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Firearm Ownership and Capability for Suicide in Post‐Deployment National Guard Service Members
Abstract
Objective
National Guard service members demonstrate increased suicide risk relative to the civilian population. One potential mechanism for this increased risk may be familiarity with and access to firearms following deployment. This study examined the association between firearm ownership, reasons for ownership, and firearm familiarity with a widely studied suicide risk factor—capability for suicide—among National Guard service members.
Method
Data were drawn from a cross‐sectional survey of National Guard service members conducted immediately post‐deployment in 2010. Service members (n = 2,292) completed measures of firearm ownership, firearm familiarity, and capability for suicide.
Results
Firearm ownership and increased firearm familiarity were associated with capability for suicide (d = 0.47 and r = .25, for firearm ownership and familiarity, respectively). When examined separately based on reason for ownership, owning a firearm for self‐protection (d = 0.33) or owning a military weapon (d = 0.27) remained significantly associated with capability for suicide. In contrast, owning a firearm for hobby purposes did not (d = −0.07).
Conclusion
Our findings support theories emphasizing practical aspects of suicide (e.g., three‐step theory) and suggest that owning firearms, in particular for self‐protection, along with familiarity using firearms may be associated with greater capability for suicide.
... Those claiming ownership was asked the following questions: "Do you store your gun(s) in a gun safe or lock box?", "Do you use a locking device (e.g., a cable lock) on your gun(s) when not in use?", and "Do you store your gun(s) loaded?". Lastly, these participants were asked about their reasons for owning a gun (Goldberg et al., 2019) by rank ordering seven common reasons for ownership: Personal safety at home, personal safety away from home, recreational purposes (e.g., hunting), basic interest (e.g., maintaining a collection of memorabilia), the gun(s) is/are a family heirloom (i.e., something that is passed down), expression of freedom, and other (please explain). 3 ...
... The three firearm storage practice items were also combined to create an overall index of storage safety , such that participants who stored their firearm(s) loaded, in an unsecure location, and without a locking device were coded as having unsafe storage practices (0 = Unsafe, 1 = Safe). Following similar procedures to Goldberg et al. (2019), we next categorized reasons for firearm ownership based on their rank ordering. Participants that ranked as first either "personal safety at home" or "personal safety away from home" comprised one category and those that ranked as first any of the other categories comprised the other category (0 = Other, 1 = Self-protection). ...
... Lastly, military experience (0 = No, 1 = Yes) was used as a covariate in only Sample B (n = 141) as only seven participants in Sample A were military veterans. Our decision to control for military experience is based on research showing greater PCS among veteran populations Goldberg et al., 2019). ...
Objective:
White men in U.S. cultures of honor die by suicide at greater rates than other demographic groups. This finding has been attributed to factors such as the prevalence and use of firearms in men's suicide in honor states, as well as motivational risk factors (e.g., thwarted belongingness). Other features of honor cultures (e.g., physical aggression, risk-taking behaviors) suggest that honor-endorsing men may frequently experience painful and provocative events (PPEs), which, in turn, may facilitate practical capability for suicide. The present work tested this hypothesis and honor ideology's relationship to firearm ownership and storage practices.
Method:
In two samples of mostly White U.S. men-one undergraduate sample (N = 472, Mage = 19.76) and one middle- to older adult sample (N = 419, Mage = 65.17)-we assessed honor ideology endorsement, PPEs, practical capability for suicide, and firearm-related outcomes.
Results:
Honor endorsement was greater among firearm owners (particularly self-protective owners), but it was unrelated to storage practices. Honor endorsement was positively associated with PPEs and practical capability. Additionally, the relationship between honor ideology and practical capability was indirectly explained by PPE exposure.
Conclusions:
Results highlight multiple avenues-PPEs, practical capability for suicide, (self-protective) firearm ownership-by which masculine honor norms may place men at risk for suicide.
... Only immediate post-deployment data were analyzed for the current study, as this time point included by far the largest sample size and provided a timely report of deployment-related experiences. Recruiting procedures can be read elsewhere (Goldberg et al., 2019). Briefly, ARNG members deployed from 2008 to 2010 volunteered to participate in this anonymous survey using paper and pencil assessments. ...
Objective:
In 2020, Army National Guard members demonstrated greater risk of suicide than their military and civilian counterparts. Though literature on deployment-related experiences and suicidal ideation (SI) is mixed, investigations of specific deployment-related experiences (e.g., injuries) may further elucidate the relationship between deployment and suicide risk. Deployment-related injuries, including pain severity and functional impairment, have been linked to increased risk of SI, and correlates like perceived burdensomeness (PB) and hopelessness. The current study sought to examine the cross-sectional relationship between deployment-related injuries, including pain severity and functional impairment, and severity of SI through PB and hopelessness.
Method:
Immediately post-deployment, Army National Guard members (N = 2,261) completed validated self-report measures on past-week SI, PB, hopelessness, and single items regarding injury sustained during deployment and associated functional impairment and pain severity.
