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Assessing the national and subnational firearm violence trends in Mexico from 1990 to 2019: secondary data analysis from the Global Burden of Disease study

Background

Mexico is among the countries with the highest mortality rates by firearms worldwide. We aimed to analyse the trend in the burden of firearm violence (FV) by age and sex in Mexico at a national and subnational level, and the association between this burden and the Sociodemographic Index.

Methods

We used estimates from the Global Burden of Disease (GBD)-2019 study for the analysis of FV mortality, premature mortality and disability for all available age-groups and by sex. The GBD data separates FV into three categories—interpersonal violence from firearms, unintentional injuries from firearms and self-harm from firearms. We used a joinpoint regression analysis to analyse the temporal trends of the FV burden.

Results

FV exhibited a non-significant increase. By cause, there was a significant increase in the burden of interpersonal violence from firearms, a non-significant decrease in the burden of self-harm from firearms and a significant decrease in the burden of unintentional injuries from firearms. Most of the FV burden is attributed to interpersonal violence from firearms. Almost the entirety of the burden of FV results from premature mortality. The incidence of FV disability adjusted life years (DALYs) was significantly higher among males than females, and was most concentrated in males aged 20–44 and females aged 15–49. Significant heterogeneity in FV DALY trends was observed at the subnational level.

Conclusion

These results may help to better understand the burden of FV and help the design and implementation of national and local preventive policies.

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.

Acceptability and feasibility of video-based firearm safety education in a Colorado emergency department for caregivers of adolescents in firearm-owning households

Background

Easy firearm access increases injury risk among adolescents. We evaluated the acceptability and feasibility of improving knowledge of a 3 min safe firearm storage education video in the paediatric emergency department.

Methods

We conducted a single-centre block trial in a large paediatric emergency department (August 2020–2022). Participants were caregivers of adolescents (10–17 years) in firearm-owning households. First block participants (control) completed a baseline survey about child safety behaviours (including firearms). Second block participants (intervention) completed a baseline survey, watched the safe firearm storage video and evaluated acceptability. Participants completed a 3-month follow-up survey about firearm safety behaviours and knowledge recall. Demographic and clinical variables were compared between the intervention and control groups using Fisher’s exact and 2 tests. McNemar’s test was used to compare firearm storage behaviours at the initial and 3-month visit within each group.

Results

Research staff approached 1264 caregivers; 371 consented to participate (29.4%) and 144 (38.8%) endorsed firearm ownership. There were 95 participants in the control group and 62 in the intervention group. Follow-up was lower in the intervention group (53.7% vs 37.1%, p=0.04). Among participants viewing the video, 80.3% liked the video and 50.0% felt they learnt something new from the video.

Conclusions

Video-based firearm education in a paediatric emergency department is acceptable among a population of caregivers of adolescents with household firearms. This is a higher-risk group that may uniquely benefit from consistent education in the paediatric emergency department. Further study with larger populations is needed to evaluate intervention effectiveness.

Trial registration

The study was registered with ClinicalTrials.gov (NCT05168878).

Exploratory qualitative study of firearm storage practices among surgeons in the USA: contexts and motivations

Background

A US survey of surgeons found that 32% store firearms unlocked and loaded. This study explored conditions and contexts impacting personal firearm storage methods among surgeons.

Methods

We conducted semi-structured interviews with English-speaking fellows of the American College of Surgeons who treated patients injured by firearms and who owned or lived in homes with firearms. Participants were recruited through email and subsequent snowball sampling from April 2022 to August 2022. All interviews were audio-recorded and transcribed verbatim. Thematic analysis was applied to transcripts to identify codes. A mixed deductive and inductive approach was used for data reduction and sorting.

Results

A total of 32 surgeons were interviewed; most were male and white. Dominant themes for firearm storage practices were based on (1) attitudes; (2) perceived norms; (3) personal agency; and (4) intention of firearm use. Personal agency often conflicted with attitudes and perceived norms for surgeons owning firearms for self-defence.

Conclusions

Storage practices in this sample of firearm-owning surgeons were driven by intent for firearm use, coupled with attitudes, perceived norms and personal agency. Personal agency often conflicted with attitudes and perceived norms, especially for surgeons who owned their firearm for self-defence.

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.