wednesdays, and were preceded by "mental health decompensation" and significant life transitions. Suicide-specific risk factors included identifying as White or Asian, having an offense type of habitual criminal or sex offender, being divorced, and not having children. We close with readily implementable suggestions to reduce suicides in prisons such as increasing off-hours and shift change staffing and social support interventions.

Characteristics and Circumstances of Suicide Among Children Aged 6 to 9 Years: 2006-2021.

Limited research exists on suicide among children aged 5 to 9 years. The objective of this study was to examine characteristics of suicide in children younger than 10 years. Data are from the National Fatality Review-Case Reporting System (NFR-CRS) for years 2006 through 2021 for children aged 6 to 9 years who died by suicide. No suicide deaths were reported in NFR-CRS for children aged ≤ 5 years. Descriptive analyses by demographics and circumstances were conducted. A thematic analysis of prevention recommendations made by child death review teams was performed. From 2006 to 2021, NFR-CRS identified 78 suicide decedents aged 6 to 9 years. The largest share were aged 9 years (72%), male (74%), non-Hispanic Black (42%), and died by hanging (86%) at home (91%). School-related problems (39%), history of child maltreatment (36%), history of mental health services (30%), argument with parents (23%), and familial discord (19%) were common circumstances. Key suicide prevention themes included education for caregivers and school staff, improved behavioral health services, and implementation of school policies and programs. Results provide a more complete picture of suicide among younger children, improving understanding of their unique characteristics. It is recommended that program planners consider both age-appropriateness and the impacts of social (eg, racism) and structural inequities in their approaches to prevention, encompassing both community and school-based strategies. For pediatricians, results emphasize the importance of lethal means counseling, safety planning, and educating parents and caregivers on the distinct warning signs of suicide for younger children.

Suicide in young and middle-aged individuals: lessons from a psychosocial autopsy study

Abstract Background Sociodemographic characteristics of suicides are available from Statistics Netherlands. To improve suicide prevention, it is not only necessary to know who dies but also why people die. A psychosocial autopsy was conducted in the Netherlands to investigate differences in psychosocial characteristics and precipitating factors of suicides of young (<30) and middle-aged (40-70) suicide decedents. Methods Data were collected from bereaved individuals. A questionnaire detailed sociodemographic and psychosocial characteristics of the decedents. We reconstructed the suicidal process in the months preceding the suicide in an interview. Findings from the questionnaire and interview were integrated. An independent expert committee formulated recommendations for suicide prevention. Results 162 suicides were investigated. Young decedents showed high levels of substance use and academic pressure. Young adults with developmental disorders were vulnerable in the transition to adulthood. Young males reached out less to support and care. By contrast, suicides of young females were distinguished by comorbidity of psychiatric disorders, frequent suicidal behaviours, high levels of care use, wait lists and a loss of (treatment) perspective, harmful social media use and bullying. Work and financial problems were common in middle-aged decedents. Physical disability and pain were frequently mentioned for middle-aged females. Suicide in middle-aged males was characterized by financial distress, interpersonal conflicts such as divorce, high levels of binge drinking and addiction. Conclusions Our data provide a topology of the needs of individuals at risk for suicide. Suicide prevention strategies can be improved by better transition support and explicit suicide monitoring in young adults with a developmental disorder, active waitlist policies in mental healthcare, and improved collaboration between debt counsellors and mental care professionals based on shared accountability. Key messages • Bereaved individuals elucidated a wide range of psychosocial problems in suicide decedents. • Suicide prevention should adhere to a needs-based approach.

Circumstantial Factors Among Kentucky Nurse Suicide Decedents, 2005 to 2019.

Background: Nurse suicide, a complex occupational health concern, is urgently in need of research due to the personal and occupational suicide risk factors experienced by nurses, namely mental health problems (e.g., depression), job problems, and substance misuse. Therefore, the study aims were to determine the contextual characteristics and circumstantial factors associated with nurse suicide in Kentucky. Methods: Secondary suicide data were obtained from the Kentucky Violent Death Reporting System (KYVDRS) from 2005 to 2019. Nurse suicide cases were identified using the Bureau of Labor Statistics Standard Occupational Classification. A mixed-methods analysis using descriptive statistics and qualitative evaluation was conducted to determine the distributions of demographic, injury, and weapon characteristics, followed by a qualitative analysis of the KYVDRS incident narrative text of nurse suicide decedents. Results: There were 88 decedents identified with a nursing occupation. The predominant means of death for male (59%) and female (45%) nurses involved firearms. Thematic analysis showed nurse decedents experienced a mental health problem (51%) and premeditated (50%) suicide preceding death. Incidentally, 51% of all cases experienced multiple circumstantial factors (e.g., relationship problems and premeditation) preceding their death by suicide. Discussion/Application to Practice: Nurse suicide decedents experienced multifactorial risk factors preceding their death by suicide, namely depression, premeditated suicide, and relationship problems. Occupational health practitioners and health care organizations can implement individual and organizational prevention efforts to help prevent nurse suicide.

