The Association of Firearm Suicide With Mental Illness, Substance Use Conditions, and Previous Suicide Attempts

Abstract

Letters15 August 2017The Association of Firearm Suicide With Mental Illness, Substance Use Conditions, and Previous Suicide AttemptsFREEJennifer M. Boggs, MSW, Gregory E. Simon, MD, MPH, Brian K. Ahmedani, PhD, Edward Peterson, PhD, Samuel Hubley, PhD, and Arne Beck, PhDJennifer M. Boggs, MSWFrom Kaiser Permanente Colorado—Institute for Health Research, Denver, Colorado; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Henry Ford Health System and Henry Ford Hospital, Detroit, Michigan; and University of Colorado at Denver, Denver, Colorado., Gregory E. Simon, MD, MPHFrom Kaiser Permanente Colorado—Institute for Health Research, Denver, Colorado; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Henry Ford Health System and Henry Ford Hospital, Detroit, Michigan; and University of Colorado at Denver, Denver, Colorado., Brian K. Ahmedani, PhDFrom Kaiser Permanente Colorado—Institute for Health Research, Denver, Colorado; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Henry Ford Health System and Henry Ford Hospital, Detroit, Michigan; and University of Colorado at Denver, Denver, Colorado., Edward Peterson, PhDFrom Kaiser Permanente Colorado—Institute for Health Research, Denver, Colorado; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Henry Ford Health System and Henry Ford Hospital, Detroit, Michigan; and University of Colorado at Denver, Denver, Colorado., Samuel Hubley, PhDFrom Kaiser Permanente Colorado—Institute for Health Research, Denver, Colorado; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Henry Ford Health System and Henry Ford Hospital, Detroit, Michigan; and University of Colorado at Denver, Denver, Colorado., and Arne Beck, PhDFrom Kaiser Permanente Colorado—Institute for Health Research, Denver, Colorado; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Henry Ford Health System and Henry Ford Hospital, Detroit, Michigan; and University of Colorado at Denver, Denver, Colorado.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0111 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Firearms account for one half of all suicide deaths in the United States (1), and reducing access to firearms among at-risk patients may reduce suicide mortality (2). Attempts to reduce access to firearms have focused on persons with a mental health condition or a history of suicidal behavior.Objective: To identify the proportion of suicide deaths that could be prevented by limiting firearm access for persons with a mental health condition or a history of suicidal behavior.Methods and Findings: The TUBS (Treatment Utilization Before Suicide) study identified 2674 adults and adolescents in 8 integrated health systems who died by suicide between 2000 and 2013 and were continuously enrolled for at least 10 of the 12 months before death (3). Using medical records and claims information, we identified 1 group who had a history of any mental health or substance use condition diagnosed at any medical or mental health visit in the year preceding death and another who had previous suicide attempts. These groups were not mutually exclusive. Persons who previously attempted suicide overlapped considerably with those who had a mental health condition, because a mental health condition is usually diagnosed in patients who have attempted suicide. Among persons who died by suicide, 54.7% had a mental health or substance use condition and 42.8% of persons with 1 of these conditions used a firearm (Table). In addition, only 10.9% of persons who died by suicide had previously attempted suicide and only 37.5% of these persons used a firearm in their death. In contrast, more persons without a mental health or substance use condition used firearms in their death than did persons with those conditions (671 vs. 627). Also, more persons without a previous suicide attempt used firearms in their death than did those with a previous attempt (1189 vs. 109). In fact, among persons who died by suicide, only 4.1% had previously attempted suicide and used a firearm; 23.5% had a mental health or substance use condition and used a firearm.Table. Suicide Deaths by Firearm in Those With a Mental Health or Substance Use Condition and Those With a Previous Suicide Attempt*Discussion: Our findings show that, even if successful, current efforts to limit firearm access only for persons with a mental health condition (including substance use disorders) or those who previously attempted suicide would prevent few suicide deaths by firearm. We suggest that prevention of firearm suicide should be expanded beyond the current focus on these patients to include other persons at risk for suicide. Suicide prevention resources are available to educate primary care providers about