Patient-Reported Firearm Access Prior to Suicide Death.
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ABSTRACT:
SUBMITTER: Richards JE
PROVIDER: S-EPMC8749466 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
Publications
Patient-Reported Firearm Access Prior to Suicide Death.
Richards Julie E JE Boggs Jennifer M JM Rowhani-Rahbar Ali A Kuo Elena E Betz Marian E ME Bobb Jennifer F JF Simon Gregory E GE
JAMA network open 20220104 1
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Project description:ImportanceUS residents report broad access to firearms, which are the most common means of suicide death in the US. Standardized firearm access questions during routine health care encounters are uncommon despite potential benefits for suicide prevention.ObjectiveTo explore patient and clinician experiences with a standard question about firearm access on a self-administered mental health questionnaire routinely used prior to primary care and mental health specialty encounters.Design, setting, and participantsQualitative semistructured interviews were conducted from November 18, 2019, to October 8, 2020, at Kaiser Permanente Washington, a large integrated care delivery system and insurance provider. Electronic health record data identified adult patients with a documented mental health diagnosis who had received a standard question about firearm access ("Do you have access to guns? yes/no") within the prior 2 weeks. A stratified sampling distribution selected 30% who answered "yes," 30% who answered "no," and 40% who left the question blank. Two groups of clinicians responsible for safety planning with patients at risk of suicide were also sampled: (1) licensed clinical social workers (LICSWs) in primary and urgent care settings and (2) consulting nurses (RNs).Main outcomes and measuresParticipants completed semistructured telephone interviews, which were recorded and transcribed. Directive (deductive) and conventional (inductive) content analyses were used to apply knowledge from prior research and describe new information. Thematic analysis was used to organize key content, and triangulation was used to describe the intersections between patient and clinician perspectives.ResultsThirty-six patients were interviewed (of 76 sampled; mean [SD] age, 47.3 [17.9] years; 19 [53%] were male; 27 [75%] were White; 3 [8%] were Black; and 1 [3%] was Latinx or Hispanic. Sixteen participants had reported firearm access and 15 had reported thoughts of self-harm on the questionnaire used for sampling. Thirty clinicians were interviewed (of 51 sampled) (mean [SD] age, 44.3 [12.1] years; 24 [80%] were female; 18 [60%] were White; 5 [17%] were Asian or Pacific Islander; and 4 [13%] were Latinx or Hispanic) including 25 LICSWs and 5 RNs. Key organizing themes included perceived value of standardized questions about firearm access, challenges of asking and answering, and considerations for practice improvement. Clinician interview themes largely converged and/or complemented patient interviews.Conclusions and relevanceIn this qualitative study using semistructured interviews with patients and clinicians, a standardized question about firearm access was found to encourage dialogue about firearm access. Respondents underscored the importance of nonjudgmental acknowledgment of patients' reasons for firearm access as key to patient-centered practice improvement.
| S-EPMC9685488 | biostudies-literature
Project description:ImportanceFirearm injury is the second leading cause of death in the United States for children and young adults. The risk of unintentional and self-inflicted firearm injury is lower when all household firearms are stored locked.ObjectiveTo estimate the reduction in youth firearm suicide and unintentional firearm mortality that would result if more adults in households with youth stored household guns locked.Design, setting, and participantsA modeling study using Monte Carlo simulation of youth firearm suicide and unintentional firearm mortality in 2015. A simulated US national sample of firearm-owning households where youth reside was derived using nationally representative rates of firearm ownership and storage and population data from the US Census to test a hypothetical intervention, safe storage of firearms in the home, on youth accidental death and suicide. Data analyses were performed from August 3, 2017, to January 9, 2018.ExposuresObserved and counterfactual household-level safe firearm storage (ie, storing all firearms locked), the latter estimated by varying the probability that a hypothetical intervention increased safe firearm storage beyond that observed in 2015.Main outcomes and measuresObserved and counterfactual counts of firearm suicide and unintentional firearm mortality among youth aged 0 to 19 years, the latter estimated by incorporating an empirically based estimate of the mortality benefit expected from additional safe storage (beyond that observed in 2015).ResultsA hypothetical intervention among firearm owners residing with children with a 20% probability of motivating these owners to lock all household firearms was significantly associated with a projected reduction in youth firearm mortality (median incidence rate ratio = 0.90; interquartile range, 0.87-0.93). In the overall model, 6% to 32% of deaths were estimated to be preventable depending on the probability of motivating safer storage.Conclusions and relevanceResults of this modeling study suggest that a relatively modest uptake of a straightforward safe storage recommendation-lock all household firearms-could result in meaningful reductions in firearm suicide and unintentional firearm fatalities among youth. Approaches that will motivate additional parents to store firearms safely are needed.
