1
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Price JH, Payton E. Firearm Deaths Impacting Older Adults. J Community Health 2025; 50:464-471. [PMID: 39885087 PMCID: PMC12069462 DOI: 10.1007/s10900-024-01441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2024] [Indexed: 02/01/2025]
Abstract
Each year in the United States (U.S.) thousands of older adults die from firearm-related injuries. The purpose of this study was to characterize the similarities and differences in the three main forms of firearm mortality (homicides, suicides, and unintentional) in older adults. Using the Web-based Inquiry Statistics Query and Reporting System (WISQARS) for the year 2021 we conducted a descriptive analysis (e.g. frequencies, percents, crude rates, rank orders) by gender, race/ethnicity, age, and census region of the U.S. Older adult firearm-related homicides were most likely to occur in males (61.2%), non-Hispanic whites (61.9%), ages 65-69 (42.4%) and in the South (53.6%). Firearm-related suicides were most common in males (91.4%), non-Hispanic whites (93.5%), ages 65-69 and 70-74 (24.8 and 24.7%, respectively), and in the South (45.1%). Firearm suicides were 12 times more common than firearm homicides and 99 times more common than unintentional firearm-related deaths. Both firearm homicides and suicides decreased with age. Years of potential life lost before 80 paralleled the demographic mortality data, resulting in over 45,000 potential years of life lost in 2021. These findings underscore the need to focus primary prevention of firearm-related mortality in older adults on the role of suicides, especially in non-Hispanic white males. In addition, improving mental health care access for older adults and their social connections are essential elements of preventing firearm-related suicides.
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Affiliation(s)
| | - Erica Payton
- University of North Carolina at Greensboro, Greensboro, NC, USA
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2
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Prahlow SP, Wilson T, Gruszecki AC. Suicide by Ethyl Methacrylate Ingestion. Am J Forensic Med Pathol 2025; 46:82-86. [PMID: 39088702 DOI: 10.1097/paf.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
ABSTRACT This case report characterizes a unique way in which suicide was accomplished through ingestion of chemicals typically used to create acrylic fingernails that resulted in death. Ethyl methacrylate and acrylic powder are commonly combined to form acrylic nails in nail salons. The process of applying acrylic nails utilizes each substance by mixing both before it typically solidifies within seconds of combining the two compounds. Ingestion of these compounds has not been previously described within the medical literature. The decedent was a nail technician at a local salon. He was found unresponsive in his yard which led to a 911 call. At the scene, a mostly empty 16-oz bottle of ethyl methacrylate, a chemical used at the salon where he worked, was found. At autopsy, the decedent's body had a strong chemical odor consistent with odors present at nail salons. Significant gastrointestinal tract damage was seen including discoloration within the esophagus, and the stomach contained a molded, hardened nail compound. The cause of death was ruled as complications of nail acrylic powder and liquid ethyl methacrylate ingestion. This case shows the unusual findings seen at autopsy from a decedent who committed suicide by ingestion of ethyl methacrylate with acrylic powder.
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Affiliation(s)
- Samuel P Prahlow
- From the Philadelphia College of Osteopathic Medicine-South Georgia, Moultrie, GA
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3
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Shah K, Mathur R, Mishra S, Dua S, Mudgal V. Non-suicidal Self-Injury and Suicide Attempts: A Secondary Analysis Describing the Patterns and Clinical Characteristics of Patients Presenting With Self-Harm to a Tertiary Care Hospital. Cureus 2025; 17:e80715. [PMID: 40242716 PMCID: PMC12002096 DOI: 10.7759/cureus.80715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2025] [Indexed: 04/18/2025] Open
Abstract
Background Self-harm includes suicide attempts and non-suicidal self-injury (NSSI), both of which are linked to psychiatric disorders and psychosocial stressors. While suicide attempts involve an intent to die, NSSI often serves as a maladaptive coping mechanism. In India, stigma and limited mental health resources hinder early intervention. This study analyzes self-harm patterns, psychiatric comorbidities, and risk factors in patients presenting to a tertiary care hospital. Methodology This retrospective study reviewed the medical records of 165 patients with suicide attempts or NSSI between January and June 2024. Data on demographics, psychiatric diagnoses, self-harm methods, and substance use were analyzed using descriptive and inferential statistics. Results Of the 165 cases, 69 involved suicide attempts, and 96 involved NSSI. Suicide attempts were more common among individuals aged 31-40, whereas NSSI was predominant in the 18-30 age group. Depressive disorder was the most frequent diagnosis among those attempting suicide, affecting 55 (68.7%) individuals, while substance use disorder was more prevalent in NSSI cases, with 51 (67.1%) individuals affected. Self-poisoning emerged as the most common method, possibly influenced by weak pesticide regulations in India. A significant association was found between suicide intent and a history of past suicide attempts. Conclusion Early screening, access control to harmful substances, identifying at-risk populations, and structured post-discharge care are essential in reducing self-harm and suicide risk. Targeted interventions can improve mental health outcomes in at-risk populations.
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Affiliation(s)
- Kashyap Shah
- Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, IND
| | - Rahul Mathur
- Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, IND
| | - Saloni Mishra
- Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, IND
| | - Shivani Dua
- Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Varchasvi Mudgal
- Psychiatry, Mahatma Gandhi Memorial Medical College, Indore, IND
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4
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Shinan-Altman S, Elyoseph Z, Levkovich I. The impact of history of depression and access to weapons on suicide risk assessment: a comparison of ChatGPT-3.5 and ChatGPT-4. PeerJ 2024; 12:e17468. [PMID: 38827287 PMCID: PMC11143969 DOI: 10.7717/peerj.17468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/05/2024] [Indexed: 06/04/2024] Open
Abstract
The aim of this study was to evaluate the effectiveness of ChatGPT-3.5 and ChatGPT-4 in incorporating critical risk factors, namely history of depression and access to weapons, into suicide risk assessments. Both models assessed suicide risk using scenarios that featured individuals with and without a history of depression and access to weapons. The models estimated the likelihood of suicidal thoughts, suicide attempts, serious suicide attempts, and suicide-related mortality on a Likert scale. A multivariate three-way ANOVA analysis with Bonferroni post hoc tests was conducted to examine the impact of the forementioned independent factors (history of depression and access to weapons) on these outcome variables. Both models identified history of depression as a significant suicide risk factor. ChatGPT-4 demonstrated a more nuanced understanding of the relationship between depression, access to weapons, and suicide risk. In contrast, ChatGPT-3.5 displayed limited insight into this complex relationship. ChatGPT-4 consistently assigned higher severity ratings to suicide-related variables than did ChatGPT-3.5. The study highlights the potential of these two models, particularly ChatGPT-4, to enhance suicide risk assessment by considering complex risk factors.
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Affiliation(s)
| | - Zohar Elyoseph
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, England, United Kingdom
- The Center for Psychobiological Research, Department of Psychology and Educational Counseling, Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tiv’on, Israel
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5
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Godshall KC, Cross Hansel T, Brewer K. Exploring Teen Suicide Rates through the Lens of Macro Risk Factors. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:313-322. [PMID: 38415692 DOI: 10.1080/19371918.2024.2324145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
As the second leading cause of death in teenagers, suicide has been a consistent public health issue for the past decade. Our goal is to understand the relationship between increasing teen suicide rates by state policies. We explore links between macro-level risk factors and state suicide rates. Risk factors explored include state behavioral health spending, child access policies for firearms, insurance coverage, tax revenue from tobacco and alcohol, school spending per pupil, pupil support services funding, and teacher spending. This research shows a relationship between pupil support spending, any child access law, required legislation, and lower teen suicide rates. The results from this study can aid in the understanding of macro-level influences on teen suicide; empowering advocates, lawmakers, and researchers to develop informed interventions and policies. Increasing multi-level understanding around suicide can provide an opportunity to slow or stop suicide rates.
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Affiliation(s)
| | | | - Kathryne Brewer
- Social Work Department, University of New Hampshire, Durham, NH, USA
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Nicosia N, Smart R, Schell TL. Effects of restricting alcohol sales on fatal violence: Evidence from Sunday sales bans. Drug Alcohol Depend 2023; 253:110982. [PMID: 37980844 PMCID: PMC11665804 DOI: 10.1016/j.drugalcdep.2023.110982] [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: 06/09/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Homicides and suicides are the second- and third-leading causes of death among young people (aged 10-24) in the US. While a substantial share of these deaths involve alcohol, evidence is needed on whether specific alcohol policies, such as day-based sales restrictions, help prevent these deaths. METHODS We constructed total and firearm-related homicide and suicide counts by state, year, and day-of-week from the Multiple Cause of Death Micro-data 1990-2019. Repeals of Sunday bans were taken from the Alcohol Policy Information System. Two-way fixed effects Poisson models with standard errors clustered at state-level and population offset control for state, year and day-of-the-week fixed effects and state time-varying covariates. RESULTS Repealing Sunday bans is associated with an increase in homicides (IRR=1.125; 95% confidence interval [CI]:1.02-1.24) and firearm homicides (IRR=1.17; 95% CI:1.03-1.33). Analyses by day-of-the-week show significant associations with homicides not only on Sundays, but also other days, consistent with delays in death. There was no significant relationship for suicides. CONCLUSION Restricting alcohol availability may prove a useful policy tool to reduce homicides, given that day-based restrictions are associated with changes in deaths rather than only shifting across days-of-the-week.
