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Reyes G, Patel AJ. In Reply: Firearm-Related Traumatic Brain Injuries in Adults: A Scoping Review. Neurosurgery 2024:00006123-990000000-01144. [PMID: 38661376 DOI: 10.1227/neu.0000000000002969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Gabriel Reyes
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
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2
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Anestis MD. Firearm Access and Suicide Rates: An Unambiguously Robust Association. Arch Suicide Res 2024; 28:701-705. [PMID: 36987987 DOI: 10.1080/13811118.2023.2192753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Firearms account for approximately half of all suicide deaths within the United States each year. Recently, Lane and Kleck published pieces reporting conflicting results regarding the relationship between firearm access and suicide rates. In this commentary, I aim to contextualize the findings within the broader literature and to provide clarity for readers aiming to navigate the findings of the two studies. Ultimately, I conclude that the results of Lane more accurately represent the nature of the relationship and align with the extant literature on the topic.
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Bond AE, Moceri-Brooks J, Bandel SL, Crifasi C, Bryan CJ, Capron DW, Bryan AO, Anestis MD. Determining who military service members deem credible to discuss firearm safety for suicide prevention. Suicide Life Threat Behav 2024. [PMID: 38431918 DOI: 10.1111/sltb.13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To examine rankings of credible sources for discussing secure storage within a representative sample of firearm-owning service members, and examine how combinations of demographic variables impact the ranking of credible sources. METHODS The probability-based sample was collected with the help of Ipsos. Participants were US service members who owned a firearm at the time of the survey (n = 719). RESULTS The total sample ranked service members, Veterans, and members of law enforcement as the most credible sources and faith leaders, casual acquittances, and celebrities as the least credible sources. Black men ranked the NRA as a highly credible source whereas Black females ranked the NRA as one of the least preferred sources. Regardless of political preference, those who lived in non-metropolitan rural environments ranked members of law enforcement as highly credible sources. Those who lived in non-metropolitan rural and urban settings and identified as liberal ranked the National Shooting Sports Foundation as a highly credible source. CONCLUSIONS Law enforcement officers, military members, and Veterans are ranked as highly credible sources by most subgroups of firearm-owning service members. Leveraging these voices in firearm safety conversations is necessary, may increase adherence to secure storage recommendations, and ultimately reduce suicide.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | | | - Shelby L Bandel
- The New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Cassandra Crifasi
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Daniel W Capron
- Department of Psychology, The University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Annabelle O Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
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Posamentier J, Seibel K, DyTang N. Preventing Youth Suicide: A Review of School-Based Practices and How Social-Emotional Learning Fits Into Comprehensive Efforts. TRAUMA, VIOLENCE & ABUSE 2023; 24:746-759. [PMID: 35139714 DOI: 10.1177/15248380211039475] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Schools in the United States increasingly incorporate social-emotional learning (SEL) as a part of comprehensive youth suicide prevention programs in schools. We reviewed the literature to investigate the inclusion of SEL in youth suicide prevention efforts. We identified several known risk factors to youth suicide, namely, hopelessness, anxiety, substance use, and child sexual abuse, then cross-walked that review to SEL competencies shown to mitigate each of those known risk factors. We found all SEL competencies, to some extent, across all the evidence-based, school-based youth suicide prevention programs we identified. Further, we found that all five SEL competencies are shown directly to address and mitigate the major, known risk factors for youth suicide. These findings suggest that SEL can play a productive role in upstream youth suicide prevention. State-level policy makers and school administrators should consider the inclusion of evidence-based SEL in efforts to address youth suicide prevention.
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5
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Stroebe W. Suicide in Switzerland: why gun ownership can be deadly. Swiss Med Wkly 2023; 153:40026. [PMID: 36652694 DOI: 10.57187/smw.2023.40026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
There is a great deal of empirical evidence that owning a firearm increases the risk of dying from suicide. Most suicides are impulsive. Nearly 50% of survivors of suicide attempts report that they took less than 10 minutes between the decision to die and their suicide attempt. The great majority of these suicide survivors never make another attempt and die of natural causes. Because nearly 90% of firearm suicide attempts have a deadly outcome, gun owners are unlikely to have such a second chance. These impulsive suicide attempts are typically carried out with the means at hand. Swiss men have much higher firearm suicide rates than men in other European countries and this excess is likely to be due to their easy access to guns, because army conscripts have to keep their guns at home. When the number of conscripts was nearly halved in 2003/4 as a result of the Swiss Army Reform XXI, the number of army-issued firearms was reduced by an estimated 20%. An analysis of suicide rates before and after the reform indicated that male (but not female) suicide rates decreased by 8%, with no evidence of substitution with other means of suicide. If the army would require that the remaining half of conscripts had to keep their weapons at their barracks rather than at home, a further decrease in male suicide rates could be expected.
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Bareis N, Olfson M, Gerhard T, Rolin S, Stroup TS. Means of suicide among adults with schizophrenia across the life span. Schizophr Res 2023; 251:82-90. [PMID: 36592524 PMCID: PMC9872522 DOI: 10.1016/j.schres.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/26/2022] [Accepted: 12/06/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND HYPOTHESES Adults with schizophrenia have increased risk of suicide with highest risk among younger adults. We investigated whether means of suicide among these adults were different from the general population. STUDY DESIGN This retrospective longitudinal analysis used the National Death Index to characterize means of suicide among 4 cohorts of Medicare patients with schizophrenia (2007-2016) by age: 18 to 34, 35 to 44, 45 to 54, and aged 55+ years. Means of suicide were categorized by age at death and sex. Adjusted hazard ratios were calculated for common means. Mortality rates per 100,000 person-years were estimated by age group stratified by sex, and standardized to the general population by age, sex, and race-ethnicity using standardized mortality ratios. STUDY RESULTS 668,836 adults were included with 2218 suicide decedents: 1444 men and 774 women. The most common means of suicide was poisoning (36.8 %), with a significant sex difference by means: 55.9 % of women died by poisoning, 13.8 % by firearms, 11.0 % by hanging and 9.4 % by jumping, while among men suicide by poisoning (26.6 %), firearms (25.5 %), and hanging (24.2 %) were similar, followed by jumping (12.0 %). Suicide by poisoning among the schizophrenia cohort was 10 times that of the general population, while suicide by firearm was twice that of the general population. CONCLUSIONS Means of suicide differed for patients with schizophrenia compared to the general population: poisoning was the most common means among men and women with schizophrenia, while firearms accounted for over half of all suicides in the general U.S. POPULATION
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Affiliation(s)
- Natalie Bareis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, United States of America.
| | - Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, United States of America; Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Tobias Gerhard
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States of America
| | - Stephanie Rolin
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, United States of America
| | - T Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, United States of America
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Bond AE, Karnick AT, Bandel SL, Capron DW, Anestis MD. Demographic differences in the type of firearm and location of bodily injury in firearm suicide decedents. DEATH STUDIES 2022; 47:948-956. [PMID: 36382498 DOI: 10.1080/07481187.2022.2144547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study describes the type of firearm used and location of bodily injury among demographic subgroups of suicide decedents. Data on those who died by suicide via firearm from the National Violent Death Reporting System (N = 117,126) between the years 2003-2018 was utilized. A series of five logistic regression analyses examining the age of decedent, type of firearm, location of wound site, loaded vs. unloaded firearms, and locked vs. unlocked storage, using predictors including gender, race, who owns the firearm and age were performed. Findings have important public health implications. Increasing safe storage or removing the specific types of firearms one is likely to use in their death from the home during a time of crisis may decrease risk of suicide.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Aleksandr T Karnick
- Department of Psychology, The University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Shelby L Bandel
- The New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Daniel W Capron
- Department of Psychology, The University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA
- School of Public Health, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
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8
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Prater L, Rooney L, Bowen AG, Conrick K, Mustafa A, Moore M, Rivara FP, Rowhani-Rahbar A. Civilian Petitioners and Extreme Risk Protection Orders in the State of Washington. Psychiatr Serv 2022; 73:1263-1269. [PMID: 35611513 DOI: 10.1176/appi.ps.202100636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Extreme risk protection orders (ERPOs) are civil orders designed to temporarily restrict access to firearms when people are at substantial risk of harm to themselves or others. A minority of ERPOs in the United States have been filed by civilians, with most filed by law enforcement. The authors examined barriers and facilitators to the ERPO filing process from the perspective of the civilian petitioner. METHODS Semistructured interviews of civilian petitioners who filed ERPOs in Washington State from December 2016 to September 2020 were conducted. The interviews examined both barriers and facilitators to filing an ERPO. A descriptive and qualitative approach with inductive-deductive thematic analysis was used to identify and code themes. RESULTS Fifteen civilian petitioners were interviewed. Barriers to ERPO filing included perceived lack of help connecting with social services to address the potential for harmful behavior, confusion regarding the filing and court process, and petitioner distress. Facilitators included having previous legal experience, having assistance from advocates who helped shepherd petitioners through the process, and simplification of the ERPO process. CONCLUSIONS ERPO is a useful tool for suicide and violence prevention, but several barriers may be inhibiting ERPO use among civilian petitioners. Better educational resources and advocacy programs, as well as simplified filing steps, could improve the process and make ERPOs more accessible for civilians.
