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Impact of Firearm Availability and Gun Regulation on State Suicide Rates
Abstract
Past studies on suicide have investigated the association of firearm ownership and suicide risk in the United States. The aim of the present study was to build on previous work by examining the impact of firearm storage practices and the strictness of firearm regulation on suicide rates at the state level. Data were compiled from primarily three sources. Suicide and firearm ownership information was obtained from the Centers for Disease Control and Prevention. Strictness of handgun regulation was derived from figures available at the Law Center to Prevent Violence, and controls were taken from the US Bureau of the Census. Mixed models were fitted to the data. Household firearm ownership was strongly associated with both suicide by all mechanisms, and firearm suicide. Storage practices had especially elevated consequences on suicide rates. Percent with loaded guns and gun readiness increased suicide rates, and strictness of gun regulation reduced suicide rates. Ready access to firearms can make a difference between life and death. Loaded and unlocked firearms within reach become risk factors for fatal outcomes from suicidal behavior. Future research might want to examine ways of obtaining more recent data on individual firearm ownership. This study proposes several policy recommendations for suicide prevention.
... Moreover, "persons with a gun in the home were [are] more likely than others to use a gun to [die by] suicide and less likely than others to [die by] suicide by means of drug overdose, hanging, or other method other than a gun" [108]. Population (household) rates of gun ownership are strongly associated with overall suicide rates, gun suicide rates, and percentage of suicides by 22:1360 gun in the US (Table 4 and Fig. 3) [112][113][114], even when prescription rates of antidepressants are considered [115]. Evidence suggests that 33%-80% of suicidal acts are impulsive [116]. ...
... We approach this topic from purely a public health perspective. Based upon the preponderance of evidence, we wish to emphasize the point, as others have, that reducing access to lethal means will almost certainly save many lives that might otherwise be lost to suicide [97,113,114,118,120,131,136]. Especially because since 1999, suicides have accounted for 55%-64% of all US firearm deaths on average, with that number being ≥ 60% since 2010 [137,138]. ...
... In support, others have presented comprehensive meta-analyses of approaches to reducing access to various lethal means that have been demonstrably effective for reducing suicide risk [97]. Regarding firearms in particular, significant evidence indicates that safe storage helps reduce suicide risk [107,113,143], with suicide risk increasing predictably with each gradation of unsafe storage. For example, versus "no guns in the home, " having "any gun kept unlocked" or "any gun kept loaded" increased all-means suicide risk by 5.6-fold and 9.2-fold, respectively [107]. ...
Suicide rates in the United States (US) reached a peak in 2018 and declined in 2019 and 2020, with substantial and often growing disparities by age, sex, race/ethnicity, geography, veteran status, sexual minority status, socioeconomic status, and method employed (means disparity). In this narrative review and commentary, we highlight these many disparities in US suicide deaths, then examine the possible causes and potential solutions, with the overarching goal of reducing suicide death disparities to achieve health equity.
The data implicate untreated, undertreated, or unidentified depression or other mental illness, and access to firearms, as two modifiable risk factors for suicide across all groups. The data also reveal firearm suicides increasing sharply and linearly with increasing county rurality, while suicide rates by falls (e.g., from tall structures) decrease linearly by increasing rurality, and suicide rates by other means remain fairly constant regardless of relative county urbanization. In addition, for all geographies, gun suicides are significantly higher in males than females, and highest in ages 51–85 + years old for both sexes. Of all US suicides from 1999–2019, 55% of male suicides and 29% of female suicides were by gun in metropolitan (metro) areas, versus 65% (Male) and 42% (Female) suicides by gun in non-metro areas. Guns accounted for 89% of suicides in non-metro males aged 71–85 + years old. Guns (i.e., employment of more lethal means) are also thought to be a major reason why males have, on average, 2–4 times higher suicide rates than women, despite having only 1/4—1/2 as many suicide attempts as women. Overall the literature and data strongly implicate firearm access as a risk factor for suicide across all populations, and even more so for male, rural, and older populations.
To achieve the most significant results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs to reduce suicidal behaviors, and 2) enhanced population-based strategies for ameliorating the two most prominent modifiable targets for suicide prevention: depression and firearms.
... Of the original 4,673 studies identified, 3,623 remained after removing duplicates. Two hundred twenty-five case reports, 23 Hierarchical linear regression with mixed effects modeling of observational data 50 states Suicides Consistent and linear correlation between strictness of gun laws and decreases in suicide rates case series, and reviews were excluded, and 3,379 studies were removed because they did not focus on firearm injury prevention or did not address our comparators of interest. Finally, seven additional studies were identified in two separate, subsequent literature reviews. ...
... Thirteen of the 14 studies showed reductions in some aspect of firearm-related injuries from 7% to 40%. 10,[12][13][14][15][16][17][18][19][20][21][22][23] Article Summaries for PICO 1 Loftin et al. 10 examined the effect of a law passed in 1976 that effectively banned the purchase, sale or transfer of possession of firearm in Washington, DC. Homicides and suicides in the capital were reviewed from 1968 through 1987. ...
... Still more recently, Kposowa et al. 23 examined the association between strictness of state gun control laws and suicide rates, as well as the effects of gun ownership and gun storage practices. Using US Centers for Disease Control and US Census Bureau data, controlling for explanatory variables, such as prevalence of gun ownership, population estimates of mental illness, and demographics, the authors found a consistent and linear correlation between strictness of gun control laws and firearm suicide rates. ...
... 15 A lack of access to mental health care 16,17 and access to firearms are also risk factors for suicide. 18,19 Data on access to firearms are nuanced; for example, Steelesmith and colleagues 10 found that the presence of gun shops has a stronger association with suicide in urban settings than in rural settings, possibly because of the prevalence of guns in rural counties. Although suicide rates are increasing fastest in rural settings, 20 examining suicide across urban contexts is important for understanding risk and protective factors, especially as suicide rates are projected to increase among all racial/ethnic groups aged 25-64. ...
... Because most suicide deaths involve guns, 23 policies that promote safe gun storage and prevent suicidal people from obtaining guns also show promise at the population level. 19,49 The Centers for Disease Control and Prevention has assembled a technical report of suicide prevention strategies across the social ecology-from individual-level interventions (eg, social-emotional programs for children and adolescents), to relationship-based approaches (eg, crisis intervention telephone lines), to community-level efforts (eg, reducing access to lethal means of suicide). 50 Data from our study may help city leaders communicate the importance of resources for these types of strategies, to address suicide in their cities. ...
Objectives
Suicide is a leading cause of death in the United States, and rates vary by race and ethnicity. An analysis of suicide across large US cities is absent from the literature. The objective of this study was to examine suicide rates among the total population, non-Hispanic Black population, and non-Hispanic White population in the United States and in the 30 largest US cities.
Methods
We used data from the National Vital Statistics System to calculate non-Hispanic White, non-Hispanic Black, and total age-adjusted suicide rates for the 30 largest US cities and for the entire nation during 2 periods: 2008-2012 and 2013-2017. We also examined absolute and relative differences in suicide rates among non-Hispanic White populations and non-Hispanic Black populations in each city.
Results
The overall age-adjusted suicide rate per 100 000 population in the United States increased significantly from 12.3 in 2008-2012 to 13.5 in 2013-2017. Total suicide rates were stable in most cities; rates increased significantly in only 1 city (Louisville), and rates decreased significantly in 2 cities (Boston and Memphis). The non-Hispanic White suicide rate was significantly higher—1.3 to 4.3 times higher—than the non-Hispanic Black suicide rate in 24 of 26 study cities during 2013-2017. From 2008-2012 to 2013-2017, non-Hispanic White suicide rates decreased significantly in 3 cities and increased significantly in 3 cities; non-Hispanic Black suicide rates increased significantly in 5 cities and decreased in none. Absolute differences in suicide rates among non-Hispanic White populations and non-Hispanic Black populations increased significantly in 1 city (Louisville) and decreased significantly in 2 cities (Memphis and Boston).
Conclusions
Our study may inform the use of evidence-based programs and practices to address population-level risk factors for suicide.
... Multiple studies have established a consistent association between household firearm ownership and increased suicide rates (Anglemyer et al. 2014;Butterworth et al. 2018;Shenassa et al. 2004;Kposowa et al. 2016;Dahlberg et al. 2004;Wiebe 2003). State laws that have reduced access by high risk individuals such as mandating background checks through purchaser licensing, waiting periods, and child access protection laws have all been found to reduce suicide rates individually and measured together (Anestis and Anestis 2015;Crifasi et al. 2015;Kaufman et al. 2018;Loftin et al. 1991;Webster et al. 2004). ...
... Research has consistently shown that the accessibility of a particular method is the primary determinant of its use in suicide (Anglemyer et al. 2014;Butterworth et al. 2018;Kposowa et al. 2016;Spicer and Miller 2000;Vyrostek et al. 2004). While the relative ownership of long guns to handguns in Maryland is not known, we do know that the most common reported purpose for having a long gun is hunting (Wolfson et al. 2018). ...
Background:
Firearms account for the majority of US suicides, largely due to lethality and accessibility. Under Federal and Maryland law, long guns are less regulated than handguns which is a concern for increased suicide risk. This study uses Maryland data to ascertain the impact of long guns on suicides in the state. We hypothesize that the prevalence of long gun use among firearm suicides will be increased in rural and young populations.
Methods:
This is a cross sectional study using police and medical examiner narratives to identify firearm type involved in all 3931 Maryland gun suicides from 2003 to 2018. Proportions of firearm suicides utilizing long guns were calculated. Urban-rural differences were determined using the National Center for Health Statistics' classification system. Logistic regression was used to calculate odds ratios of long gun to handgun suicides across the urban-rural spectrum, controlling for decedent demographics.
Results:
From 2003 to 2018, 28.4% of Maryland gun suicides used long guns. The proportion of long guns used was highest in the most rural counties, where 51.6% of firearm suicides were by long gun, compared to 16.8% in the most urban counties. Long guns were disproportionately used by the young. For decedents 18 or younger, 44.6% used long guns, compared to 20.2% in those 65 or older. Compared to the most urban counties, firearm suicide decedents in the most rural counties were 3.74x more likely to use long guns (OR = 3.74; 95% CI 2.19, 6.40; p < .001) after adjusting for demographics, intoxication, and hunting season.
Conclusions:
Long guns are used in a large proportion of Maryland firearm suicides, particularly in rural areas and disproportionately in youth suicides. Long guns must be considered as part of access to lethal means or policy strategies in efforts to reduce the burden of firearm suicide.
... Suicide prevention by restriction of means is particularly promising in the case of firearms. Numerous studies from various countries have shown that, in a given population, the occurrence of households with firearms correlates with the frequency of suicides by this method [1,6,8,[11][12][13][14][15][16][17][18][19][20][21][22]. The occurrence of households with firearms further correlates with the total suicide rate [12][13][14][15][16][17][18][23][24][25][26][27][28][29][30]. ...
... Numerous studies from various countries have shown that, in a given population, the occurrence of households with firearms correlates with the frequency of suicides by this method [1,6,8,[11][12][13][14][15][16][17][18][19][20][21][22]. The occurrence of households with firearms further correlates with the total suicide rate [12][13][14][15][16][17][18][23][24][25][26][27][28][29][30]. People dying by suicide using firearms mostly use weapons that they own themselves or that belong to a family member living in the same household [31][32][33]. ...
Aims:
In comparison with other central European countries, Switzerland has a high prevalence of gun ownership and a high rate of suicide by shooting. After the Army XXI reform in 2003, which reduced personnel from about 400,000 to approximately 200,000, a decline in suicides by firearms and a decline in the total number of suicides was observed in national data spanning the period from 2000 to 2010. It is, however, unclear whether this decline can be linked to the reduced availability of military guns. This study explored whether the decline in suicide by firearms is related to the decline of suicides by army weapons.