Results:
Indirect effect analyses revealed that experience of deployment-related injury was related to SI through PB and hopelessness (R2 = .1993), functional impairment was related to SI through PB, and pain severity was related to SI through PB. Contrary to hypotheses, hopelessness was not associated with SI when PB was simultaneously considered.
Conclusions:
Army National Guard members who develop a sense of PB related to their injury and functional impairment of that injury may be at increased risk for suicidal ideation. Military suicide-prevention efforts may be potentiated through targeting distorted cognitions such as PB and hopelessness, especially in service members who have been injured.
... Practical capability, on the other hand, encompasses pragmatic factors that facilitate engagement in suicidal behavior, particularly knowledge about, and access to, lethal means and cognitive factors that make suicidal behavior more or less effortful. Most evidence for practical capability thus far has examined associations between self-reported capability for suicide and aspects of firearm ownership/storage, including lifetime experiences with firing a firearm (Anestis & Capron, 2018;Butterworth et al., 2018), unsafe firearm storage practices (Butterworth et al., 2018;Khazem et al., 2015), and firearm ownership and familiarity (Goldberg et al., 2019). ...
Previous evidence has highlighted the potential roles of both physical and psychological distance to suicide methods as an important factor in conferring suicide risk; however, less is known about the temporal stability of and associations between these constructs, other facets of capability for suicide, and suicide-related outcomes. The present study examined fluctuations in and associations between physical and psychological distance to suicide methods, fearlessness about death, and suicidal intent using ecological momentary assessment. A sample of 237 adults at high risk for suicide (61.6% female, Mage = 27.12 years) responded to six prompts daily for 2 weeks assessing their physical and psychological distance to preferred suicide methods, fearlessness about death, and suicidal intent. Results indicated that physical and psychological distance to suicide methods exhibited both trait- and state-like properties, that lower physical and psychological distance and higher fearlessness about death were associated with higher concurrent suicidal intent, and that lower psychological distance was uniquely predictive of higher subsequent time-point suicidal intent, controlling for concurrent suicidal intent. Suicide attempt history and preferred suicide methods were explored as potential moderating factors. Overall, these findings highlight the importance of assessing and intervening upon psychological distance to suicide methods, in addition to physical proximity to these methods, in lethal means counseling. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Beyond dispositional capability for suicide, military personnel and first responder populations may also have greater acquired and practical capabilities for suicide (Bryan et al., 2016;Chu et al., 2016;Kimbrel et al., 2016;Smith et al., 2012), specifically due to a likelihood of experiencing painful and provocative events (e.g., combat exposure, trauma exposure) and access to firearms (Mahon et al., 2005;Mills et al., 2011). Indeed, research suggests practical capability is an important factor in regard to suicide risk and suicide risk management (Klonsky & May, 2015), with a particular indication of a relationship between suicide risk and firearm access and/or familiarity (Goldberg et al., 2019). Notably, veterans who died by suicide were more likely to utilize a firearm than civilians who died by suicide (Horwitz et al., 2019). ...
... Second, we did not collect data on the participants' reasons for intending to obtain a firearm; thus, we do not have data on whether the intention to obtain a firearm represents a preparatory behavior for a suicide attempt or some other reason (e.g., hunting). These data are crucial to obtain because individuals who own firearms for protection-related reasons appear more likely to store their firearms loaded and/or unlocked (Simonetti et al., 2018; see also Stanley, Hom, Marx, et al., 2020) and have greater suicide risk factors (e.g., capability; Goldberg et al., 2019). Third, and relatedly, we did not assess the type of firearm (e.g., handgun, rifle) participants intended to obtain; although most firearm suicide deaths are enacted with handguns (CDC, 2020; Hanlon et al., 2019), suicides enacted by long guns do occur, and perhaps more so in rural areas of the U.S. (Nestadt et al., 2020). ...
Most suicide deaths in the United States are enacted with a firearm, and recent and first-time purchasers of firearms represent at-risk groups. This study aimed to examine differences in indicators of suicide risk among individuals who either (a) reported current firearm ownership/access or (b) denied current firearm ownership/access but reported an intention to obtain a firearm (i.e., prospective firearm owners). Participants were 96 young adults with a lifetime history of suicidal ideation and firearm ownership, access, or interest. We assessed recent suicidal ideation severity with the Depressive Symptom Index-Suicidality Subscale (DSI-SS) and sought to internally replicate findings with the Patient Health Questionnaire (PHQ-9) item 9. Fifty-two (54.2%) participants reported firearm ownership/access and 44 (45.8%) identified as prospective firearm owners. Prospective firearm owners had significantly greater DSI-SS suicidal ideation severity scores compared with those who already own/have access to a firearm, corresponding to a medium effect size; results were consistent with the PHQ-9 suicidal ideation item. Findings of this initial investigation suggest that the intention to commence firearm ownership might represent an at-risk period, especially for individuals with a history of suicidal thinking. Replication of findings in larger and more clinically severe samples is needed.
