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Association between state minimum wage and firearm suicides in the USA, 2000-2020

Background

Firearm suicides constitute a major public health issue. Policies that enhance economic security and decrease community-level poverty may be effective strategies for reducing risk of firearm suicide. This study examined the association between state minimum wage and firearm suicide.

Methods

State minimum wage, obtained from Temple’s Law Atlas and augmented by legal research, was conceptualised using the modified Kaitz Index and a continuous variable centred on the federal minimum wage. State-level suicide counts were obtained from 2000 to 2020 multiple-cause-of-death mortality data from the National Vital Statistics System. Log-linear regressions were conducted to model the associations between state minimum wage and firearm suicides, stratifying by demographic groups. Analyses were conducted in 2023.

Results

A one percentage point increase in a state’s modified Kaitz Index was associated with a 0.3% (95% CI –0.6% to –0.0%) decrease in firearm suicides within a state. A US$1.00 increase in a state’s minimum wage above the federal minimum wage was associated with a 1.4% (95% CI –2.1% to –0.6%) decrease in firearm suicides. When stratified by quartile of firearm ownership, the modified Kaitz Index was associated with decreases in firearm suicides most consistently in the two lowest quartiles.

Conclusion

Increasing a state’s minimum wage may be a policy option to consider as part of a comprehensive approach to reducing firearm suicides. These findings expand the evidence base for how economic policies may be leveraged to reduce firearm suicides.

Examining the impacts of firearm purchaser licensing laws on firearm deaths among youth aged 15 to 24, by age group–USA, 1990-2019

Background

Youth aged 15–24 experience high rates of firearm homicide and suicide, yet there is limited research on the impact of promising preventative policies, such as firearm purchaser licensing (FPL) laws, among this age group. The purpose of this study was to evaluate the effect of adopting or repealing an FPL law on homicide and suicide among those aged 15–24, by age subgroup (ie, 15–17, 18–20, 21–24).

Methods

Mortality data from 1990 to 2019 were obtained from the National Center for Health Statistics. We used augmented synthetic controls to estimate the effect of FPL law adoption in Connecticut and Maryland and repeal in Missouri and Michigan on youth homicide and suicide rates. Analyses were stratified by age subgroup and firearm involvement.

Results

FPL adoption was associated with decreases in firearm homicide and suicide among those aged 15–24 overall and among most age subgroups in Connecticut. FPL repeal was consistently associated with increases in firearm suicide among each age subgroup, with less consistent results for firearm homicide.

Discussion and conclusions

FPL law changes had meaningful impacts on firearm homicide and suicide among youth aged 15–24, with consistent protective effects observed following adoption in Connecticut and consistent harmful effects following repeal in Missouri. Mixed results in Maryland and Michigan highlight the importance of policy features and sociopolitical context in shaping the effectiveness of these laws. These findings reinforce the effectiveness of FPL laws as a strategy to reduce firearm-related mortality among youth.

Global trends in youth suicide

Suicide is the third leading cause of death in young people. It accounts for more than 150 000 deaths each year worldwide, most of which occur in low and middle income countries (LMICs).1 Concerningly, youth suicide rates seem to be rising in many countries, including in the UK.2 In India and China, which together account for around a third of the world’s youth population, previously downward trends appear to have reversed.34Interpreting these trends is complex. Suicide data can be affected by numerous biases,1 and ecological studies, which examine exposures and outcomes at the group or population level and are fundamental to assessing population level drivers of suicide trends, have methodological limitations.5 Nonetheless, the global pattern of rising youth suicide rates warrants explanation.234Suicide related research has typically prioritised mental illness as a key determinant.26 However, for youth suicide prevention strategies to have the greatest global impact, it is essential to understand…

Systematic review of the impact of interventions changing access to lethal means on suicide attempts and deaths

Objective

The study objective was to examine if interventions changing access to lethal means are associated with changes in suicide deaths and/or attempts by conducting a systematic review of controlled intervention studies.

