Methods of suicide among persons aged 10-19 years--United States, 1992-2001

In 2001, suicide was the third leading cause of death among persons aged 10-19 years. The most common method of suicide in this age group was by firearm (49%), followed by suffocation (mostly hanging) (38%) and poisoning (7%). During 1992-2001, although the overall suicide rate among persons aged 10-19 years declined from 6.2 to 4.6 per 100,000 population, methods of suicide changed substantially. To characterize trends in suicide methods among persons in this age group, CDC analyzed data for persons living in the United States during 1992-2001. This report summarizes the results of that analysis, which indicated a substantial decline in suicides by firearm and an increase in suicides by suffocation in persons aged 10-14 and 15-19 years. Beginning in 1997, among persons aged 10-14 years, suffocation surpassed firearms as the most common suicide method. The decline in firearm suicides combined with the increase in suicides by suffocation suggests that changes have occurred in suicidal behavior among youths during the preceding decade. Public health officials should develop intervention strategies that address the challenges posed by these changes, including programs that integrate monitoring systems, etiologic research, and comprehensive prevention activities.     

The epidemiology of firearm suicide in the United States

Context Little attention has been given to the role of firearms in suicide. In 1998, firearms were the leading method of committing suicide for both men and women, responsible for three times the number of suicides compared to the next leading method. Understanding the epidemiology of firearm suicide will increase awareness of firearm suicide as a major public health problem. Results Rates of firearm suicide have changed little over the past two decades and have consistently exceeded rates of firearm homicide. the firearm suicide rate among men is approximately six times that of women. While firearm suicide rates are highest among the elderly, the majority (66%) of firearm suicides are among persons under 55 years of age. Firearm suicide rates among women of all ages have dropped modestly, while rates among elderly men have risen considerably. Whites have roughly twice the rate of firearm suicide as do blacks and other race/ethnicity groups. Individual-level empirical studies have consistently indicated that keeping firearms in the home is associated with an increased risk of suicide. Conclusions For suicide prevention to be effective, the availability and use of firearms in suicides must be addressed.     

Household firearm ownership and suicide rates in the United States

BACKGROUND: In the United States, more people kill themselves with firearms than with all other methods combined. A central question regarding the relation between firearms and suicide is whether the ready availability of firearms increases the suicide rate, rather than merely increasing the proportion of suicides from guns. METHODS: We used publicly available data for the nine regions and 50 states in the United States over a 10-year period (1988-1997) to examine the association between levels of household firearm ownership and rates of suicide, firearm suicide, and non-firearm suicide by age groups and gender. RESULTS: In both regional and state-level analyses, for the U.S. population as a whole, for both males and females, and for virtually every age group, a robust association exists between levels of household firearm ownership and suicide rates. CONCLUSIONS: Where firearm ownership levels are higher, a disproportionately large number of people die from suicide.     

Firearm homicide and firearm suicide: opposite but equal

OBJECTIVE: Homicide and suicide are intentional acts of violence that disproportionately involve firearms. Much more effort has been devoted to the ecological study of homicide; methods that have been developed to better understand and subsequently prevent homicide may be applicable to suicide. The purpose of the present study was to compare the occurrence of firearm homicide and firearm suicide using routine activity theory as a framework for analysis. METHODS: Detailed mortality data pertaining to decedents, their neighborhoods, and use of firearms were collected from 1994 to 1998 for the counties containing and surrounding three small to medium-sized U.S. cities. Data from a total of 468 neighborhoods that collectively experienced 1,025 intentional deaths from firearms (396 firearm homicides and 629 firearm suicides) were analyzed. RESULTS: Firearm homicide was consistently associated with out-of-home, nighttime activity in neighborhoods where many people were likely to be coming and going. In an opposite-but-equal fashion, firearm suicide was consistently associated with in-home, daytime activity in out-of-the-way neighborhoods. CONCLUSIONS: Firearm homicide and firearm suicide were found to be consistently associated with markers of routine activity in all three cities, albeit in an opposite-but-equal manner. Because firearm suicides very often occur as lonely events in lonely neighborhoods, they may go under-noticed relative to firearm homicides. More awareness and additional public health studies of firearm suicide, in tandem with firearm homicide, should be pursued to better identify individuals and neighborhoods that are at greatest risk of experiencing each event.     

Firearm-related fatalities: an epidemiologic assessment of violent death

This study examines 1970-78 South Carolina firearm fatalities utilizing vital record data. During this period, 5,808 firearm deaths, classified as accident, homicide, suicide, or undetermined, were reported with an average annual fatality rate of 23.35 deaths per 100,000 estimated population. Firearm fatalities in South Carolina were the sixth leading cause of death in 1975 and accounted for 2.9 per cent of all deaths to residents. A significant period decline in the firearm fatality rate was observed and was attributed mainly to decreases in the non-White rate. In 1978, the fatality rate for non-Whites (18.5) fell below the rate for Whites (19.1) for the first time in the years investigated. Firearm deaths represent a major community health problem and, as such, warrant attention and direct involvement by state and local health professionals.     