Methods:
In 83.1% (n = 1112) of the 1338 suicides by firearm between 2000 and 2010 in Switzerland, the firearm could be categorised as an army weapon or a non-army weapon. The army weapon was used in 39.1% of these suicides. In comparison with other firearms, those who used army weapons tended to be younger and more likely to have a university degree. A prior suicide attempt was found less often in cases using a military weapon than other firearms. After the Army XXI reform, there was a significant drop in suicides by males aged 18 to 43 years using an army weapon, but no change in male suicide rates in the same age group who used a non-army weapon. The drop was statistically linked to a reduction of suicide by the army gun.
Results:
The army weapon was used in 39.1% of suicides by firearm between 2000 and 2010 in Switzerland. In comparison with other methods, those who used army weapons tended to be younger and more likely to have a university degree. A prior suicide attempt was found less often in cases using a military weapon than other methods. After the Army XXI reform, there was a significant drop in suicides by males aged 18 to 43 years using an army weapon, but no change in males' suicide rates in the same age group who used a non-army weapon. The drop was statistically linked to a reduction of suicide by the army gun.
Conclusions:
Males who use army weapons differ from those who use other types of weapons. The significant drop in suicides was found in males aged 18 to 43 but there was no change in males of the same age group who used a non-army weapon. These results support the hypotheses that the observed drop in suicides is linked to the Army XXI reform and that restriction of access to guns is essential for reducing suicides by firearm.
... 5 Firearms were the cause of nearly 51% of US suicide deaths from 2004 to 2012, never falling below 50% in any year. 6,7 In the United States, there are over 200 million firearms in civilian hands, far more than in any other developed nation. There are also far more firearm related injuries. ...
... In the case of a suicidal or homicidal individual, easy and quick access to a loaded weapon is demonstrated in all studies we reviewed to increase the risk of completing the intended suicide or homicide. 1,[4][5][6]13,14 Owning a firearm and the presence of a firearm in the home with suicidal adolescents or middle aged adults have been shown to increase the risk of a completed suicide. 19,24,25 Additional studies on the epidemiology of suicide have noted that when less lethal means are used (attempted lethal overdose, hanging) and survived, the individual makes a second suicide attempt in only 10% of cases. ...
Background:
Over 50,000 homicides and suicides occur each year. An estimated half of all U.S. households are believed to have a firearm present, making them one of the most ubiquitous consumer products. Our goal was to determine if the manner of storage of a firearm in a home could potentially make a difference in the outcomes of intentional and unintentional injuries involving a firearm; specifically addressing the use of gun safes and devices that block/disable firearm function (trigger locks, cable locks, etc.).
Methods:
A comprehensive review of the literature was performed. We used GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology to assess the breadth and quality of the data specific to our PICO (Population, Intervention, Comparator, Outcomes) questions.
Results:
A total of 176 studies were initially identified, then 120 more added after a subsequent, literature review with 97 removed as duplicates. One hundred and ninety-one case reports, case series, and reviews were removed because they did not focus on prevention or did not address our comparators of interest. This left a total of two studies which merited inclusion for PICO #1, should gun locks be used to prevent firearm injuries and six studies which merited inclusion for PICO #2, should safe storage for guns be used to prevent firearm injuries.
Conclusion:
PICO 1: We conditionally recommend that gun locks be used to prevent unintentional firearm injury.PICO 2: Because of the large effect size and the reasonable quality of available evidence with safe storage of firearms, we recommend safe storage prevent firearm-related injuries.
Level of evidence:
Systematic review, level III.
... Past ecological research has shown that the prevalence of gun ownership is correlated with suicide in census regions (4,5), states (4,6,7), and cities (8)(9)(10), even in models that control for rates of mental health conditions (e.g., 6,7). Studies that examine individual suicide cases can shed additional light on why and how gun prevalence may be associated with increased suicides. ...
... Past ecological research has shown that the prevalence of gun ownership is correlated with suicide in census regions (4,5), states (4,6,7), and cities (8)(9)(10), even in models that control for rates of mental health conditions (e.g., 6,7). Studies that examine individual suicide cases can shed additional light on why and how gun prevalence may be associated with increased suicides. ...
Many Americans own guns to protect themselves against other people, but there is evidence that both victimization and gun access increase suicide risk. We conducted qualitative interviews with informants of 17 suicide cases in New Orleans of the 60 who died between January 2015 and April 2016 to understand the relationship between past trauma, gun access and storage, and suicide. Nine cases had experienced a past trauma, including three who had recently had a family member killed by homicide. Eight died via firearm; of those, seven owned the guns they used to take their lives and stored them locked (but loaded) at home or in their cars. Preventing community violence and addressing its sequelae may be important for reducing suicides. A multi-pronged strategy consisting of policies, education, and marketing will likely be needed to address the risk of suicide conferred by gun access.
... Past ecological research has shown that the prevalence of gun ownership is correlated with suicide in census regions (4,5), states (4,6,7), and cities (8)(9)(10), even in models that control for rates of mental health conditions (e.g., 6,7). Studies that examine individual suicide cases can shed additional light on why and how gun prevalence may be associated with increased suicides. ...
... Past ecological research has shown that the prevalence of gun ownership is correlated with suicide in census regions (4,5), states (4,6,7), and cities (8)(9)(10), even in models that control for rates of mental health conditions (e.g., 6,7). Studies that examine individual suicide cases can shed additional light on why and how gun prevalence may be associated with increased suicides. ...
To validate warning signs for suicide, researchers interviewed 20 respondents, representing 17 suicides in Orleans Parish, Louisiana, about characteristics of the decedent in the year, month, and days preceding the death. Decedents did exhibit behaviors consistent with existing warning signs, but these were rarely new behaviors present 7 days prior to the suicide but not previously. Research is needed to continue to test warning signs for suicide, and education campaigns that teach warning signs may not be relevant for preventing suicide among those in mental health treatment or involved in the criminal justice system.
... Kaplan and Mueller-Williams (2019) suggest a targeted prevention strategy that restricts access to firearms when warning signs are present for individuals at considerable risk of suicide by firearm, such as firearm owners, experienced military, older adults, and non-Hispanic white men. Kposowa et al. (2016) analyzed gun storage practices and suicide, finding that 'household gun ownership and keeping guns in the home that are loaded, and especially loaded guns that are unlocked, are significant contributors to U.S. suicide rates' (p. 690). ...
... Other scholars have demonstrated that suicide is more likely to occur in households with a gun (Simon, 2007) and households with a history of firearm purchases (Cummings et al., 1997). Having a firearm in the household that is loaded and not kept in a safe has also been demonstrated to be associated with increased fatal suicidal behavior (Anestis, 2018;Brent, 2001;Kposowa et al., 2016). Research on the association between suicide and firearms is unequivocal increased firearms are associated with increased suicide. ...
The United States has a deep and compassionate culture of firearms. Therefore, any restrictions or limitations on access to guns are met with strong opposition. States have enacted different gun control laws aimed at reducing homicide and violence. Past analyses of gun control laws have focused on homicide. However, suicide is also associated with gun violence in the United States. Examining two gun control laws, the current analysis explores if the laws are predictive of decreases in lethal violence, homicide, and suicide. The findings demonstrate that gun control laws are associated with decreased lethal violence and suicide. There was not a significant association between gun control laws and homicide. The analysis illustrates the need to include suicide in examinations of gun violence.
... In addition to age group differences, racial/ethnic and geographic variations in suicide methods show that method choice is influenced by culture/norms of the racial/ethnic group and familiarity with and high acceptability of the methods, especially firearms, fostered by their easy availability/accessibility. The finding that women in the South [where gun ownership is high (28)] were 2.5 times more likely than women in the Northeast to die by firearms is consistent with the previous findings of positive relationships between household/self gun ownership and firearm suicide (28)(29)(30)(31)(32)(33). Hispanics and Asian/Pacific Islanders were significantly less likely than Non-Hispanic White to use firearms but they were more likely to use hanging/suffocation. ...
Background and Aims: The U.S. suicide data show that use of lethal methods, specifically firearms and hanging/suffocation, has been increasing among young and middle-aged adults of both sexes over the past decades. In this study, we examined demographic and clinical correlates of use of firearms, hanging/suffocation, and poisoning as suicide methods among suicide decedents age 18+.
Methods: Data came from the 2017-2019 National Violent Death Reporting System (NVDRS; N=94,454, age>=18 at the time of suicide; 74,042 men and 20,412 women). We fit generalized linear models (GLMs) for a Poisson distribution with a log link to examine (1) changes in four suicide methods (firearms, hanging/suffocation, poisoning, and other) during the study period, controlling for sex and age group; and (2) correlates of firearms, hanging/suffocation, and poisoning use.
Results: In all age groups, 55% of men and 30% of women used firearms; 28% of men and 29% of women hanging/suffocation; 9% of men and 32% of women poisoning, and 8% of men and 9% of women “other” methods. Men age<45 had higher likelihood of firearm and/or hanging/suffocation use than those age 45-64. Women age<45 also had higher likelihood of hanging/suffocation than those age 45-64. Prior suicide attempt history was associated with higher likelihood of poisoning in both sexes and hanging/suffocation in men; mental disorders/SUD were associated with higher likelihood of hanging/suffocation and poisoning in both sexes; physical health problems were associated with higher likelihood poisoning in both sexes and firearm use in men; relationship problems were associated with higher likelihood of firearm use; legal problems and job/financial/housing problems were associated with higher likelihood of hanging/suffocation in both sexes; and more crises were associated with higher likelihood of firearm use in both sexes.
Implications: The findings call for the following suicide prevention strategies: (1) restricted access to firearms; (2) improved access to mental health/substance use treatment; (3) improved long-term and palliative care services for those (mostly older adults) with physical health problems; (4) financial/housing support policies to mitigate economic hardship; and (5) more research to identify effective strategies to curtail the increasing use of firearm and hanging/suffocation among young and middle-aged adults.
... In addition to age group differences, racial/ethnic and geographic variations in suicide methods show that method choice is influenced by culture/norms of the racial/ethnic group and familiarity with and high acceptability of the methods, especially firearms, fostered by their easy availability/accessibility. The finding that women in the South [where gun ownership is high (28)] were 2.5 times more likely than women in the Northeast to die by firearms is consistent with the previous findings of positive relationships between household/self gun ownership and firearm suicide (28)(29)(30)(31)(32)(33). Hispanics and Asian/Pacific Islanders were significantly less likely than Non-Hispanic White to use firearms but they were more likely to use hanging/suffocation. ...
Background and aims
The U.S. suicide data show that use of lethal methods, specifically firearms and hanging/suffocation, has been increasing among young and middle-aged adults of both sexes over the past decades. In this study, we examined demographic and clinical correlates of use of firearms, hanging/suffocation, and poisoning as suicide methods among suicide decedents age 18+.
Methods
Data came from the 2017-2019 National Violent Death Reporting System (NVDRS; N = 94,454, age ≥ 18 at the time of suicide; 74,042 men and 20,412 women). We fit generalized linear models (GLMs) for a Poisson distribution with a log link to examine (1) changes in four suicide methods (firearms, hanging/suffocation, poisoning, and other) during the study period, controlling for sex and age group; and (2) correlates of firearms, hanging/suffocation, and poisoning use.