Methods

Authors searched key databases (PubMed, PsycInfo, CINAHL) from inception to March 2024 for longitudinal controlled intervention studies with at least one contemporaneous comparator group evaluating the impact of interventions changing access to lethal means on suicide attempts and/or deaths in a primarily adult population. Reviewers dually screened articles, then extracted study characteristics and assessed methodological quality.

Results

Researchers screened 8522 studies and 36 articles met eligibility for inclusion. Most studies evaluated the impact of population-level firearm interventions on suicide deaths and found that stricter regulations were associated with a small reduction, if any, in total and/or firearm-specific suicide deaths. The ecological level of analysis precluded individual-level causal inference. Findings within interventions targeting methods other than firearms were limited, mixed and/or inconclusive. Notably, no high-quality randomised controlled trials (RCTs) were identified that met our eligibility criteria.

Conclusion

Future studies should use an RCT design or advanced statistical causal inference techniques to further elucidate the effectiveness of these interventions on suicide deaths and/or attempts.

PROSPERO registration number

CRD42022364775.

Circumstantial variables preceding firearm suicide among females with and without mobility disability in the USA: comparative analysis using data from the National Violent Death Reporting System

Background

Mobility disability impacts approximately 12% of the US population; females are overrepresented among persons with mobility disability. Those with mobility disability are at increased risk of suicide compared with their non-disabled counterparts. Suicide using a firearm has increased among females in the last two decades. This study aims to describe and explore significant circumstantial variables (eg, socio-demographic, health indicators) preceding firearm suicide among females with mobility disability as compared with females without mobility disability.

Methods

This is a secondary comparative, retrospective analysis of the narrative data from the National Violent Death Reporting System Restricted Access Database. Persons with mobility disability were identified through text mining and manual review and subsequently analysed with a summative form of content analysis. Pearson/Fisher’s X2 or t-tests were used to assess differences in the circumstantial variables between those with and without mobility disabilities.

Results

Among female firearm suicide decedents, persons with mobility disability were more commonly older (p<0.001), identified as a homemaker (p<0.001), were perceived to be in a depressed mood before death (p<0.05), had a history of suicidal thoughts (p<0.05) and were perceived to have physical pain (p<0.001); they less commonly had relationship problems (p<0.05).

Conclusions

Females with mobility disability who die by firearm suicide may be differentiated from suicide decedents without mobility disability by age, employment status, depressive mood, relationship problems and physical pain. The significance of these variables as independent risk factors for firearm suicide may be tested with prospective study designs, which in turn may inform the development of targeted or disability-inclusive prevention strategies.

Association of veteran suicide risk with state-level firearm ownership rates and firearm laws in the USA

Background

Veterans have higher suicide rates than matched non-veterans, with firearm suicides being especially prevalent among veterans. We examined whether state firearm laws and state firearm ownership rates are important risk factors for suicide among veterans.

Methods

US veteran’s and demographically matched non-veteran’s suicide rates, 2002–2019, are modelled at the state level as a function of veteran status, lethal means, state firearm law restrictiveness, household firearm ownership rates and other covariates.

Results

Marginal effects on expected suicide rates per 100 000 population were contrasted by setting household firearm ownership to its 75th versus 25th percentile values of 52.3% and 35.3%. Ownership was positively associated with suicide rates for both veterans (4.35; 95% credible interval (CrI): 1.90, 7.14) and matched non-veterans (3.31; 95% CrI: 1.11, 5.77). This association was due to ownership’s strong positive association with firearms suicide, despite a weak negative association with non-firearm suicide. An IQR difference in firearm laws corresponding to three additional restrictive laws was negatively associated with suicide rates for both veterans (–2.49; 95% CrI: –4.64 to –0.21) and matched non-veterans (–3.19; 95% CrI: –5.22 to –1.16). Again, these differences were primarily due to associations with firearm suicide rates. Few differences between veterans and matched non-veterans were found in the associations of state firearm characteristics with suicide rates.

Discussion

Veterans’ and matched non-veterans’ suicide risk, and specifically their firearm suicide risk, was strongly associated with state firearm characteristics.