Military Veterans die by suicide more often than their civilian counterparts, with over 6000 deaths annually from 2008 to 2017. To combat this crisis, organizations such as the VA, DoD, and the National Action Alliance for Suicide Prevention are conducting research and developing frameworks for suicide prevention for Veterans. Recently, changes in therapeutic modalities and the incorporation of the family system into therapy have been used with Veterans, as well as an increase in online resources for Veterans and their loved one. This chapter will discuss these and other implementations used to prevent death by suicide in Veterans.
Previous research has linked unsafe firearm storage practices and other ownership-related characteristics to key factors that facilitate the transition from suicidal thoughts to suicidal behaviors (i.e., acquired capability for suicide). This research has not investigated the extent to which firearm owners store firearms in their vehicles, a factor that increases ready access to the most lethal means of suicide.
Objective
This cross-sectional study investigated the prevalence of occasional and permanent vehicle firearm storage as well as demographic and psychological correlates of this practice in a sample of N = 408 adult male firearm owners oversampled for historical thoughts of suicide.
Methods
Participants completed an online survey for monetary compensation.
Results
Over 40% of participants indicated at least occasionally storing firearms in their vehicles with over 15% indicating storage of firearms unlocked and loaded. Elevated scores on measures of negative affect, worry, intolerance of uncertainty, and historical suicidal thoughts and behaviors were seen in those who endorsed vehicle firearm storage compared to those who did not.
Conclusion
Individual and public health firearm safety strategies would benefit from an explicit focus on the transition of firearms to and from one’s vehicle.
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HIGHLIGHTS
• Over 40% of male firearm owners at least occasionally store a firearm in a vehicle.
• 15% of those who store a firearm in a vehicle do so unlocked and loaded.
• Suicidal thought severity was related to storing a firearm in a vehicle.
• Historical suicidal behaviors were related to storing a firearm in a vehicle.
Suicide is a public health crisis in the United States and around the world. Despite decades of research, prevention efforts have not substantially influenced suicide rates. Theoretical foundations for research are essential in building the science of suicide prevention. This article analyzes and evaluates the most recently published suicide theory based on an ideation-to-action framework, the Three-Step Theory of Suicide (3ST). This theory demonstrates significant scope and context as well as coherent content. Suggested theory improvements include enhanced clarity and directions for testability. Empirical evidence supports the merits of this theory, although further research is needed for population-specific application.
Objective
To present an approach for integrating recently developed methods in behavioral economics into suicidology research. At present, existing applications of delay discounting in suicidology have focused predominantly on hypothetical choices related to monetary value as a proxy to “risky” choices linked to unsafe or suicidal behavior. In this report, we outline a more targeted approach that directly indexes choices related to treatment in suicide prevention initiatives and incorporates the strengths afforded by multi‐level modeling. This more targeted approach precludes the need for multi‐step comparisons (improving power), avoids compressing choice variability across delays into individual values (improving precision), and better accommodates decision‐making at the upper and lower extremes (improving reliability).
Method
We present this analytical approach within the context of a Hypothetical Firearm Decision‐making Task with simulated participants. A simulated study is provided to illustrate how this approach can be used to evaluate how individuals make temporally delayed decisions related to treatment for suicidal behavior (i.e., temporarily limiting their access to firearms while undergoing treatment).
Results and Conclusions
The results of this simulated study are provided to illustrate how more advanced behavioral decision‐making models can be used to supplement existing research methods in suicidology.
2016 suicide data pages prepared for the American Association.
Background:
While the majority of veteran suicides involve firearms, no contemporary data describing firearm ownership among US veterans are available. This study uses survey data to describe the prevalence of firearm ownership among a nationally representative sample of veterans, as well as veterans' reasons for firearm ownership.
Methods:
A cross-sectional, nationally representative web-based survey conducted in 2015.
Results:
Nearly half of all veterans own one or more firearms (44.9%, 95% CI 41.3-48.6%), with male veterans more commonly owning firearms than do female veterans (47.2%, 95% CI 43.4-51.0% versus 24.4%, 95%CI 15.6-36.1%). Most veteran firearm owners own both handguns and long guns (56.5%, 95% CI 51.1-61.8%); a majority cite protection as a primary reason for firearm ownership (63.1%, 95% CI 58.2-67.8%).
Conclusions:
The current study is the first to provide detailed, nationally representative information about firearm ownership among U.S. veterans. Better understanding firearm ownership among veterans can usefully inform ongoing suicide prevention efforts aiming to facilitate lethal means safety among vulnerable veterans during at-risk periods.