Vital Signs: Changes in Firearm Homicide and Suicide Rates — United States, 2019–2020

IntroductionThe majority of homicides (79%) and suicides (53%) in the United States involved a firearm in 2020. High firearm homicide and suicide rates and corresponding inequities by race and ethnicity and poverty level represent important public health concerns. This study examined changes in firearm homicide and firearm suicide rates coinciding with the emergence of the COVID-19 pandemic in 2020.MethodsNational vital statistics and population data were integrated with urbanization and poverty measures at the county level. Population-based firearm homicide and suicide rates were examined by age, sex, race and ethnicity, geographic area, level of urbanization, and level of poverty.ResultsFrom 2019 to 2020, the overall firearm homicide rate increased 34.6%, from 4.6 to 6.1 per 100,000 persons. The largest increases occurred among non-Hispanic Black or African American males aged 10–44 years and non-Hispanic American Indian or Alaska Native (AI/AN) males aged 25–44 years. Rates of firearm homicide were lowest and increased least at the lowest poverty level and were higher and showed larger increases at higher poverty levels. The overall firearm suicide rate remained relatively unchanged from 2019 to 2020 (7.9 to 8.1); however, in some populations, including AI/AN males aged 10–44 years, rates did increase.Conclusions and Implications for Public Health PracticeDuring the COVID-19 pandemic, the firearm homicide rate in the United States reached its highest level since 1994, with substantial increases among several population subgroups. These increases have widened disparities in rates by race and ethnicity and poverty level. Several increases in firearm suicide rates were also observed. Implementation of comprehensive strategies employing proven approaches that address underlying economic, physical, and social conditions contributing to the risks for violence and suicide is urgently needed to reduce these rates and disparities.     

Adolescent suicide and household access to firearms in Colorado: results of a case-control study.

PURPOSE: To determine whether, compared with age- and sex-matched controls who did not commit suicide, adolescents who committed suicide by firearms were more likely to have had household access to firearms (after adjusting for significant risk factors for adolescent suicide). METHODS: A case-control study design was used; case subjects were Colorado adolescents who committed suicide between 1991 and 1993; controls were sex- and age-matched adolescents who were randomly selected from the same school the subjects had attended. Interviews were conducted with the parent or guardian of cases and controls. RESULTS: Of the 36 case subjects in this study, 67% committed suicide using a gun obtained from their home. Adolescent suicide victims who committed suicide by firearms were significantly more likely to have a firearm in their home (72%) than age- and sex-matched community controls (50%), after adjusting for significant risk factors. Conduct disorder and previous mental health treatment were also found to be independent risk factors for adolescent firearm suicide. CONCLUSIONS: Two types of public health interventions to prevent adolescent firearm suicides are likely to be successful: (a) limiting household access to firearms, and (b) identifying adolescents at high risk of firearm suicide.     

State firearm laws and rates of suicide in men and women

BACKGROUND: To evaluate the associations of state laws restricting firearms and incidence rates of suicide in men and women using a cross-sectional design. METHODS: States were divided into three categories based on the restrictiveness of their firearm laws: restrictive (n =8); modest (n =22); and unrestrictive (n =20). State suicide incidence rates stratified by gender were compared using Poisson regression analyses that controlled for measures of race/ethnicity, income, and urbanization. Analyses were based on 2000 census data and state suicide data from 1999 and 2000. RESULTS: In the analysis of women, compared to states with restrictive firearm laws, there were higher suicide incidence rate ratios (IRR) in states with modest (IRR=1.64; 95% confidence interval [CI], 1.34-2.01) and unrestrictive laws (IRR=1.55; 95% CI, 1.23-1.95). The analysis of men showed comparable results: modest firearm laws (IRR=1.51; 95% CI, 1.27-1.79); unrestrictive firearm laws (IRR=1.49; 95% CI, 1.23-1.82). CONCLUSIONS: Results support the hypothesis that state restrictions on firearms have the potential to reduce the suicide rate. Findings do not support a hypothesis that greater firearm restrictions are associated with the substitution of alternative methods of suicide. Firearms appear to be a comparable exposure for suicide in men and women. Although men are more likely to use firearms in suicide than women, this difference may merely reflect more frequent gun ownership among men.     

The choice of weapons in firearm suicides.