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Affiliation(s)
- Laura Prater
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Lauren Rooney
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Andrew G Bowen
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Kelsey Conrick
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Ayah Mustafa
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Megan Moore
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Frederick P Rivara
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
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9
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Peeples L. US gun policies: what researchers know about their effectiveness. Nature 2022; 607:434-435. [PMID: 35778495 DOI: 10.1038/d41586-022-01791-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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10
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Bond AE, Anestis MD. Firearm Type and Number: Examining Differences among Firearm Owning Suicide Decedents. Arch Suicide Res 2022; 26:1624-1631. [PMID: 33570007 DOI: 10.1080/13811118.2021.1885536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The present study sought to determine if among a sample of firearm owning suicide decedents, the type and number of firearms owned was associated with dying by suicide using a firearm compared to another method. METHOD Data were collected as part of a larger online study that gathered information on suicide decedents and the context surrounding their death from family members and friends. The present study used data from those who owned at least one firearm (n = 121). Participants in the present study were mostly male and white. RESULTS Among firearm owners, handgun ownership was significantly associated with dying by suicide using a firearm compared to using another method. The number of firearms owned was inversely associated with using a firearm compared to another method in a suicide death. The average number of firearms owned was higher among those who owned shotguns compared to handguns. CONCLUSIONS Handgun ownership, not shotgun ownership, was associated with having died from a self-inflicted gunshot wound. The finding regarding number of firearms should be interpreted with caution. Overall, findings provide insight into what differentiates firearm owners who die by suicide using a firearm compared to another method.
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11
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Bond AE, Bandel SL, Anestis MD. Determining subgroups that exist among US firearm owners. Suicide Life Threat Behav 2022; 52:537-548. [PMID: 35261074 DOI: 10.1111/sltb.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/29/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify and verify classes of firearm owners that exist within the United States and determine the sources that classes deemed credible to discuss firearm safety for suicide prevention. METHODS The study is composed of two parts. Part 1 (N = 1018) utilizes a nationally representative sample of firearm owners. Part 2 (N = 1064) consists of firearm owners from Mississippi, Minnesota, and New Jersey. RESULTS Four unique classes were identified in Sample 1: multiple firearms class, single handgun class, few firearms class, and long-gun class. A three-class solution was found for sample 2. Two of the classes from sample 1 replicated: multiple firearms class and single handgun class. Although many of the classes differed in the ranking of credible sources, a combination of The American Foundation for Suicide Prevention, law enforcement officers, and family members was ranked as credible sources among all classes. CONCLUSIONS Findings provide evidence of the heterogenous nature of firearm owners and can be utilized to better understand the subgroups of firearm owners. Additionally, the findings from the credible sources analyses can be leveraged to create more effective safe firearm storage messaging which may increase adherence with safe storage suggestions and ultimately reduce suicide rates.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA.,Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Shelby L Bandel
- The New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA.,Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA.,Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
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12
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Yunik NP, Schiff M, Barzilay S, Yavnai N, Ben Yehuda A, Shelef L. Military mental health professionals' suicide risk assessment and management before and after experiencing a patient's suicide. Suicide Life Threat Behav 2022; 52:392-400. [PMID: 35122315 DOI: 10.1111/sltb.12829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/03/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study examines the association between a patient's suicide and the therapist's suicide risk assessment (SRA) and suicide risk management (SRM) of patients, following the occurrence. METHOD SRA values range from "absence of suicidality" to "immediate suicidal intent to die". SRM consists of therapists' written recommendations. Rates of the various SRA and SRM values in therapists' evaluations were assessed 6-months prior to the suicide and at the two three- and six-month time-points thereafter. RESULTS Of the 150 soldiers who died by suicides, 30 (20%) visited 50 military therapists in the 6 months preceding their deaths. Using Wilcoxon signed rank test, lower SRA rates of "threatens suicide" were found 2 months after a patient's suicide. Regarding SRM, the mean rates for "recommendations for psychotherapy treatment" were higher at the two (p = 0.022) and the 3 month time-points (p = 0.031) after a suicide. CONCLUSIONS The SRA findings may indicate therapists' fear of treating suicidal patients, causing them to overlook patients' non-prominent suicide-risk indicators. In SRM, the higher rate of recommendations for additional therapy sessions rather than military release or referrals to other therapists may relate to over-caution and attempts to control the patient's therapy ensuring it's done properly.
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Affiliation(s)
- Noam Paz Yunik
- Psychology Branch, Israel Air Force, Ramat Gan, Israel.,Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Miriam Schiff
- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shira Barzilay
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Nirit Yavnai
- Department of health and well-being, IDF's Medical corps, Israel Defense Forces, Ramat Gan, Israel
| | - Ariel Ben Yehuda
- Department of health and well-being, IDF's Medical corps, Israel Defense Forces, Ramat Gan, Israel
| | - Leah Shelef
- Department of health and well-being, IDF's Medical corps, Israel Defense Forces, Ramat Gan, Israel.,Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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13
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Consolino TA, Yarvis JS. Veteran Suicide: Missed Opportunities for Suicide Prevention Within Concealed Pistol License Curriculum. Mil Med 2022; 188:e985-e990. [PMID: 35425956 DOI: 10.1093/milmed/usab545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/12/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
Introduction
Veteran suicide is a growing topic for public health concern. Despite enhancements from the Department of Veterans Health Administration, clinicians continue to struggle to identify and engage veterans at risk for suicide.
Materials and Methods
Examining suicide prevention efforts, epidemiology, risk factors, and barriers to care; Substance Abuse and Mental Health Services Administration and the U.S. Department of Veterans Affairs Governor’s Challenges identified lethal means as one of 3 priority areas to focus on in during this agenda.
Results
The writers identified gaps within the current literature as an area for future research on lethal means within the veteran population and opportunity for intervention with concealed pistol license curriculum.
Conclusion
This article ends with recommendations for further research on veteran suicides, acquisition of concealed pistol licenses, and advocacy for legislative change to require suicide prevention resources and education to be included in the training curriculum for concealed pistol license holders.
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Affiliation(s)
- Tara A Consolino
- School of Social Work, Tulane University, New Orleans, LA 70112-2627, USA
- Department of Veteran Affairs, Detroit VA Medical Center, Detroit, MI 48201-1916, USA
| | - Jeffrey S Yarvis
- School of Social Work, Tulane University, New Orleans, LA 70112-2627, USA
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14
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Abstract
Suicide is a major public health concern in the United States. Between 2000 and 2018, US suicide rates increased by 35%, contributing to the stagnation and subsequent decrease in US life expectancy. During 2019, suicide declined modestly, mostly owing to slight reductions in suicides among Whites. Suicide rates, however, continued to increase or remained stable among all other racial/ethnic groups, and little is known about recent suicide trends among other vulnerable groups. This article (a) summarizes US suicide mortality trends over the twentieth and early twenty-first centuries, (b) reviews potential group-level causes of increased suicide risk among subpopulations characterized by markers of vulnerability to suicide, and (c) advocates for combining recent advances in population-based suicide prevention with a socially conscious perspective that captures the social, economic, and political contexts in which suicide risk unfolds over the life course of vulnerable individuals.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
- Department of Psychiatry, La Paz University Hospital, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Tammy Jiang
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA;
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
| | - Jaimie L Gradus
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA;
- Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts, USA;
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15
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Sivaraman JJC, Greene SB, Naumann RB, Proescholdbell S, Ranapurwala SI, Marshall SW. Association Between Medical Diagnoses and Suicide in a Medicaid Beneficiary Population, North Carolina 2014-2017. Epidemiology 2022; 33:237-245. [PMID: 34799475 PMCID: PMC10281339 DOI: 10.1097/ede.0000000000001439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Firearms are used in about half of U.S. suicides. This study investigated how various medical diagnoses are associated with firearm and nonfirearm suicide. METHODS We used a case-control design including n = 691 North Carolina Medicaid beneficiaries who died from suicide between 1 January 2014 and 31 December 2017 as cases. We selected a total of n = 68,682 controls (~1:100 case-control ratio from North Carolina Medicaid member files using incidence density sampling methods). We linked Medicaid claims to the North Carolina Violent Death Reporting System to ascertain suicide and means (firearm or nonfirearm). We matched cases and controls on number of months covered by Medicaid over the past 36 months. Analyses adjusted for sex, race, age, Supplemental Security Income status, the Charlson Comorbidity Index, and frequency of health care encounters. RESULTS The case-control odds ratios for any mental health disorder were 4.2 (95% confidence interval [CI]: 3.3, 5.2) for nonfirearm suicide and 2.2 (95% CI: 1.7, 2.9) for firearm suicide. There was effect measure modification by sex and race. Behavioral health diagnoses were more strongly associated with nonfirearm suicides than firearm suicide in men but did not differ substantially in women. The association of mental health and substance use diagnoses with suicides appeared to be weaker in Blacks (vs. non-Blacks), but the estimates were imprecise. CONCLUSION Behavioral health diagnoses are important indicators of risk of suicide. However, these associations differ by means of suicide and sex, and associations for firearm-related suicide are weaker in men than women.