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7
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Paul ME, Coakley BA. State Gun Regulations and Reduced Gun Ownership are Associated with Fewer Firearm-Related Suicides Among Both Juveniles and Adults in the USA. J Pediatr Surg 2023; 58:1796-1802. [PMID: 36797108 DOI: 10.1016/j.jpedsurg.2023.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/27/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Few studies have investigated the relationship between specific gun regulations and gun ownership with the firearm-related suicide rate among juveniles and adults across U.S. states. Therefore, this study seeks to determine if gun ownership rates and gun restrictions are related to the firearm-related suicide rate in both the pediatric and adult populations. METHODS Fourteen measures of state gun law restrictions and gun ownership were collected. These included Giffords Center ranking, gun ownership percentages, and 12 specific firearm laws. Unadjusted linear regressions modeled the relationship between each individual variable and the rate of firearm-related suicides for adults and children across states. This was repeated using a multivariable linear regression adjusting for poverty, poor mental health, race, gun ownership, and divorce rates by state. P values of <0.004 were considered significant. RESULTS In the unadjusted linear regression, 9 of 14 firearm-related measures were statistically associated with fewer firearm-related suicides in adults. Similarly, 9 of 14 measures were found to be associated with fewer firearm-related suicides in the pediatric population. In the multivariable regression, 6 of 14 vs. 5 of 14 measures were statistically associated with fewer firearm-related suicides in the adult and pediatric populations, respectively. CONCLUSIONS Ultimately, this study found that increased state gun restrictions and lower gun ownership rates were associated with fewer firearm related suicides among juveniles and adults in the US. This paper provides objective data to help lawmakers as they create gun control legislation that can potentially decrease the rate of fire-arm related suicide. LEVELS OF EVIDENCE II.
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Affiliation(s)
- Megan E Paul
- The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Brian A Coakley
- Division of Pediatric Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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8
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An S, Lim S, Kim HW, Kim HS, Lee D, Son E, Kim TW, Goh TS, Kim K, Kim YH. Global prevalence of suicide by latitude: A systematic review and meta-analysis. Asian J Psychiatr 2023; 81:103454. [PMID: 36634498 PMCID: PMC9822839 DOI: 10.1016/j.ajp.2023.103454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Affiliation(s)
- Seongjun An
- School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Sungju Lim
- School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Hyun-Woo Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyung-Sik Kim
- Department of Oral Biochemistry, Dental and Life Science Institute, School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - Dongjun Lee
- Department of Convergence Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Eunjeong Son
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Tae Woo Kim
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Tae Sik Goh
- Department of Orthopaedic Surgery, Pusan National University, Busan, Republic of Korea
| | - Kihun Kim
- Department of Occupational and Environmental Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea.
| | - Yun Hak Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, Republic of Korea; Department of Anatomy, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
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Lasky T, Jarrouj A, Samanta D. A 10-Year Epidemiologic Overview of Firearm Injuries in Southern West Virginia. VIOLENCE AND VICTIMS 2023; 38:3-14. [PMID: 36717196 DOI: 10.1891/vv-2022-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The firearm mortality rate in West Virginia (WV) increased over the past four years and is currently 50% higher than the national rate. These alarming statistics, combined with the urban-to-rural shift in firearm injuries, prompted this 10-year epidemiologic overview. To the best of the authors' knowledge, the current study stands alone as the only report of its kind on firearm injuries in the rural setting of southern WV. Firearm injuries were common in White males within the age range of 20-49 years. Assault, which is typically identified as an urban problem, was found to be the most common injury in the study population. In our data series, injury severity score was the strongest predictor of mortality, followed by self-inflicted cause of injury and trauma to the neck/head region.
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Affiliation(s)
- Tiffany Lasky
- Department of Surgery, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Aous Jarrouj
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Institute for Academic Medicine, Charleston, West Virginia, USA
| | - Damayanti Samanta
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Institute for Academic Medicine, Charleston, West Virginia, USA
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10
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Faulkner A, Ogeil RP, Stojcevski V, Scott D. Identifying Points of Prevention in Firearm-Related Suicides: A Mixed-Methods Study Based on Coronial Records. Arch Suicide Res 2022; 26:1815-1830. [PMID: 34157235 DOI: 10.1080/13811118.2021.1938322] [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] [Indexed: 10/21/2022]
Abstract
PURPOSE Firearm-related suicide is a noteworthy and preventable public health issue that has drawn limited attention in Australian research. Firearms are highly lethal and remain in the top three methods of suicide among Australian males. This study examines suicides occurring in Tasmania, the jurisdiction with the highest rate of firearm-related suicide, with the aim of aiding suicide prevention strategies. METHODS A mixed-methods approach was used to analyze data from the Tasmanian Suicide Register. The quantitative analysis examined socio-demographic factors, substance use, physical and mental health, and access to services for suicides occurring between January 1, 2012 and December 31, 2016. The qualitative analysis comprised firearm-related suicides occurring between January 1, 2012 and December 31, 2017. RESULTS Firearms users were more likely than those employing other means of suicide to be male, retired, and residing in remote areas but were less likely to have had a previous mental illness diagnosis or evidence of suicidal ideation or self-harming behaviors. There was some evidence of increased impulsiveness among firearm users. We found 54% of decedents were licensed to own a firearm at the time of death. Firearms most often belonged to the decedent (52%) and 26% sourced a firearm from family or friends. Only 58% of cases involved a firearm with a dedicated storage facility. CONCLUSIONS Prevention efforts need to take into account the unique profiles of those at risk of firearm-related suicide. Impulsiveness and the varying levels of adherence to firearms safety practices point to the need for strategies that limit physical access to firearms.HIGHLIGHTSFirearms-related suicides have a unique risk profile compared with other means of suicide.Mental illness diagnosis, suicidal thoughts, and self-harming behaviors were less commonly identified among firearms-related suicides than other means of suicide.Impulsiveness and the varying levels of adherence to firearms safety practices point to the need for strategies that limit physical access to firearms.
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11
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Iwundu CN, Homan ME, Moore AR, Randall P, Daundasekara SS, Hernandez DC. Firearm Violence in the United States: An Issue of the Highest Moral Order. Public Health Ethics 2022. [DOI: 10.1093/phe/phac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Firearm violence in the United States produces over 36,000 deaths and 74,000 sustained firearm-related injuries yearly. The paper describes the burden of firearm violence with emphasis on the disproportionate burden on children, racial/ethnic minorities, women and the healthcare system. Second, this paper identifies factors that could mitigate the burden of firearm violence by applying a blend of key ethical theories to support population level interventions and recommendations that may restrict individual rights. Such recommendations can further support targeted research to inform and implement interventions, policies and laws related to firearm access and use, in order to significantly reduce the burden of firearm violence on individuals, health care systems, vulnerable populations and society-at-large. By incorporating a blended public health ethics to address firearm violence, we propose a balance between societal obligations and individual rights and privileges.