| S-EPMC6515586 | biostudies-literature
Project description: Not available
| S-EPMC11780471 | biostudies-literature
Project description:IntroductionIn 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.MethodsMortality 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.ResultsBetween 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.ConclusionsState-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.
| S-EPMC8608719 | biostudies-literature
Project description:Background and aimsA majority of older adult suicide decedents used firearms. In this study, we focused on suicide decedents age 75+ who disclosed their suicidal intent within a month of their injury/death to examine demographic and clinical characteristics associated with firearm use and firearm access restriction attempts by their family members.MethodsThe 2017-2019 U.S. National Violent Death Reporting System provided data (N = 1,734 suicidal intent disclosers; 1,476 males and 258 females; 21.4% of decedents age 75+). Generalized linear model (GLM) for a Poisson distribution with a log link was used to examine firearm use risk factors. Firearm access restriction attempts by decedents' family members were examined based on coroner/medical examiner and law enforcement (CME/LE) reports.ResultsNearly three quarters of disclosers disclosed their intent to family members, and 82.9% of males and 27.5% of females used firearms. GLM results showed males, non-Hispanic white people, and residents in the South and West regions had higher likelihood of firearm use. CME/LE reports of 140 out of 1,294 firearm decedents included narratives related to firearm restriction attempts or lack thereof. Firearm access restrictions were not attempted in 65 cases because family members did not take suicidal intent disclosure seriously or because decedents promised no self-harm. Partial or complete removal of firearms in 75 cases were not effective as decedents had hidden a firearm or purchased a new one. Others used different lethal methods.ImplicationsThe findings indicate a need for: (a) training family members of older adults who are at risk of suicide in effective means safety/access restriction and strategies to prevent means substitution; (b) more comprehensive legislative reforms reducing access to firearms by those at risk of suicide; and (c) more comfort and palliative care and counseling for psychosocial risk factors.
| S-EPMC10654963 | biostudies-literature
Project description:IntroductionAcute alcohol intoxication is a contributing factor in firearm-involved suicides. However, knowledge of the relationship between alcohol intoxication and firearm-involved suicide by age and sex (defined herein as the biological sex of the decedent) is limited. The purpose of the current study was to evaluate the sex- and age group-specific relationship between alcohol intoxication and firearm-involved suicide.MethodsData from the National Violent Death Reporting System, 2003-2020, on suicide decedents (18+ years of age) were utilized. Age-group- and sex-specific multivariate binary logistic regression analyses were conducted. Statistical analyses were performed in 2023.ResultsAlcohol intoxication (i.e., having a blood alcohol concentration of 0.08 g/dL or more) was significantly associated with using a firearm as the method of suicide for young (18-34 years; relative risk (RR)=1.31, 95% CI: 1.22-1.40) and middle-aged (35-64 years; RR=1.34, 95% CI: 1.27-1.39) females but not among older females (65+ years; RR=1.01, 95% CI: 0.87-1.17). Among males, the association was significant for all age-groups (young: RR=1.28, 95% CI: 1.25-1.30; middle-aged: RR=1.17, 95% CI: 1.15-1.19; and older: RR=1.04, 95% CI: 1.01-1.07).ConclusionsAmong males of all ages and young and middle-aged females, alcohol intoxication was associated with increased risk of suicide by firearm-an extremely lethal method that accounts for a majority of suicides in the U.S.-compared to their non-intoxicated counterparts. Interventions targeting excessive alcohol consumption may be effective in reducing suicide mortality rates.
| S-EPMC11833663 | biostudies-literature
Project description:ObjectiveA first study to compare suicides by missing persons with other suicide cases.DesignRetrospective cohort study for the period 1994-2007. GEOGRAPHICAL LOCATION: Queensland, Australia.Population194 suicides by missing persons and 7545 other suicides were identified through the Queensland Suicide Register and the National Coroners Information System.Main outcome measureχ(2) statistics and binary logistic regression were used to identify distinct characteristics of suicides by missing persons.ResultsCompared with other suicide cases, missing persons significantly more often died by motor vehicle exhaust gas toxicity (23.7% vs 16.4%; χ(2)=7.32, p<0.01), jumping from height (6.7% vs 3.2%; χ(2)=7.08, p<0.01) or drowning (8.2% vs 1.8%; χ(2)=39.53, p<0.01), but less frequently by hanging (29.4% vs 39.9%; χ(2)=8.82, p<0.01). They were most frequently located in natural outdoors locations (58.2% vs 11.1%; χ(2)=388.25, p<0.01). Persons gone missing were less likely to have lived alone at time of death (OR 0.45, 95% CI 0.26 to 0.76), yet more likely to be institutionalised (OR 3.12, 95% CI 1.28 to 7.64). They were less likely to have been physically ill (OR 0.64, 95% CI 0.43 to 0.95) or have a history of problematic consumptions of alcohol (OR 0.52, 95% CI 0.31 to 0.87). In comparison to other suicide cases, missing persons more often communicated their suicidal intent prior to death (OR 1.58, 95% CI 1.13 to 2.22).ConclusionsSuicides by missing persons show several distinct characteristics in comparisons to other suicides. The findings have implications for development of suicide prevention strategies focusing on early identification and interventions targeting this group. In particular, it may offer assistance to police in designing risk assessment procedures and subsequent investigations of missing persons.