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Affiliation(s)
- Josie J. Caves Sivaraman
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Sandra B. Greene
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Rebecca B. Naumann
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Scott Proescholdbell
- North Carolina Department of Health and Human Services, Division of Public Health, Injury and Violence Prevention Branch
| | - Shabbar I. Ranapurwala
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Stephen W. Marshall
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
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16
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Gunn JF, Boxer P. Youth Gun and Weapon Carrying and Suicide Rates for Those Aged 24 Years and Younger, 2005-2017. J Adolesc Health 2022; 70:457-462. [PMID: 34815160 DOI: 10.1016/j.jadohealth.2021.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Gun access among youth may contribute to youth suicide deaths by increasing practical capability. The present work examines the association between youth gun and weapon carrying behavior and suicide rates among those aged 24 years and younger. METHODS Using the 2005-2017 Youth Risk Behavior Surveillance System, the associations over time between youth gun and weapon carrying and youth suicide rates were examined. A series of generalized estimating equations were used to examine population-level associations between states and across time. RESULTS As anticipated youth gun carrying behavior was a significant contributor to the prediction of firearm suicide rates for those aged 24 years and younger, with higher rates of youth gun carrying associated with higher suicide rates. Youth gun carrying was not a significant predictor of overall suicide rates for those aged 24 years and younger. Youth weapon carrying (which includes guns, knives, and other weapons) was a significant predictor of both firearm-specific and overall suicide rates for those aged 24 years and younger. CONCLUSIONS Previous research has linked youth gun carrying behavior to past year suicide attempts. This study represents the first attempt at examining the associations between youth gun carrying behavior and suicide mortality among the young. In line with our expectations, states with higher percentages of youth reporting gun and weapon carrying behavior had greater rates of suicide among the young (those aged 24 years and younger). The present work points toward the importance of limiting youth access to firearms in reducing suicide mortality.
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Affiliation(s)
- John F Gunn
- New Jersey Center on Gun Violence Research, Rutgers University, Newark, New Jersey; Gwynedd Mercy University, Gwynedd Valley, Pennsylvania.
| | - Paul Boxer
- Department of Psychology, Rutgers University, Newark, New Jersey
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17
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Cai Z, Junus A, Chang Q, Yip PSF. The lethality of suicide methods: A systematic review and meta-analysis. J Affect Disord 2022; 300:121-129. [PMID: 34953923 DOI: 10.1016/j.jad.2021.12.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The use of suicide methods largely determines the outcome of suicide acts. However, no existing meta-analysis has assessed the case fatality rates (CFRs) by different suicide methods. The current study aimed to fill this gap. METHODS We searched Scopus, Web of Science, PubMed, ProQuest and Embase for studies reporting method-specific CFRs in suicide, published from inception to 31 December 2020. A random-effect model meta-analysis was applied to compute pooled estimates. RESULTS Of 10,708 studies screened, 34 studies were included in the meta-analysis. Based on the suicide acts that resulted in death or hospitalization, firearms were found to be the most lethal method (CFR:89.7%), followed by hanging/suffocation (84.5%), drowning (80.4%), gas poisoning (56.6%), jumping (46.7%), drug/liquid poisoning (8.0%) and cutting (4.0%). The rank of the lethality for different methods remained relatively stable across study setting, sex and age group. Method-specific CFRs for males and females were similar for most suicide methods, while method-CFRs were specifically higher in older adults. CONCLUSIONS This study is the first meta-analysis that provides significant evidence for the wide variation of the lethality of suicide methods. Restricting highly lethal methods based on local context is vital in suicide prevention.
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Affiliation(s)
- Ziyi Cai
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Alvin Junus
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Qingsong Chang
- School of Sociology and Anthropology, Xiamen University, Xiamen, China.
| | - Paul S F Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China; Hong Kong Jockey Club Center for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China.
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18
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Motivating Behavior Change in Parents for Suicide Prevention in the Midwest, USA. J Community Health 2022; 47:495-503. [PMID: 35211847 DOI: 10.1007/s10900-022-01077-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
Safe storage of lethal means is an evidence-based approach to suicide prevention that is underutilized. This naturalistic study investigated whether a presentation on parenting teenagers that includes education about safe storage of firearms and medications, paired with tools to enact change, can impact storage practices. Ten community presentations for parents were given between November 2018 and September 2019 in the Midwest region of the United States. Multiple topics pertinent to parenting adolescents were included with an emphasis on safe storage of firearms and medications to reduce suicide risk. Toolkits including medication storage boxes and cable gun locks were offered to help parents enact recommended changes. Surveys were completed prior to the presentation (T1), immediately following the presentation (T2), and 2 weeks after the presentation (T3). Five-hundred eighty-one parents comprised the initial study sample, of whom 410 (70.6%) completed the primary study endpoint. Generalized linear mixed models with and without worst-case imputation were used to evaluate changes in safe storage practices. Results suggested the odds of storing firearms in the safest manner possible increased 5.9 times (95% CI 2.6-13.5, p < 0.001) without imputation and increased 2.0 times (95% CI 1.1-3.4, p = 0.02) with the worst-case imputation. Among participants with unlocked medications at baseline, 56.5% reported they had disposed of old medications and 53.0% reported locking up bottles of medication by the primary study endpoint. This study provides preliminary evidence that safe storage education paired with tools for behavior change motivates parents to enact safe storage measures.
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19
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Rosen MR, Michael KD, Jameson JP. CALM gatekeeper training is associated with increased confidence in utilizing means reduction approaches to suicide prevention among college resident assistants. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:501-508. [PMID: 32407219 DOI: 10.1080/07448481.2020.1756825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 02/12/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Most suicide prevention programs focus on increasing knowledge regarding the problem of suicide, yet many fail to include information on the science and application of means reduction approaches. In an attempt to address this gap in practice, the Counseling on Access to Lethal Means (CALM) program was developed to educate clinicians on the importance of means reduction interventions. METHODS In the current study, a gatekeeper CALM training was delivered to 167 resident assistants. Confidence levels regarding suicide prevention and means reduction skills were assessed at baseline, post-training, and after a 6-week follow-up. RESULTS Results were suggestive of medium to large training effects. Though there was a small decay of training effects at follow-up, the effects were durable when compared to baseline levels. CONCLUSION Given these findings, future gatekeeper trainings should be provided more consistently to help sustain the effects and data on the implementation of CALM principles should be measured during follow-up assessments.
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Affiliation(s)
- Melanie R Rosen
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
- Department of Psychology, Appalachian State University, Boone, North Carolina, USA
| | - Kurt D Michael
- Department of Psychology, Appalachian State University, Boone, North Carolina, USA
| | - J P Jameson
- Department of Psychology, Appalachian State University, Boone, North Carolina, USA
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20
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Shakarchy N, Tatsa-Laur L, Kedem R, Ben Yehuda A, Shelef L. Risk Factors Associated With Various Severities of Suicidal and Non-Suicidal Self-Harm Among Israel Defense Forces Soldiers-A Nested Case-Control Study. Mil Med 2022; 188:usab541. [PMID: 35015892 DOI: 10.1093/milmed/usab541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/20/2021] [Accepted: 12/18/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Severe suicide attempt is a major risk factor for completed suicide. The aim of the present study was to focus on suicide behavior and timing to gain better understanding of these populations. METHOD The nested case-control retrospective study based on medical records of 246,866 soldiers, who demonstrated suicide attempts of varying severity, including death by suicide were compared with soldiers who did not demonstrate such behavior. RESULTS Risk for death by suicide was associated with males, military seniority of less than 12 months. High frequency of visits with mental health care professionals was associated with being severe suicide attempters (SAs). Moderate suicide attempts were associated with being a male, visiting a primary care physician frequently, and belonging to one of the two latest immigrant groups in Israel (Ethiopians and former Soviet Union). Mild suicide attempts were associated with having a psychiatric diagnosis on the enlistment day, visiting a mental health care professional at high or average frequency, visiting a primary care physician at high or average frequency, being a male, and being born in the former Soviet Union. While the proportion of males demonstrating suicidal behavior was higher than the females', severe SAs were higher among females. There was a clear tendency of female suicide attempters at all levels to act toward the end of their military service. CONCLUSIONS Although half of the SAs were females, their characteristics may be similar to those of the male SAs, contrary to the sex differences in suicide behavior among civilians.