Psychosocial and pandemic-related circumstances of suicide deaths in 2020: Evidence from the National Violent Death Reporting System.

To describe and explore variation in 'pandemic-related circumstances' among suicide decedents during the first year of the COVID-19 pandemic. We identified pandemic-related circumstances using decedents' text narratives in the 2020 National Violent Death Reporting System. We use time-series analysis to compare other psychosocial characteristics (e.g., mental health history, interpersonal difficulties, financial strain) of decedents pre-pandemic (2017/2018: n = 56,968 suicide and n = 7,551 undetermined deaths) to those in 2020 (n = 31,887 suicide and n = 4,100 undetermined). We characterize common themes in the narratives with pandemic-related circumstances using topic modeling, and explore variation in topics by age and other psychosocial circumstances. In 2020, n = 2,502 (6.98%) narratives described pandemic-related circumstances. Compared to other deaths in 2020 and to the pre-pandemic period, decedents with pandemic-related circumstances were older and more highly educated. Common themes of pandemic-related circumstances narratives included: concerns about shutdown restrictions, financial losses, and infection risk. Relative to decedents of the same age that did not have pandemic-related circumstances in 2020, those with pandemic-related circumstances were more likely to also have financial (e.g., for 25-44 years, 43% vs. 12%) and mental health (76% vs. 66%) psychosocial circumstances, but had similar or lower prevalence of substance abuse (47% vs. 49%) and interpersonal (40% vs. 42%) circumstances. While descriptive, these findings help contextualize suicide mortality during the acute phase of the COVID-19 pandemic and can inform mental health promotion efforts during similar public health emergencies.

Gun Ownership for Safety/Protection and Unsecure Firearm Storage Practices: Suicide Risk and Prevention among U.S. Army Servicemembers

Introduction: 2021 had the highest number firearm suicide deaths in U.S. history, with veterans representing 62.4% of firearm suicide deaths. The study objective is to understand motivations for firearm ownership, storage practices, history of mental health disorders and suicide risk in servicemembers, as reported by family members. Methods. Data were obtained from a case-control psychological autopsy study of 135 suicide decedents in the U.S. Army compared to a probability sample of 255 living controls, who are also service members weighted to be representative of the Army. Next-of-kin and Army supervisor informants participated in structured interviews and assessed reasons for firearm ownership, and storage practices. The military medical record provided mental health history of suicide decedents. A subsample of 123 personal firearm owners (n = 31 cases and n = 92 living controls) addressed the study objectives. Multivariable logistic regression analyses were constructed to examine predictors of unsecured firearm storage practices. Results: Family members reported safety/protection as the main reason for suicide decedents’ firearm ownership, which was significantly associated with unsecure firearm storage practices (OR = 3.8, 95% CI, 1.65, 8.75, x2 = 9.88, p = 0.0017). Ownership for safety/protection and lifetime history of Generalized Anxiety Disorder (GAD) from the military medical record (OR = 3.65, 95% CI, 1.48 – 9.02, x2 = 7.89 p = 0.0050) predicted unsecure storage. Conclusions: Ownership for safety/protection and the presence of clinically significant anxiety predicted unsecure firearm storage practices. Future research examining motivations for gun ownership for safety/protection, anxiety, and unsecure storage practices may help target interventions to prevent suicide.