| S-EPMC3323803 | biostudies-literature
Project description:Firearm availability has been linked to firearm self-harm, but the joint relationship with alcohol availability, while supported by theory, has not been examined. This study sought to quantify the separate and joint relations of community firearm and alcohol availability with individual-level risk of (fatal and nonfatal) firearm self-harm. We conducted a case-control study of California residents, 2005-2015, using statewide mortality, hospital, firearm transfer, and alcohol license data. We estimated monthly marginal risk differences per 100,000 in the overall population and in white men aged 50+ under various hypothetical changes to firearm and alcohol availability and assessed additive interactions using case-control-weighted g-computation. In the overall population, non-pawn shop firearm dealer density was associated with firearm self-harm (RD: 0.02, 95% CI: 0.003, 0.04) but pawn shop firearm dealer and alcohol outlet densities were not. Secondary analyses revealed a relationship between firearm sales density and firearm self-harm (RD: 0.07, 95% CI: 0.04, 0.10). There were no additive interactions between measures of firearm and alcohol availability. Among older white men, generally the same exposures were related to self-harm as in the overall population, but point estimates were substantially larger. Findings suggest community-level approaches to reducing firearm sales may help mitigate suicide risk.
| S-EPMC10153632 | biostudies-literature
Project description:Access to firearms and perceived unsafe school environments are associated with negative adolescent health outcomes. Whether widespread acceptance of firearms alters these associations, however, is unknown. To address this literature gap, we examined whether peer acceptance of firearms moderates associations between personal firearm access and health outcomes. In 2018-2019, we analyzed Wave I of the National Longitudinal Study of Adolescent to Adult Health (collected 1994-1995) to assess personal firearm access and school-level percentage of firearm access, using weighted multilevel analyses with interactions to determine associations among personal access, school-level percentage of access, and adolescent depression, suicidality, general health, and perceived school safety. Models controlled for age, sex, race, region, urbanicity, family structure, parental income and education level, school type, school size, and school quality. Results showed that personal firearm access was associated with depression (OR 1.20 p = 0.03), suicidal ideation (OR 1.73, p < 0.001), and perceiving school as unsafe (OR 1.59, p < 0.001). A higher school-level percentage of access, however, was associated with lower rather than higher odds of perceiving school as unsafe (OR 0.83, p = 0.003). With interaction terms included, the association between personal access and suicidal ideation was weaker when school-level access was more common. Similarly, the association between school-level access and poor general health was negative among students with personal access but positive among students with no access. These findings suggest firearm access is a complex social phenomenon. In a low-access environment, personal firearm access may signify a high-risk physical and mental state. In schools where access is common, however, personal access may signify social belonging, possibly mitigating some potential negative health effects. Although evidence that firearm access is harmful remains clear, local norms may have a substantial moderating impact.
| S-EPMC7115163 | biostudies-literature
Project description:Although 39,000 individuals die annually from gunshots in the US, research examining the effects of laws designed to reduce these deaths has sometimes produced inconclusive or contradictory findings. We evaluated the effects on total firearm-related deaths of three classes of gun laws: child access prevention (CAP), right-to-carry (RTC), and stand your ground (SYG) laws. The analyses exploit changes in these state-level policies from 1970 to 2016, using Bayesian methods and a modeling approach that addresses several methodological limitations of prior gun policy evaluations. CAP laws showed the strongest evidence of an association with firearm-related death rate, with a probability of 0.97 that the death rate declined at 6 y after implementation. In contrast, the probability of being associated with an increase in firearm-related deaths was 0.87 for RTC laws and 0.77 for SYG laws. The joint effects of these laws indicate that the restrictive gun policy regime (having a CAP law without an RTC or SYG law) has a 0.98 probability of being associated with a reduction in firearm-related deaths relative to the permissive policy regime. This estimated effect corresponds to an 11% reduction in firearm-related deaths relative to the permissive legal regime. Our findings suggest that a small but meaningful decrease in firearm-related deaths may be associated with the implementation of more restrictive gun policies.
| S-EPMC7334522 | biostudies-literature