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Affiliation(s)
- Nizan Shakarchy
- Medical Corps, Israel Defense Forces Ramat Gan 5262000, Israel
- Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Lucian Tatsa-Laur
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Ron Kedem
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Ariel Ben Yehuda
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Leah Shelef
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
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21
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Massey AE, Borghesani P, Stuber J, Ratzliff A, Rivara FP, Rowhani-Rahbar A. Lethal Means Assessment in Psychiatric Emergency Services: Frequency and Characteristics of Assessment. Arch Suicide Res 2022; 26:112-126. [PMID: 32585123 DOI: 10.1080/13811118.2020.1783411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Lethal means safety is an effective suicide prevention strategy with demonstrated results at the population level, yet individual-level uptake is less well understood. METHODS Using automated data extraction methods, we conducted an investigation of electronic health records from psychiatric emergency service (PES) patients from January 1, 2012 to December 31, 2017 at a busy urban medical center in the Pacific Northwest. At each PES mental health evaluation, every patient received a Suicide Risk Assessment during which providers used an electronic template with standardized fields to record lethal means access and other suicide risk factors. RESULTS We assessed 32,658 records belonging to 15,652 patients. Among all visits, 69.9% (n = 22,824) had some documentation of lethal means assessment. However, 54.1% (n = 17,674) of all visits lacked some or all potential documentation detail. Additionally, among 59.6% of visits in which a patient had documented access to lethal means, the specific means available were not indicated. Across the twenty risk and demographic factors we assessed, the prevalence of documentation did not vary by any given risk factor and only varied minimally by age and race. For example, when comparing visits which indicated family history of suicide to those which indicated no family history of suicide, the prevalence ratio was 0.99 (95% CI: 0.95, 1.03). CONCLUSION Despite the high-risk patient population, mental health focus of the facility, and the presence of a standardized tool, lethal means documentation was suboptimal. In alignment with recent recommendations, our findings indicate that additional focus on implementation is needed to improve documentation of lethal means assessment.HighlightsFifteen times larger than prior comparable studiesFindings demonstrate persistent under-documentation patterns in new setting and regionStandardized methods likely needed to improve documentation detail and frequency.
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22
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Martínez-Alés G, Gimbrone C, Rutherford C, Kandula S, Olfson M, Gould MS, Shaman J, Keyes KM. Role of Firearm Ownership on 2001-2016 Trends in U.S. Firearm Suicide Rates. Am J Prev Med 2021; 61:795-803. [PMID: 34420829 PMCID: PMC8608719 DOI: 10.1016/j.amepre.2021.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In the U.S., state-level household firearm ownership is strongly associated with firearm suicide mortality rates. Whether the recent increases in firearm suicide are explained by state-level household firearm ownership rates and trends remains unknown. METHODS Mortality data from the U.S. National Vital Statistics System and an estimate of state-level household firearm ownership rate were used to conduct hierarchical age-period-cohort (random-effects) modeling of firearm suicide mortality between 2001 and 2016. Models were adjusted for individual-level race and sex and for state-level poverty rate, unemployment rate, median household income in U.S. dollars, population density, and elevation. RESULTS Between 2001 and 2016, the crude national firearm suicide mortality rate increased from 6.8 to 8.0 per 100,000, and household firearm ownership rate remained relatively stable, at around 40%. Both variables were markedly heterogeneous and correlated at the state level. Age-period-cohort models revealed period effects (affecting people across ages) and cohort effects (affecting specific birth cohorts) underlying the recent increases in firearm suicide. Individuals born after 2000 had higher firearm suicide rates than most cohorts born before. A 2001-2006 decreasing period effect was followed, after 2009, by an increasing period effect that peaked in 2015. State-level household firearm ownership rates and trends did not explain cohort effects and only minimally explained period effects. CONCLUSIONS State-level firearm ownership rates largely explain the state-level differences in firearm suicide but only marginally explain recent increases in firearm suicide. Although firearms in the home increase firearm suicide risk, the recent national rise in firearm suicide might be the result of broader, more distal causes of suicide risk.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, La Paz University Hospital, Madrid, Spain.
| | - Catherine Gimbrone
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Caroline Rutherford
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Sasikiran Kandula
- Department of Environmental Health Sciences (EHS), Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Mark Olfson
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, Columbia University, New York, New York
| | - Madelyn S Gould
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, Columbia University, New York, New York
| | - Jeffrey Shaman
- Department of Environmental Health Sciences (EHS), Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
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23
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Abstract
Safety planning to reduce suicide or other-directed violence risk involves efforts toward "making the environment safe," including working collaboratively with at-risk patients to encourage voluntary changes in their firearm storage decisions [ie, lethal means safety (LMS) counseling]. This column provides a conceptual framework and real-world evidence to support the delivery of LMS counseling to at-risk patients, as well as guidance on asking about firearm access and making individualized safety recommendations. It also reviews important elements related to documenting LMS discussions and legal considerations related to these conversations.
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24
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Salhi C, Berrigan J, Azrael D, Beatriz E, Barber C, Runyan C, Miller M. ' It's changed how we have these conversations': emergency department clinicians' experiences implementing firearms and other lethal suicide methods counseling for caregivers of adolescents. Int Rev Psychiatry 2021; 33:617-625. [PMID: 33496204 DOI: 10.1080/09540261.2020.1870938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Counseling parents to reduce access to firearms and other potentially lethal suicide methods is commonly known as lethal means counseling (LMC). The current study explores the experiences that emergency department-based behavioural health clinicians described having as they provided lethal means counseling to parents of adolescents at risk for suicide. Clinicians were purposively sampled from four hospital networks in Colorado after their hospitals adopted LMC protocols as part of an intervention that also included online training in LMC and provision of free medication and firearm lockboxes. Twenty-three clinicians were interviewed using semi-structured interviews. Data were analysed using a modified grounded theory-based approach. Clinicians felt more comfortable and effective in their abilities to provide LMC after the intervention. Clinicians also described how being able to offer free storage devices helped them engage in LMC. In advising parents to make guns and medications inaccessible to their at-risk child, most clinicians pointed to at least one of three research findings highlighted in the online training: (1) Suicide attempts with guns rarely afford second chances, (2) medication overdoses can kill, (3) suicidal behaviour is always unpredictable and often impulsive. All clinicians described a desire to continue LMC as currently protocolized at their hospital after the study ended.
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Affiliation(s)
- C Salhi
- Department of Health Sciences, Northeastern University, Boston, MA, USA.,Colorado School of Public Health, Aurora, CO, USA
| | - J Berrigan
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA
| | - D Azrael
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA
| | - E Beatriz
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - C Barber
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA
| | | | - M Miller
- Department of Health Sciences, Northeastern University, Boston, MA, USA.,Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA
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25
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Hoyt T, Holliday R, Simonetti JA, Monteith LL. Firearm Lethal Means Safety with Military Personnel and Veterans: Overcoming Barriers using a Collaborative Approach. ACTA ACUST UNITED AC 2021; 52:387-395. [PMID: 34421193 DOI: 10.1037/pro0000372] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Suicides by firearm have increased over the past decade among United States service members and veterans. As firearm access is a suicide risk factor, firearm-related lethal means safety is critical to suicide prevention. However, identity, occupational, and cultural barriers may deter efforts to promote lethal means safety with service members and veterans. The current manuscript describes a collaborative framework to guide mental health providers' in conducting firearm-related lethal means safety with service members and veterans, including within the context of Safety Planning. In approaching firearm lethal means safety conversations with patients, clinicians must work to overcome their own reticence, address patient concerns directly, and remain culturally sensitive to the values of the military and veteran communities. This approach is illustrated using case vignettes that encompass addressing firearm-related lethal means safety with service members and veterans.
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Affiliation(s)
- Tim Hoyt
- Psychological Health Center of Excellence, Defense Health Agency
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.,Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | - Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.,Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration.,Hospital Medicine Group, Rocky Mountain Regional VA Medical Center
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.,Department of Psychiatry, University of Colorado Anschutz Medical Campus
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26
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Goldner L, Shelef L, Goldstein BA, Scharf M. Understanding processes that advance suicidal behavior among Israeli active duty soldiers: A mediation model. J Clin Psychol 2021; 78:590-601. [PMID: 34380174 DOI: 10.1002/jclp.23237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/08/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The current study was aimed to identify the factors and mechanisms that promote nonsuicidal self-injury and suicidal ideation (SI) as precursors of suicidal behaviors in a sample of 553 Israeli active-duty soldiers. METHODS A mediation model was used to examine the contribution of posttraumatic stress disorder (PTSD) symptoms, emotion-regulation difficulties, habituation, and risk-taking behaviors to soldiers' self-injury and SI. RESULTS Results indicated direct effects between PTSD symptoms and self-injury and SI, as well as between emotion regulation difficulties and self-injury. Indirect effects were found between PTSD symptoms and nonsuicidal self-injury (NSSI) through the mechanisms of habituation and risk-taking behavior and between difficulties in emotion regulation and NSSI through the mechanism of risk-taking behaviors. CONCLUSION To tackle soldiers' suicidal behaviors, clinicians might assess soldiers' PTSD symptoms and difficulties in emotion regulation and intervene by lessening their access to thrill-seeking situations and situations that increase habituation to pain and death.