Conclusions

These results suggest that changes to state firearm policies might be an effective primary prevention strategy for reducing suicide rates among veterans and non-veterans.

Firearm businesses as partners in suicide prevention: a cross-sectional study of the Gun Shop Project in Colorado, USA

Background

The Gun Shop Project aims to reduce firearm suicide and is widely implemented in the USA, yet little is known about the core firearm business practices and behaviours that might contribute to preventing firearm suicide.

Methods

Owners or managers of all firearm businesses identified as participants in Colorado’s Gun Shop Project were invited to respond to a questionnaire. Data collection occurred from March to May 2021. Analyses included unweighted descriptive statistics with CIs and Pearson 2 tests for categorical associations.

Results

54 firearm businesses participated (response rate: 28%). Under half reported practices that are Gun Shop Project core aspects (range: 14%–45%). 22% of businesses frequently engaged customers on the importance of safe firearm storage in suicide prevention while 26% had denied a firearm sale and 14% had assisted with temporary secure storage in the past year with customers perceived to be in suicidal crisis. However, high proportions reported willingness to engage in these behaviours if a customer was in crisis: 74% were willing to refuse a sale of a firearm or ammunition, 70% were willing to discuss temporary secure storage options and 70% were willing to direct customers to mental health services.

Conclusions

This study suggests that efforts to continue educating and involving firearm businesses may have an impact on the adoption of organisational suicide prevention practices and behaviours. Ongoing efforts are needed to understand core components of Gun Shop Project to inform standardised recommendations for effective firearm business practices that prevent firearm suicide.

Prediction of the mechanism of suicide among Minnesota residents using data from the Minnesota violent death reporting system (MNVDRS)

Background

Suicide remains a major public health problem, and firearms are used in approximately half of all such incidents. This study sought to predict the occurrence of suicide specifically by firearm, as opposed to any other means of suicide, in order to help inform possible life-saving interventions.

Methods

This study involved data from the Minnesota Violent Death Reporting System. Models evaluated whether data beyond basic demographics generated increased prediction accuracy. Models were built using random forests, logistic regression and data imputation. Models were evaluated for prediction accuracy using the area under the curve analysis and for proper calibration.

Results

Results showed that models constructed with social determinants and personal history data led to increased prediction accuracy in comparison to models constructed with basic demographic information only. The study identified an optimised ‘top 20’ variables model with a 73% chance of correctly discerning relative incident risk for a pair of individuals. Age, height/weight, employment industry/occupation, sex and education level were found to be most highly predictive of firearm suicide in the study’s ‘top 20’ model.

Conclusions

The study demonstrated that the use of a firearm in a death by suicide, as opposed to any other means of suicide, can be reasonably well predicted when an individual’s social determinants and personal history are considered. These predictive models could help inform many prevention strategies, such as safe storage practices, background checks for firearm purchases or red flag laws.

Trends in mortality after emergency department presentation for suicidal behaviour in California

Introduction

Emergency department patients presenting with non-fatal suicidal behaviour face elevated risk of suicide and all-cause mortality, but the extent to which this has changed over time is unknown. This study tracked trends in mortality risks faced by emergency department patients presenting with deliberate self-harm and suicidal ideation in California.

Methods

Using statewide linked emergency department and death data, we estimated 2010–2016 trends in suicide and all-cause mortality among emergency department patients with either deliberate self-harm (n=111 658) or suicidal ideation (n=162 959). We also calculated average annual percent changes in age-adjusted mortality rates and compared these to the general California population.

Results

Deliberate self-harm and suicidal ideation patients’ age-adjusted suicide rates decreased by approximately 5% per year during the study period; however, their all-cause mortality trends were flat. In the general California population, suicide rate trends were flat while all-cause mortality slightly declined.

Conclusions

Suicide mortality unexpectedly declined among self-harming and suicidal patients presenting to California emergency departments. Additional research is needed to understand the reasons behind this decline and inform quality improvement efforts for suicide prevention in hospital settings.