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Affiliation(s)
- Chisom N Iwundu
- Department of Rehabilitation and Health Services, University of North Texas , Denton, TX , USA
| | - Mary E Homan
- Department of Ethics and Theology, Providence-St Joseph Health , Renton, WA , USA
| | - Ami R Moore
- Department of Rehabilitation and Health Services, University of North Texas , Denton, TX , USA
| | - Pierce Randall
- Albany Medical College, Alden March Bioethics Institute , Albany, NY , USA
| | - Sajeevika S Daundasekara
- Cizik School of Nursing, University of Texas Health Science Center at Houston , Houston, TX , USA
| | - Daphne C Hernandez
- Cizik School of Nursing, University of Texas Health Science Center at Houston , Houston, TX , USA
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Perry SW, Rainey JC, Allison S, Bastiampillai T, Wong ML, Licinio J, Sharfstein SS, Wilcox HC. Achieving health equity in US suicides: a narrative review and commentary. BMC Public Health 2022; 22:1360. [PMID: 35840968 PMCID: PMC9284959 DOI: 10.1186/s12889-022-13596-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Suicide rates in the United States (US) reached a peak in 2018 and declined in 2019 and 2020, with substantial and often growing disparities by age, sex, race/ethnicity, geography, veteran status, sexual minority status, socioeconomic status, and method employed (means disparity). In this narrative review and commentary, we highlight these many disparities in US suicide deaths, then examine the possible causes and potential solutions, with the overarching goal of reducing suicide death disparities to achieve health equity.The data implicate untreated, undertreated, or unidentified depression or other mental illness, and access to firearms, as two modifiable risk factors for suicide across all groups. The data also reveal firearm suicides increasing sharply and linearly with increasing county rurality, while suicide rates by falls (e.g., from tall structures) decrease linearly by increasing rurality, and suicide rates by other means remain fairly constant regardless of relative county urbanization. In addition, for all geographies, gun suicides are significantly higher in males than females, and highest in ages 51-85 + years old for both sexes. Of all US suicides from 1999-2019, 55% of male suicides and 29% of female suicides were by gun in metropolitan (metro) areas, versus 65% (Male) and 42% (Female) suicides by gun in non-metro areas. Guns accounted for 89% of suicides in non-metro males aged 71-85 + years old. Guns (i.e., employment of more lethal means) are also thought to be a major reason why males have, on average, 2-4 times higher suicide rates than women, despite having only 1/4-1/2 as many suicide attempts as women. Overall the literature and data strongly implicate firearm access as a risk factor for suicide across all populations, and even more so for male, rural, and older populations.To achieve the most significant results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs to reduce suicidal behaviors, and 2) enhanced population-based strategies for ameliorating the two most prominent modifiable targets for suicide prevention: depression and firearms.
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Affiliation(s)
- Seth W Perry
- Department of Psychiatry and Behavioral Sciences, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.
- Department of Neuroscience & Physiology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.
- Department of Neurosurgery, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.
- Department of Public Health and Preventive Medicine, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.
| | - Jacob C Rainey
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Stephen Allison
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Mind and Brain Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
- Department of Psychiatry, Monash University, Clayton, Australia
| | - Ma-Li Wong
- Department of Psychiatry and Behavioral Sciences, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
- Department of Neuroscience & Physiology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Julio Licinio
- Department of Psychiatry and Behavioral Sciences, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
- Department of Neuroscience & Physiology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Department of Medicine, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
- Department of Pharmacology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
| | - Steven S Sharfstein
- Sheppard Pratt Health System, Baltimore, MD, USA
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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13
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Dunton ZR, Kohlbeck SA, Lasarev MR, Vear CR, Hargarten SW. The Association Between Repealing the 48-Hour Mandatory Waiting Period on Handgun Purchases and Suicide Rates in Wisconsin. Arch Suicide Res 2022; 26:1327-1335. [PMID: 33616014 DOI: 10.1080/13811118.2021.1886209] [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] [Indexed: 10/22/2022]
Abstract
IMPORTANCE Suicide is a significant public health burden in the United States. There is little understanding how policies regarding gun purchasing affects suicide rates. Wisconsin state legislature rescinded a 48-hour waiting period for handgun purchases, which took effect in June 2015. OBJECTIVE To determine whether firearm-related suicide increased with the repeal of the 48-hour waiting period for handgun purchases in 2015. METHOD We obtained data through the Wisconsin Department of Health Services via the Wisconsin Interactive Statistics on Health Query System. Suicide rates were compared by Comparative Mortality Figures (CMF). RESULTS We reviewed all suicides in Wisconsin between 2012-2014 and 2016-2018. The rate ratios (R) and second generation P values (pδ) comparing deaths between 2012-2014 and 2016-2018 indicate significant increases in firearm-related suicide among people of color (R = 1.927; pδ = 0.0) and among Wisconsinites residing in urban counties (R = 1.379, pδ = 0.0). There was no significant increase in non-firearm-related suicide (R = 1.117, pδ = 0.092), nor in firearm-related suicide among White non-Hispanics (R = 1.107, pδ = 0.164) or Wisconsinites residing in rural counties (R = 1.085, pδ = 0.500). CONCLUSION Our findings suggest that the repeal of the 48-hour waiting period on handgun purchases in 2015 is correlated with the increase of firearm-related suicides among Wisconsin residents of color and Wisconsinites residing in urban counties.Key Messages:Firearm policies are associated with changes in suicide rates.
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14
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Longitudinal analysis of suicides among pharmacists during 2003-2018. J Am Pharm Assoc (2003) 2022; 62:1165-1171. [DOI: 10.1016/j.japh.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022]
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15
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Bryan CJ, Bryan AO, Anestis MD. Rates of Preparatory Suicidal Behaviors across Subgroups of Protective Firearm Owners. Arch Suicide Res 2022; 26:948-960. [PMID: 33211635 DOI: 10.1080/13811118.2020.1848672] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Firearm availability is correlated with increased suicide mortality. Some firearm owners may be more vulnerable to suicide than others, but heterogeneity among firearm owners has received little empirical attention. The present study used latent class analysis (LCA) to identify subgroups of firearm owners who keep firearms primarily for protection (i.e., protective firearm owners) in a national sample of 2311 U.S. adult firearm owners. Self-protection was the primary motive for firearm ownership for 1135 (49.1%) participants. Results of the LCA identified three latent classes that differed with respect to secondary reasons for firearm ownership, number and types of firearms owned, firearm ownership history, and demographics. The smallest latent class (n = 26, 2.3% of protective firearm owners), which owned a high volume of firearms and had high levels of early childhood exposure to firearms, reported significantly higher rates of lifetime preparatory suicidal behaviors. Results suggest that firearm owners are a heterogeneous population, with some subgroups being more vulnerable to suicide than others.
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16
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Zuriaga A, Kaplan MS, Choi NG, Hodkinson A, Storman D, Brudasca NI, Hirani SP, Brini S. Association of mental disorders with firearm suicides: A systematic review with meta-analyses of observational studies in the United States. J Affect Disord 2021; 291:384-399. [PMID: 34098496 DOI: 10.1016/j.jad.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
In the United States (US), 61% of all suicide cases may involve firearms, and some evidence suggests that mental disorders may play a role in suicide by firearm. We performed the first systematic review and meta-analyses to investigate: (i) whether mental disorders are associated with suicide by firearm, and (ii) whether the risk of using a firearm compared with alternative means is associated with higher levels of suicide in individuals with a mental disorder METHODS AND FINDINGS: We searched twelve databases from inception to the 24th of May 2020. We retrieved 22 observational studies conducted in the US. Random-effects meta-analyses showed individuals who had a diagnosis of a mental disorder had lower odds (odds ratios (OR)= 0.50, 95% CI: 0.36 to 0.69; I2=100 (95% CI: 87 to 100%), of dying by suicide with a firearm than those who did not have a diagnosis of a mental disorder. Secondary analysis showed that decedents who had a mental health diagnosis resulted in lower odds of dying by suicide by using firearms than using other means LIMITATIONS: Risk of bias revealed a heterogeneous and poor definition of mental disorders as well as lack of control for potential demographic confounding factors. In the meta-analyses, studies were combined in the same analytic sample as 77% of these studies did not specify the type of mental disorder CONCLUSION: While our results seem to suggest that having a mental disorder may not be consistently associated with the odds of dying by suicide using a firearm, the presence of substantial heterogeneity and high risk of bias precludes any firm conclusions.
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Affiliation(s)
- Ana Zuriaga
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom.
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, United States
| | - Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, United States
| | - Alexander Hodkinson
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Nicoleta I Brudasca
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Shashivadan P Hirani
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Stefano Brini
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
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Charder N, Liberatos P, Trobiano M, Dornbush RL, Way BB, Lerman A. The Influence of New York's SAFE Act on Individuals Seeking Mental Health Treatment. Psychiatr Q 2021; 92:473-487. [PMID: 32809110 DOI: 10.1007/s11126-020-09816-4] [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] [Indexed: 11/30/2022]
Abstract
Responding to mass shootings, some states have passed gun removal laws (e.g., NYS' SAFE Act), requiring that mental health professionals report patients who might potentially harm themselves/others. The purpose of this study was to assess whether knowledge of the SAFE Act impacts patients' mental health treatment-seeking and symptom-reporting behaviors. Patients at two mental health centers were surveyed during 2014-2018. Participants were asked if they would be concerned about being reported to county government, likelihood of seeking mental health treatment, and willingness to report mental health symptoms/behaviors given the SAFE Act's provisions. 228 patients (71.5% response rate) completed questionnaires. About 18% were concerned about being reported to county government, 9% would be less likely to seek mental health treatment, and about 23% would be less willing to report mental health symptoms/behaviors. Although these behaviors were not affected for most participants, there was a small minority who were concerned and less willing to report mental health symptoms/behaviors.