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Affiliation(s)
- Limor Goldner
- School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Leah Shelef
- Mental Health Unit, Medical Corps, Israel Defense Forces, Ramat Gan, Israel
| | - Becky Amit Goldstein
- Mental Health Unit, Medical Corps, Israel Defense Forces, Ramat Gan, Israel.,Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Miri Scharf
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
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27
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Hoyt T, Richter K, Saitzyk A, Long S, Lippy R, Kennedy CH. Containing the good idea fairy: A deep dive into Navy firearms restriction policy. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1897497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Tim Hoyt
- Psychological Health Center of Excellence, Silver Spring, Maryland, USA
| | - Kenneth Richter
- Headquarters Marine Corps, Health Services, Arlington, Virginia, USA
| | - Arlene Saitzyk
- Navy Bureau of Medicine and Surgery, Falls Church, Virginia
| | - Stephanie Long
- Office of the Chief of Naval Personnel, Millington, Tennessee, USA
| | - Robert Lippy
- Navy Bureau of Medicine and Surgery, Falls Church, Virginia
| | - Carrie H. Kennedy
- Psychological Health Center of Excellence, Silver Spring, Maryland, USA
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28
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Baker JC, Bryan CJ, Bryan AO, Button CJ. The Airman's Edge Project: A Peer-Based, Injury Prevention Approach to Preventing Military Suicide. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063153. [PMID: 33803772 PMCID: PMC8003198 DOI: 10.3390/ijerph18063153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 12/03/2022]
Abstract
In light of data indicating military personnel are more likely to reach out to peers during times of need, peer-to-peer (P2P) support programs have been implemented for military suicide prevention. Often designed to reduce suicidal thoughts and behaviors by reducing mental health symptom severity, existing data suggest that P2P programs have little to no effect on mental health symptoms. Conceptualizing suicide prevention from an occupational safety and injury prevention perspective to promote positive health-related behavior change at both the group and individual level may enhance the effectiveness of P2P programs and military suicide prevention efforts more broadly. To illustrate these concepts, the present article provides an overview of the Airman’s Edge project, a P2P program design based upon the occupational safety and injury prevention model of suicide prevention, and describes a program evaluation effort designed to test the effectiveness of this approach.
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Affiliation(s)
- Justin C. Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (C.J.B.); (A.O.B.)
- Correspondence:
| | - Craig J. Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (C.J.B.); (A.O.B.)
| | - AnnaBelle O. Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (C.J.B.); (A.O.B.)
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29
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Davidson JE, Ye G, Deskins F, Rizzo H, Moutier C, Zisook S. Exploring nurse suicide by firearms: A mixed-method longitudinal (2003-2017) analysis of death investigations. Nurs Forum 2020; 56:264-272. [PMID: 33345325 DOI: 10.1111/nuf.12536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/06/2020] [Accepted: 12/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previously it was noted that firearm use by nurses in suicide was changing. The Center for Disease Control and Prevention suicide dataset contains investigation narratives that no researcher has analyzed and may provide context to inform suicide prevention. OBJECTIVE Explore firearm deaths in nurse suicide. Second, test topic modeling techniques to analyze investigation narratives. METHODS/STATISTICAL ANALYSIS Mixed-method retrospective analysis of 739 nurse versus 94,838 nonnurse suicides. Odds ratios (OR) were calculated to determine relative incidence. After tokenization and stop word removal, Latent Dirichlet Analysis and Latent Semantic Indexing topic modeling techniques were applied. Topics were evaluated for clinical significance and content analysis performed. RESULTS Aim 1: Female nurses used firearms significantly less often than other females between 2003 and 2013 (OR: 0.71; p < .001; 95% confidence interval [CI]: 4.23%-9.83%). A rise in nurse firearm use occurred between 2014 and 2017; with rates now similar to nonnurse females (OR: 0.98; p = .7574; 95% CI: -2.68 to 3.49). Clinically relevant topics identified by topic modeling: preventable deaths, chronic pain, and job loss before suicide. CONCLUSIONS From this research we know that work-related issues in nurse suicides by firearms center around chronic pain, substance use, and job loss. The codes tied to suicidal ideation, previous attempt and/or depression, represented preventable deaths because it is known that if a weapon is removed from the home in these situations a suicide can be aborted. The change in firearm use warrants nurse education regarding firearm safety and suicide prevention. Topic modeling holds promise in focusing analyses of suicide investigations.
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Affiliation(s)
- Judy E Davidson
- Department of Nursing Education, Research and Development, University of California San Diego Health, La Jolla, California, USA.,Department of Psychiatry, University of California School of Medicine, La Jolla, California, USA
| | - Gordon Ye
- Department of Psychiatry, University of California School of Medicine, La Jolla, California, USA
| | | | | | | | - Sidney Zisook
- Department of Psychiatry, University of California School of Medicine, La Jolla, California, USA
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30
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Bryan CJ, Bryan AO, Anestis MD. Associations among exaggerated threat perceptions, suicidal thoughts, and suicidal behaviors in U.S. firearm owners. J Psychiatr Res 2020; 131:94-101. [PMID: 32950708 DOI: 10.1016/j.jpsychires.2020.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/02/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
Firearm availability has traditionally been conceptualized as an environmental risk factor for suicide mortality. Firearm acquisition for the primary purpose of self-protection (i.e., protective gun ownership) is often motivated by exaggerated threat expectancies-a central component of anticipatory anxiety-but firearm acquisition may paradoxically reinforce or exacerbate threat expectancies and contribute to behavioral disinhibition. Firearm ownership may therefore confer increased risk for suicide mortality through biobehavioral mechanisms. The present study conducted an initial test of this hypothesis by examining associations among firearm ownership, intentions to acquire additional firearms, threat expectancies, and past-month suicidal thoughts and behaviors using data collected from a national sample of 6200 U.S. adults. Results indicated threat expectancies and rates of suicide-related behaviors were significantly elevated among protective gun owners and participants who intended to acquire a firearm within the next year as compared to non-gun owners and non-protective gun owners. Threat expectancies were associated with significantly increased risk for past-month suicide-related behavior. Results suggest that threat expectancies in particular, and anticipatory anxiety more generally, may be biobehavioral processes associated with the correlation of firearm ownership and increased suicide risk.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA.
| | - AnnaBelle O Bryan
- National Center for Veterans Studies, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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Mental Health Care Utilization and Psychiatric Diagnoses in a Sample of Military Suicide Decedents and Living Matched Controls. J Nerv Ment Dis 2020; 208:646-653. [PMID: 32502074 PMCID: PMC7483990 DOI: 10.1097/nmd.0000000000001192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article examines mental health care utilization and psychiatric diagnoses among US military personnel who died by suicide. We employed an existing electronic health record dataset including 800 US military suicide decedents and 800 matched controls. Suicide decedents were more likely to have received outpatient and inpatient mental health care and to have been diagnosed with depression, bipolar, and nonaffective psychotic disorders. Younger decedents and those in the US Marine Corps were less likely to receive MH care before suicide. Given that approximately half of the suicide decedents in our sample had no mental health care visits before their death, our study suggests the need for programs to increase treatment engagement by at-risk individuals. Such programs could address barriers to care such as stigma regarding mental illness and concerns that seeking mental health care would damage a service member's career.
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Anestis MD, Bandel SL, Butterworth SE, Bond AE, Daruwala SE, Bryan CJ. Suicide risk and firearm ownership and storage behavior in a large military sample. Psychiatry Res 2020; 291:113277. [PMID: 32886959 DOI: 10.1016/j.psychres.2020.113277] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
Firearms account for the majority of suicide deaths in the United States military and access to firearms is a risk factor for suicide. Prior research has shown service members tend to store firearms unsafely, with some research indicating this is particularly true among those with elevated suicide risk. Existing research has focused on individuals at known risk for suicide; however, those who die by suicide using a firearm are prone to avoiding mental healthcare and underreporting suicidal ideation, thereby necessitating an understanding of this phenomenon among firearm owners outside of the mental healthcare system. The present study examined firearm storage and suicide risk in a large nonclinical sample of service members (total sample n = 953; firearm owning sample = 473). Lifetime suicidal ideation, current depressive symptoms, and perceived likelihood of making a future suicide attempt were associated with unsafe firearm storage. In contrast, lifetime suicidal ideation was not associated with a greater likelihood to own firearms. These findings suggest those at risk of suicide are more likely to store firearms unsafely, which increases ease of access to firearms. These findings reiterate the importance of means safety as a suicide prevention strategy.