Over the past decade, the interpersonal theory of suicide has contributed to substantial advances in the scientific and clinical understanding of suicide and related conditions. The interpersonal theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide. A growing number of studies have tested these posited pathways in various samples; however, these findings have yet to be evaluated meta-analytically. This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct meta-analyses testing the interpersonal theory hypotheses, and (c) evaluate the influence of various moderators on these relationships. Four electronic bibliographic databases were searched through the end of March, 2016: PubMed, Medline, PsycINFO, and Web of Science. Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples. Findings supported the interpersonal theory: the interaction between thwarted belongingness and perceived burdensomeness was significantly associated with suicidal ideation; and the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide was significantly related to a greater number of prior suicide attempts. However, effect sizes for these interactions were modest. Alternative configurations of theory variables were similarly useful for predicting suicide risk as theory-consistent pathways. We conclude with limitations and recommendations for the interpersonal theory as a framework for understanding the suicidal spectrum.
Firearms account for half of all U.S. suicide deaths, but research on mechanisms through which firearms confer risk is limited. Although research has indicated firearm ownership and the unsafe storage of firearms are associated with an elevated risk of suicide, such research cannot provide insight into the extent to which a history of using a gun plays a role. We recruited a community sample (N = 100; 76% female; 44% Black) oversampled for prior suicidal behavior in a high gun ownership state (Mississippi). Consistent with hypotheses, a greater number of lifetime experiences of firing a gun were associated with elements of the capability for suicide (fearlessness about death, pain tolerance, pain persistence) and lifetime suicide attempts, but not with suicide ideation or simple pain detection. These findings indicate that guns may confer risk of suicide in part through increased comfort and aptitude with the weapon, a notion consistent with the construct of practical capability. Furthermore, these findings are consistent with research indicating that guns do not cause healthy individuals to become suicidal, but rather increase risk among already suicidal individuals. Overall, our findings highlight the importance of considering practical experience with guns as well as simple ownership and storage methods.
The Acquired Capability for Suicide Scale (ACSS) assesses one of three main constructs in the Interpersonal Theory of Suicide but evidence of its validity is limited. In two studies (Ns = 287 and 738) validity of the full 20-item ACSS and its shorter versions (ACSS-5, ACSS-8, ACSS-FAD) were examined in terms of factor structure and relation to indices of self-reported suicidal behaviour and self-harm. Confirmatory factor analysis (CFA) failed to show good fit for one-, two-, or three-factor models of the ACSS in its various versions. Exploratory factor analysis of the 20-item scale in the first study pointed instead to a five-factor structure and this was supported using CFA in the second study. In both studies all scale versions showed moderate negative correlations to fear of death and dying, indicating scale validity for the purpose of assessing fearlessness about death. In the second study, a model in which the five factors were indicators of a latent variable of Capability was found to predict a latent variable of Suicidality as indicated by suicidal behaviours, but the prediction was substantially enhanced by the addition of Item 20 to the model. This single item was also found in the first study to better predict suicidal and self-harming behaviour than the full ACSS or any of its short versions.
The relationship between firearm ownership and suicide is well documented. This study hypothesized that how soldiers store their firearms would moderate the relationship between suicidal ideation and the self-reported likelihood of engaging in a future suicide attempt, and that this relationship would be explained by fearlessness about death. There were 432 military personnel (91.3% men, 74.2% White, M-age = 27.60) who endorsed current ownership of a private firearm and who were recruited from a military base in the southeastern United States (94.5% National Guard). Firearm storage moderated the relationship between suicidal ideation and the self-reported likelihood of engaging in a future suicide attempt, but this relationship was not explained by fearlessness about death. Individuals who reported keeping their firearms loaded and stored in an unsecure location exhibited higher mean levels of fearlessness about death. Findings highlight the need for research examining contributors to suicide risk in the context of firearm storage, and provide support for suicide prevention efforts involving restricting means.
Klonsky and May (2014) argued that an " ideation-to-action " framework should guide suicide theory, research, and prevention. From this perspective, (a) the development of suicide ideation and (b) the progression from ideation to suicide attempts are distinct processes with distinct explanations. The present article introduces a specific theory of suicide rooted in the ideation-to-action framework: the Three-Step Theory (3ST). First, the theory hypothesizes that suicide ideation results from the combination of pain (usually psychological pain) and hopelessness. Second, among those experiencing both pain and hopelessness, connectedness is a key protective factor against escalating ideation. Third, the theory views the progression from ideation to attempts as facilitated by dispositional, acquired, and practical contributors to the capacity to attempt suicide. To examine the theory, the authors administered self-report measures to 910 U.S. adults utilizing Amazon's Mechanical Turk (oversampling for ideation and attempt histories). Results supported the theory's central tenets. First, an interactive model of pain and hopeless-ness accounted for substantial variance in suicide ideation. This result replicated in both men and women, and across age groups (i.e., 18–25, 26–35, and 36–70). Also as predicted, connectedness was most protective against ideation in those high on both pain and hopelessness. Finally, dispositional, acquired, and practical aspects of suicide capacity each predicted suicide attempt history over and above current and lifetime suicidal ideation. These initial findings support the 3ST. Implications for suicide prevention and future research are discussed.