Using Natural Language Processing to develop risk-tier specific suicide prediction models for Veterans Affairs patients

Suicide is a leading cause of death. Suicide rates are particularly elevated among Department of Veterans Affairs (VA) patients. While VA has made impactful suicide prevention advances, efforts primarily target high-risk patients with documented suicide risk. This high-risk population accounts for less than 10% of VA patient suicide deaths. We previously evaluated epidemiological patterns among VA patients that had lower classified suicide risk and derived moderate- and low-risk groupings. Expanding upon VA's leading suicide prediction model, this study uses national VA data to refine high-, moderate-, and low-risk specific suicide prediction methods. We selected all VA patients who died by suicide in 2017 or 2018 (n = 4584), matching each case with five controls who remained alive during treatment year and shared suicide risk percentiles. We extracted all sample unstructured electronic health record notes, analyzed them using natural language processing, and applied machine-learning classification algorithms to develop risk-tier-specific predictive models. We calculated area under the curve (AUC) and suicide risk concentration to evaluate predictive accuracy and analyzed derived words. ResultsOur high-risk model (AUC = 0.621 (95% CI: 0.55–0.68)), moderate-risk (AUC = 0.669 (95% CI: 0.64–0.71)), and low-risk (AUC = 0.673 (95% CI: 0.63–0.72)) models offered significant predictive accuracy over VA's leading suicide prediction algorithm. Derived words varied considerably, the high-risk model including chronic condition service words, moderate-risk model including outpatient care, and low-risk model including acute condition care.Study suggests benefit of leveraging unstructured electronic health records and expands prediction resources for non-high-risk suicide decedents, an historically underserved population.

Characterizing Veteran suicide decedents that were not classified as high-suicide-risk.

Although the Department of Veterans Affairs (VA) has made important suicide prevention advances, efforts primarily target high-risk patients with documented suicide risk, such as suicidal ideation, prior suicide attempts, and recent psychiatric hospitalization. Approximately 90% of VA patients that go on to die by suicide do not meet these high-risk criteria and therefore do not receive targeted suicide prevention services. In this study, we used national VA data to focus on patients that were not classified as high-risk, but died by suicide. Our sample included all VA patients who died by suicide in 2017 or 2018. We determined whether patients were classified as high-risk using the VA's machine learning risk prediction algorithm. After excluding these patients, we used principal component analysis to identify moderate-risk and low-risk patients and investigated demographics, service-usage, diagnoses, and social determinants of health differences across high-, moderate-, and low-risk subgroups. High-risk (n = 452) patients tended to be younger, White, unmarried, homeless, and have more mental health diagnoses compared to moderate- (n = 2149) and low-risk (n = 2209) patients. Moderate- and low-risk patients tended to be older, married, Black, and Native American or Pacific Islander, and have more physical health diagnoses compared to high-risk patients. Low-risk patients had more missing data than higher-risk patients. Study expands epidemiological understanding about non-high-risk suicide decedents, historically understudied and underserved populations. Findings raise concerns about reliance on machine learning risk prediction models that may be biased by relative underrepresentation of racial/ethnic minorities within health system.

Personal Circumstances Preceding Firearm Suicide Death Among Black Adults in the United States.

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 firearmavailability 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 5years.

Suicide Prevention Effects of Extreme Risk Protection Order Laws in Four States.

More than half of suicide deaths in the United States result from self-inflicted firearm injuries. Extreme risk protection order (ERPO) laws in 21 states and the District of Columbia temporarily limit access to firearms for individuals found in a civil court process to pose an imminent risk of harm to themselves or others. Research with large multistate study populations has been lacking to determine effectiveness of these laws. This study assembled records pertaining to 4,583 ERPO respondents in California, Connecticut, Maryland, and Washington. Matched records identified suicide decedents and self-injury method. Researchers applied case fatality rates for each suicide method to estimate nonfatal suicide attempts corresponding to observed deaths. Comparison of counterfactual to observed data patterns yielded estimates of the number of lives saved and number of ERPOs needed to avert one suicide. Estimates varied depending on the assumed probability that a gun owner who attempts suicide will use a gun. Two evidence-based approaches yielded estimates of 17 and 23 ERPOs needed to prevent one suicide. For the subset of 2,850 ERPO respondents with documented suicide concern, comparable estimates were 13 and 18, respectively. This study's findings add to growing evidence that ERPOs can be an effective and important suicide prevention tool.

