Factors associated with firearm suicide in the United States

1. Firearm suicide risk is elevated among those living in states with high firearm ownership, those living in rural areas, those with a military background, and those of white, non-Hispanic backgrounds.

Evidence Rating Level: 2 (Good)

Suicide is an ongoing pandemic and a leading cause of death in the U.S. The most common method among those who die by suicide is firearm (50.5%). However, limited information is known regarding the personal characteristics associated with firearm suicide risk. This retrospective cohort study examined respondents from the Mortality Disparities Across Communities study, which linked 2008-2015 National Death Index death records with 2008 American Community Survey data. Firearm suicide rates were found to be highest among those with military background (21.2 per 100,000 person-years), 95% CI 19.4 to 23.1). Other high-risk groups were disabled individuals (14.0 per 100,000 person-years, 95% CI 12.7 to 15.3), male gender (13.6 per 100,000 person-years, 95% CI 13.0 to 14.3), adults ≥ 65 years of age (11.8 per 100,000 person-years, 95% CI 10.7 to 13.0), rural residents (11.5 per 100,000 person-years, 95% CI 10.6 to 12.4), separated/divorced individuals (11.3 per 100,000 person-years, 95% CI 10.2 to 12.5), and adults in states with > 50% firearm ownership (11.5 per 100,000 person-years, 95% CI 9.5 to 13.7). U.S. firearm owners had a greater risk of firearm suicide (HR 3.00, 95% CI 2.50 to 4.39) and non-firearm suicide (HR 1.20, 95% CI 0.97 to 1.48) than noncitizens. Risk increased with combinations of these variables. For example, firearm suicide rates were higher among males in high firearm ownership states (19.9 per 100,000 person-years) than the same demographic in states with low firearm ownership (7.9 per 100,000 person-years). For females, firearm suicide rates were highest among those with a net income loss (5.5 per 100,000 person-years, 95% CI 3.2 to 9.0), those who were disabled, (3.8 per 100,000 person-years), and those in states with high firearm ownership (3.5 per 100,000 person-years, 95% CI 2.1 to 5.5). Overall, this study suggests that there are specific factors that should be considered when assessing for suicide risk in certain populations. This is particularly timely given the rise in gun ownership and mental health concerns during the COVID-19 pandemic.

Click to read the study in JAMA Internal Medicine

Image: PD

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