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Affiliation(s)
- Nicole Charder
- New York University Medical Center and New York State Office of Mental Health, New York, NY, USA
| | - Penny Liberatos
- Division of Health Behavior & Community Health, New York Medical College School of Health Sciences & Practice, 40 Sunshine Cottage Rd., Valhalla, NY, 10595, USA.
| | - Michael Trobiano
- Department of Psychiatry, New York Medical College at Westchester Medical Center, Valhalla, NY, USA
| | - Rhea L Dornbush
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
| | - Bruce B Way
- Upstate Medical University, Syracuse, NY, USA
| | - Alexander Lerman
- Department of Psychiatry, New York Medical College, Valhalla, NY, USA
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18
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Kappelman J, Fording RC. The effect of state gun laws on youth suicide by firearm: 1981-2017. Suicide Life Threat Behav 2021; 51:368-377. [PMID: 33876479 DOI: 10.1111/sltb.12713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many studies have found that state gun laws that regulate the purchase and possession of firearms can lead to a reduction in suicide rates. Yet, the literature has primarily focused on the effects of state gun laws on adult suicides, despite the fact that some gun laws are specifically tailored to restrict the purchase and possession of firearms by youths. AIMS In this study, we estimate the effect of two such laws-Child Access Prevention (CAP) laws and minimum age laws-on youth suicide by firearm rates. MATERIALS & METHODS Our sample consists of state-level panel data for 41 states observed over the years 1981-2017. RESULTS Based on a series of negative binomial regression analyses, we confirm previous research by finding that CAP laws are associated with a decrease in youth suicides by firearm, especially among males. However, we show that this effect is limited to states that have adopted relatively strict CAP laws. We also find that minimum age laws serve to reduce the youth suicide rate, but once again this effect is largely concentrated among males. Finally, we investigate the possibility that these effects were countered to some degree by "means substitution"-the substitution of firearms with other methods of suicide. DISCUSSION Similar to other studies that have examined this question, we find no effect of youth-targeted gun laws on nonfirearm suicide deaths. CONCLUSION Despite the noteworthy increase in youth suicide rates over the last decade, our results suggest that state laws which restrict firearm access to young people continue to represent a potentially effective strategy for suicide reduction.
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Affiliation(s)
- Jack Kappelman
- Department of Political Science, University of Alabama, Tuscaloosa, AL, USA
| | - Richard C Fording
- Department of Political Science, University of Alabama, Tuscaloosa, AL, USA
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19
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Bojanić L, Pitman A, Kapur N. Suicide prevention through means restriction: the example of firearms control in Croatia. J Public Health (Oxf) 2021; 44:402-407. [PMID: 33429426 DOI: 10.1093/pubmed/fdaa251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/13/2020] [Accepted: 12/11/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health, Division of Psychology and Mental Health, University of Manchester, M13 9PL, Manchester, UK
| | - A Pitman
- Division of Psychiatry, University College London, W1T 7NF, London, UK.,Camden and Islington NHS Foundation Trust, NW1 0PE, London, UK
| | - N Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health, Division of Psychology and Mental Health, University of Manchester, M13 9PL, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, M25 3BL, Manchester, UK
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20
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Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury. J Spinal Cord Med 2021; 44:102-162. [PMID: 33630722 PMCID: PMC7993020 DOI: 10.1080/10790268.2021.1863738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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21
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Bombardier CH, Azuero CB, Fann JR, Kautz DD, Richards JS, Sabharwal S. Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Top Spinal Cord Inj Rehabil 2021; 27:152-224. [PMID: 34108836 PMCID: PMC8152173 DOI: 10.46292/sci2702-152] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Casey B. Azuero
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Donald D. Kautz
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA
| | - J. Scott Richards
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sunil Sabharwal
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
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22
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Blakaj F, Dylhasi F, Haliti D, Kukaj I, Krasniqi D. An unusual method of suicide by rifle using a supportive device and string to pull the trigger – A case report. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2020. [DOI: 10.1016/j.fsir.2020.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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23
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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: 35] [Impact Index Per Article: 7.0] [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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Saadi A, Choi KR, Takada S, Zimmerman FJ. The impact of gun violence restraining order laws in the U.S. and firearm suicide among older adults: a longitudinal state-level analysis, 2012-2016. BMC Public Health 2020; 20:334. [PMID: 32252702 PMCID: PMC7137454 DOI: 10.1186/s12889-020-08462-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults complete suicide at a disproportionately higher rate compared to the general population, with firearms the most common means of suicide. State gun laws may be a policy remedy. Less is known about Gun Violence Restricting Order (GVRO) laws, which allow for removal of firearms from people deemed to be a danger to themselves or others, and their effects on suicide rates among older adults. The purpose of this study was to examine the association of state firearm laws with the incidence of firearm, non-firearm-related, and total suicide among older adults, with a focus on GVRO laws. METHODS This is a longitudinal study of US states using data from 2012 to 2016. The outcome variables were firearm, non-firearm and total suicide rates among older adults. Predictor variables were [1] total number of gun laws to assess for impact of overall firearm legislation at the state level, and [2] GVRO laws. RESULTS The total number of firearm laws, as well as GVRO laws, were negatively associated with firearm-related suicide rate among older adults ages 55-64 and > 65 years-old (p < 0.001). There was a small but significant positive association of total number of firearm laws to non-firearm-related suicide rates and a negative association with total suicide rate. GVRO laws were not significantly associated with non-firearm-related suicide and were negatively associated with total suicide rate. CONCLUSION Stricter firearm legislation, as well as GVRO laws, are protective against firearm-relate suicides among older adults.
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Affiliation(s)
- Altaf Saadi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
| | - Kristen R Choi
- University of California Los Angeles School of Nursing, Los Angeles, CA, 90024, USA
| | - Sae Takada
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90024, USA
| | - Fred J Zimmerman
- Department of Health Policy and Management, Fielding School of Public Health University of California, Los Angeles, 90024, USA
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25
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Thompson LH, Lang JJ, Olibris B, Gauthier-Beaupré A, Cook H, Gillies D, Orpana H. Participatory model building for suicide prevention in Canada. Int J Ment Health Syst 2020; 14:27. [PMID: 32266005 PMCID: PMC7118927 DOI: 10.1186/s13033-020-00359-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/20/2020] [Indexed: 01/02/2023] Open
Abstract
Background Suicide is a behaviour that results from a complex interplay of factors, including biological, psychological, social, cultural, and environmental factors, among others. A participatory model building workshop was conducted with fifteen employees working in suicide prevention at a federal public health organization to develop a conceptual model illustrating the interconnections between such factors. Through this process, knowledge emerged from participants and consensus building occurred, leading to the development of a conceptual model that is useful to organize and communicate the complex interrelationships between factors related to suicide. Methods A model building script was developed for the facilitators to lead the participants through a series of group and individual activities that were designed to elicit participants' implicit models of risk and protective factors for suicide in Canada. Participants were divided into three groups and tasked with drawing the relationships between factors associated with suicide over a simplified suicide process model. Participants were also tasked with listing prevention levers that are in use in Canada and/or described in the scientific literature. Results Through the workshop, risk and prevention factors and prevention levers were listed and a conceptual model was drafted. Several "lessons learned" which could improve future workshops were generated through reflection on the process. Conclusions This workshop yielded a helpful conceptual model contextualising upstream factors that can be used to better understand suicide prevention efforts in Canada.
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Affiliation(s)
- Laura H Thompson
- 1Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada.,2Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Justin J Lang
- 1Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada
| | - Brieanne Olibris
- 3Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Amélie Gauthier-Beaupré
- 3Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada.,4Centre for Chronic Disease Prevention and Health Equity, Public Health Agency of Canada, Ottawa, Canada
| | - Heather Cook
- 5Centre for Health Promotion, Public Health Agency of Canada, Ottawa, Canada.,6Faculty of Humanities and Social Sciences, Memorial University of Newfoundland, St. John's, Canada
| | - Dakota Gillies
- 1Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada
| | - Heather Orpana
- 1Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada.,7School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Keyes KM, Hamilton A, Swanson J, Tracy M, Cerdá M. Simulating the Suicide Prevention Effects of Firearms Restrictions Based on Psychiatric Hospitalization and Treatment Records: Social Benefits and Unintended Adverse Consequences. Am J Public Health 2020; 109:S236-S243. [PMID: 31242005 DOI: 10.2105/ajph.2019.305041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate the number of lives saved from firearms suicide with expansions of gun restrictions based on mental health compared with the number who would be unnecessarily restricted. Methods. Agent-based models simulated effects on suicide mortality resulting from 5-year ownership disqualifications in New York City for individuals with any psychiatric hospitalization and, more broadly, anyone receiving psychiatric treatment. Results. Restrictions based on New York State Office of Mental Health-identified psychiatric hospitalizations reduced suicide among those hospitalized by 85.1% (95% credible interval = 36.5%, 100.0%). Disqualifications for anyone receiving psychiatric treatment reduced firearm suicide rates among those affected and in the population; however, 244 820 people were prohibited from firearm ownership who would not have died from firearm suicide even without the policy. Conclusions. In this simulation, denying firearm access to individuals in psychiatric treatment reduces firearm suicide among those groups but largely will not affect population rates. Broad and unfeasible disqualification criteria would needlessly restrict millions at low risk, with potential consequences for civil rights, increased stigma, and discouraged help seeking.