Results
In all age groups, 55% of men and 30% of women used firearms; 28% of men and 29% of women hanging/suffocation; 9% of men and 32% of women poisoning, and 8% of men and 9% of women “other” methods. Men age < 45 had higher likelihood of firearm and/or hanging/suffocation use than those age 45–64. Women age<45 also had higher likelihood of hanging/suffocation than those age 45–64. Prior suicide attempt history was associated with higher likelihood of poisoning in both sexes and hanging/suffocation in men; mental disorders/SUD were associated with higher likelihood of hanging/suffocation and poisoning in both sexes; physical health problems were associated with higher likelihood poisoning in both sexes and firearm use in men; relationship problems were associated with higher likelihood of firearm use; legal problems and job/financial/housing problems were associated with higher likelihood of hanging/suffocation in both sexes; and more crises were associated with higher likelihood of firearm use in both sexes.
Implications
The findings call for the following suicide prevention strategies: (1) restricted access to firearms; (2) improved access to mental health/substance use treatment; (3) improved long-term and palliative care services for those (mostly older adults) with physical health problems; (4) financial/housing support policies to mitigate economic hardship; and (5) more research to identify effective strategies to curtail the increasing use of firearm and hanging/suffocation among young and middle-aged adults.
... It is well known that household firearm ownership is associated with a higher incidence of suicide (Anglemyer et al., 2014;Dahlberg et al., 2004;Kposowa et al., 2016;Se et al., 2018;Shenassa et al., 2004;Wiebe, 2003). Furthermore, states with strong policies that limit firearm access have lower rates of both firearm suicide and total suicide Rudolph et al., 2015), while the repeal of such laws has been associated with increases in suicide rates (Crifasi et al., 2015). ...
Objectives:
In 2013, the state of Maryland passed the Firearms Safety Act limiting the private sales of handguns, which did not apply to long guns often used for hunting (e.g., rifles and shotguns). This decreased the accessibility of handguns relative to long guns. We assessed the frequency of long gun suicides in the years before and after the policy change during winter season, which encompasses hunting season in Maryland.
Methods:
We performed a retrospective analysis on all 4107 well-characterized adult suicides caused by firearms in Maryland from 2003 through 2019. Logistic regression was performed, stratifying by decedent sex, race, and age.
Results:
While handgun suicides decreased in the period after 2013's Firearm Safety Act (p < 0.008), wintertime long gun suicides increased after 2013 (p < 0.004). Caucasian race (p < 0.006), male sex (p < 0.005), and middle age (p < 0.001) were significantly associated with wintertime long gun suicides after 2013.
Conclusion:
Our findings suggest that while the 2013 Firearms Safety Act decreased handgun suicides significantly, it did not reduce long gun suicides and there may even have been replacement with long guns during hunting season, when rifles are out and accessible. This association was most prominent among the demographics most likely to hunt (Caucasian, middle-aged, and male).
... Despite some differences in how researchers conceptualize gun availability and ownership, decades of research documented the association between firearm availability and violent crime (Braga et al., 2002(Braga et al., , 2021Hepburn and Hemenway, 2004;Kellermann et al., 1993;Kovandzic et al., 2013;Kposowa et al., 2016;Steidley et al., 2017). Although a far from settled debate, there is relatively consistent evidence of a positive relationship between gun availability in the broader community and rates of crime (Hepburn and Hemenway, 2004;McDowall, 1991). ...
This city-level study examines the association of federally licensed firearm dealers (FFLs) and measures of illegal firearm availability with the risk of intimate partner homicide. Annual data for a sample of 286 large cities in the United States were collected for the years 2010–2019, incorporating city-level information on the number of gun-perpetrated homicides, the rate of licensed firearm dealers, and guns reported lost or stolen. All data were compiled and analyzed in 2020. Negative binomial models were used to assess the relation of firearm availability and gun homicide by intimate partners, in comparison to gun homicide between non-intimates. Results indicate that a higher rate of licensed firearm dealers was associated with a higher risk of intimate partner homicide, although more pronounced in states with lower-than-average existing gun ownership. This association was robust to different analytical methods and alternate ways of capturing illegal guns. A supplementary analysis using unique data from The Trace further supports the argument that FFL presence is a risk factor for intimate partner firearm homicide specifically, but not necessarily firearm homicide characterized by other motives.
... Firearm regulations, firearm availability and safe storage practices have also been found to be significant predictors of state suicide rates, indicating that the more available firearms are, the more relaxed regulations, and the use of unsafe storage practices were all associated with increased suicide rates. 13 Previous work using Brady Campaign data found that a higher number of firearm laws in states were associated with lowered suicide and homicide rates for the period of 2007-2010. 14 Siegel et al. 15 investigated the impact of universal background checks, violent misdemeanor prohibitions on handgun possession, age 21 limitations for handgun possession, shall issue laws, permitless carry, trafficking laws, junk gun bans, stand your ground laws, assault weapons ban, and large-capacity magazine bans on suicide and homicide rates from 1991 to 2016. ...
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 50 US 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 25 years 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.
... Further, by including variation in the dynamics of suicide by the method of lethality, it may be possible to improve projections when the availability of an attempt method changes. For example, changes to firearm availability affect suicide rates (Brent et al., 1991;Kposowa, Hamilton, & Wang, 2016;Miller et al., 2013), and simulations can incorporate these changing dynamics in mathematical models. ...
Suicide in the US has increased in the last decade, across virtually every age and demographic group. Parallel increases have occurred in non-fatal self-harm as well. Research on suicide across the world has consistently demonstrated that suicide shares many properties with a communicable disease, including person-to-person transmission and point-source outbreaks. This essay illustrates the communicable nature of suicide through analogy to basic infectious disease principles, including evidence for transmission and vulnerability through the agent–host–environment triad. We describe how mathematical modeling, a suite of epidemiological methods, which the COVID-19 pandemic has brought into renewed focus, can and should be applied to suicide in order to understand the dynamics of transmission and to forecast emerging risk areas. We describe how new and innovative sources of data, including social media and search engine data, can be used to augment traditional suicide surveillance, as well as the opportunities and challenges for modeling suicide as a communicable disease process in an effort to guide clinical and public health suicide prevention efforts.
... Examples include regulatory changes in the use of pesticides, or the implementation of the lock-box method for safe pesticide storage [48], the success of which was facilitated by urbanisation and migration from rural areas to the cities, where there is less access to pesticides. The success of such means restriction policies has also been successfully implemented in other Lower-and Middle-Income Countries such as India [49], and may inform firearm regulation policies in the US [50]. ...
Background
Although the suicide rate in China has decreased over the past 20 years, there have been reports that the younger age group has been experiencing an increased incidence of completed suicide. Given that undergraduate groups are at higher risks of suicidality, it is important to monitor and screen for risk factors for suicidal ideation and behaviors to ensure their well-being.
Objective
To examine the risk and protective factors contributing to suicidality among undergraduate college students in seven provinces in China.
Methods
We conducted a cross-sectional study involving 13,387 college students from seven universities in Ningxia, Shandong, Shanghai, Jilin, Qinghai, Shaanxi, and Xinjiang. Data were collected using self-report questionnaires.
Results
Higher scores in the psychological strain, depression, anxiety, stress, and psychache (psychological risk factors for suicidality) and lower scores in self-esteem and purpose in life (psychological protective factors against suicidality) were associated with increased suicidality among undergraduate students in China. Demographic factors which were associated with higher risks of suicidality were female gender, younger age, bad academic results, were an only child, non-participation in school associations, and had an urban household registration. Perceived good health was protective against suicidality.
Conclusions
Knowing the common risk and protective factors for suicidality among Chinese undergraduate students is useful in developing interventions targeted at this population and to guide public health policies on suicide in China.
... 4 Studies using composite measures of firearm law strength find states with stronger laws have fewer firearm injuries, fewer firearm suicides, fewer firearm homicides, and fewer mass shooting events. [5][6][7][8][9] Firearm laws regulate how guns may be sold or purchased and who is eligible to own them, and they fall generally into categories of access restrictions from prohibited persons, possession and carry regulations, regulations on dealers and purchasers of firearms, regulations on types of firearms and ammunition, storage laws, "stand your ground laws", liability/immunity laws and anti-trafficking laws. 10 Many laws currently in effect have been shown to affect firearm mortality but appear to have differential effects on suicide vs homicide and a variable effect on different demographic populations. ...
Background:
Considerable variation in firearm legislation exists. Prior studies show an association between stronger state laws and fewer firearm deaths. We hypothesized that firearms would flow from states with weaker laws to states with stronger laws based on proximity and population.
Methods:
Crime gun trace data from 2015-2017 was accessed from the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) and compared to the count and composition of firearm legislation in 2015 among the contiguous 48 states. Additional independent variables included population, median household income, distance, and presence or absence of a shared border. We used Exponential Random Graph Models to identify predictors of traced firearm transfers between origin and destination states.
Results:
After controlling for network structure, firearm laws in origin states were associated with fewer traced firearm transfers (IRR = 0.88; 95%CI: 0.83, 0.93, p<0.001). Conversely, more firearm laws in destination states were associated with more traced firearm transfers (IRR = 1.10; 95%CI: 1.06, 1.15, p<0.001). Larger population at the origin was associated with increased transfers (IRR = 1.38; 95%CI: 1.27, 1.50, p<0.001), as was larger population at the destination state (IRR = 1.45; 95%CI: 1.35, 1.56, p<0.001). Greater distance was associated with fewer transfers (For each 1,000 kilometers, IRR = 0.35; 95%CI: 0.27, 0.46, p<0.001), and transfers were greater between adjacent states (IRR = 2.49; 95%CI: 1.90, 3.27, p<0.001).
Conclusions:
State firearm legislation has a significant impact on gun trafficking even after controlling for network structure. States with stricter firearm legislation are negatively impacted by states with weaker regulations, as crime guns flow from out-of-state.
Level of evidence:
Level III, retrospective epidemiologic.
... 77,79 On a population level, state firearms suicide rates are related to per capita gun ownership and accessibility and are inversely proportion to the restrictiveness of laws for purchase or storage of firearms. [80][81][82] Means restriction may result in method substitution, but since the case fatality rate for all other methods of suicide is much lower than for firearms, method substitution still gives the suicideattempting patient a better chance at survival. 83 Directing families to remove firearms from the home is rarely successful. ...
Objective:
The rate of adolescent suicide and suicidal behavior has risen dramatically in the past decade. The title of this article comes from the classic coming-of-age novel by J.D. Salinger, The Catcher in the Rye. Its protagonist, Holden Caulfield, is a precocious adolescent who, in the face of his inability to cope with his own self-destructives urges, imagines himself saving "little kids playing some game in this big field of rye." He is standing on the edge of a cliff trying to catch "thousands of little kids" before they fall to their demise. This vignette from The Catcher in the Rye provides a useful metaphor for the relationship between mental health professionals and youth at risk for suicide, and suggests more efficient and effective alternative interventions to prevent youth suicide compared to standing by a cliff.
Method:
These four alternative approaches are described, namely: (1) leading youth away from the cliff (ie, prevention); (2) going to where youth are (ie, improving access to care); (3) working with others to change the rules in the field (ie, changing the way care is delivered); and (4) putting a fence around the cliff (ie, restriction of access to lethal agents). The evidence to support the utility and cost-effectiveness of each of these approaches is reviewed.
Conclusion:
There are extant, empirically supported, cost-effective approaches to the prevention and management of adolescent suicidal behavior that, if implemented widely, are likely to significantly reverse the decade-long rise in adolescent suicide.
... In addition to providing a thorough literature review with a sociological lens, Kposowa et al. (2016) uses a random effects strategy to estimate the association between ease of access to firearms and both overall suicide rates and firearm suicide rates. Their results find a positive correlation between ease of access to firearms and firearm suicide rates, and a negative correlation between strictness of gun laws and firearm suicide rates. ...