We report on the firearms used in 235 suicides in Sacramento County, California, during 1983-85. Handguns were used in 69 per cent of firearm suicides--65 per cent for males, 88 per cent for females--and in all such deaths among women ages 35 and older. We tested the hypothesis that the choice of firearms by persons committing suicide at home would passively reflect the reported prevalence of firearms by type in households in the region. Handguns were used more frequently (rate ratio 2.00; 95% CI = 1.68, 2.39), and rifles and shotguns less frequently than expected.     

Factors Associated with State Variations in Homicide, Suicide, and Unintentional Firearm Deaths

This study examined the relationship of 16 variables with homicide, suicide, and unintentional firearm deaths. This cross-sectional analysis, using adjusted partial correlation coefficients, found that state-level firearm homicide rates significantly varied by the prevalence of firearms and by percent of the population which was African American. Whereas, state-level variations in firearm suicide mortality significantly varied by firearm prevalence, per capita alcohol consumption, percent of the population which was African American, and level of urbanization. None of the variables were significantly (p < or = .05) related to state-level variations in unintentional firearm mortality. Furthermore, state gun laws had only a limited effect on firearm-related homicide deaths. Although the current study cannot determine causation, firearm mortality in its various forms is most commonly related to the prevalence of firearms and the percent of the population that is African American.     

Suicides in Alaska: firearms and alcohol.

A manual review of death certificates and autopsy records identified 195 suicides in Alaska during 1983-84. Native males, 20-24 years old, had the highest rate of suicide (257 per 100,000 person-years). Gunshot wounds caused 76 per cent of all suicide deaths; 79 per cent of Native and 48 per cent of White suicides had detectable levels of blood alcohol. Suicide by firearms was weakly associated with blood alcohol levels above 100 mg/dl (odds ratio 1.3, 95 per cent confidence interval 1.11-1.47).     

Suicide acts in 8 states: incidence and case fatality rates by demographics and method

OBJECTIVES: This study examined incidence rates of medically identified suicide acts (self-inflicted injuries, either fatal or nonfatal) and case fatality rates by age, sex, race, and method used. METHODS: The authors analyzed data on 10,892 suicides and 57,439 attempted suicides among hospital-admitted individuals in 8 states, along with 6219 attempted suicides among individuals released from emergency departments in 2 states. RESULTS: The 8 states experienced a mean of 11 suicides and 119 attempted suicides per 100,000 residents each year. Groups with high suicide rates were men, the elderly, and Whites; groups with high attempted suicide rates were teenagers, young adults, women, and Blacks and Whites aged 25 to 44 years. Blacks aged 15 to 44 years evidenced high attempted suicide rates undocumented in previous studies. Poisoning and firearm were the most common methods used among those attempting suicide and those completing suicide acts, respectively. The most lethal method was firearm. CONCLUSIONS: The characteristics of suicides and attempted suicides differ dramatically. Method used is important in the lethality of the act.     

Household firearm storage practices: Do responses differ by whether or not individuals ever use firearms?

INTRODUCTION: The prevalence with which firearms are stored loaded or unlocked has been measured in previous surveys. Our purpose was to compare household firearm storage practices reported by firearm users and nonusers. METHODS: We analyzed telephone survey data from the 1992 and 1993 Oregon Behavioral Risk Factor Surveillance System on 2454 randomly selected adults in households with firearms. We compared reported firearm storage practices among persons who ever used firearms with persons who had never used firearms by demographics and type of firearm. RESULTS: Nonusers of firearms were much less likely than firearm users to report that household firearms were always or sometimes stored loaded [odds ratio (OR) = 0.45, 95% confidence interval (CI):0.36-0.54] or stored loaded and unlocked (OR = 0.46, 95% CI: 0.36-0.57). Except for persons aged 18 to 34 years and persons in handgun-only households, differences in reported firearm storage practices between nonusers and users varied little by demographic characteristics or by type of firearm. Nonusers of household firearms may be unaware that firearms are stored loaded or stored loaded and unlocked in their homes. CONCLUSIONS: Surveys that do not consider firearm use status may underestimate household exposure to loaded firearms or to loaded and unlocked firearms.     