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Affiliation(s)
- Katherine M Keyes
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| | - Ava Hamilton
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| | - Jeffrey Swanson
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| | - Melissa Tracy
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| | - Magdalena Cerdá
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
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Abstract
PURPOSE OF REVIEW As a global pandemic, COVID-19 has profoundly disrupted the lives of individuals, families, communities, and nations. This report summarizes the expected impact of COVID-19 on behavioral health, as well as strategies to address mental health needs during the COVID-19 pandemic and its aftermath. The state of Michigan in the USA is used to illustrate the complexity of the mental health issues and the critical gaps in the behavioral health infrastructure as they pertain to COVID-19. Scoping review was conducted to identify potential mental health needs and issues during the COVID-19 pandemic and its aftermath. RECENT FINDINGS The ramifications of COVID-19 on mental health are extensive, with the potential to negatively impact diverse populations including healthcare providers, children and adolescents, older adults, the LGBTQ community, and individuals with pre-existing mental illness. Suicide rates, alone, are expected to rise for Michiganders due to the economic downturn, isolation and quarantine, increased substance use, insomnia, and increased access to guns associated with the COVID-19 pandemic. This report promotes awareness of a behavioral health crisis due to COVID-19. Increasing access to behavioral health care should minimize COVID-19's negative influence on mental health in Michigan. We propose a three-prong approach to access: awareness, affordability, and technology. Addressing workforce development and fixing gaps in critical behavioral health infrastructure will also be essential. These actions need to be implemented immediately to prepare for the expected "surge" of behavioral health needs in the ensuing months.
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Clarke S, Allerhand LA, Berk MS. Recent advances in understanding and managing self-harm in adolescents. F1000Res 2019; 8:F1000 Faculty Rev-1794. [PMID: 31681470 PMCID: PMC6816451 DOI: 10.12688/f1000research.19868.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 12/28/2022] Open
Abstract
Adolescent suicide is a serious public health problem, and non-suicidal self-injury (NSSI) is both highly comorbid with suicidality among adolescents and a significant predictor of suicide attempts (SAs) in adolescents. We will clarify extant definitions related to suicidality and NSSI and the important similarities and differences between these constructs. We will also review several significant risk factors for suicidality, evidence-based and evidence-informed safety management strategies, and evidence-based treatment for adolescent self-harming behaviors. Currently, dialectical behavior therapy (DBT) for adolescents is the first and only treatment meeting the threshold of a well-established treatment for self-harming adolescents at high risk for suicide. Areas in need of future study include processes underlying the association between NSSI and SAs, clarification of warning signs and risk factors that are both sensitive and specific enough to accurately predict who is at imminent risk for suicide, and further efforts to sustain the effects of DBT post-treatment. DBT is a time- and labor-intensive treatment that requires extensive training for therapists and a significant time commitment for families (generally 6 months). It will therefore be helpful to assess whether other less-intensive treatment options can be established as evidence-based treatment for suicidal adolescents.
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Affiliation(s)
- Stephanie Clarke
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5719, USA
| | - Lauren A. Allerhand
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5719, USA
| | - Michele S. Berk
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5719, USA
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Kirby AV, Bakian AV, Zhang Y, Bilder DA, Keeshin BR, Coon H. A 20-year study of suicide death in a statewide autism population. Autism Res 2019; 12:658-666. [PMID: 30663277 PMCID: PMC6457664 DOI: 10.1002/aur.2076] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/29/2018] [Indexed: 01/11/2023]
Abstract
Scientific Summary Growing concern about suicide risk among individuals with autism spectrum disorder (ASD) necessitates population‐based research to determine rates in representative samples and to inform appropriate prevention efforts. This study used existing surveillance data in Utah to determine incidence of suicide among individuals with ASD over a 20‐year period, and to characterize those who died. Between 1998 and 2017, 49 individuals with ASD died by suicide. Suicide cumulative incidence rates did not significantly differ between 1998 and 2012 across the ASD and non‐ASD populations. Between 2013 and 2017, the cumulative incidence of suicide in the ASD population was 0.17%, which was significantly higher than in the non‐ASD population (0.11%; P < 0.05). During this period, this difference was driven by suicide among females with ASD; suicide risk in females with ASD was over three times higher than in females without ASD (relative risk (RR): 3.42; P < 0.01). Among the individuals with ASD who died by suicide, average age at death and manner of death did not differ significantly between males and females. Ages at death by suicide ranged from 14 to 70 years (M[SD] = 32.41[15.98]). Individuals with ASD were significantly less likely to use firearms as a method of suicide (adjusted odds ratio: 0.33; P < 0.001). Study results expand understanding of suicide risk in ASD and point to the need for additional population‐based research into suicide attempts and ideation, as well as exploration of additional risk factors. Findings also suggest a need for further study of female suicide risk in ASD. Autism Research 2019, 12: 658–666. © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. Lay Summary This study examined suicide risk among individuals with autism spectrum disorder (ASD) in Utah over a 20‐year period. Risk of suicide death in individuals with ASD was found to have increased over time and to be greater than in individuals without ASD between 2013 and 2017. Females with ASD were over three times as likely to die from suicide as females without ASD. Young people with ASD were at over twice the risk of suicide than young people without ASD. Individuals with ASD were less likely than others to die from firearm‐related suicides.
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Affiliation(s)
- Anne V Kirby
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT
| | - Amanda V Bakian
- Department of Psychiatry, University of Utah, Salt Lake City, UT
| | - Yue Zhang
- Department of Internal Medicine, University of Utah, Salt Lake City, UT.,Study Design and Biostatistics Center, Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT
| | - Deborah A Bilder
- Department of Psychiatry, University of Utah, Salt Lake City, UT
| | - Brooks R Keeshin
- Department of Pediatrics, University of Utah, Salt Lake City, UT.,Center for Safe and Healthy Families, Primary Children's Hospital, Salt Lake City, UT
| | - Hilary Coon
- Department of Psychiatry, University of Utah, Salt Lake City, UT
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The association between economic uncertainty and suicide in the short-run. Soc Sci Med 2019; 220:403-410. [DOI: 10.1016/j.socscimed.2018.11.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/03/2018] [Accepted: 11/23/2018] [Indexed: 11/21/2022]
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Hofmann LJ, Keric N, Cestero RF, Babbitt-Jonas R, Khoury L, Panzo M, Perez JM, Cohn SM. Trauma Surgeons' Perspective on Gun Violence and a Review of the Literature. Cureus 2018; 10:e3599. [PMID: 30680260 PMCID: PMC6338409 DOI: 10.7759/cureus.3599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background In the United States, there is a constant debate between the proponents of the right to bear arms and those desiring to reduce the epidemic of gun violence. We sought to capture the trauma surgeons' perspective on gun control. Methods We presented an on-line based survey to the members of the American Association for the Surgery of Trauma (AAST). Survey questions were chosen to reflect the popular media poll questions as well as trauma-specific perspectives. We compared the trauma surgeons' perspectives to that of the general populace from a poll conducted by the New York Times (NYT). Results A total of 120 trauma surgeons responded to the survey. The age group ranged from 34 to 82 years, and the median age was 51. Most respondents were male (64%, n = 67) and worked at a Level I trauma center (80%, n = 96) in an academic setting (67%, n = 80). About half of the responding surgeons owned a household firearm (40%; n = 48 of the AAST members vs. 47%; n = 521 of the general populace). Sixty-one percent of the trauma surgeons (n = 73) and 53% (n = 588) of the NYT respondents favor stricter gun control laws. While 80% (n = 888) of the NYT respondents felt that mental health screening and treatment would decrease gun violence, only 56% (n = 67) of surgeons felt that mental health screening would be beneficial. The majority (90%, n = 999) of the NYT poll respondents favor a law restricting the sale of guns only by licensed dealers. Only (66%, n = 79) of the trauma surgeons were in agreement with the stricter gun sale legislation by licensed dealers. Conclusion Trauma surgeons appear to share similar views with the general American populace regarding gun violence and injury control.