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Affiliation(s)
- Michael D Anestis
- New Jersey Gun Violence Research Center, United States; School of Public Health, Rutgers, The State University of New Jersey, United States.
| | - Shelby L Bandel
- School of Psychology, University of Southern Mississippi, United States
| | | | - Allison E Bond
- School of Psychology, University of Southern Mississippi, United States
| | | | - Craig J Bryan
- Department of Psychiatry & Behavioral Health, The Ohio State University, United States
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Lemle RB. Veterans, Firearms, and Suicide: Safe Storage Prevention Policy and the PREVENTS Roadmap. Fed Pract 2020; 37:426-433. [PMID: 33029068 PMCID: PMC7535955 DOI: 10.12788/fp.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND US veterans die by suicide at a higher rate than that of the civilian population and are more likely to use a firearm as their method. Systemic efforts to address the use of firearms in suicide had been largely evaded. In June 2020, the White House published the Roadmap to Empower Veterans and End the National Tragedy of Suicide (PREVENTS) task force report, which verified the link between, and the need to address, at-risk veterans and their access to firearms. This paper reviews the literature on the intersection of veterans, firearms, and suicide, then explores existing VA prevention initiatives aimed at reducing at-risk veterans' access to lethal means and offers policy recommendations to expand efforts in the context of the PREVENTS Roadmap. OBSERVATIONS The PREVENTS report recommends widespread distribution of safety education materials that encourage at-risk individuals to temporarily transfer or store their guns safely and the expansion of free or affordable options for storing weapons. Recommended policy actions to accomplish this goal include delaying access to firearms for at-risk veterans, facilitating temporary storage out of the home, improving in-home safe storage options, requiring that health care providers who care for high-risk veterans are trained in lethal means safety counseling, and creating campaigns to shift cultural norms for firearms' storage during crises. CONCLUSIONS Suicide prevention requires a multimodal approach, and attention to firearms access must become a more salient component. The high rate of veteran suicides involving firearms requires far-reaching interventions at societal, institutional, community, family, and individual levels.
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Affiliation(s)
- Russell B Lemle
- is Senior Policy Analyst, Veterans Healthcare Policy Institute and a Clinical Professor in the Department of Psychiatry, University of California, San Francisco
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Dodson NA, Hemenway D. Toward a Deeper Understanding of Gun Violence. Pediatrics 2020; 146:peds.2019-3333. [PMID: 32527749 DOI: 10.1542/peds.2019-3333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nancy A Dodson
- Division of Adolescent Medicine, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York; and
| | - David Hemenway
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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Boggs JM, Beck A, Ritzwoller DP, Battaglia C, Anderson HD, Lindrooth RC. A Quasi-Experimental Analysis of Lethal Means Assessment and Risk for Subsequent Suicide Attempts and Deaths. J Gen Intern Med 2020; 35:1709-1714. [PMID: 32040838 PMCID: PMC7280370 DOI: 10.1007/s11606-020-05641-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/03/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Counseling on access to lethal means is highly recommended for patients with suicide risk, but there are no formal evaluations of its impact in real-world settings. OBJECTIVE Evaluate whether lethal means assessment reduces the likelihood of suicide attempt and death outcomes. DESIGN Quasi-experimental design using an instrumental variable to overcome confounding due to unmeasured patient characteristics that could influence provider decisions to deliver lethal means assessment. SETTING Kaiser Permanente Colorado, an integrated health system serving over 600,000 members, with comprehensive capture of all electronic health records, medical claims, and death information. PARTICIPANTS Adult patients who endorsed suicide ideation on the Patient Health Questionnaire-9 (PHQ-9) depression screener administered in behavioral health and primary care settings from 2010 to 2016. INTERVENTIONS Provider documentation of lethal means assessment in the text of clinical notes, collected using a validated Natural Language Processing program. MEASUREMENTS Main outcome was ICD-9 or ICD-10 codes for self-inflicted injury or suicide death within 180 days of index PHQ-9 event. RESULTS We found 33% of patients with suicide ideation reported on the PHQ-9 received lethal means assessment in the 30 days following identification. Lethal means assessment reduced the risk of a suicide attempt or death within 180 days from 3.3 to 0.83% (p = .034, 95% CI = .069-.9). LIMITATIONS Unmeasured suicide prevention practices that co-occur with lethal means assessment may contribute to the effects observed. CONCLUSIONS Clinicians should expand the use of counseling on access to lethal means, along with co-occurring suicide prevention practices, to all patients who report suicide ideation.
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Affiliation(s)
- Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, 2550 S. Parker Rd., Suite 200, Aurora, CO, 80014, USA.
- University of Colorado Anschutz Medical Campus, Aurora, USA.
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, 2550 S. Parker Rd., Suite 200, Aurora, CO, 80014, USA
- University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Debra P Ritzwoller
- Kaiser Permanente Colorado Institute for Health Research, 2550 S. Parker Rd., Suite 200, Aurora, CO, 80014, USA
- University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Catherine Battaglia
- University of Colorado Anschutz Medical Campus, Aurora, USA
- Department of Veterans Affairs (VA) Eastern Colorado Health Care System, Aurora, CO, USA
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Butterworth SE, Daruwala SE, Anestis MD. The Role of Reason for Firearm Ownership in Beliefs about Firearms and Suicide, Openness to Means Safety, and Current Firearm Storage. Suicide Life Threat Behav 2020; 50:617-630. [PMID: 32011028 DOI: 10.1111/sltb.12619] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 10/30/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Firearm means safety strategies, such as safe storage, are effective in reducing suicide rates but are not widely implemented in the United States. This study examined the association between reason for firearm ownership, beliefs about firearm ownership and storage and suicide risk, willingness to engage in means safety, and current firearm storage practices. METHOD A sample of 300 American firearm owners (53.0% male; 82.3% White; Mage = 36.11, age range = 20-69) completed an online survey via Amazon's Mechanical Turk (mTurk) program. RESULTS Firearm owners who own a firearm for protection, compared to owning a firearm for other reasons, (1) endorsed decreased belief in the relationship between firearm ownership and storage and suicide risk, (2) were less willing to engage in the means safety measures of storing firearms safely and allowing a trusted individual to temporarily remove firearms from the home, and (3) were more likely to store their firearms loaded. CONCLUSIONS Reason for firearm ownership influences views regarding firearms and suicide, willingness to engage in firearm means safety, and firearm storage practices. It is essential to understand how differences in reason for firearm ownership impact these outcomes so appropriate, efficacious messaging can be developed and implemented.
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Affiliation(s)
- Sarah E Butterworth
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Samantha E Daruwala
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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Leah S, Eyal G, Nirit Y, Ariel BY, Yossi LB. Suicide among Ethiopian origin soldiers in the IDF - A qualitative view of risk factors, triggers, and life circumstances. J Affect Disord 2020; 269:125-133. [PMID: 32250865 DOI: 10.1016/j.jad.2020.03.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/22/2019] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ethiopian soldiers in the IDF comprise an at-risk group for suicide. The study investigated the unique characteristics of these soldiers, compared with other suicides in the Israel Defense Forces (IDF). METHOD The research group included all (n = 36) male soldiers born an Ethiopian family, who died by suicide during their compulsory military service in the years 1990-2017. The control group included all (n = 55) non-Ethiopian soldiers who died by suicide during their military service in the years 2009-2013. Socio-demographic, military-service, and suicide-related variables were examined. RESULTS Logistic regression analysis revealed that risk for suicide among Ethiopian soldiers were being incarcerated in a military prison, belonging to a bereaved family, seniority in the military service, and avoidance of help-seeking (explaining 87.8% of the variance). DISCUSSION Ethiopian suicide soldiers have endured heavy environmental pressure, such as financial problems and family bereavement. These circumstances could lead to conflict with the soldier's military service, resulting in absence from service or even imprisonment. When the Ethiopian soldier's distress goes un-expressed in words or actions with others, the psychological crisis signs remain unapparent to those around him, and the risk for eventual suicide is high. LIMITATIONS The case analysis did not include retrieving information from family and relatives outside the military but was derived from archived material, collected primarily for legal purposes. This limitation was addressed by assembling objective variables and information collected prior to the suicide, along with post-mortem information collected by mental health personnel in their assessments.
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Affiliation(s)
- Shelef Leah
- Mental Health Unit, Medical Corps, Israel Defense Forces.
| | - Garber Eyal
- Mental Health Unit, Medical Corps, Israel Defense Forces; The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Yavnai Nirit
- Israel Defense Force Medical Corps, Ramat Gan, Israel
| | | | - Levi-Belz Yossi
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.
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Raifman J, Sampson L, Galea S. Suicide fatalities in the US compared to Canada: Potential suicides averted with lower firearm ownership in the US. PLoS One 2020; 15:e0232252. [PMID: 32353022 PMCID: PMC7192495 DOI: 10.1371/journal.pone.0232252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/12/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction and objective The United States (US) has the highest rate of firearm suicides in the world. The US and Canada are comparable countries with markedly different rates of firearm ownership, providing an opportunity to estimate suicide fatalities that could be averted in the US with a lower rate of firearm ownership. Methods We compared 2016 US suicide fatality rates–standardized within fourteen sex-specific age groups to reflect the ethnic composition of Canada–to 2016 Canadian suicide rates. We then calculated the number and proportion of suicides that could be averted in the US if the US had the same rates of suicide as in Canada. Results If the US had the same suicide rates as in Canada, we estimate there would be approximately 25.9% fewer US suicide fatalities, equivalent to 11,630 suicide fatalities averted each year. This decline would be driven by a 79.3% lower rate of firearm-specific suicide fatalities. The male suicide fatality rate would be 28.8% lower and equivalent to 9,992 fewer suicide fatalities each year. The female suicide fatality rate would be 16.0% lower and equivalent to 1,638 fewer suicide fatalities each year. While 36% of firearm suicide fatalities could be replaced by non-firearm suicide fatalities, 64% of firearm fatalities could be averted entirely. Conclusions US policymakers may wish to consider policies that would reduce rates of firearm ownership, given that that about 26% of US suicide fatalities might be averted if the US had the same suicide rates as in Canada, a country with drastically lower firearm ownership rates.