With a growing debate over tighter firearm regulations, we consider an important social consequence of increased firearm access: increased firearm suicides. Using data from the federal criminal background check system, we consider the impact of firearm ownership on firearm suicide rates. To deal with concerns of identification, we instrument for firearm background checks with state-year-level Google search intensity for phrases that reflect fear of future gun shortages and learning about the constitutional rights of firearm owners. We find that an increase in firearm ownership has a sizable and statistically significant impact on firearm suicide rates. A 10% increase in firearm ownership increases firearm suicide rates by approximately 3%, which is five times larger than non-instrumented estimates. Furthermore, we find no effect of gun ownership on non-firearm suicide rates, suggesting our findings are not simply capturing a suicide method substitution effect. The results are consistent with a variety of validity and robustness tests. Our results make clear the link between firearm ownership and firearm suicide rates, which have increased dramatically over the last decade.
Background
Although secure firearm storage can prevent firearm injury and death, secure storage is relatively rare. This tendency may be driven in part by a perceived lack of utility for secure storage in preventing suicide and other gun violence‐related outcomes.
Method
We recruited a large ( n = 3510) representative sample of residents from five US states and assessed the degree to which those who do and do not store their firearms securely perceive different utility in specific firearm storage practices for suicide prevention. To test for specificity, we examined if those differences hold when considering unintentional shooting and firearm theft prevention.
Results
Those who currently store their firearms unsecured reported lower perceived utility in several firearm storage practices, particularly for suicide and theft prevention.
Conclusions
Our findings highlight that a lack of perceived utility in secure firearm storage may partially drive unsecure firearm storage. Efforts to promote secure storage must address this misperception.
Background and aims
A 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.
Methods
The 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.
Results
Nearly 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.
Implications
The 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.
The current state of gun violence in the United States involves an uneven distribution of firearms’ lethal violence that undermines the common good by creating intolerable risks of gun death for certain communities and certain people. Building on Catholic commitments to the dignity of every human life and the importance of solidarity as a counterbalance to structural sin, this article explains how Catholics can respond to this problematic status quo in a fashion that aligns with their faith convictions. The article draws on empirical data about the correlations between firearm availability and firearm mortality rates both internationally and within the United States to lay the foundation for a more nuanced evaluation of gun control laws, consistent with the expectation that Catholics will engage political life thoughtfully and with prudential judgment.
Introduction:
Ecologic studies have examined the relationship across states between levels of household gun ownership and suicide rates using household gun ownership data from the Behavioral Risk Factor Surveillance System (BFRSS) or proxies. However, no study has examined how race-specific survey-based or proxy measures of gun ownership are related to race-specific suicide rates.
Methods:
We use cross-sectional state-level race-specific data to examine how well various proxies correlate with race-specific BRFSS gun ownership rates. We examine whether BRFSS measures of household gun ownership are correlated with firearm suicide, non-firearm suicide, and total suicide rates, for Black and for White adults, and repeat these assessments with select proxies. The core BRFSS only included gun questions in 2001, 2002, and 2004, but not since; mortality data are collapsed 2001-2010.
Results:
Among a set of proxies, the race-specific fraction of suicides that are firearm suicides (FS/S) is the measure most highly correlated with BRFSS household gun ownership. Across states, White adult BFRSS household gun ownership levels are highly correlated with White adult firearm suicide rates (correlation coefficient .82) and moderately correlated with White overall suicide rates (.63). However, for Black adults, we find that while the state-level Black gun ownership levels are moderately correlated with Black firearm suicide rates (.67)-more strongly for older (.70) than for younger (.47) Black adults-Black BRFSS gun ownership levels are only weakly correlated with Black overall suicide rates (.17) owing to a moderate inverse correlation with Black non-firearm suicide rates (-.45). For Black adults, the relationship between FS/S and suicide is similar to the relation between BRFSS and suicide.
Conclusion:
For White adults, states with higher levels of measured household gun ownership have higher overall suicide rates. This relationship does not hold for Black adults, largely due to a more attenuated correlation between these measures of firearm availability and firearm suicide rates coupled with a more substantial countervailing (inverse) relationship between these measures and non-firearm suicide rates. Future efforts using individual level data might help determine why this puzzling difference exists, especially for young Black adults.
Backgroud
Firearm injuries are a significant public health problem facing young people in the USA. In 2015, a total of 16 878 people under 19 years old were injured or killed by firearms. To reduce firearm injuries, 29 states and Washington, DC have enacted child access prevention (CAP) legislation. CAP legislation is intended to reduce the likelihood of a minor obtaining a weapon and subsequent injury or death. This study evaluates the impact of CAP legislation based on language of the legislation, specifically it evaluates a relationship of the legal threshold of liability and the number of firearm injuries per capita of minors.
Methods
Data were collected from the Web-based Injury Statistics Query and Reporting System for patients less than 19 years of age who presented to emergency departments with firearm injuries in 2016. The Giffords Law Center classification was used to group states into three categories ( strong / weak / no CAP ) based on CAP language. Differences of firearm-related injury rates per capita were assessed.
Results
When controlling for population, states with CAP legislation had a 22% decrease in firearm injuries per capita compared with states without CAP legislation. States with ‘strong’ CAP legislation had a 41% decrease in firearm injuries per capita compared with states with ‘weak’ or no CAP legislation when controlling for population.
Conclusions
States with ‘strong’ CAP legislation had lower pediatric firearm injury rates per capita, but more complete data and further studies are needed to evaluate this relationship as well as other factors that may impact firearm injury rates.
Objective:
The presence of unlocked firearms in the home is associated with increased risk of suicide and unintentional injury in youth. We adapted an evidence-based program for promoting safe firearm storage, Safety Check, to enhance its acceptability as a universal suicide prevention strategy in pediatric primary care.
Methods:
We applied ADAPT-ITT, an established adaptation framework, to guide iterative program adaptation with ongoing input from key stakeholders. The present study describes two phases of ADAPT-ITT: the Production phase (generating adaptations) and the Topical Experts phase (gathering stakeholder feedback on adaptations). After generating proposed program adaptations based on three inputs (stakeholder feedback collected in a prior study, the behavioral science literature, and best practices in pediatric medicine), we elicited feedback from stakeholders with firearm expertise. The adaptations included changes such as clarifying firearm ownership will not be documented in the medical record and offering follow-up reminders. We also crowdsourced feedback from 337 parents to select a new name and program logo.
Results:
Saturation was reached with 9 stakeholders. Feedback confirmed the value of adaptations that: a) considered context (e.g., reason for ownership), b) promoted parent autonomy in decision-making, and c) ensured privacy. The most preferred program name was Suicide and Accident prevention through Family Education (SAFE) Firearm.
Conclusions:
Guided by an established adaptation framework that prioritized multi-stage stakeholder feedback, adaptations to the original Safety Check were deemed acceptable. We plan to test the SAFE Firearm program as a universal suicide prevention strategy in pediatric primary care via a hybrid effectiveness-implementation trial.
Background:
100,000 Americans are shot annually and 39,000 die. State laws restricting firearm sales and use have been shown to decrease firearm deaths, yet little is known about what impacts their passage or repeal. We hypothesized that spending by groups that favor firearm restrictive legislation would increase new state firearm restrictive laws (FRL) and that states increasing these laws would endure fewer firearm deaths.
Methods:
We acquired 2013-2018 state data on spending by groups against firearm restrictive legislation (A-FRL) and for it (F-FRL) regarding lobbying, campaign, independent and total expenditures from the National Institute on Money in State Politics. State level political party representation data was acquired from the National Conference of State Legislatures. Mass shooting data was obtained from the Mass Shooter Database of the Violence Project and firearm death rates were obtained from CDC WONDER and FBI UCR databases. FRL were obtained from the State Firearms Law Database. A univariate panel linear regression with fixed effect for state was performed with change in FRL from baseline as the outcome. A final multivariable panel regression with fixed effect for state was then utilized. Firearm death rates were compared by whether states increased, decreased or had no change in FRL.
Results:
22 states gained and 13 lost FRL while 15 states had no net change (44%, 26% and 30%, p=0.484). In multivariable regression accounting for partisan control of state government, F-FRL groups outspending A-FRL groups had the largest association with increased FRL (β 1.420, 95% CI 0.63 to 2.21, p<0.001). States which gained FRL had significantly lower firearm death rates (p<0.001). Relative to states with no change in FRL, states which lost FRL had an increase in overall firearm death of 1 per 100,000 individuals. States which gained FRL had a net decrease in median overall firearm death of 0.5 per 100,000 individuals.
Conclusions:
Higher political spending by groups in favor of restrictive firearm legislation has a powerful association with increasing and maintaining FRL States which increased their FRL, in turn, showed lower firearm death rates.
Level of evidence:
Retrospective cohort study, level 3 evidence.
Suicide is among the leading causes of death of 5–24-year-olds in the US, and rates of suicide in this age group have increased over the past 10 years. Almost half of suicides among youth involve a firearm. Substantial evidence indicates that a firearm in the home increases the risk of dying by suicide by making it more likely that suicidal acts will involve firearms. Evidence also suggests that suicide risk among youth living in households with firearms depends on how household firearms are stored (locked is safer than unlocked; unloaded safer than loaded; stored separately from ammunition safer than together with ammunition). Despite the elevated risk that household firearms impose on youth, and the ability to reduce risk by storing guns in ways that make them less accessible, millions of youth live in homes with readily accessible firearms. Approaches to preventing youth suicide by reducing access to firearms have relied largely on efforts to inform personal decision-making by adults in gun-owning homes through interventions at the community level, in primary care practices, and, more recently, in acute care settings. Despite endorsement of counseling parents to reduce access to potentially lethal suicide methods by several US medical societies and parents’ willingness to discuss firearm safety with their child’s pediatrician, few clinicians routinely counsel parents to reduce access to firearms, even for youth acutely at risk for suicide. The limited number of evaluations of clinical interventions to date suggests, though not uniformly, that clinician counseling supplemented with provision of firearm storage devices encourages some parents to store their firearms more safely.
This dissertation examines the causes and effects of four major firearm-related policies in the United States: Concealed Carry Weapons (CCW), Stand Your Ground (SYG), Child Access Prevention (CAP), and Universal Background Checks (UBC). Applying a social movement approach, the first research question addresses how a social movement organization (SMO) has employed resources to shape the adoption of (counter-)movement-related legislation. Using the gun rights movement as a case-in-point, I explore how campaign contributions – conceptualized as a professionalized SMO resource – have been employed by the National Rifle Association (NRA) to shape the adoption of CCW, SYG, CAP, and UBC laws at the state-level between 1990 and 2016. Employing event-history analyses and mediation models, I find campaign contributions are associated with social movement successes – in this case, policy adoption – albeit indirectly: NRA campaign contributions have no direct association with the adoption of any state-level firearm-related legislation. However, campaign contributions do effectively shape the percentage of Republican legislators in a given state’s legislature which, in turn, increases the adoption of gun rights laws (SYG) and decreases the adoption of gun control laws (CAP). The second research question examines the extent to which state-level firearm-related policies affect local-level homicides above and beyond socio-criminological correlates. Although the majority of homicides are conducted with a firearm and homicides vary greatly across counties, gun policy scholarship has often ignored socio-criminological insights and, in turn, may be making inaccurate inferences about the impact of gun policies on homicides, including firearm-related homicides. Analyses presented in this chapter employ hierarchical (i.e., counties nested in states) logistic and negative-binomial models to address substantive and methodological shortcomings in extant gun policy research. Focusing on recent homicide data (2014-2016), results indicate socio-criminological correlates, specifically at the county-level, robustly explain variation in the number of reported homicides, including those associated with firearms. In contrast, state-level gun policies do not seem to provide any additional explanation of county-level homicide variation above these correlates.