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Affiliation(s)
- Luke J Hofmann
- Surgery, University of Texas Health Science Center, San Antonio, USA
| | - Natasha Keric
- Surgery, Banner University Medical Center, Phoenix, USA
| | - Ramon F Cestero
- Surgery, University of Texas Health Science Center, San Antonio, USA
| | | | - Leen Khoury
- Surgery, Staten Island University Hospital, Staten Island, USA
| | - Melissa Panzo
- Emergency Medicine, Staten Island University Hospital, Staten Island, USA
| | | | - Stephen M Cohn
- Surgery, Staten Island University Hospital, Staten Island, USA
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Gilmour S, Wattanakamolkul K, Sugai MK. The Effect of the Australian National Firearms Agreement on Suicide and Homicide Mortality, 1978-2015. Am J Public Health 2018; 108:1511-1516. [PMID: 30252523 DOI: 10.2105/ajph.2018.304640] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the impact of the Australian National Firearms Agreement (NFA) on suicide and assault mortality. METHODS We conducted a retrospective cross-sectional difference-in-difference study of the impact of the NFA on national mortality rates in the Australian population from 1961 to 2015. RESULTS The NFA had no additional statistically observable impact on firearm-related suicides in women (P = .09) and was associated with a statistically significant increase in the trend in men (P < .001). Trends in non-firearm-related suicide deaths declined by 4.4% per year (95% confidence interval [CI] = 4.1%, 4.8%) in men after the introduction of the NFA and increased in women by 0.3% (95% CI = 0.1%, 0.7%). Trends in non-firearm-related homicides declined by 2.2% per year (95% CI = 1.5, 3.8%) in women and 2.9% per year (95% CI = 2.0%, 3.7%) in men after the introduction of the NFA, with a statistically significant improvement in trends for women (P = .04) but not for men (P = .80). CONCLUSIONS The NFA had no statistically observable additional impact on suicide or assault mortality attributable to firearms in Australia.
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Affiliation(s)
- Stuart Gilmour
- Stuart Gilmour is with the Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke's International University, Tokyo, Japan. Kittima Wattanakamolkul and Maaya Kita Sugai are with the Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo
| | - Kittima Wattanakamolkul
- Stuart Gilmour is with the Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke's International University, Tokyo, Japan. Kittima Wattanakamolkul and Maaya Kita Sugai are with the Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo
| | - Maaya Kita Sugai
- Stuart Gilmour is with the Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke's International University, Tokyo, Japan. Kittima Wattanakamolkul and Maaya Kita Sugai are with the Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo
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Balestra S. Gun prevalence and suicide. JOURNAL OF HEALTH ECONOMICS 2018; 61:163-177. [PMID: 30149247 DOI: 10.1016/j.jhealeco.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 06/08/2023]
Abstract
In light of the ongoing debate over tighter firearm regulations, this paper considers the relationship between gun prevalence and suicide. I exploit a reform in Switzerland that reduced the prevalence of military-issued guns in private households. In Switzerland, military service is compulsory for men, and military-issued guns account for nearly half of the total number of firearms available. The results show that the firearm suicide rate decreases by 9% for a reduction in gun prevalence of 1000 guns per 100,000 inhabitants. The elasticity of gun suicides with respect to firearm prevalence is +0.48, but converges towards zero for low levels of gun prevalence. The overall suicide rate is negatively and significantly related to firearm prevalence, which indicates that non-gun methods of suicide are not perfect replacements for firearms.
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Affiliation(s)
- Simone Balestra
- University of St. Gallen, Rosenbergstrasse 51, CH-9000 St. Gallen, Switzerland.
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Kuhl NO, Lieberman MP. Gun Violence: Two Medical Students' Hometown Connection to This Public Health Crisis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1268-1270. [PMID: 29727316 DOI: 10.1097/acm.0000000000002267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The school shooting in Parkland, Florida in February 2018 left 17 people dead and countless other children and teachers with physical and psychological trauma that will require decades of healing. As Marjory Stoneman Douglas High School alumni and current medical students, the authors of this Invited Commentary contend that they are in a unique position to advocate on behalf of their neighbors, classmates, and future patients. Since the authors began medical school in 2015, there have been 19 mass shootings in the United States, resulting in 253 deaths. During this same time period, there have been nearly 100,000 gun-related deaths in the United States. While 60.7% of those gun deaths were suicides, the public must not, and should not, attribute all gun violence to the spectrum of psychiatric diagnoses. Several studies have shown that increased access to firearms directly increases the rate of one of the United States' most pressing public health issues-gun violence. Despite this fact, and as the result of misguided health policies like the Dickey Amendment, the funding for research on gun violence pales in comparison with that for other leading causes of death. Consequently, the health care community has long been without adequate data to engage in evidence-based gun violence prevention and education efforts. As two students on the cusp of beginning their medical careers, the authors argue that they and other health care providers can no longer sit idly on the sidelines as this public health crisis continues to impact the United States.
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Affiliation(s)
- Nicholas O Kuhl
- N.O. Kuhl is a third-year medical student, Vanderbilt University School of Medicine, Nashville, Tennessee. M.P. Lieberman is a third-year medical student, University of Miami Miller School of Medicine, Miami, Florida
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Boggs JM, Beck A, Hubley S, Peterson EL, Hu Y, Williams LK, Prabhakar D, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Owen-Smith AA, Simon GE, Ahmedani BK. General Medical, Mental Health, and Demographic Risk Factors Associated With Suicide by Firearm Compared With Other Means. Psychiatr Serv 2018; 69:677-684. [PMID: 29446332 PMCID: PMC5984116 DOI: 10.1176/appi.ps.201700237] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mitigation of suicide risk by reducing access to lethal means, such as firearms and potentially lethal medications, is a highly recommended practice. To better understand groups of patients at risk of suicide in medical settings, the authors compared demographic and clinical risk factors between patients who died by suicide by using firearms or other means with matched patients who did not die by suicide (control group). METHODS In a case-control study in 2016 from eight health care systems within the Mental Health Research Network, 2,674 suicide cases from 2010-2013 were matched to a control group (N=267,400). The association between suicide by firearm or other means and medical record information on demographic characteristics, general medical disorders, and mental disorders was assessed. RESULTS The odds of having a mental disorder were higher among cases of suicide involving a method other than a firearm. Fourteen general medical disorders were associated with statistically significant (p<.001) greater odds of suicide by firearm, including traumatic brain injury (TBI) (odds ratio [OR]=23.53), epilepsy (OR=3.17), psychogenic pain (OR=2.82), migraine (OR=2.35), and stroke (OR=2.20). Fifteen general medical disorders were associated with statistically significant (p<.001) greater odds of suicide by other means, with particularly high odds for TBI (OR=7.74), epilepsy (OR=3.28), HIV/AIDS (OR=6.03), and migraine (OR=3.17). CONCLUSIONS Medical providers should consider targeting suicide risk screening for patients with any mental disorder, TBI, epilepsy, HIV, psychogenic pain, stroke, and migraine. When suicide risk is detected, counseling on reducing access to lethal means should include both firearms and other means for at-risk groups.
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Affiliation(s)
- Jennifer M Boggs
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Arne Beck
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Sam Hubley
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Edward L Peterson
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Yong Hu
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - L Keoki Williams
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Deepak Prabhakar
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Rebecca C Rossom
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Frances L Lynch
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Christine Y Lu
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Beth E Waitzfelder
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Ashli A Owen-Smith
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Gregory E Simon
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Brian K Ahmedani
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
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Thompson C. Firearms, Fiduciaries, and Veterans: Complications of a Flawed Federal Policy Designed to Keep Veterans Safe. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:687-688. [PMID: 29774493 DOI: 10.1007/s10488-018-0884-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Baumann ML, Teasdale B. Severe mental illness and firearm access: Is violence really the danger? INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 56:44-49. [PMID: 29701598 DOI: 10.1016/j.ijlp.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 10/26/2017] [Accepted: 11/21/2017] [Indexed: 06/08/2023]
Abstract
In response to a spate of mass shootings, national debate over the root of America's gun violence epidemic has centered on mental illness. Consequently, calls have been made to legislatively restrict firearm access among individuals with mental illness to reduce gun violence. While there is a link between mental illness and suicide, a dearth of empirical evidence exists to inform public policy on the link between firearm access and mental illness. The current study addresses this gap by exploring the nature of firearm-related risk among disordered individuals as compared to others from the same communities. We examined a subsample of the MacArthur Violence Risk Assessment Study, including 255 recently discharged psychiatric patients and 490 census-matched community residents. We conducted binomial logistic regressions to explore the impact of firearm access and patient status on violence and suicidality. In total, 15.3% reported firearm access, 23.5% violence, and 21.5% suicidality. Multivariate analyses revealed that, in the context of firearm access, patients were no more likely to perpetrate violence (OR=0.588; 95% CI=0.196-1.764) but were significantly more likely to report suicidality (OR=4.690; 95% CI=1.147-19.172). These results indicate that firearms constitute a serious risk factor for suicide, not violence, for disordered individuals. Thus, legislative efforts to reduce firearm-related risk among disordered individuals should focus on self-harm, not violence. Moreover, claims that mental illness is a principal cause of gun violence may reduce help-seeking among individuals at high risk for suicide. Researchers should devote further attention to addressing these claims empirically.
