The Association of Firearm Suicide With Mental Illness, Substance Use Conditions, and Previous Suicide Attempts
Authors: Jennifer M. Boggs, Gregory E. Simon, Brian K. Ahmedani, Edward Peterson, Samuel Hubley, Arne Beck
Journal: Annals of Internal Medicine (2017)

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 how to identify patients at risk, evaluate firearm access, engage patients in treatment, and transition patients to specialty care (4). Our findings also highlight the importance of expanding attention beyond an exclusive focus on firearms—especially for persons with mental health or substance use conditions—to include other common means of suicide, such as instruments used for suffocation (for example, rope for hanging) and poison (for example, medications, alcohol, and recreational drugs). Suicide prevention resources are also available to educate primary care providers about restricting access to common means of suicide and counseling at-risk patients and their families about how to implement restrictions (5).References1. Centers for Disease Control and Prevention. Welcome to WISQARS. 2017. Accessed at www.cdc.gov/injury/wisqars on 15 February 2017. Google Scholar2. The Joint Commission. Detecting and treating suicide ideation in all settings. Sentinel Alert Event no. 56. 24 February 2016. Accessed at www.jointcommission.org/assets/1/18/SEA_56_Suicide.pdf on 15 February 2017. Google Scholar3. Ahmedani B, Peterson EL, Hu Y, Rossom RC, Lynch F, Lu CY, et al. Major physical health conditions and risk of suicide. Am J Prev Med. 2017;23. [Forthcoming]. doi:10.1016/j.amepre.2017.04.001 CrossrefGoogle Scholar4. Suicide Prevention Resource Center. Zero Suicide in Health and Behavioral Health Care. 2017. Accessed at http://zerosuicide.sprc.org on 1 March 2017. Google Scholar5. Suicide Prevention Resource Center. CALM: Counseling on Access to Lethal Means. 2017. Accessed at www.sprc.org/resources-programs/calm-counseling-access-lethal-means on 1 March 2017. Google Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From 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.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0111.This article was published at Annals.org on 4 July 2017. 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Taichman, MD, PhD 15 August 2017Volume 167, Issue 4Page: 287-288KeywordsAlcoholsAsphyxiaBehaviorDisclosureDrugsFirearm injuriesMortalityPsychiatry and mental healthRecreational drug useSuicide ePublished: 4 July 2017 Issue Published: 15 August 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...