The restriction of potentially lethal means during periods of high risk has been identified as one of the more promising suicide prevention strategies. The purpose of this paper is to introduce clinicians to means restriction counseling and to describe a Motivational Interviewing (MI) based approach for use with ambivalent or challenging patients. This paper examines empirical support behind legislative efforts for means restriction along with the limitations. It explains the need for means restriction counseling with adults and requisite challenges. For patients who are reluctant, it describes an MI-based approach to means restriction counseling and provides a case example. By the end of the paper, readers should be aware of the potential importance of means restriction counseling and the possible use of an MI-based approach with challenging patients. Means restriction counseling is a promising clinical intervention for suicidal patients and research on MI-based and other approaches is sorely needed.
Research suggests that access to firearms in the home increases the risk for violent death.
To understand current estimates of the association between firearm availability and suicide or homicide.
PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and Web of Science were searched without limitations and a gray-literature search was performed on 23 August 2013.
All study types that assessed firearm access and outcomes between participants with and without firearm access. There were no restrictions on age, sex, or country.
Two authors independently extracted data into a standardized, prepiloted data extraction form.
Odds ratios (ORs) and 95% CIs were calculated, although published adjusted estimates were preferentially used. Summary effects were estimated using random- and fixed-effects models. Potential methodological reasons for differences in effects through subgroup analyses were explored. Data were pooled from 16 observational studies that assessed the odds of suicide or homicide, yielding pooled ORs of 3.24 (95% CI, 2.41 to 4.40) and 2.00 (CI, 1.56 to 3.02), respectively. When only studies that used interviews to determine firearm accessibility were considered, the pooled OR for suicide was 3.14 (CI, 2.29 to 4.43).
Firearm accessibility was determined by survey interviews in most studies; misclassification of accessibility may have occurred. Heterogeneous populations of varying risks were synthesized to estimate pooled odds of death.
Access to firearms is associated with risk for completed suicide and being the victim of homicide.
None.
Suicidal behavior is highly complex and multifaceted. Consequent to the pioneering work of Durkheim and Freud, theoreticians have attempted to explain the biological, social and psychological nature of suicide. The present work presents an overview and critical discussion of the most influential theoretical models of the psychological mechanisms underlying the development of suicidal behavior. All have been tested to varying degrees and have important implications for the development of therapeutic and preventive interventions. Broader and more in-depth approaches are still needed to further our understanding of suicidal phenomena.
The Interpersonal Theory of Suicide proposes that suicidal behavior is so frightening that in order for an individual to engage in suicidal behavior, desire for suicide must be accompanied by the capability to do so. The capability for suicide is characterized by both a sense of fearlessness about death and elevated physiological pain tolerance. The primary aim of the current project was to reevaluate and revise the Acquired Capability for Suicide Scale (ACSS; Van Orden, Witte, Gordon, Bender, & Joiner, 2008) and offer a revision to the scale. Expert review of the scale items resulted in retaining 7 items assessing fearlessness about death. The recommendation is made to refer to the revised scale as the ACSS-Fearlessness About Death (ACSS-FAD) to reflect its content more specifically. A model with the 7 retained items provided good fit to the data across 3 independent samples of young adults. Multiple-group analyses examining measurement invariance across men and women found that the latent structure of the scale is comparable across gender. Data are also presented demonstrating convergent and discriminant validity for the scale in young adults and an inpatient psychiatric sample. Findings support the viability of the ACSS-FAD, indicating the scale has a replicable factor structure that generalizes across males and females and is substantively related to the construct of fearlessness about death. Taken together, the present work extends knowledge of the psychometrics of the ACSS-FAD in particular and the nature of fearlessness about death in general. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Beginning in 2005, the incidence of suicide deaths in the US military began to sharply increase. Unique stressors, such as combat deployments, have been assumed to underlie the increasing incidence. Previous military suicide studies, however, have relied on case series and cross-sectional investigations and have not linked data during service with postservice periods.
To prospectively identify and quantify risk factors associated with suicide in current and former US military personnel including demographic, military, mental health, behavioral, and deployment characteristics.
Prospective longitudinal study with accrual and assessment of participants in 2001, 2004, and 2007. Questionnaire data were linked with the National Death Index and the Department of Defense Medical Mortality Registry through December 31, 2008. Participants were current and former US military personnel from all service branches, including active and Reserve/National Guard, who were included in the Millennium Cohort Study (N = 151,560).
Death by suicide captured by the National Death Index and the Department of Defense Medical Mortality Registry.