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Affiliation(s)
- Julia Raifman
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Laura Sampson
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Sandro Galea
- Boston University School of Public Health, Boston, Massachusetts, United States of America
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Miller M, Salhi C, Barber C, Azrael D, Beatriz E, Berrigan J, Brandspigel S, Betz ME, Runyan C. Changes in Firearm and Medication Storage Practices in Homes of Youths at Risk for Suicide: Results of the SAFETY Study, a Clustered, Emergency Department-Based, Multisite, Stepped-Wedge Trial. Ann Emerg Med 2020; 76:194-205. [PMID: 32307124 DOI: 10.1016/j.annemergmed.2020.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/16/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE We evaluate whether a counseling intervention implemented at the hospital level resulted in safer firearm and medication storage by caregivers of youths aged 10 to 17 years after their child's evaluation in the emergency department (ED) for a behavioral health concern. METHODS We used a stepped-wedge clustered design rolled out at 4 hospital sites to assess primary preregistered outcomes (self-reported storage changes caregivers made to household firearms and medications), assessed by survey 2 weeks after the ED visit. Three logistic models provided estimates of the intervention effect: an unadjusted model, a model with hospital-level fixed effects, and a model that further adjusts for time. RESULTS Of the 575 caregiver participants, 208 were firearm owners (123 in usual care, 85 in the intervention). Baseline (pre-ED visit) characteristics did not differ between usual care and intervention phases. During the 2-year study period, twice as many caregivers whose child visited the ED after (compared with before) a hospital adopted the intervention improved firearm storage and 3 times as many improved medication storage (odds ratio [OR]=2.1 [95% confidence interval {CI} 1.0 to ∞] and OR=3.0 [95% CI 2.2 to ∞], respectively). After adjusting for time, the intervention effect for medications persisted (OR=2.0 [95% CI 1.0 to ∞]); the effect on firearms did not (OR=0.7 [95% CI 0.1 to ∞]). CONCLUSION To our knowledge, this study is the first controlled trial to estimate the effectiveness of an intervention on firearm and medication storage in homes of youths at elevated risk of suicide. We found evidence that caregivers' medication storage improved after their child's ED visit, with evidence suggestive of improvement for firearm storage.
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Affiliation(s)
- Matthew Miller
- Northeastern University, Boston, MA; Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA.
| | | | - Catherine Barber
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA
| | | | - John Berrigan
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA
| | | | - Marian E Betz
- University of Colorado School of Medicine, Aurora, CO
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Jordan L, Kalin J, Dabrowski C. Characteristics of Gun Advertisements on Social Media: Systematic Search and Content Analysis of Twitter and YouTube Posts. J Med Internet Res 2020; 22:e15736. [PMID: 32217496 PMCID: PMC7148552 DOI: 10.2196/15736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/15/2019] [Accepted: 01/13/2020] [Indexed: 01/22/2023] Open
Abstract
Background Although gun violence has been identified as a major public health concern, the scope and significance of internet gun advertising is not known. Objective This study aimed to quantify the characteristics of gun advertising on social media and to compare the reach of posts by manufacturers with those of influencers. Methods Using a systematic search, we created a database of recent and popular Twitter and YouTube posts made public by major firearm manufacturers and influencers. From our sample of social media posts, we reviewed the content of the posts on the basis of 19 different characteristics, such as type of gun, presence of women, and military or police references. Our content analysis summarized statistical differences in the information conveyed in posts to compare advertising approaches across social media platforms. Results Sample posts revealed that firearm manufacturers use social media to attract audiences to websites that sell firearms: 14.1% (131/928; ±2.9) of Twitter posts, 53.6% (228/425; ±6.2) of YouTube videos, and 89.5% (214/239; ±5.1) of YouTube influencer videos link to websites that facilitate sales. Advertisements included women in efforts to market handguns and pistols for the purpose of protection: videos with women included protection themes 2.5 times more often than videos without women. Top manufacturers of domestic firearms received 98 million channel views, compared with 6.1 billion channel views received by the top 12 YouTube influencers. Conclusions Firearm companies use social media as an advertising platform to connect viewers to websites that sell guns. Gun manufacturers appropriate YouTube servers, video streaming services, and the work of YouTube influencers to reach large audiences to promote the widespread sale of consumer firearms. YouTube and Twitter subsidize gun advertising by offering server and streaming services at no cost to gun manufacturers, to the commercial benefit of Google and Twitter’s corporate ownership.
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Shelef L, Tatsa-Laur L, Derazne E, Mann J, Fruchter E. An effective suicide prevention program in the Israeli Defense Forces: A cohort study. Eur Psychiatry 2020; 31:37-43. [DOI: 10.1016/j.eurpsy.2015.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/11/2015] [Accepted: 10/17/2015] [Indexed: 11/30/2022] Open
Abstract
AbstractObjectiveTo evaluate the effectiveness of the IDF Suicide Prevention Program, implemented since 2006.DesignQuasi-experimental (before and after) cohort study.ParticipantsTwo cohorts of IDF mandatory service soldiers: the first inducted prior to (1992–2005, n = 766,107) and the second subsequent to (2006–2012, n = 405,252) the launching of the intervention program.ExposureThe IDF Suicide Prevention Program is a population-based program, incorporating: reducing weapon availability, de-stigmatizing help-seeking behavior, integrating mental health officers into service units, and training commanders and soldiers to recognize suicide risk factors and warning signs.Main outcome measureSuicide rate and time to suicide in cohorts before and after exposure to the Suicide Prevention Program.ResultsTrend analysis showed lower suicide rates in the cohort after intervention. The hazard ratio for the intervention effect on time to suicide was 0.44 (95% CI = 0.34–0.56, P < .001) among males. Lower risk was associated with: male gender; born in Israel; higher socio-economic status; higher intelligence score; and serving in a combat unit (HR = 0.43: 95% CI = 0.33–0.55).ConclusionsThere was a 57% decrease in the suicide rate following the administration of the IDF Suicide Prevention Program. The effect of the intervention appears to be related to use of a weapon, and being able to benefit from improved help-seeking and de-stigmatization. Future efforts should seek to extend the program's prevention reach to other demographic groups of soldiers. The success of the IDF program may inform suicide prevention in other military organizations and in the civilian sector.
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Shelef L, Tomer G, Tatsa-Laur L, Kedem R, Bonne O, Fruchter E. Risk factors for suicide in the Israeli army between the years 1992–2012: A case-control study. Eur Psychiatry 2020; 39:106-113. [DOI: 10.1016/j.eurpsy.2016.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 11/27/2022] Open
Abstract
AbstractObjectiveYoung age, availability of weapons, and stressful life events, increase the risk of suicide. The aim of the present study was to assess additional risk factors for suicide in the Israeli army.MethodsWe conducted a case-control study, to assess risk factors for suicide. The cases comprised soldiers who died by suicide during their military service (n = 462; 0.039% of all soldiers in the cohort). The control group consisted of soldiers who did not commit suicide but were in active service during the investigated period (n = 1,170,895; 99.96%). Predictor variables, including socio-demographic and psychiatric diagnoses, were considered.ResultsUsing a Generalized Linear Model with a Binary Logistic dependent variable to predict suicide, while controlling the effect of intervening variables, we found the following variables enhanced the risk for committing suicide: male (RR = 6.703; P < 0.001), country of origin: Ethiopia (RR = 4.555; P = 0.014), low socioeconomic status (RR = 1.448; P = 0.016) and low adjustment difficulties (RR = 2.324; P < 0.001). In addition, we found that in males only, Cluster B Personality Disorder (RR = 2.548; P = 0.027), low (RR = 1.657; P = 0.002), to average motivation to serve in a combat unit (RR = 1.322; P = 0.046) increased the risk for suicide.ConclusionsIDF Soldiers bearing a psychiatric diagnosis or severe adjustment difficulties remained tightly monitored through their military service, and were found to be at a lower risk for suicide. However, those enlisted with mild (low) difficulties, were found to be at greater risk for suicide, as well as soldiers whose country of origin is Ethiopia. Suicide prevention program should focus on monitoring soldiers with these risk factors, together with soldiers’ guidance regarding help seeking and de-stigmatizing suicide.