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Affiliation(s)
- Miranda Lynne Baumann
- Department of Criminal Justice and Criminology, Andrew Young School of Policy Studies, Georgia State University, USA.
| | - Brent Teasdale
- Department of Criminal Justice Sciences, Illinois State University, USA
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Alban RF, Nuño M, Ko A, Barmparas G, Lewis AV, Margulies DR. Weaker gun state laws are associated with higher rates of suicide secondary to firearms. J Surg Res 2017; 221:135-142. [PMID: 29229119 DOI: 10.1016/j.jss.2017.08.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/20/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Firearm-related suicides comprise over two-thirds of gun-related violence in the United States, and gun laws and policies remain under scrutiny, with many advocating for revision of the regulatory map for lawful gun ownership, aiming at restricting access and distribution of these weapons. However, the quantitative relationship between how strict gun laws are and the incidence of firearm violence with their associated mortality is largely unknown. We therefore, sought to explore the impact of firearm law patterns among states on the incidence and outcomes of firearm-related suicide attempts, utilizing established objective criteria. METHODS The National Inpatient Sample for the years 1998-2011 was queried for all firearm-related suicides. Discharge facilities were stratified into five categories (A, B, C, D, and F, with A representing states with the most strict and F representing states with the least strict laws) based on the Brady Campaign to prevent Gun Violence that assigns scorecards for every state. The primary outcomes were suicide attempts and in-hospital mortality per 100,000 populations by Brady state grade. RESULTS During the 14-year study period, 34,994 subjects met inclusion criteria. The mean age was 42.0 years and 80.1% were male. A handgun was utilized by 51.8% of patients. The overall mortality was 33.3%. Overall, 22.0% had reported psychoses and 19.3% reported depression. After adjusting for confounding factors and using group A as reference, there were higher adjusted odds for suicide attempts for patients admitted in group C, D, and F category states (1.73, 2.09, and 1.65, respectively, all P < 0.001). CONCLUSIONS Firearm-related suicide attempt injuries are more common in states with less strict gun laws, and these injuries tend to be associated with a higher mortality. Efforts aimed at nationwide standardization of firearm state laws are warranted, particularly for young adults and suicide-prone populations. LEVEL OF EVIDENCE III. STUDY TYPE Trauma Outcomes study.
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Affiliation(s)
- Rodrigo F Alban
- Division of Acute Care Surgery, Department of Surgery, Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Miriam Nuño
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ara Ko
- Division of Acute Care Surgery, Department of Surgery, Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Galinos Barmparas
- Division of Acute Care Surgery, Department of Surgery, Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Azaria V Lewis
- Division of Acute Care Surgery, Department of Surgery, Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel R Margulies
- Division of Acute Care Surgery, Department of Surgery, Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
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Morrissey TW. Associations between active shooter incidents and gun ownership and storage among families with young children in the United States. Prev Med 2017; 100:50-55. [PMID: 28389329 DOI: 10.1016/j.ypmed.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 03/28/2017] [Accepted: 04/01/2017] [Indexed: 11/25/2022]
Abstract
The presence of firearms and their unsafe storage in the home can increase risk of firearm-related death and injury, but public opinion suggests that firearm ownership is a protective factor against gun violence. This study examined the effects of a recent nearby active shooter incident on gun ownership and storage practices among families with young children. A series of regression models, with data from the nationally representative Early Childhood Longitudinal Study-Birth Cohort merged with the FBI's Active Shooter Incidents data collected in 2003-2006, were used to examine whether household gun ownership and storage practices differed in the months prior to and following an active shooter incident that occurred anywhere in the United States or within the same state. Approximately one-fifth of young children lived in households with one or more guns; of these children, only two-thirds lived in homes that stored all guns in locked cabinets. Results suggest that the experience of a recent active shooter incident was associated with an increased likelihood of storing all guns locked, with the magnitude dependent on the temporal and geographic proximity of the incident. The severity of the incident, defined as the number of fatalities, predicted an increase in storing guns locked. Findings suggest that public shootings change behaviors related to firearm storage among families with young children.
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Affiliation(s)
- Eliot W Nelson
- Department of Pediatrics, University of Vermont Children's Hospital, Burlington, Vermont
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A culture gap in the United States: Implications for policy on limiting access to firearms for suicidal persons. J Public Health Policy 2017; 37 Suppl 1:110-21. [PMID: 27638246 DOI: 10.1057/s41271-016-0007-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Suicide is a critical public health problem worldwide. In the United States (US), firearm ownership is common, and firearms account for the majority of deaths by suicide. While suicide prevention strategies may include limiting access to firearms, the contentious nature of gun regulations in the US, particularly among members of rural communities, often gives rise to constitutional concerns and political polarization that could inhibit suicidal persons from seeking the help they need. We examine potential outcomes of public health strategies in the US that encourage limiting access to firearms for populations who both value firearm ownership and are vulnerable to suicide. Based on preliminary results from a firearm safety study, we argue that attempts to limit access to firearms among those at risk of suicide will only succeed when the most affected cultural groups are engaged in collaborative discussions.
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Jashinsky JM, Magnusson B, Hanson C, Barnes M. Media Agenda Setting Regarding Gun Violence before and after a Mass Shooting. Front Public Health 2017; 4:291. [PMID: 28119907 PMCID: PMC5220185 DOI: 10.3389/fpubh.2016.00291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/21/2016] [Indexed: 11/13/2022] Open
Abstract
Gun violence is related to substantial morbidity and mortality with surrounding discussions framed and shaped by the media. This study's objective was to explore national news media's reporting of gun violence around a mass shooting. National news pieces were coded according to categories of gun violence, media frames, entities held responsible, responses, and reporting of the public heath approach. Individuals were held responsible for gun violence in 63% of pieces before and 32% after the shooting. Lawmakers were held responsible in 30% of pieces before and 66% after. Background checks were a proposed gun violence prevention method in 18% of pieces before and 55% after Sandy Hook, and lethality reduction of firearms was in 9% before and 57% after. Following a mass shooting, the media tended to hold government, not individuals, primarily responsible. The media often misrepresented the real picture of gun violence and key public health roles.
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Affiliation(s)
| | - Brianna Magnusson
- Department of Health Science, Brigham Young University, Provo, UT, USA
| | - Carl Hanson
- Department of Health Science, Brigham Young University, Provo, UT, USA
| | - Michael Barnes
- Department of Health Science, Brigham Young University, Provo, UT, USA
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Morrissey TW. Parents' Depressive Symptoms and Gun, Fire, and Motor Vehicle Safety Practices. Matern Child Health J 2017; 20:799-807. [PMID: 26733482 DOI: 10.1007/s10995-015-1910-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study examined associations between mothers' and fathers' depressive symptoms and their parenting practices relating to gun, fire, and motor vehicle safety. METHODS Using data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a nationally representative sample of children birth to age five, linear probability models were used to examine associations between measures of parents' depressive symptoms and their use of firearms, smoke detectors, and motor vehicle restraints. Parents reported use of smoke detectors, motor vehicle restraints, and firearm ownership and storage. RESULTS Results suggest mothers with moderate or severe depressive symptoms were 2 % points less likely to report that their child always sat in the back seat of the car, and 3 % points less likely to have at least one working smoke detector in the home. Fathers' depressive symptoms were associated with a lower likelihood of both owning a gun and of it being stored locked. Fathers' depressive symptoms amplified associations between mothers' depressive symptoms and owning a gun, such that having both parents exhibit depressive symptoms was associated with an increased likelihood of gun ownership of between 2 and 6 % points. CONCLUSIONS Interventions that identify and treat parental depression early may be effective in promoting appropriate safety behaviors among families with young children.
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Affiliation(s)
- Taryn W Morrissey
- Department of Public Administration and Policy, School of Public Affairs, American University, Ward Circle Building, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA.
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Dudley MJ, Rosen A, Alpers PA, Peters R. The Port Arthur massacre and the National Firearms Agreement: 20 years on, what are the lessons? Med J Aust 2016; 204:381-3. [PMID: 27256649 DOI: 10.5694/mja16.00293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/12/2016] [Indexed: 11/17/2022]
Abstract
The 20th anniversary of the National Firearms Agreement (NFA) offers lessons for mental health and public health. Along with similar international legislation, the NFA exemplifies how firearms regulation can prevent firearm mortality and injuries. The gun lobby claims that mental illness underpins gun violence and should be a key site for intervention. A modest but significant link exists between mental disorders and community violence. However, the vast majority of mentally ill individuals are not violent. Despite media portrayals of their dangerousness, they are more likely to be victims of violence and of suicide. Most violent individuals do not have mental illness, and most mass murderers do not have identifiable severe mental illness. Many have maladaptive personality configurations. Gun availability and gun ownership, not severe mental illness, determines most gun homicides. Following recent gun massacres in the United States, there have been calls for better resourcing of mental health services to help identify and respond to those at risk and to regulate firearms access. Screening mentally ill populations for violence risk is misguided. However, clinicians can play a key role in working with legal authorities to monitor and assist regulation of firearm access, especially among high risk populations. Clinician involvement must be complemented by wider gun control measures. The gun lobby's turning the firearms availability debate into a question about whether people with mental illness histories should access such weapons is a calculated appeal to prejudice.