Objectives
Although lesbian, gay, bisexual, and transgender (LGBT) people have a higher prevalence of reporting a lifetime suicide attempt than non-LGBT people, suicide prevention research on access to lethal means (eg, firearms) among LGBT people is limited. Our study examined (1) the presence of firearms in the home and (2) among respondents with firearms in the home, the storage of firearms as stored unloaded, stored as loaded and locked, or stored as loaded and unlocked.
Methods
We used data from the 2017 Behavioral Risk Factor Surveillance System surveys from California and Texas (N = 11 694), which were the only states to include items about both sexual orientation and gender identity and the status of firearms in the home. We used logistic regression analysis to assess the association of sexual orientation and gender identity with having firearms in the home while accounting for sociodemographic characteristics and survey state. All analyses were weighted to account for the complex sampling design.
Results
Approximately 4.2% of the sample identified as lesbian, gay, and bisexual (LGB). About 18.2% of LGB people reported firearms in the home compared with 29.9% of their heterosexual peers. After adjusting for sex, age, race/ethnicity, educational attainment, and military veteran status, LGB respondents had significantly lower odds of reporting firearms in the home than their heterosexual peers (adjusted odds ratio = 0.47; 95% CI, 0.27-0.84). Among respondents with firearms in the home, firearm storage did not differ by sexual orientation.
Conclusions
Further research is needed to examine whether lower odds of firearms in the home are protective against suicide deaths among LGB populations.
Blunted: The Effects of Cannabis on Cognition and Motivation
The effects of cannabis on cognition and motivation are key considerations both for clinicians and policy makers alike. The medical research on this topic shows some inconsistency in their conclusions but overall suggests that cannabis can indeed lead to reduced cognitive and motivational abilities, particularly in the areas of verbal memory and attention. Despite suggestions to the contrary, the strength of this evidence goes well beyond simple correlational studies. Fortunately, evidence suggests that at least most of the deficits can be reversed with sustained abstinence, although more research in this area needs to be done. One reason for some of the inconsistent findings in this area may be related to important variables such as amount of use, age, and perhaps THC content that can moderate the amount of risk involved in cannabis use. Research is now going beyond the question of if cannabis is related to cognitive problems and toward a greater understanding of mechanisms that may underlie this process.
Cannabis and Psychiatric Conditions
Cannabis has been legalized in several states for both medical and recreational purposes despite the paucity of scientific evidence regarding its safety and efficacy. Since 2009, a variety of public health and safety trends and statistics have been published, raising questions about the long-term impact of cannabis use on mental health. Research on the use of cannabis for psychiatric conditions is lacking, partly because cannabis is classified as a Schedule I drug, making it all but impossible to conduct the randomized, double-blind, placebo-controlled studies necessary to assess efficacy and safety. For the most part, past studies have been retrospective, with small numbers of subjects. Differing cannabinoid concentrations, differing exclusion criteria, and confounding variables limit the reliability of early study outcomes. Unlike medications approved by the FDA, no post-marketing surveillance is conducted to track unforeseen adverse effects. Despite being a Schedule I drug, cannabis has bypassed the prescription drug monitoring program in many states. Psychosis, depression, anxiety, addiction, violence, and suicidality have all been associated with cannabis use in recent years. In this chapter, I will summarize information about the use of cannabis and how it relates to mental illnesses and behavior, using the strongest publications identified in the literature.
Cannabis Use and Psychosis, Mood, and Anxiety Disorders
Over the past 25 years, results of numerous studies have shown an association between cannabis use and psychosis, mood, and anxiety disorders. However, methodological limitations of individual studies have prevented determination of whether the association is causal or not. Moreover, most previous studies were conducted prior to the increasingly widespread access to high potency cannabis products available in a post-legalization environment. This chapter reviews current research examining the relationship between cannabis use and psychiatric disorders, including findings from a recent meta-analysis (Murrie et al. Schizophr Bull. 16:sbz102, 2019) and a growing body of research addressing the effects of high potency cannabis on this relationship.
Marijuana and Suicide: Case-Control Studies, Population Data, and Potential Neurochemical Mechanisms
A substantial body of epidemiological case-control literature now supports a relationship between chronic marijuana use and an increased risk for suicide, while an emerging clinical literature suggests acute use can lead to the sudden development of suicidal urges in an important minority of subjects. This chapter will review those studies, as well as covering regression analyses conducted on population data for the United States vis-á-vis the correspondence between suicide rates and marijuana use rates, in conjunction with potentially confounding covariates. The data show cause for alarm and highlight the need for public health agencies to forecast potential impacts for the United States as marijuana use rates continue to climb. Mechanisms for an effect of marijuana on suicide are explored, from indirect effects through mental disorders promoted by chronic use to more direct effects relating to underlying neurochemical changes elicited by marijuana both in humans and in animal models.
Cannabis Use Disorder, Treatment, and Recovery
Recovery from a cannabis use disorder is the same as recovery from any substance use disorder from a clinical perspective; from a practical or “real-world” application, it can have many unique qualities.
In this chapter we will refer often to the treatment of SUD, the diagnostic criteria, and treatment recommendations set forth in the latest version of the Diagnostic Statistical Manual (American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edn. 2013.). Recommending cannabis-/THC-specific treatment strategies should be considered adjunctive and complementary to all we know and currently practice when treating SUD. While the cannabis-dependent patient is in many ways unique, they are still a patient being treated/evaluated for SUD.
Introduction:
During the past 2 decades, gun owners have become more likely to store household firearms loaded and unlocked, and believe that guns make homes safer rather than more dangerous.
Methods:
Self-reported household firearm storage practices were described among 2,001 gun owners in relation to whether they report that firearms make homes (1) safer, (2) more dangerous, or (3) it depends. Data were from a probability-based online survey administered in 2015 (completion rate, 55%) and analyzed in 2018.
Results:
Nearly 60% of gun owners said that guns make homes safer (57.6%, 95% CI=55.1%, 60.1%), 39.9% (95% CI=37.4%, 42.5%) said that it depends (on other factors), and 2.5% (95% CI=1.8%, 3.4%) said that guns make homes more dangerous. A higher proportion of gun owners who reported that they believe guns increase household safety said that they store household firearms loaded and unlocked (39.2%, 95% CI=35.9%, 42.6%), compared with those who thought guns make the home either more dangerous (3.7%, 95% CI=1.3%, 10.1%) or those who thought the effect of guns on household safety depends on additional factors (17.5%, 95% CI=14.7%, 20.7%).
Conclusions:
Gun owners who are most likely to assert categorically that firearms in the home make homes safer are, as a group, far more likely to store guns in their home loaded and unlocked.
Objective
To systematically review the methods and findings of previous macro‐level research on the effect of firearms prevalence on suicide rates, and carry out a better state‐level analysis.
Methods
A cross‐sectional model of suicide rates is estimated with weighted least squares, using direct survey measures of gun prevalence.
Results and Conclusion
Prior macro‐level research is afflicted by the use of small samples of large heterogeneous units, invalid measures of gun prevalence, and few controls for confounders. The methodologically soundest prior research indicates that gun prevalence affects rates of gun suicides, but not total suicides. The new analysis likewise finds no significant effect of gun prevalence on total suicide rates.
An extensive body of research has demonstrated an association between gun ownership and suicide that extends beyond the effects of a range of covariates. We aimed to expand on extant research by examining the extent to which gun ownership predicts statewide overall suicide rates beyond the effects of demographic, geographic, religious, psychopathological, and suicide-related variables. By extending the list of covariates utilized, considering those covariates simultaneously, and using more recent data, we sought to present a more stringent test. Gun ownership predicted statewide overall suicide rates, with the full model accounting for more than 92% of the variance in statewide suicide rates. The correlation between firearm suicide rates and the overall suicide rate was significantly stronger than the correlation between nonfirearm suicide rates and the overall suicide rate. These findings support the notion that access to and familiarity with firearms serves as a robust risk factor for suicide. Therefore, means safety efforts aimed at reducing accessibility and increasing safe storage of firearms would likely have a dramatic impact on statewide overall suicide rates.
American Psychological Association report on the prevention of gun violence. Available online http://www.apa.org/news/press/releases/2013/12/gun-violence.aspx
Importance:
Over 30,000 people die annually in the United States from injuries caused by firearms. Although most firearm laws are enacted by states, whether the laws are associated with rates of firearm deaths is uncertain.
Objective:
To evaluate whether more firearm laws in a state are associated with fewer firearm fatalities.
Design:
Using an ecological and cross-sectional method, we retrospectively analyzed all firearm-related deaths reported to the Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System from 2007 through 2010. We used state-level firearm legislation across 5 categories of laws to create a "legislative strength score," and measured the association of the score with state mortality rates using a clustered Poisson regression. States were divided into quartiles based on their score.
Setting:
Fifty US states.
Participants:
Populations of all US states.
Main outcome measures:
The outcome measures were state-level firearm-related fatalities per 100,000 individuals per year overall, for suicide, and for homicide. In various models, we controlled for age, sex, race/ethnicity, poverty, unemployment, college education, population density, nonfirearm violence-related deaths, and household firearm ownership.
Results:
Over the 4-year study period, there were 121,084 firearm fatalities. The average state-based firearm fatality rates varied from a high of 17.9 (Louisiana) to a low of 2.9 (Hawaii) per 100,000 individuals per year. Annual firearm legislative strength scores ranged from 0 (Utah) to 24 (Massachusetts) of 28 possible points. States in the highest quartile of legislative strength (scores of ≥9) had a lower overall firearm fatality rate than those in the lowest quartile (scores of ≤2) (absolute rate difference, 6.64 deaths/100,000/y; age-adjusted incident rate ratio [IRR], 0.58; 95% CI, 0.37-0.92). Compared with the quartile of states with the fewest laws, the quartile with the most laws had a lower firearm suicide rate (absolute rate difference, 6.25 deaths/100,000/y; IRR, 0.63; 95% CI, 0.48-0.83) and a lower firearm homicide rate (absolute rate difference, 0.40 deaths/100,000/y; IRR, 0.60; 95% CI, 0.38-0.95).
Conclusions and relevance:
A higher number of firearm laws in a state are associated with a lower rate of firearm fatalities in the state, overall and for suicides and homicides individually. As our study could not determine cause-and-effect relationships, further studies are necessary to define the nature of this association.
Objectives:
The purpose of the study was to examine the association of suicide rates, firearm ownership, political conservatism, religious integration at the state level, and individual suicide risk. Social structural and social learning and social integration theories were theoretical frameworks employed. It was hypothesized that higher suicide rates, higher state firearm availability, and state conservatism elevate individual suicide risk.
Method:
Data were pooled from the Multiple Cause of Death Files. Multilevel logistic regression models were fitted to all deaths occurring in 2000 through 2004 by suicide.
Results:
The state suicide rate significantly elevated individual suicide risk (AOR = 1.042, CI = 1.037, 1.046). Firearm availability at the state level was associated with significantly higher odds of individual suicide (AOR = 1.004, CI = 1.003, 1.006). State political conservatism elevated the odds of individual suicides (AOR = 1.005, CI = 1.003, 1.007), while church membership at the state level reduced individual odds of suicide (AOR = 0.995, CI = 0.993, 0.996). The results held even after controlling for socioeconomic and demographic variables at the individual level.
Conclusion:
It was concluded that the observed association between individual suicide odds and national suicide rates, and firearm ownership cannot be discounted. Future research ought to focus on integrating individual level data and contextual variables when testing for the impact of firearm ownership. Support was found for social learning and social integration theories.