Through the end of 2008, findings were 83 suicides in 707,493 person-years of follow-up (11.73/100,000 person-years [95% CI, 9.21-14.26]). In Cox models adjusted for age and sex, factors significantly associated with increased risk of suicide included male sex, depression, manic-depressive disorder, heavy or binge drinking, and alcohol-related problems. None of the deployment-related factors (combat experience, cumulative days deployed, or number of deployments) were associated with increased suicide risk in any of the models. In multivariable Cox models, individuals with increased risk for suicide were men (hazard ratio [HR], 2.14; 95% CI, 1.17-3.92; P = .01; attributable risk [AR], 3.5 cases/10,000 persons), and those with depression (HR, 1.96; 95% CI, 1.05-3.64; P = .03; AR, 6.9/10,000 persons), manic-depressive disorder (HR, 4.35; 95% CI, 1.56-12.09; P = .005; AR, 35.6/10,000 persons), or alcohol-related problems (HR, 2.56; 95% CI, 1.56-4.18; P <.001; AR, 7.7/10,000 persons). A nested, matched case-control analysis using 20:1 control participants per case confirmed these findings.
In this sample of current and former military personnel observed July 1, 2001-December 31, 2008, suicide risk was independently associated with male sex and mental disorders but not with military-specific variables. These findings may inform approaches to mitigating suicide risk in this population.
In most Western countries females have higher rates of suicidal ideation and behavior than males, yet mortality from suicide is typically lower for females than for males. This article explores the gender paradox of suicidal behavior, examines its validity, and critically examines some of the explanations, concluding that the gender paradox of suicidal behavior is a real phenomenon and not a mere artifact of data collection. At the same time, the gender paradox in suicide is a more culture-bound phenomenon than has been traditionally assumed; cultural expectations about gender and suicidal behavior strongly determine its existence. Evidence from the United States and Canada suggests that the gender gap may be more prominent in communities where different suicidal behaviors are expected of females and males. These divergent expectations may affect the scenarios chosen by females and males, once suicide becomes a possibility, as well as the interpretations of those who are charged with determining whether a particular behavior is suicidal (e.g., coroners). The realization that cultural influences play an important role in the gender paradox of suicidal behaviors holds important implications for research and for public policy.
Suicidal behavior is a major problem worldwide and, at the same time, has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current article presents the interpersonal theory of suicidal behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs-thwarted belongingness and perceived burdensomeness (and hopelessness about these states)-and further that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current article, the theory's hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory's hypotheses.
In most Western countries females have higher rates of suicidal ideation and behavior than males, yet mortality from suicide is typically lower for females than for males. This article explores the gender paradox of suicidal behavior, examines its validity, and critically examines some of the explanations, concluding that the gender paradox of suicidal behavior is a real phenomenon and not a mere artifact of data collection. At the same time, the gender paradox in suicide is a more culture-bound phenomenon than has been traditionally assumed; cultural expectations about gender and suicidal behavior strongly determine its existence. Evidence from the United States and Canada suggests that the gender gap may be more prominent in communities where different suicidal behaviors are expected of females and males. These divergent expectations may affect the scenarios chosen by females and males, once suicide becomes a possibility, as well as the interpretations of those who are charged with determining whether a particular behavior is suicidal (e.g., coroners). The realization that cultural influences play an important role in the gender paradox of suicidal behaviors holds important implications for research and for public policy.
The interpersonal-psychological theory of suicidal behavior (T. E. Joiner, 2005) proposes that an individual will not die by suicide unless he or she has both the desire to die by suicide and the ability to do so. Three studies test the theory's hypotheses. In Study 1, the interaction of thwarted belongingness and perceived burdensomeness predicted current suicidal ideation. In Study 2, greater levels of acquired capability were found among individuals with greater numbers of past attempts. Results also indicated that painful and provocative experiences significantly predicted acquired capability scores. In Study 3, the interaction of acquired capability and perceived burdensomeness predicted clinician-rated risk for suicidal behavior. Implications for the etiology, assessment, and treatment of suicidal behavior are discussed.
Introduction:
Interventions that reduce access to highly lethal and commonly used methods of suicide (e.g., limiting firearm access) are considered essential elements of effective suicide prevention programs. Scant epidemiologic data are available to inform such efforts among Veterans. The aim of this study is to describe firearm storage practices and correlates of those practices among a nationally representative sample of U.S. Veteran firearm owners.
Methods:
The authors used a probability-based online survey of Veteran firearm owners in 2015 (data analyzed in 2017; 54.6% response rate). The primary outcome was firearm storage practices. Additional items assessed individual and household-level sociodemographic characteristics, firearm-related characteristics, and risk perceptions related to firearm ownership.
Results:
One in three (33.3%, 95% CI=28.6%, 38.4%) Veteran firearm owners stores at least one firearm loaded and unlocked. The prevalence of this practice ranges substantially (9%-65%) across individual, household, and firearm ownership characteristics, and is strongly related to other firearm-related behaviors (e.g., carrying handguns); reasons for firearm ownership (e.g., protection versus other); number of firearms owned; and perceptions about the utility of guns stored safely and whether guns make homes safer.