Federal Firearm Licensee Rates and Suicide in Maryland, 2014 to 2019

Federal firearm licensee density is associated with interpersonal firearm violence. Yet the role of Federal firearm licensees in firearm suicide remains understudied, even though firearms are the method used in more than half of suicides. This study tested associations between the spatial distribution of federal firearm licensees and firearm suicides in Maryland. Kernel density estimation measured federal firearm licensee and suicide rates at the census tract level (n=1,397), and SaTScan detected clusters of licensees and suicides. Choropleth maps compared visual associations between federal firearm licensee, firearm, and non-firearm suicide rates and clusters. Generalized estimating equations tested associations between Federal firearm licensee rates and clusters and the odds of using a firearm as the lethal means overall and after stratifying by biological sex. Data were obtained in 2020 and analyzed in 2020-2024. The federal firearm licensee rate was associated with greater odds of firearm suicide overall (aOR=1.29, 95% CI=1.21, 1.38, p<0.001), for men (aOR=1.29, 95% CI=1.20, 1.39, p<0.001), and for women (aOR=1.26, 95% CI=1.07, 1.49, p=0.007). Suicide decedents in a census tract located in a federal firearm licensee cluster (vs not) had higher odds of firearm use overall (aOR=1.70, 95% CI=1.28, 2.27, p<0.001) and for men (aOR=1.67, 95% CI=1.22, 2.27, p=0.001), but not for women (aOR=1.65, 95% CI=0.81, 3.34, p=0.168). The federal firearm licensee rate and clusters were associated with firearm suicides and unrelated to the spatial distribution of non-firearm suicides. Prevention approaches that limit the number of these federal firearm licensees or alter their sales practices, such as federal firearm licensee zoning and land use provisions, advertising restrictions, or gun shop projects, may prevent firearm suicides.

Increased somatic mosaicism in autosomal and X chromosomes for suicide death.

Mosaic chromosomal alterations (mCAs) are classified as mosaic deletions (loss), copy-neutral loss of heterozygosity (CN-LOH), and duplications (gain), attracting special attention as biological aging-related acquired genetic alterations. While these mCAs have been linked with aging and various diseases, no study has investigated their association with suicide risk which is associated with abnormal biological aging. Here, we examined the association between suicide deaths and mCAs, including mosaic loss of the X (mLOX) and Y chromosomes, by leveraging blood-derived single nucleotide polymorphism-array data. The first (410 suicide decedents and 88,870 controls) and the second (363 suicide decedents and 88,870 controls) cohorts were analyzed and integrated using meta-analyses (773 suicide decedents and 177,740 controls). Total mCAs in autosomal chromosomes were significantly increased in suicide (p = 1.28 × 10-6, odds ratio [OR] = 1.78), mostly driven by loss (p = 4.05 × 10-9, OR = 2.70) and gain (p = 1.08 × 10-3, OR = 2.23). mLOX were significantly increased in female suicide (p = 2.66 × 10-21, OR = 4.00). The directions of effects of all mCAs in autosomal and sex chromosomes on suicide were the same in the first and second sets. Subgroup analyses suggest that our findings were mostly driven by suicide itself, and not confounded by comorbid psychiatric disorders or physical diseases, smoking status, sample location, or postmortem sample status. In conclusion, we provide the first evidence for aberrant mCAs in somatic autosomal and X chromosomes in suicide, which may contribute to an improved understanding of the genomic pathophysiology underlying suicide.

Altered transcriptomes, cell type proportions, and dendritic spine morphology in hippocampus of suicide decedents

BackgroundSuicide is a manner of death resulting from complex environmental and genetic risks that affect millions of people globally. Both structural and functional studies identified the hippocampus as one of the vulnerable brain regions contributing to suicide risk. MethodsWe have identified the hippocampal tissue transcriptomes, gene ontology, cell type proportions, and dendritic spine morphology in controls (n = 28) and suicide decedents (n = 22). In addition, the transcriptomic signature in iPSC-derived neuronal precursor cells (NPCs) and neurons were also investigated in controls (n = 2) and suicide decedents (n = 2). ResultsThe hippocampal tissue transcriptomic data revealed that NPAS4 gene expression was downregulated while ALDH1A2, NAAA, and MLXIPL gene expressions were upregulated in hippocampal tissue of suicide decedents. The gene ontology identified 29 significant pathways including NPAS4-associated gene ontology terms “excitatory post-synaptic potential”, “regulation of postsynaptic membrane potential” and “long-term memory” indicating alteration of glutamatergic synapses in the hippocampus of suicide decedents. The cell type deconvolution identified decreased excitatory neuron proportion and an increased inhibitory neuron proportion providing evidence of excitation/inhibition imbalance in the hippocampus of suicide decedents. In addition, suicide decedents had increased dendric spine density in the hippocampus, due to an increase of thin (relatively unstable) dendritic spines, compared to controls. The transcriptomes of iPSC-derived hippocampal-like NPCs and neurons revealed 31 and 33 differentially expressed genes in NPC and neurons, respectively, of suicide decedents. ConclusionsOur findings will provide new insights into the hippocampal neuropathology of suicide.