Using pooled cross-sectional time-series data for the 50 U.S. states over a 25-year period, this article examines how well four conceptual groups of social correlates-demographic, economic, social, and cultural factors-are associated with the 1976-2000 patterns in overall suicide rates and suicide by firearms and other means. Unlike past research that typically considers only one dimension, this analysis differentiates between spatial and temporal variation in suicide rates to determine whether and how social correlates operate differently in these two contexts. Results indicate that suicide rates correspond closely to social correlates. Within U.S. states, lower overall suicide rates between 1976 and 2000 were associated with demographic change (e.g., larger numbers of foreign-born) as well as with fewer numbers of Episcopalians. Across U.S. states, variation in overall suicide rates over the period was related to demographic (percentage male), economic (per capita income), social (percentage divorced), and cultural (alcohol consumption and gun ownership) factors. However, findings differ importantly by type of suicide, and across time and space. Reasons for these distinct patterns are discussed.
We examined trends in suicide rates for U.S. residents aged 40 to 59 years from 1979 to 2005 and explored alternative explanations for the notable increase in such deaths from 1999 to 2005.
We obtained information on suicide deaths from the National Center for Health Statistics and population data from the U.S. Census Bureau. Age- and gender-specific suicide rates were computed and trends therein analyzed using linear regression techniques.
Following a period of stability or decline, suicide rates have climbed since 1988 for males aged 40-49 years, and since 1999 for females aged 40-59 years and males aged 50-59 years. A crossover in rates for 40- to 49-year-old vs. 50- to 59-year-old males and females occurred in the early 1990s, and the younger groups now have higher suicide rates. The post-1999 increase has been particularly dramatic for those who are unmarried and those without a college degree.
The timing of the post-1999 increase coincides with the complete replacement of the U.S. population's middle-age strata by the postwar baby boom cohorts, whose youngest members turned 40 years of age by 2005. These cohorts, born between 1945 and 1964, also had notably high suicide rates during their adolescent years. Cohort replacement may explain the crossover in rates among the younger and older middle-aged groups. However, there is evidence for a period effect operating between 1999 and 2005, one that was apparently specific to less-protected members of the baby boom cohort.
The purpose of the study was to examine the effect of marital status on the risk of suicide, using a large nationally representative sample. A related objective was to investigate the association between marital status and suicide by sex.
Cox proportional hazards regression models were applied to data from the National Longitudinal Mortality Study, based on the 1979-1989 follow up. In estimating the effect of marital status, adjustments were made for age, sex, race, education, family income, and region of residence.
For the entire sample, higher risks of suicide were found in divorced than in married persons. Divorced and separated persons were over twice as likely to commit suicide as married persons (RR = 2.08, 95% confidence intervals (95% CI) 1.58, 2.72). Being single or widowed had no significant effect on suicide risk. When data were stratified by sex, it was observed that the risk of suicide among divorced men was over twice that of married men (RR = 2.38, CI 1.77, 3.20). Among women, however, there were no statistically significant differentials in the risk of suicide by marital status categories.
Marital status, especially divorce, has strong net effect on mortality from suicide, but only among men. The study showed that in epidemiological research on suicide, more accurate results would be obtained if samples are stratified on the basis of key demographic or social characteristics. The study further observed that failure to control for relevant socioeconomic variables or combining men and women in the same models could produce misleading results.
Cross sectional studies in the United States often find a significant positive association between levels of household firearm ownership and suicide rates. This study investigates whether the association can be explained by differences in levels of mental health.
The relationship between household handgun ownership and overall suicide rates across United States regions after accounting for two mental health variables-lifetime prevalence of major depression and serious suicidal thoughts-were examined. Analyses also add another control variable (urbanization, education, unemployment, or alcohol consumption). Data on mental health variables come from the National Comorbidity Study, conducted in the early 1990s. Data on household handgun ownership come from the General Social Surveys.
Across the nine regions for the early 1990s (n = 9), household handgun ownership rates are positively correlated with the suicide rate (r = 0.59) and are not correlated with either the lifetime prevalence of major depression or suicidal thoughts. After controlling for major depression and suicidal thoughts (and any of the four additional control variables), handgun ownership rates remain significantly associated with the overall suicide rate.
In United States regions with higher levels of household handgun ownership, there are higher suicide rates. This relationship cannot be explained by differences in the prevalence of two mental health indicators-lifetime rates of either major depression or suicidal thoughts.
(1) To quantify lethality of firearms relative to other suicide methods, (2) to quantify the extent to which suicide mortality may be reduced by limiting access to firearms.
Data on suicides and hospitalised para-suicides that occurred in the state of Illinois from 1990 to 1997 were combined. Total number of episodes for each suicide method was estimated as the sum of the number of suicides and the number of para-suicides for that method. Gender and suicide method were used as proxies for intention to die, and estimated lethality of suicide methods within method-gender groups (for example, male firearm users). Logistic regression was used to quantify the lethality of firearms relative to other suicide methods. Excess mortality associated with the use of firearms was estimated by conservatively assuming that in the absence of firearms the next most lethal suicide method would be used.
From January 1990 to December 1997, among individuals 10 years or older in the state of Illinois, there were 37,352 hospital admissions for para-suicide and 10,287 completed suicides. Firearms are the most lethal suicide method. Episodes involving firearms are 2.6 times (95% CI 2.1 to 3.1) more lethal than those involving suffocation-the second most lethal suicide method. Preventing access to firearms can reduce the proportion of fatal firearms related suicides by 32% among minors, and 6.5% among adults.
Limiting access to firearms is a potentially effective means of reducing suicide mortality.
To determine the proportion of unintentional and undetermined firearm related deaths preventable by three safety devices: personalization devices, loaded chamber indicators (LCIs), and magazine safeties. A personalized gun will operate only for an authorized user, a LCI indicates when the gun contains ammunition, and a magazine safety prevents the gun from firing when the ammunition magazine is removed.
Information about all unintentional and undetermined firearm deaths from 1991-98 was obtained from the Office of the Chief Medical Examiner for Maryland, and from the Wisconsin Firearm Injury Reporting System for Milwaukee. Data regarding the victim, shooter, weapon, and circumstances were abstracted. Coding rules to classify each death as preventable, possibly preventable, or not preventable by each of the three safety devices were also applied.
There were a total of 117 firearm related deaths in our sample, 95 (81%) involving handguns. Forty three deaths (37%) were classified as preventable by a personalized gun, 23 (20%) by a LCI, and five (4%) by a magazine safety. Overall, 52 deaths (44%) were preventable by at least one safety device. Deaths involving children 0-17 (relative risk (RR) 3.3, 95% confidence interval (CI) 2.1 to 5.1) and handguns (RR 8.1, 95% CI 1.2 to 53.5) were more likely to be preventable. Projecting the findings to the entire United States, an estimated 442 deaths might have been prevented in 2000 had all guns been equipped with these safety devices.
Incorporating safety devices into firearms is an important injury intervention, with the potential to save hundreds of lives each year.
To estimate the protective effect of storing firearms locked or unloaded, or both, on the risk of suicide by firearms among people with relatively low intention to die.
Cross sectional survey. The 1993 National Mortality Followback Survey of 22 957 deaths in the United States, representing 2.2 million people, conducted by the National Center for Health Statistics.
Decedent's next of kin answered questions regarding various aspects of decedent's life to supplement information from death certificates.
Compared with decedents who stored their firearm unlocked or loaded, those who stored their firearms locked or unloaded, or both, were less likely to commit suicide by firearms (locked: OR = 0.39, 95% CI = 0.24 to 0.66; unloaded OR = 0.30, 95% CI = 0.18 to 0.49).
This study further supports the utility of devices and practices intended to reduce the likelihood of unauthorised or impulsive use of firearms.
Household firearms are associated with an elevated risk of firearm death to occupants in the home. Many organizations and health authorities advocate locking firearms and ammunition to prevent access to guns by children and adolescents. The association of these firearm storage practices with the reduction of firearm injury risk is unclear.
To measure the association of specific household firearm storage practices (locking guns, locking ammunition, keeping guns unloaded) and the risk of unintentional and self-inflicted firearm injuries.
Case-control study of firearms in events identified by medical examiner and coroner offices from 37 counties in Washington, Oregon, and Missouri, and 5 trauma centers in Seattle, Spokane, and Tacoma, Wash, and Kansas City, Mo. CASES AND CONTROLS: Case firearms were identified by involvement in an incident in which a child or adolescent younger than 20 years gained access to a firearm and shot himself/herself intentionally or unintentionally or shot another individual unintentionally. Firearm assaults and homicides were excluded. We used records from hospitals and medical examiners to ascertain these incidents. Using random-digit dial telephone sampling, control firearms were identified by identification of eligible households with at least 1 firearm and children living or visiting in the home. Controls were frequency matched by age group and county. MAIN EXPOSURE MEASURES: The key exposures of interest in this study were: (1) whether the subject firearm was stored in a locked location or with an extrinsic lock; (2) whether the firearm was stored unloaded; (3) whether the firearm was stored both unloaded in a locked location; (4) whether the ammunition for the firearm was stored separately; and (5) whether the ammunition was stored in a locked location. Data regarding the storage status of case and control guns were collected by interview with respondents from the households of case and control firearms.
We interviewed 106 respondents with case firearms and 480 with control firearms. Of the shootings associated with the case firearms, 81 were suicide attempts (95% fatal) and 25 were unintentional injuries (52% fatal). After adjustment for potentially confounding variables, guns from case households were less likely to be stored unloaded than control guns (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.16-0.56). Similarly, case guns were less likely to be stored locked (OR, 0.27; 95% CI, 0.17-0.45), stored separately from ammunition (OR, 0.45; 95% CI, 0.34-0.93), or to have ammunition that was locked (OR, 0.39; 95% CI, 0.23-0.66) than were control guns. These findings were consistent for both handguns and long guns and were also similar for both suicide attempts and unintentional injuries.
The 4 practices of keeping a gun locked, unloaded, storing ammunition locked, and in a separate location are each associated with a protective effect and suggest a feasible strategy to reduce these types of injuries in homes with children and teenagers where guns are stored.
To explore whether recent declines in household firearm prevalence in the United States were associated with changes in rates of suicide for men, women, and children.
This time series study compares changes in suicide rates to changes in household firearm prevalence, 1981-2002. Multivariate analyses adjust for age, unemployment, per capita alcohol consumption, and poverty. Regional fixed effects controlled for cross sectional, time invariant differences among the four census regions. Standard errors of parameter estimates are adjusted to account for serial autocorrelation of observations over time.
Over the 22 year study period household firearm ownership rates declined across all four regions. In multivariate analyses, each 10% decline in household firearm ownership was associated with significant declines in rates of firearm suicide, 4.2% (95% CI 2.3% to 6.1%) and overall suicide, 2.5% (95% CI 1.4% to 3.6%). Changes in non-firearm suicide were not associated with changes in firearm ownership. The magnitude of the association between changes in household firearm ownership and changes in rates of firearm and overall suicide was greatest for children: for each 10% decline in the percentage of households with firearms and children, the rate of firearm suicide among children 0-19 years of age dropped 8.3% (95% CI 6.1% to 10.5%) and the rate of overall suicide dropped 4.1% (2.3% to 5.9%).
Changes in household firearm ownership over time are associated with significant changes in rates of suicide for men, women, and children. These findings suggest that reducing availability to firearms in the home may save lives, especially among youth.
To examine the size and composition of the privately held firearm stock in the US; and to describe demographic patterns of firearm ownership and motivations for ownership. Design,
A nationally representative household telephone survey of 2770 adults aged>or=18 years living in the US, conducted in the spring of 2004.
Responses to questions regarding firearm ownership, the number and types of guns owned, and motivations for ownership.
38% of households and 26% of individuals reported owning at least one firearm. This corresponds to 42 million US households with firearms, and 57 million adult gun owners. 64% of gun owners or 16% of American adults reported owning at least one handgun. Long guns represent 60% of the privately held gun stock. Almost half (48%) of all individual gun owners reported owning>or=4 firearms. Men more often reported firearm ownership, with 45% stating that they personally owned at least one firearm, compared with 11% for women.