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Wilson MP, Moutier C, Wolf L, Nordstrom K, Schulz T, Betz ME. ED recommendations for suicide prevention in adults: The ICAR2E mnemonic and a systematic review of the literature. Am J Emerg Med 2020; 38:571-581. [DOI: 10.1016/j.ajem.2019.06.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 01/28/2023] Open
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König D, Swoboda P, Cramer RJ, Krall C, Postuvan V, Kapusta ND. Austrian firearm legislation and its effects on suicide and homicide mortality: A natural quasi-experiment amidst the global economic crisis. Eur Psychiatry 2020; 52:104-112. [DOI: 10.1016/j.eurpsy.2018.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 12/22/2022] Open
Abstract
AbstractBackground:Restriction of access to suicide methods has been shown to effectively reduce suicide mortality rates.Aims:To examine how the global economic crisis of 2008 and the firearm legislation reform of 1997 affected suicide and homicide mortality rate within Austria.Methods:Official data for the years 1985–2016 for firearm certificates, suicide, homicide, unemployment rates and alcohol consumption were examined using auto regressive error and Poisson regression models.Results:Firearm certificates, total suicide mortality rate, suicide and homicides by firearms, and the fraction of firearm suicides/homicides among all suicides/homicides decreased after the firearm legislation reform in 1997. However, significant trend changes can be observed after 2008. The availability of firearm certificates significantly increased and was accompanied by significant changes in trends of firearm suicide and homicide rates. Concurrently, the total suicide mortality rate in 2008, for the first time since 1985, stopped its decreasing trend. While the total homicide rate further decreased, the fraction of firearm homicides among all homicides significantly increased.Conclusion:The initially preventative effect of the firearm legislation reform in Austria in 1997 seems to have been counteracted by the global economic downturn of 2008. Increased firearm availability was associated with corresponding increases in both firearm suicide and firearm homicide mortality. Restrictive firearm legislation should be an imperative part of a country’s suicide prevention programme. Although firearm legislation reform may have long-lasting effects, societal changes may facilitate compensatory firearm acquisitions and thus counteract preventive efforts, calling in turn again for adapted counter-measures.
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Use of lethal means restriction counseling for suicide prevention in pediatric primary care. Prev Med 2020; 130:105855. [PMID: 31644896 DOI: 10.1016/j.ypmed.2019.105855] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/12/2019] [Accepted: 09/20/2019] [Indexed: 12/26/2022]
Abstract
Suicide is the second-leading cause of death for adolescents in the United States. Counseling patients and families on safe storage of firearms and medications is an effective method of suicide prevention. We sought to determine the self-reported frequency of lethal means restriction (LMR) counseling among primary care pediatric providers working with adolescents who are at risk for suicide as well as factors associated with consistently employing LMR counseling. An anonymous, self-report, electronic survey was conducted of primary care pediatricians in the Washington, DC metropolitan area of LMR counseling for suicide prevention. The survey was conducted over 10 weeks in autumn of 2017. Stepwise, multivariate logistic models were used to determine factors associated with firearm screening and LMR counseling for patients at risk for suicide. Response rate was 11% (n = 1546). Over a range of suicide risk scenarios, few respondents reported consistently screening for firearms (21.9%) or employing LMR counseling (19.4%). When adjusting for confounding, five or more years in practice was associated with higher odds of screening for firearms (aOR 4.6 [1.3-16]). Previous LMR training was strongly associated with consistent LMR counseling (aOR 8.3 [1.8-38.4]). While LMR counseling can reduce risk for completed suicide, most respondents do not consistently employ it. Those who have received training are more likely to counsel. Thus, LMR counseling should be a standard part of medical education for pediatricians.
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Bauer BW, Capron DW. How Behavioral Economics and Nudges Could Help Diminish Irrationality in Suicide-Related Decisions. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2019; 15:44-61. [PMID: 31697611 DOI: 10.1177/1745691619866463] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
People regularly make decisions that are not aligned with their own self-interests. These irrational decisions often stem from humans having bounded rationality (e.g., limited computational power), which produces reliable cognitive biases that occur outside of people's awareness and influences the decisions people make. There are many important decisions leading up to a suicide attempt, and it is likely that these same biases exist within suicide-related decisions. This article presents an argument for the likely existence of cognitive biases within suicide-related decision making and how they may influence people to make irrational decisions. In addition, this article provides new evidence for using a behavioral economic intervention-nudges-as a potential way to combat rising suicide rates. We explore how nudges can help increase means safety, disseminate suicide prevention skills/materials, diminish well-known biases (e.g., confirmation bias), and uncover biases that may be occurring when making suicide-related decisions.
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Affiliation(s)
- Brian W Bauer
- Department of Psychology, University of Southern Mississippi
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi
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Katz C, Bhaskaran J, Bolton JM. Access to Firearms Among People Assessed by Psychiatric Services in the Emergency Department. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:770-776. [PMID: 31615276 PMCID: PMC6882073 DOI: 10.1177/0706743719882200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In Canada, 80% of firearm-related deaths are suicides. Access to firearms is associated with increased suicide rates. This study examines the frequency and factors that influence assessment of firearm access in an emergency setting. METHODS A total of 15,847 consecutive adults seen for psychiatric consultation in two tertiary emergency departments (EDs) in Winnipeg, Manitoba were interviewed. Data captured whether access to firearms was assessed, and whether respondents endorsed access or not. Comparisons were done to determine group differences among those with and without and with known and unknown firearm access. RESULTS Access to firearms was unknown in 47% (n = 7,363) of psychiatric ED consultations, including 43% (n = 998) of individuals who presented with a suicide attempt. Female sex was associated with decreased odds of firearm access (odds ratio [OR] 0.28; 95% CI, 0.22 to 0.35). Being single was associated with lower odds of known firearm access (OR 0.83; 95% CI, 0.77 to 0.89) yet higher likelihood of firearm access (OR 1.36; 95% CI, 1.11 to 1.68). Presenting with a suicide attempt (OR 2.45; 95% CI, 1.80 to 3.34), preparatory acts (OR 6.40; 95% CI, 4.38 to 9.36) and suicidal ideation (OR 2.45; 95% CI, 1.87 to 3.21) were associated with increased odds of reporting access. When clinicians felt there was a high likelihood of future suicide, firearm access remained unknown in half of cases. CONCLUSION Firearm ownership and access is an essential component of a suicide risk assessment and remains unknown in half of individuals seen by psychiatry in this tertiary care ED sample. People presenting with suicidal ideation and attempts were more likely to report access to firearms.
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Affiliation(s)
- Cara Katz
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joanna Bhaskaran
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M. Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
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Kapoor R, Benedek E, Bonnie RJ, Gandhi T, Gold L, Judd S, Pinals DA. Resource Document on Risk-Based Gun Removal Laws. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:443-451. [PMID: 32015728 DOI: 10.1176/appi.focus.17403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
(Reprinted with permission from APA Resource Document, June 2018).
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Butterworth SE, Anestis MD. Political Beliefs, Region of Residence, and Openness to Firearm Means Safety Measures to Prevent Suicide. Arch Suicide Res 2019; 23:616-633. [PMID: 29952717 DOI: 10.1080/13811118.2018.1486250] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Firearms account for approximately half of all suicides in the United States and are highly lethal, widely available, and popular; thus, are an ideal candidate for targeted means safety interventions. However, despite their value as a suicide prevention tool, firearm means safety strategies are not widely utilized, possibly due to factors which impede openness to their use. This study examines the relationship between region, political beliefs, and openness to firearm means safety in a sample of 300 American firearm owners. Overall, firearm owners were more willing to engage in means safety for others than for themselves and to store firearms safely than temporarily remove them from the home. Social policy views and region were significantly associated with openness to firearm means safety measures, however, economic policy views were not. This study provides further context for the development and implementation of efficacious means safety measures capable of overcoming potential barriers to their use.
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The effect of the Suicide Prevention Program (SPP) on the characteristics of Israeli soldiers who died by suicide after its implementation. Eur Psychiatry 2019; 62:74-81. [PMID: 31550581 DOI: 10.1016/j.eurpsy.2019.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/18/2019] [Accepted: 08/26/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Suicide is major cause of death in the IDF. The Suicide Prevention Program (SPP) led to significant reduction in yearly rates of suicide. A study regarding demographic changes of those who died by suicide was done to further investigate its affect. METHOD Nested case control retrospective study based on medical and HR data gathered between 1992 and 2016. Participants were divided into four groups: soldiers who died by suicide and non-suicidal soldiers, before and after SPP implementation. RESULTS Multivariate analysis with suicide as the binary logistic dependent variable before and after implementation of the SPP among four groups revealed that before SPP the OR was higher for males (OR, 7.885; 95% CI, 5.071-12.259;p < 0.001) compared to after (OR, 3.281; 95% CI, 1.600-6.726; p = 0.001). For support unit soldiers the values before SPP were OR, 14.962 and 95% CI, 8.427-26.563 (p < 0.001) while after SPP they were OR, 6.304 and 95% CI, 3.334-11.919 (p < 0.001). After SPP, OR was higher for psychiatric diagnosis at recruitment (OR, 5.830; 95% CI, 2.046-16.612; p = 0.001) than before SPP (OR, 2.422; 95% CI, 1.526-3.842; p < 0.001).For soldiers from Ethiopian ethnicity, after SPP values were higher (OR, 8.130 and 95% CI, 2.868-23.047 (p < 0.001) compared to before (OR, 3.522; 95% CI, 1.2891-6.650; p < 0.001). For those of Druse religion before values (OR, 4.027; 95% CI, 2.211-7.331; p < 0.001) were significant but not after. CONCLUSIONS While the SPP succeeded in reducing risk of suicide in situational factors, dispositional risk factors were not affected by the SPP. The OR decreased in critical masses and rose in unique and smaller groups.
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