Characteristics Associated With Mental Health Treatment Prior to Suicide Among Youth in the United States

To examine individual and contextual characteristics associated with receipt of mental health treatment prior to youth suicide. Data from the US National Violent Death Reporting System, Area Health Resource File, and Social Vulnerability Index were used to examine characteristics associated with receipt of mental health treatment within 2 months before death among youth suicide decedents aged 5 to 17 years from 2013 to 2020 (N= 6,229). The association between individual (demographic, precipitating circumstances, and clinical characteristics) and contextual-level variables (county health resources, Social Vulnerability Index) and mental health service use was modeled using logistic regression. Mental health treatment was received by 31.6% of youth suicide decedents (n= 1,967) in the 2 months before suicide. Male individuals and youth from all racial and ethnic minority groups were less likely to receive mental health treatment in the 2 months prior to suicide, as were youth residing in non-metropolitan counties and living in counties characterized by high compared to low levels of social vulnerability. A history of family problems, a recent crisis, criminal/legal problems, and suicidal thoughts and attempts were associated with increased odds of receiving mental health services. Youth suicide decedents who were male, members of a racial or ethnic minority group, and residing in counties that are non-metropolitan and/or socially disadvantaged were less likely to have received mental health services in the months prior to death. Suicide prevention efforts that focus on improving access to care are essential for these vulnerable populations at risk for suicide.

Youth Suicide and Preceding Mental Health Diagnosis

Suicide is a leading cause of death among US youths, and mental health disorders are a known factor associated with increased suicide risk. Knowledge about potential sociodemographic differences in documented mental health diagnoses may guide prevention efforts. To examine the association of documented mental health diagnosis with (1) sociodemographic and clinical characteristics, (2) precipitating circumstances, and (3) mechanism among youth suicide decedents. This retrospective, cross-sectional study of youth suicide decedents aged 10 to 24 years used data from the Centers for Disease Control and Prevention National Violent Death Reporting System from 2010 to 2021. Data analysis was conducted from January to November 2023. Sociodemographic characteristics, clinical characteristics, precipitating circumstances, and suicide mechanism. The primary outcome was previously documented presence of a mental health diagnosis. Associations were evaluated by multivariable logistic regression. Among 40 618 youth suicide decedents (23 602 aged 20 to 24 years [58.1%]; 32 167 male [79.2%]; 1190 American Indian or Alaska Native [2.9%]; 1680 Asian, Native Hawaiian, or Other Pacific Islander [4.2%]; 5118 Black [12.7%]; 5334 Hispanic [13.2%]; 35 034 non-Hispanic; 30 756 White [76.1%]), 16 426 (40.4%) had a documented mental health diagnosis and 19 027 (46.8%) died by firearms. The adjusted odds of having a mental health diagnosis were lower among youths who were American Indian or Alaska Native (adjusted odds ratio [aOR], 0.45; 95% CI, 0.39-0.51); Asian, Native Hawaiian, or Other Pacific Islander (aOR, 0.58; 95% CI, 0.52-0.64); and Black (aOR, 0.62; 95% CI, 0.58-0.66) compared with White youths; lower among Hispanic youths (aOR, 0.76; 95% CI, 0.72-0.82) compared with non-Hispanic youths; lower among youths aged 10 to 14 years (aOR, 0.70; 95% CI, 0.65-0.76) compared with youths aged 20 to 24 years; and higher for females (aOR, 1.64; 95% CI, 1.56-1.73) than males. A mental health diagnosis was documented for 6308 of 19 027 youths who died by firearms (33.2%); 1691 of 2743 youths who died by poisonings (61.6%); 7017 of 15 331 youths who died by hanging, strangulation, or suffocation (45.8%); and 1407 of 3181 youths who died by other mechanisms (44.2%). Compared with firearm suicides, the adjusted odds of having a documented mental health diagnosis were higher for suicides by poisoning (aOR, 1.70; 95% CI, 1.62-1.78); hanging, strangulation, and suffocation (aOR, 2.78; 95% CI, 2.55-3.03); and other mechanisms (aOR, 1.59; 95% CI, 1.47-1.72). In this cross-sectional study, 3 of 5 youth suicide decedents did not have a documented preceding mental health diagnosis; the odds of having a mental health diagnosis were lower among racially and ethnically minoritized youths than White youths and among firearm suicides compared with other mechanisms. These findings underscore the need for equitable identification of mental health needs and universal lethal means counseling as strategies to prevent youth suicide.