The US population continues to contain at least one firearm for every adult, and ownership is becoming increasingly concentrated. Long guns are the most prevalent type of gun in the US but handgun ownership is widespread. Ownership demographic patterns support findings of previous studies.
In examining various aspects of the provision of security, the Small Arms Survey 2011 considers the growth of the private security industry and its firearms holdings worldwide; the firearms holdings of private security personnel; the use of private security companies by multinational corporations; the use of emerging weapons technology among Western police forces; and legislative controls over the civilian possession of firearms in 42 jurisdictions around the world. Case studies provide original research on ongoing security challenges in Côte d'Ivoire, Haiti and Madagascar. This edition also presents the 2011 Small Arms Trade Transparency Barometer, an estimate of the annual authorized trade in light weapons, and a review of developments related to small arms control at the United Nations. © Small Arms Survey, Graduate Institute of International and Development Studies, Geneva 2011.
Objective
We examined trends in suicide rates for U.S. residents aged 40 to 59 years from 1979 to 2005 and explored alternative explanations for the notable increase in such deaths from 1999 to 2005.
Methods
We obtained information on suicide deaths from the National Center for Health Statistics and population data from the U.S. Census Bureau. Age- and gender-specific suicide rates were computed and trends therein analyzed using linear regression techniques.
Results
Following a period of stability or decline, suicide rates have climbed since 1988 for males aged 40–49 years, and since 1999 for females aged 40–59 years and males aged 50–59 years. A crossover in rates for 40- to 49-year-old vs. 50- to 59-year-old males and females occurred in the early 1990s, and the younger groups now have higher suicide rates. The post-1999 increase has been particularly dramatic for those who are unmarried and those without a college degree.
Conclusions
The timing of the post-1999 increase coincides with the complete replacement of the U.S. population's middle-age strata by the postwar baby boom cohorts, whose youngest members turned 40 years of age by 2005. These cohorts, born between 1945 and 1964, also had notably high suicide rates during their adolescent years. Cohort replacement may explain the crossover in rates among the younger and older middle-aged groups. However, there is evidence for a period effect operating between 1999 and 2005, one that was apparently specific to less-protected members of the baby boom cohort.
Context: The source and ownership of guns used by children to shoot themselves or others is largely unknown. Objective: To determine the ownership and usual storage location of firearms used in unintentional and self-inflicted intentional firearm deaths and injuries. Design: Retrospective case series. Setting: King County, Washington. Patients: Youths aged from birth to 19 years who sought medical treatment at a level I trauma center for a self-inflicted or unintentional firearm injury between 1990 and 1995 or who presented to the county medical, examiner with a fatal self-inflicted or unintentional firearm injury between 1990 and 1995. Data Sources: County medical examiner records, regional police investigative reports, medical records from a level I trauma center, and surveys of victims' families. Main Outcome Measures: Source and ownership of the associated firearm. Results: Fifty-six fatal injuries and 68 nonfatal firearm injuries that met the criteria were identified. Of these, 59 were intentionally self-inflicted deaths and injuries and 65 were unintentional deaths and injuries. A firearm owned by a household member living with the victim was used in 33 (65%) of 51 suicides and suicide attempts and 11 (23%) of 47 unintentional injuries and deaths. Additionally, a firearm owned by another relative, friend, or parent of a friend of the victim was used in 4 (8%) of the 51 suicides and suicide attempts and 23 (49%) of the 47 unintentional injuries and deaths. Parental ownership accounted for 29 (57%) of the 51 suicides and suicide attempts and 9 (19%) of the 47 unintentional injuries and deaths. More than 75% of the guns used in suicide attempts and unintentional injuries were stored in the residence of the victim, a relative, or a friend. Conclusion: Most guns involved in self-inflicted and unintentional firearm injuries originate either from the victim's home or the home of a friend or relative.
Education at a Glance 2013: Highlights summarises the OECD’s flagship compendium of education statistics, Education at a Glance. It provides easily accessible data on key topics in education today, including:
• Education levels and student numbers: How far have adults studied, and how does early childhood education affect student performance later on?
• Higher education and work: How many young people graduate from tertiary education, and how easily do they enter the world of work?
• Economic and social benefits of education: How does education affect people’s job prospects, and what is its impact on incomes?
• Paying for education: What share of public spending goes on education, and what is the role of private spending?
• The school environment: How many hours do teachers work, and how does class size vary?
Each indicator is presented on a two-page spread. The left-hand page explains the significance of the indicator, discusses the main findings, examines key trends and provides readers with a roadmap for finding out more in the OECD education databases and in other OECD education publications. The right-hand page contains clearly presented charts and tables, accompanied by dynamic hyperlinks (StatLinks) that direct readers to the corresponding data in Excel™ format.
SAS PROC MIXED is a flexible program suitable for fitting multilevel models, hierarchical linear models, and individual growth models. Its position as an integrated program within the SAS statistical package makes it an ideal choice for empirical researchers and applied statisticians seeking to do data reduction, management, and analysis within a single statistical package. Because the program was developed from the perspective of a "mixed" statistical model with both random and fixed effects, its syntax and programming logic may appear unfamiliar to users in education and the social and behavioral sciences who tend to express these models as multilevel or hierarchical models. The purpose of this paper is to help users familiar with fitting multilevel models using other statistical packages (e.g., HLM, MLwiN, MIXREG) add SAS PROC MIXED to their array of analytic options. The paper is written as a step-by-step tutorial that shows how to fit the two most common multilevel models: (a) school effects models, designed for data on individuals nested within naturally occurring hierarchies (e.g., students within classes); and (b) individual growth models, designed for exploring longitudinal data (on individuals) over time. The conclusion discusses how these ideas can be extended straighforwardly to the case of three level models. An appendix presents general strategies for working with multilevel data in SAS and for creating data sets at several levels.
This study investigated whether state levels of social capital are associated with rates of completed suicides in the fifty U.S. states. To do this we regressed state-level suicide rates on an index of social capital, along with other variables known to influence suicide rates such as gun ownership, income inequality, alcohol abuse and dependence, drug abuse and dependence, serious mental illness, unemployment, percent of population living in urban areas, poverty, population instability, and living in a "suicide belt" state. Suicide rates were aggregated from 1999 to 2002, and examined separately by sex and different race/ethnic groups. The results showed that White men and women in states with higher levels of social capital had significantly lower rates of suicide when controlling for the other influential variables. When we examined sub-dimensions of social capital, we found that community organizations (for White women) and group membership (for White men) were particularly strongly associated with lower suicide risk.
Case-control studies show an association between firearms in the home and completed suicide, with higher risks associated with loaded guns and handguns in the home. Quasi-experimental studies also show a relationship between greater restrictiveness of gun control laws and lower suicide rates by firearms and overall, although some studies fail to show an effect or show method substitution. A prospective study shows that handgun purchasers have an elevated risk for suicide for up to 6 years after the purchase. Relatively few studies have examined the impact of intervention to encourage families to store guns safely or remove firearms from the home on suicidal outcome.
SAS PROC MIXED is a flexible program suitable for fitting multilevel models, hierarchical linear models, and individual growth models. Its position as an integrated program within the SAS statistical package makes it an ideal choice for empirical researchers and applied statisticians seeking to do data reduction, management, and analysis within a single statistical package. Because the program was developed from the perspective of a "mixed" statistical model with both random and fixed effects, its syntax and programming logic may appear unfamiliar to users in education and the social and behavioral sciences who tend to express these models as multilevel or hierarchical models. The purpose of this paper is to help users familiar with fitting multilevel models using other statistical packages (e.g., HLM, MLwiN, MIXREG) add SAS PROC MIXED to their array of analytic options. The paper is written as a step-by-step tutorial that shows how to fit the two most common multilevel models: (a) school effects models, designed for data on individuals nested within naturally occurring hierarchies (e.g., students within classes); and (b) individual growth models, designed for exploring longitudinal data (on individuals) over time. The conclusion discusses how these ideas can be extended straighforwardly to the case of three level models. An appendix presents general strategies for working with multilevel data in SAS and for creating data sets at several levels.
There is an intuitive appeal to the notion that the more lethal the weaponry the more lethal the violence. We explore one aspect of lethal weaponry, firearm accessibility. Using nation-level (N = 168) data from the Small Arms Survey and the World Health Organization's measures of mortality we examine whether rates of small arm ownership have a positive effect on rates of homicide and suicide. Contrary to the opportunity model, the accessibility of firearms does not produce more homicide or suicide when other known factors are controlled for. Consistent with past research, structural factors, like deprivation, explain a large portion of the cross-national variation in homicide and suicide, with some interesting differences between the two models. We discuss explanations for our findings and suggest that firearm accessibility may make some structural positions more lethal.
Previous studies have found that primary care resources are associated with various health outcomes. The primary purpose of the study was to test for associations between psychiatrist availability, social disintegration and suicide rates. Data utilized were from the 2002 Area Resource File on U.S. counties (N=3080). Suicide rates were averaged over 6 years covering 1990 through 1995. Poisson and Negative binomial regression models were used to assess the association of psychiatrist availability and suicide rate ratios. Availability of psychiatrists was significantly related to suicide. Counties with greater availability of psychiatrists per 10,000 experienced a 0.12% reduction in their suicide rates (β=−0.0012, incidence density ratio [IDR]=0.9988, 95% CI=0.9984–0.9992). Divorce strongly elevated suicide rates (β=0.0724, IDR=1.0751, 95% CI=1.0664–.0858). Counties with a high percentage of men 65 years or older had significantly high suicide rates. An increase in the White population between 1980 and 1990 was also associated with a significant increase in suicide. Increases in psychiatrists reduced suicide rates, but the association was small. Psychiatrist availability may also partially reduce the effects of social disintegration at the county level. Primary care was not associated with suicide once other variables, including hospital beds were taken into account. Results provide evidence to suggest that greater mental health promotion might reduce area inequalities in suicide rates. © 2008 Wiley Periodicals, Inc.
Suicide rates are affected by many factors—psychiatric, biological, familial and situational. This paper focuses on one potential risk factor for completed suicide in the United States—the availability of firearms. Whether the availability of firearms might increase the rate of attempted suicide is not examined. This article is not an exhaustive review of every existing firearm-related suicide study. Rather, it provides a detailed review of the most commonly cited, representative, and thorough empirical studies in the published peer-reviewed literature relating firearms and suicide, focusing largely on the United States. The empirical studies reviewed are grouped according to whether the unit of analysis is the individual (e.g., case-control studies) or a population (e.g., ecological studies) and further divided depending on whether the analysis uses cross-sectional or time-series (longitudinal) data. We begin with a very brief overview of the suicide problem in the United States.
Suicide mortality varies widely across age, sex, race, and geography, far more than does mortality from the leading causes of natural death. Unlike the tight correlation between cancer mortality and the incidence of cancer, suicide mortality is only modestly correlated with the incidence of suicidal acts and other established risk factors for suicidal behavior, such as major psychiatric disorders. An implication of this modest correlation is that the proportion of all suicidal acts that prove fatal (the case fatality ratio) must account for a substantial portion of the (nonrandom) variation observed in suicide mortality. In the United States, the case fatality ratio is strongly related to the availability of household firearms. Findings from ecologic and individual-level studies conducted over the past two decades illustrate the importance of accounting for the availability of highly lethal suicide methods in efforts to understand (and ultimately reduce) disparities in suicide mortality across populations.