Conclusions:
Storing a firearm loaded and unlocked is common among Veterans. Storage practices are strongly related to reasons for ownership and potentially malleable perceptions including beliefs about firearm-related risks. Suicide prevention initiatives among Veterans should incorporate communication strategies that address common misperceptions about household firearm risk and whether safe storage practices may better align with reasons most Veterans own firearms (i.e., safety)-especially when someone in their home is at increased risk for suicide.
Despite the disproportionate use of firearms in Veteran suicides and the well‐established link between firearm access and suicide, little is known about how Veterans store their firearms or what they think about the relationship between firearm access and suicide risk. Using data from 2015 nationally representative online survey (response rate 60.9%), we compare characteristics of Veteran firearm owners with and without self‐harm risk factors with respect to how they store their firearms and their beliefs about suicide risk related to firearms. Overall, one in three U.S. Veteran firearm owners store household firearms loaded and unlocked, one in twenty believe that a firearm increases household suicide risk, and one in four consider their loaded and unlocked firearm to be inaccessible to suicidal household members. Storage practices and risk perceptions are similar among those with and without self‐reported suicide risk factors. Affecting risk perceptions may be a critical aspect of interventions addressing lethal means safety among U.S. Veterans.
Purpose:
To compare rates of external causes of mortality among individuals who served in the military (before and after separation from the military) to the U.S.
Population:
Methods:
This retrospective cohort study examined all 3.9 million service members who served from 2002 to 2007. External cause mortality data from 2002 to 2009 were used to calculate standardized mortality ratios. Negative binomial regression compared differences in the mortality rates for pre- and post-separation.
Results:
Accident and suicide mortality rates were highest among cohort members under 30 years of age, and most of the accident and suicide rates for these younger individuals exceeded expectation given the U.S. population mortality rates. Military suicide rates began below the expected U.S. rate in 2002 but exceeded the U.S. rate by 2009. Accident, homicide, and undetermined mortality rates remained below the U.S. rates throughout the study period. Mortality rates for all external causes were significantly higher among separated individuals compared with those who did not separate. Mortality rates for individuals after separation from service decreased over time but remained higher than the rates for those who had not separated from service.
Conclusions:
Higher rates of death for all external causes of mortality after separation suggest prevention opportunities. Future research should examine how preseparation characteristics and experiences may predict postseparation adverse outcomes to inform transition programs.
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.
Studies have documented a link between gun ownership and suicide, but little is known about characteristics of those most likely to use a gun in a suicide attempt rather than alternative methods. We examined which factors differentiate suicide decedents who died using a gun from those who died by other methods. We further examined whether such findings are consistent within the subcomponent of our larger sample comprised entirely of gun owning suicide decedents. Data reflect 267 suicide decedents, with data provided by individuals who identified as having lost someone to suicide (loss survivors). Within the full sample, a higher proportion of gun-owning and male suicide decedents died by firearm. Further, individuals who had previously discussed suicide or engaged in one or more non-lethal suicide attempts were less likely to die by suicide using a gun. Within the subsample of gun owning suicide decedents, a greater proportion of decedents who stored guns at home and in unsecure locations died from self-inflected gunshot wounds. These findings add clarity to the relationship between firearm ownership and death by suicide at the individual level. Furthermore, these findings are consistent with the notion that means safety implementation may represent a vital suicide prevention tool.
Despite the magnitude and consistency of risk estimates in the peer-reviewed literature linking firearm availability and suicide,
inferring causality has been questioned on the theoretical basis that existing studies may have failed to account for the
possibility that members of households with firearms differ from members of households without firearms in important ways
related to suicide risk. The current bias analysis directly addresses this concern by describing the salient characteristics
that such an unmeasured confounder would need to possess in order to yield the associations between firearm availability and
suicide observed in the literature when, in fact, the causal effect is null. Four US studies, published between 1992 and 2003,
met our eligibility criteria. We find that any such unmeasured confounder would need to possess an untenable combination of
characteristics, such as being not only 1) as potent a suicide risk factor as the psychiatric disorders most tightly linked
to suicide (e.g., major depressive and substance use disorders) but also 2) an order of magnitude more imbalanced across households
with versus without firearms than is any known risk factor. No such confounder has been found or even suggested. The current
study strongly suggests that unmeasured confounding alone is unlikely to explain the association between firearms and suicide.
The interpersonal-psychological theory of suicide has been the focus of considerable empirical investigation over the past decade. However, little research has focused on the theory’s proposition that the capability for suicide is “acquired” as a consequence of exposure to painful and provocative experiences such as violence, aggression, and trauma. To determine if capability for suicide is “acquired” over time, we conducted a prospective study of 168 military personnel deployed to Iraq. Capability scores remained stable over the course of 2 years from pre- to postdeployment, even among military personnel reporting high combat exposure. Significant positive correlations among capability and combat exposure were comparable both before and after deployment. These findings suggest that capability for suicide was not “acquired” following combat exposure in this sample of military personnel. Capability was, instead, a stable construct.