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Affiliation(s)
- Michael J Dudley
- Child and Adolescent Mental Health Service, Prince of Wales and Sydney Children's Hospitals, Sydney, NSW
| | - Alan Rosen
- Illawarra Institute for Mental Health, University of Wollongong, Wollongong, NSW
| | - Philip A Alpers
- Sydney School of Public Health, University of Sydney, Sydney, NSW
| | - Rebecca Peters
- Centre for Disability Research and Policy, University of Sydney, Sydney, NSW
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Kaskie BP, Leung C, Kaplan MS. Deploying an Ecological Model to Stem the Rising Tide of Firearm Suicide in Older Age. J Aging Soc Policy 2016; 28:233-45. [DOI: 10.1080/08959420.2016.1167512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Betz ME, Arias SA, Miller M, Barber C, Espinola JA, Sullivan AF, Manton AP, Miller I, Camargo CA, Boudreaux ED. Change in emergency department providers' beliefs and practices after use of new protocols for suicidal patients. Psychiatr Serv 2015; 66:625-31. [PMID: 25726978 PMCID: PMC4852852 DOI: 10.1176/appi.ps.201400244] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined changes in self-reported attitudes and practices related to suicide risk assessment among providers at emergency departments (EDs) during a three-phase quasi-experimental trial involving implementation of ED protocols for suicidal patients. METHODS A total of 1,289 of 1,828 (71% response rate) eligible providers at eight EDs completed a voluntary, anonymous survey at baseline, after introduction of universal suicide screening, and after introduction of suicide prevention resources (nurses) and a secondary risk assessment tool (physicians). RESULTS Among participants, the median age was 40 years old, 64% were female, and there were no demographic differences across study phases; 68% were nurses, and 32% were attending physicians. Between phase 1 and phase 3, increasing proportions of nurses reported screening for suicide (36% and 95%, respectively, p<.001) and increasing proportions of physicians reported further assessment of suicide risk (63% and 80%, respectively, p<.01). Although increasing proportions of providers said universal screening would result in more psychiatric consultations, decreasing proportions said it would slow down clinical care. Increasing proportions of nurses reported often or almost always asking suicidal patients about firearm access (18%-69%, depending on the case), although these numbers remained low relative to ideal practice. Between 35% and 87% of physicians asked about firearms, depending on the case, and these percentages did not change significantly over the study phases. CONCLUSIONS These findings support the feasibility of implementing universal screening for suicide in EDs, assuming adequate resources, but providers should be educated to ask suicidal patients about firearm access.
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Affiliation(s)
- Marian E Betz
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Sarah A Arias
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Matthew Miller
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Catherine Barber
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Janice A Espinola
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Ashley F Sullivan
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Anne P Manton
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Ivan Miller
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Carlos A Camargo
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Edwin D Boudreaux
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
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Kvaran RB, Gunnarsdottir OS, Kristbjornsdottir A, Valdimarsdottir UA, Rafnsson V. Number of visits to the emergency department and risk of suicide: a population-based case-control study. BMC Public Health 2015; 15:227. [PMID: 25884880 PMCID: PMC4361138 DOI: 10.1186/s12889-015-1544-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 02/16/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The aim was to study whether number of visits to emergency department (ED) is associated with suicide, taking into consideration known risk factors. METHODS This is a population-based case-control study nested in a cohort. Computerized database on attendees to ED (during 2002-2008) was record linked to nation-wide death registry to identify 152 cases, and randomly selected 1520 controls. The study was confined to patients attending the ED, who were subsequently discharged, and not admitted to hospital ward. Odds ratio (OR) and 95% confidence intervals (CI) of suicide risk according to number of visits (logistic regression) adjusted for age, gender, mental and behavioral disorders, non-causative diagnosis, and drug poisonings. RESULTS Suicide cases had on average attended the ED four times, while controls attended twice. The OR for attendance due to mental and behavioral disorders was 3.08 (95% CI 1.61-5.88), 1.60 (95% CI 1.06-2.43) for non-causative diagnosis, and 5.08 (95% CI 1.69-15.25) for poisoning. The ORs increased gradually with increasing number of visits. Adjusted for age, gender, and the above mentioned diagnoses, the OR for three attendances was 2.17, for five attendances 2.60, for seven attendances 5.97, and for nine attendances 12.18 compared with those who had one visit. CONCLUSIONS Number of visits to the ED is an independent risk factor for suicide adjusted for other known and important risk factors. The prevalence of four or more visits was 40% among cases compared with 10% among controls. This new risk factor may open new venues for suicide prevention.
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Affiliation(s)
| | | | | | | | - Vilhjalmur Rafnsson
- Department of Preventive Medicine, University of Iceland, Reykjavik, IS-101, Iceland.
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Metzl JM, MacLeish KT. Mental illness, mass shootings, and the politics of American firearms. Am J Public Health 2015; 105:240-9. [PMID: 25496006 PMCID: PMC4318286 DOI: 10.2105/ajph.2014.302242] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2014] [Indexed: 11/04/2022]
Abstract
Four assumptions frequently arise in the aftermath of mass shootings in the United States: (1) that mental illness causes gun violence, (2) that psychiatric diagnosis can predict gun crime, (3) that shootings represent the deranged acts of mentally ill loners, and (4) that gun control "won't prevent" another Newtown (Connecticut school mass shooting). Each of these statements is certainly true in particular instances. Yet, as we show, notions of mental illness that emerge in relation to mass shootings frequently reflect larger cultural stereotypes and anxieties about matters such as race/ethnicity, social class, and politics. These issues become obscured when mass shootings come to stand in for all gun crime, and when "mentally ill" ceases to be a medical designation and becomes a sign of violent threat.
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Affiliation(s)
- Jonathan M Metzl
- Jonathan M. Metzl is with the Center for Medicine, Health, and Society and the Departments of Sociology and Psychiatry, Vanderbilt University, Nashville, TN. Kenneth T. MacLeish is with the Center for Medicine, Health, and Society and the Department of Anthropology, Vanderbilt University
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Champeaux C, Raballand E. Craniocerebral gunshot wound in a baby chimpanzee--an uncommon experience of neurosurgical treatment conducted in the Guinean forest. J Med Primatol 2014; 44:49-52. [PMID: 25523755 DOI: 10.1111/jmp.12156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2014] [Indexed: 11/28/2022]
Abstract
An orphan female chimpanzee was wounded by a left craniocerebral gunshot complicated with a right hemiparesis. Local treatment and long-term antibiotherapy failed to lead to healing. A neurosurgical procedure was planned and achieved. She fully recovered, and 2 years after the procedure, there is no evidence of infection.
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Affiliation(s)
- C Champeaux
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
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50
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Houle JN, Light MT. The home foreclosure crisis and rising suicide rates, 2005 to 2010. Am J Public Health 2014; 104:1073-9. [PMID: 24825209 PMCID: PMC4062039 DOI: 10.2105/ajph.2013.301774] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between state-level foreclosure and suicide rates from 2005 to 2010 and considered variation in the effect of foreclosure on suicide by age. METHODS We used hybrid random- and fixed-effects models to examine the relation between state foreclosure rates and total and age-specific suicide rates from 2005 to 2010 (n = 306 state-years). RESULTS Net of other factors, an increase in the within-state total foreclosure rate was associated with a within-state increase in the crude suicide rates (b = 0.04; P < .1), and effects were stronger for the real estate-owned foreclosure rate (b = 0.16; P < .05). Analysis of age-specific suicide rates indicated that the effects were strongest among the middle-aged (46-64 years: total foreclosure rate, b = 0.21; P < .001; real estate-owned foreclosure rate, b = 0.83; P < .001). Rising home foreclosure rates explained 18% of the variance in the middle-aged suicide rate between 2005 and 2010. CONCLUSIONS The foreclosure crisis has likely contributed to increased suicides, independent of other economic factors associated with the recession. Rising foreclosure rates may be partially responsible for the recent uptick in suicide among middle-aged adults.
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Affiliation(s)
- Jason N Houle
- At the time of the study, Jason N. Houle was with the University of Wisconsin-Madison. Michael T. Light is with the Department of Sociology, Purdue University, West Lafayette, IN
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