The current investigation explores the association between rates of household firearm ownership and suicide across the 50 states. Prior ecologic research on the relationship between firearm prevalence and suicide has been criticized for using problematic proxy-based, rather than survey-based, estimates of firearm prevalence and for failing to control for potential psychological risk factors for suicide. We address these two criticisms by using recently available state-level survey-based estimates of household firearm ownership, serious mental illness, and alcohol/illicit substance use and dependence.
Negative binomial regression was used to assess the relationship between household firearm ownership rates and rates of firearm, nonfirearm, and overall suicide for both sexes and for four age groups. Analyses controlled for rates of poverty, urbanization, unemployment, mental illness, and drug and alcohol dependence and abuse.
US residents of all ages and both sexes are more likely to die from suicide when they live in areas where more households contain firearms. A positive and significant association exists between levels of household firearm ownership and rates of firearm and overall suicide; rates of nonfirearm suicide were not associated with levels of household firearm ownership.
Household firearm ownership levels are strongly associated with higher rates of suicide, consistent with the hypothesis that the availability of lethal means increases the rate of completed suicide.
The association between home firearms and the likelihood and nature of suicidal thoughts and plans was examined using the Second Injury Control and Risk Survey, a 2001-2003 representative telephone survey of U.S. households. Of 9,483 respondents, 7.4% reported past-year suicidal thoughts, 21.3% with a plan. Similar proportions of those with and without a home firearm reported suicidal thoughts, plans, and attempts. Among respondents with suicidal plans, the odds of reporting a plan involving a firearm were over seven times greater among those with firearms at home, compared with those without firearms at home. The results suggest people with home firearms may not be more likely to be suicidal, but when suicidal they may be more likely to plan suicide by firearm.
To empirically assess the impact of firearm regulation on male suicides.
A negative binomial regression model was applied by using a panel of state level data for the years 1995-2004. The model was used to identify the association between several firearm regulations and male suicide rates.
Our empirical analysis suggest that firearms regulations which function to reduce overall gun availability have a significant deterrent effect on male suicide, while regulations that seek to prohibit high risk individuals from owning firearms have a lesser effect.
Restricting access to lethal means has been identified as an effective approach to suicide prevention, and firearms regulations are one way to reduce gun availability. The analysis suggests that gun control measures such as permit and licensing requirements have a negative effect on suicide rates among males. Since there is considerable heterogeneity among states with regard to gun control, these results suggest that there are opportunities for many states to reduce suicide by expanding their firearms regulations.
The aspects of this text which we believe are novel, at least in degree, include: an effort to motivate different sections with practical examples and an empirical orientation; an effort to intersperse several easily motivated examples throughout the book and to maintain some continuity in these examples; and the extensive use of Monte Carlo simulations to demonstrate particular aspects of the problems and estimators being considered. In terms of material being presented, the unique aspects include the first chapter which attempts to address the use of empirical methods in the social sciences, the seventh chapter which considers models with discrete dependent variables and unobserved variables. Clearly these last two topics in particular are quite advanced--more advanced than material that is currently available on the subject. These last two topics are also currently experiencing rapid development and are not adequately described in most other texts.
It has been suggested that limiting access to firearms could prevent many suicides, but this belief is controversial. To assess the strength of the association between the availability of firearms and suicide, we studied all suicides that took place in the homes of victims in Shelby County, Tennessee, and King County, Washington, over a 32-month period.
For each suicide victim (case subject), we obtained data from police or the medical examiner and interviewed a proxy. Their answers were compared with those of control subjects from the same neighborhood, matched with the victim according to sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods.
During the study period, 803 suicides occurred in the two counties, 565 of which (70 percent) took place in the home of the victim. Fifty-eight percent (326) of these suicides were committed with a firearm. After excluding 11 case subjects for various reasons, we were able to interview 80 percent (442) of the proxies for the case subjects. Matching controls were identified for 99 percent of these subjects, producing 438 matched pairs. Univariate analyses revealed that the case subjects were more likely than the controls to have lived alone, taken prescribed psychotropic medication, been arrested, abused drugs or alcohol, or not graduated from high school. After we controlled for these characteristics through conditional logistic regression, the presence of one or more guns in the home was found to be associated with an increased risk of suicide (adjusted odds ratio, 4.8; 95 percent confidence interval, 2.7 to 8.5).
Ready availability of firearms is associated with an increased risk of suicide in the home. Owners of firearms should weigh their reasons for keeping a gun in the home against the possibility that it might someday be used in a suicide.
The source and ownership of guns used by children to shoot themselves or others is largely unknown.
To determine the ownership and usual storage location of firearms used in unintentional and self-inflicted intentional firearm deaths and injuries.
Retrospective case series.
King County, Washington.
Youths aged from birth to 19 years who sought medical treatment at a level I trauma center for a self-inflicted or unintentional firearm injury between 1990 and 1995 or who presented to the county medical examiner with a fatal self-inflicted or unintentional firearm injury between 1990 and 1995.
County medical examiner records, regional police investigative reports, medical records from a level I trauma center, and surveys of victims' families.
Source and ownership of the associated firearm.
Fifty-six fatal injuries and 68 nonfatal firearm injuries that met the criteria were identified. Of these, 59 were intentionally self-inflicted deaths and injuries and 65 were unintentional deaths and injuries. A firearm owned by a household member living with the victim was used in 33 (65%) of 51 suicides and suicide attempts and 11 (23%) of 47 unintentional injuries and deaths. Additionally, a firearm owned by another relative, friend, or parent of a friend of the victim was used in 4 (8%) of the 51 suicides and suicide attempts and 23 (49%) of the 47 unintentional injuries and deaths. Parental ownership accounted for 29 (57%) of the 51 suicides and suicide attempts and 9 (19%) of the 47 unintentional injuries and deaths. More than 75% of the guns used in suicide attempts and unintentional injuries were stored in the residence of the victim, a relative, or a friend.
Most guns involved in self-inflicted and unintentional firearm injuries originate either from the victim's home or the home of a friend or relative.
In February 1994, the Brady Handgun Violence Prevention Act established a nationwide requirement that licensed firearms dealers observe a waiting period and initiate a background check for handgun sales. The effects of this act have not been analyzed.
To determine whether implementation of the Brady Act was associated with reductions in homicide and suicide rates.
Analysis of vital statistics data in the United States for 1985 through 1997 from the National Center for Health Statistics.
Total and firearm homicide and suicide rates per 100,000 adults (>/=21 years and >/=55 years) and proportion of homicides and suicides resulting from firearms were calculated by state and year. Controlling for population age, race, poverty and income levels, urban residence, and alcohol consumption, the 32 "treatment" states directly affected by the Brady Act requirements were compared with the 18 "control" states and the District of Columbia, which had equivalent legislation already in place.
Changes in rates of homicide and suicide for treatment and control states were not significantly different, except for firearm suicides among persons aged 55 years or older (-0.92 per 100,000; 95% confidence interval [CI], -1.43 to -0.42). This reduction in suicides for persons aged 55 years or older was much stronger in states that had instituted both waiting periods and background checks (-1.03 per 100,000; 95% CI, -1.58 to -0.47) than in states that only changed background check requirements (-0.17 per 100,000; 95% CI, -1.09 to 0.75).
Based on the assumption that the greatest reductions in fatal violence would be within states that were required to institute waiting periods and background checks, implementation of the Brady Act appears to have been associated with reductions in the firearm suicide rate for persons aged 55 years or older but not with reductions in homicide rates or overall suicide rates. However, the pattern of implementation of the Brady Act does not permit a reliable analysis of a potential effect of reductions in the flow of guns from treatment-state gun dealers into secondary markets. JAMA. 2000;284:585-591
With a set of relevant controls, including population change, income, urbanity, unemployment, and female labor-force participaion, Durkheim's religious and family integration hypotheses are tested with new and highly reliable church membership rates and similar divorce rates. Eight data sets are analyzed at two levels of analysis, state and county: 50 states at six different times betwen 1933 and 1980 and 216 counties in 1970 and 1980. The religous and family integration variables are generally supported at both levels of analysis and across the 47 years of the study. Contrary to previous studies, support is found for Durkheim's thesis that Catholics have lower suicide rates than non-Catholics. Strong Catholic/non-Catholic suicide differences are found even when the analysis is extended to 414 counties in 1970 and 1980.
I test the hypothesis that having a gun in the home is a risk factor for adults to be killed (homicide) or to commit suicide.
Two case-control analyses were based on national samples of subjects 18 years of age or older. Homicide and suicide case subjects were drawn from the 1993 National Mortality Followback Survey. Living control subjects were drawn from the 1994 National Health Interview Survey. Ten control subjects matched by sex, race, and age group were sought for each case subject.
The homicide sample consisted of 1,720 case subjects and 8,084 control subjects. Compared with adults in homes with no guns, the adjusted odds ratio (OR) for homicide was 1.41 (95% confidence interval [CI] 1.20 to 1.65) for adults with a gun at home and was particularly high among women (adjusted OR 2.72; 95% CI 1.89 to 3.90) compared with men (adjusted OR 1.23; 95% CI 1.01 to 1.49) and among nonwhite subjects (adjusted OR 1.74; 95% CI 1.37 to 2.21) compared with white subjects (adjusted OR 1.27; 95% CI 1.03 to 1.56). Further analyses revealed that a gun in the home was a risk factor for homicide by firearm means (adjusted OR 1.72; 95% CI 1.40 to 2.12) but not by nonfirearm means (OR 0.83; 95% CI 0.62 to 1.11). The suicide sample consisted of 1,959 case subjects and 13,535 control subjects. The adjusted OR for suicide was 3.44 (95% CI 3.06 to 3.86) for persons with a gun at home. However, further analysis revealed that having a firearm in the home was a risk factor for suicide by firearm (adjusted OR 16.89; 95% CI 13.26 to 21.52) but was inversely associated with suicide by other means (adjusted OR 0.68; 95% CI 0.55 to 0.84).
Having a gun at home is a risk factor for adults to be shot fatally (gun homicide) or commit suicide with a firearm. Physicians should continue to discuss with patients the implications of keeping guns at home. Additional studies are warranted to address study limitations and to better understand the implications of firearm ownership.
This study examined the relationship of 16 variables with homicide, suicide, and unintentional firearm deaths. This cross-sectional analysis, using adjusted partial correlation coefficients, found that state-level firearm homicide rates significantly varied by the prevalence of firearms and by percent of the population which was African American. Whereas, state-level variations in firearm suicide mortality significantly varied by firearm prevalence, per capita alcohol consumption, percent of the population which was African American, and level of urbanization. None of the variables were significantly (p < or = .05) related to state-level variations in unintentional firearm mortality. Furthermore, state gun laws had only a limited effect on firearm-related homicide deaths. Although the current study cannot determine causation, firearm mortality in its various forms is most commonly related to the prevalence of firearms and the percent of the population that is African American.
Data from a US mortality follow-back survey were analyzed to determine whether having a firearm in the home increases the risk of a violent death in the home and whether risk varies by storage practice, type of gun, or number of guns in the home. Those persons with guns in the home were at greater risk than those without guns in the home of dying from a homicide in the home (adjusted odds ratio = 1.9, 95% confidence interval: 1.1, 3.4). They were also at greater risk of dying from a firearm homicide, but risk varied by age and whether the person was living with others at the time of death. The risk of dying from a suicide in the home was greater for males in homes with guns than for males without guns in the home (adjusted odds ratio = 10.4, 95% confidence interval: 5.8, 18.9). Persons with guns in the home were also more likely to have died from suicide committed with a firearm than from one committed by using a different method (adjusted odds ratio = 31.1, 95% confidence interval: 19.5, 49.6). Results show that regardless of storage practice, type of gun, or number of firearms in the home, having a gun in the home was associated with an increased risk of firearm homicide and firearm suicide in the home.
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