Nearly all mental disorders increase suicide risk; however, some better predict ideation versus attempts. The interpersonal theory of suicide provides a framework to understand these relationships, via the constructs of thwarted belongingness, perceived burdensomeness, and acquired capability. The current study examined the relationships between various mental disorders and theory constructs among 997 adult outpatients, controlling for sex and age. Disorders generally symptomatically associated with social withdrawal or potential liability to others (i.e., depressive and bipolar disorders, social phobia, borderline personality disorder, schizophrenia and other psychotic disorders, certain drug dependence) were uniquely positively associated with thwarted belongingness and perceived burdensomeness. Disorders associated with potential exposure to painful and provocative events (i.e., posttraumatic stress disorder, schizophrenia and other psychotic disorders, certain drug use) were associated with increased acquired capability. Notably, alcohol use disorders, attention-deficit/hyperactivity disorder subtypes, and panic/agoraphobia were negatively associated with thwarted belongingness or perceived burdensomeness; avoidant personality disorder, and certain anxiety disorders and drug use disorders, were associated with decreased acquired capability. Importantly, disorders associated with both thwarted belongingness and perceived burdensomeness may place individuals at greatest risk for suicide if acquired capability develops. Implications for comorbidity and suicide risk assessment and treatment are discussed.
Research has implicated a relationship between anger and suicidality, though underlying mechanisms remain unclear. The current study examined this relationship through the lens of the interpersonal theory of suicide (ITS). According to the ITS, individuals who experience thwarted belongingness, perceived burdensomeness, and elevated acquired capability for suicide are at increased risk for death by suicide.. The relationships between anger and these variables were examined and these variables were examined as potential mediators between anger and suicidal ideation and behavior. Additionally, exposure to painful and provocative events was examined as a potential mediator between anger and acquired capability. As part of intake at a community mental health clinic, 215 outpatients completed questionnaires assessing depression, suicidal ideation, anger, perceived burdensomeness, thwarted belongingness, and acquired capability. Regression analyses revealed unique relationships between anger and both thwarted belongingness and perceived burdensomeness, covarying for depression. The association between anger and acquired capability trended toward significance. The links between anger and suicidal ideation and behavior were fully mediated by thwarted belongingness and perceived burdensomeness, but this effect was driven by perceived burdensomeness. Additionally, the link between anger and acquired capability was fully mediated by experience with painful and provocative events. In conclusion, results suggest that anger is uniquely associated with perceived burdensomeness and thwarted belongingness. Anger is associated with suicidal ideation and behavior via perceived burdensomeness and with greater acquired capability for suicide via experiences with painful and provocative events. Treatment for problematic anger may be beneficial to decrease risk for suicide.
On an average day in the USA more than 100 Americans die by suicide-half use firearms. Suicide rates overall and by firearms are higher, on average, in states where household firearm ownership is more common. In general this means in states where a greater proportion of the population lives in rural areas. The current ecological study focuses on the relation between measures of household firearm prevalence and suicide mortality in urban areas (metropolitan statistical areas and divisions) using survey-based measures of firearm ownership. Suicide rates (1999-2010) for metropolitan statistical areas that are comprised of large US cities come from death certificate records; rates of household firearm ownership come from the 2002 and 2004 Behavioural Risk Factor Surveillance System. Higher rates of firearm ownership are strongly associated with higher rates of overall suicide and firearm suicide, but not with non-firearm suicide. Stratification by gender, age and race did not materially affect the association between firearms and suicide. This study provides evidence consistent with previous case-control work and extends evidence from previous state- and region-level ecological studies that firearms in the home impose suicide risk above and beyond baseline.
Missing data in medical research is a common problem that has long been recognised by statisticians and medical researchers alike. In general, if the effect of missing data is not taken into account the results of the statistical analyses will be biased and the amount of variability in the data will not be correctly estimated. There are three main types of missing data pattern: Missing Completely At Random (MCAR), Missing At Random (MAR) and Not Missing At Random (NMAR). The type of missing data that a researcher has in their dataset determines the appropriate method to use in handling the missing data before a formal statistical analysis begins. The aim of this practice note is to describe these patterns of missing data and how they can occur, as well describing the methods of handling them. Simple and more complex methods are described, including the advantages and disadvantages of each method as well as their availability in routine software. It is good practice to perform a sensitivity analysis employing different missing data techniques in order to assess the robustness of the conclusions drawn from each approach.
There has been conspicuously little research concerning missing data problems in the applied psychology literature. Fortunately, other fields have begun to investigate this issue. These include survey research, marketing, statistics, economics, and biometrics. A review of this literature suggests several trends for applied psychologists. For example, listwise deletion of data is often the least accurate technique to deal with missing data. Other methods for estimating missing data scores may be more accurate and preserve more data for investigators to analyze. Further, the literature reveals that the amount of missing data and the reasons for deletion of data impact how investigators should handle the problem. Finally, there is a great need for more investigation of strategies for dealing with missing data, especially when data are missing in nonrandom or systematic patterns.
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.
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