A cross-sectional study found that firearm suicide decedents were more likely to disclose their suicidal thoughts or plans, indicating there may be a potential opening for intervention. These findings were published in JAMA Network Open.
Data were sourced for this study from the US National Violent Death Reporting System (NVDRS) which is a cross-sectional dataset of suicide decedents between 2003 and 2018. Decedents (N=234,652) were evaluated for previous suicide attempt, their history of mental health treatment and substance use, and treatment at the time of their death.
The study population was comprised of 77.8% men or boys, aged mean 46.3 (range, 3-112) years, 87.8% were White, and 17.3% were affiliated with the military. The most common suicide methods were firearm (n=117,126), hanging (n=62,674), or poisoning (n=35,937). The firearm cohort was more male, White or mixed race, and to have a military affiliation.
Most decedents were not receiving mental health care at the time of their suicide (73.2%), had never sought treatment during their life (66.4%), had no documentation of suicidal ideation (80.4%), had not attempted suicide (82.0%), or disclosed their ideation or plan in the month before their death (76.7%).
Compared with other suicide methods, those who used a firearm were less likely to have a lifetime history of suicide attempt (adjusted odds ratio [aOR], 0.44; 95% CI, 0.43-0.46; P <.001), mental health treatment (aOR, 0.75; 95% CI, 0.72-0.78; P <.001), or current treatment (aOR, 0.85; 95% CI, 0.82-0.88; P <.001) but were more likely to disclose their suicidal ideation in the previous month (aOR, 1.16; 95% CI, 1.13-1.18; P <.001).
Compared with poisoning, firearm suicide was associated with lower rates of lifetime suicide attempt (aOR, 0.39; 95% CI, 0.38-0.41; P <.001), current treatment (aOR, 0.53; 95% CI, 0.51-0.56; P <.001), and lifetime history of treatment (aOR, 0.86; 95% CI, 0.81-0.90; P <.001), and increased rates of past month disclosure (aOR, 1.06; 95% CI, 1.03-1.10; P <.001), and lifetime history of suicidal ideation (aOR, 1.19; 95% CI, 1.15-1.23; P <.001).
Compared with hanging, suicide by firearm was also associated with decreased rates of lifetime history of treatment and suicide attempts and increased disclosure in the past month (all P <.00). Firearm suicides were associated with lower rates of lifetime history of suicidal ideation (aOR, 0.90; 95% CI, 0.87-0.92; P <.001). A similar proportion of decedents of firearm or hanging were receiving mental health treatment at the time of their suicide (aOR, 0.99; 95% CI, 0.95-1.03; P =.53).
This study was limited by not having access to data about type or length of mental health treatment.
The study authors concluded, “The findings suggest that those likely to die by firearm suicide are unlikely to engage with mental health services, yet such services are often tasked with reducing access to lethal means. This study emphasizes the importance of community-based interventions in firearm suicide prevention. The finding that firearm decedents were more likely to have disclosed such thoughts suggests an important avenue for suicide prevention and warrants further research to better understand who these suicide decedents are and what information is disclosed.”
Bond AE, Bandel SL, Rodriguez TR, Anestis JC, Anestis MD. Mental health treatment seeking and history of suicidal thoughts among suicide decedents by mechanism, 2003-2018. JAMA Netw Open. 2022;5(3):e222101. doi:10.1001/jamanetworkopen.2022.2101