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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.

Violent deaths among individuals subject to domestic violence protection orders

Objectives

Individuals (ie, respondents) subject to domestic violence protection orders have threatened or engaged in one form of violence perpetration and may be at increased risk for experiencing others forms of violence, including violent death.

Methods

Using a cohort of granted domestic violence protection orders in King County, Washington, USA, from 2014 to 2020 (n=3543), we calculated standardised mortality ratios for violent death, including suicide, homicide, legal intervention and undetermined intent, comparing domestic violence protection order respondents to King County residents adjusting for year, age, sex, and race and ethnicity through indirect standardisation.

Results

There were 66 deaths among domestic violence protection order respondents; 25.8% were violent deaths and 52.9% of violent deaths involved firearms. The standardised mortality ratio for violent death was 3.71 (95% CI: 2.16 to 5.93) among domestic violence protection order respondents compared with King County residents.

Conclusion

The domestic violence protection order process may provide an opportunity for referrals to services to address shared risk factors for violence perpetration and victimisation.