Suicide among Veterans in Veterans Health Administration care: Differences in methods by tier of predicted suicide risk

Veterans' suicide rates exceed those of non-Veteran adults, and Veteran suicides more often involve firearms. However, the relationship between Veteran characteristics and suicide method is not well understood. Using the Veteran Health Administration suicide prediction algorithm, we assessed differences in suicide method by predicted risk among Veteran suicide decedents. Significant predictors of firearm involvement included lower algorithm-predicted suicide risk, no recent suicide attempts, male sex, and older age. Non-firearm methods were most common at high tiers of suicide risk. Firearm safety counseling is important for all Veterans and non-firearm lethal means safety counseling may be particularly important for high-risk Veterans.

Circumstantial variables preceding firearm suicide among females with and without mobility disability in the USA: comparative analysis using data from the National Violent Death Reporting System

BackgroundMobility disability impacts approximately 12% of the US population; females are overrepresented among persons with mobility disability. Those with mobility disability are at increased risk of suicide compared with their...

Updated Estimate of the Number of Extreme Risk Protection Orders Needed to Prevent 1 Suicide

Extreme risk protection orders (ERPOs)-also known as red flag, risk warrant, and gun violence restraining orders-authorize law enforcement, family members, and sometimes others to petition a court to remove firearms from and prevent the acquisition of new firearms by a person judged to pose an immediate danger to themselves or others. Previous estimates suggest that 1 suicide is prevented for every 10 ERPOs issued, a number needed to treat that depends critically on the counterfactual estimate of the proportion of suicidal acts by ERPO respondents that would have involved firearms in the absence of ERPOs. To empirically inform updated estimates of the number of ERPOs needed to prevent 1 suicide. This cohort study used data from California for method-specific suicides by handgun ownership (October 18, 2004, to December 31, 2015). Handgun-owning suicide decedents in California were identified using individual-level registry data about lawful handgun ownership linked to cause-specific mortality for a cohort of more than 25 million adults. The study also used data from Connecticut for method-specific suicides among ERPO respondents who died by suicide, extracted from published data (October 1999 to June 2013). Data analysis was performed in December 2023. Handgun ownership. The primary outcomes were the number and distribution of suicidal acts by handgun owners in California, estimated using method-specific suicide mortality data and published case fatality ratios, and the counterfactual number and distribution of suicidal acts and deaths among ERPO respondents in Connecticut had no ERPOs been issued. A total of 1216 handgun owners (mean [SD] age, 50 [18] years; 1019 male [83.8%]) died by suicide during the study period. Among male handgun owners in California, 28% of suicidal acts involved firearms, 54% involved drug poisoning, 9% involved cutting or piercing, 3% involved hanging or suffocation, 2% involved poisoning with solids and/or liquids, and the remaining 4% involved other methods. Assuming this distribution approximates the counterfactual distribution among ERPO respondents in Connecticut in the absence of ERPOs, 1 suicide death was prevented for every 22 ERPOs issued. The estimates produced by this cohort study of California handgun owners suggest that ERPOs can play an important role in averting deaths among high-risk individuals.

Examining the Etiology of Asian American Suicide in the United States.

Research highlights racial and ethnic disparities in suicide, but Asian American suicide receives very little attention in the literature. This is the first comprehensive, large-scale, nationally representative study of completed suicide among Asian Americans in the United States. Descriptive and multilevel regression techniques compared the risk factors for completed suicide across 227,786 Asian American, White, African American, Hispanic, and American Indian suicide decedents from 2003 to 2019. Results indicated that Asian American suicide decedents were significantly less likely than their counterparts to have several risk factors for suicide. Asian Americans were less likely to be male, uneducated, and unmarried. Asian Americans were less likely to use alcohol and drugs, to have mental health problems, and to die by firearm, relative to other suicide methods. Asian Americans were less likely to have a history of prior suicide attempts, to have intimate partner problems, and to have criminal legal problems. Conversely, Asian Americans were more likely to reside in places with higher levels of concentrated disadvantage, residential instability, racial and ethnic heterogeneity, and population density. The results underscore the need for race-specific suicide prevention strategies that, for Asian Americans in particular, take into account cultural values and barriers to help-seeking behavior.

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.

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. 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. 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. 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.