The decline in Australian young male suicide

Since the late 1990s there has been a sharp downward trend in Australian young male suicide. It is possible that a major government youth suicide prevention initiative, the National Youth Suicide Prevention Strategy (NYSPS), implemented during 1995-1999 may have influenced the decline. In this article, we examine time trends in age- and means-specific male and female Australian suicide rates in relation to unemployment rates and the NYSPS. Based on Australian suicide data over the period 1966-2003, we assess secular changes in the 20-24 year male suicide to total (crude) male suicide rate ratio in relation to the NYSPS, using interrupted time series analysis (ARIMA), since this was previously found to be significantly associated with the 20-24 year male unemployment to total employment ratio. Results show that a dramatic reduction in Australian young male (aged 20-34 years) suicide has occurred since 1997-1998, declining from approximately 40 per 100,000 in 1997-1998 to approximately 20 per 100,000 in 2003. Most of the decline is due to a decrease in suicide by hanging and to a lesser extent from motor vehicle carbon monoxide and other gases. Further, the previously established strong secular association (lasting over 3 decades from 1966) between the rate ratio of 20-24 year male suicide to total (crude) male suicide, and the rate ratio of 20-24 year male unemployment to total unemployment, appears to have been disrupted. ARIMA modelling of the suicide ratio against the initiative indicates a highly significant statistical association between the NYSPS and the suicide ratio reduction but not between the NYSPS and the unemployment indicator trend, suggesting a break in the link between young male suicide and unemployment. The recent sudden turnaround in Australian young male suicide trends and its extent appears to preclude explanations centring on slow-moving social indices traditionally associated with suicide, or on possible cohort effects. This sudden decrease has occurred mainly in non-impulsive means, and at the same time has broken a long-standing secular link between 20 and 24-year-male suicide and unemployment, lending plausibility to the case for the NYSPS having had an impact on young male suicide in Australia.     

Suicide among young people in selected Brazilian State capitals

This study analyzes suicide among young Brazilians (15-24 years old) in nine metropolitan areas. Mortality data for 1979-1998 were obtained from the Mortality Information System of the Ministry of Health. External causes are the main causes of death among youth, and suicide is the sixth most frequent of these causes. The distribution is heterogeneous, varying according to the social stratum, specific age group, sex, and means used to commit suicide. All cities analyzed showed increased suicide rates from 1979 to 1998 (from 3.5 to 5.0 per 100,000 inhabitants 15-24 years old). Salvador and Rio de Janeiro had the lowest suicide rates, while Porto Alegre and Curitiba had the highest. The principal means used by youth to commit suicide were hanging, strangling, and suffocation (Porto Alegre), followed by firearms and explosives (Belo Horizonte).     

Lethality of firearms relative to other suicide methods: a population based study

OBJECTIVES: (1) To quantify lethality of firearms relative to other suicide methods, (2) to quantify the extent to which suicide mortality may be reduced by limiting access to firearms. METHODS: Data on suicides and hospitalised para-suicides that occurred in the state of Illinois from 1990 to 1997 were combined. Total number of episodes for each suicide method was estimated as the sum of the number of suicides and the number of para-suicides for that method. Gender and suicide method were used as proxies for intention to die, and estimated lethality of suicide methods within method-gender groups (for example, male firearm users). Logistic regression was used to quantify the lethality of firearms relative to other suicide methods. Excess mortality associated with the use of firearms was estimated by conservatively assuming that in the absence of firearms the next most lethal suicide method would be used. RESULTS: From January 1990 to December 1997, among individuals 10 years or older in the state of Illinois, there were 37,352 hospital admissions for para-suicide and 10,287 completed suicides. Firearms are the most lethal suicide method. Episodes involving firearms are 2.6 times (95% CI 2.1 to 3.1) more lethal than those involving suffocation-the second most lethal suicide method. Preventing access to firearms can reduce the proportion of fatal firearms related suicides by 32% among minors, and 6.5% among adults. CONCLUSIONS: Limiting access to firearms is a potentially effective means of reducing suicide mortality.     

Gun control and suicide: the impact of state firearm regulations in the United States, 1995-2004

Objective

To empirically assess the impact of firearm regulation on male suicides.

Method

A negative binomial regression model was applied by using a panel of state level data for the years 1995-2004. The model was used to identify the association between several firearm regulations and male suicide rates.

Results

Our empirical analysis suggest that firearms regulations which function to reduce overall gun availability have a significant deterrent effect on male suicide, while regulations that seek to prohibit high risk individuals from owning firearms have a lesser effect.

Conclusions

Restricting access to lethal means has been identified as an effective approach to suicide prevention, and firearms regulations are one way to reduce gun availability. The analysis suggests that gun control measures such as permit and licensing requirements have a negative effect on suicide rates among males. Since there is considerable heterogeneity among states with regard to gun control, these results suggest that there are opportunities for many states to reduce suicide by expanding their firearms regulations.     

The role of firearm and alcohol availability in firearm suicide: A population-based weighted case-control study

Firearm availability has been linked to firearm self-harm, but the joint relationship with alcohol availability, while supported by theory, has not been examined. This study sought to quantify the separate and joint relations of community firearm and alcohol availability with individual-level risk of (fatal and nonfatal) firearm self-harm. We conducted a case-control study of California residents, 2005–2015, using statewide mortality, hospital, firearm transfer, and alcohol license data. We estimated monthly marginal risk differences per 100,000 in the overall population and in white men aged 50+ under various hypothetical changes to firearm and alcohol availability and assessed additive interactions using case-control-weighted g-computation. In the overall population, non-pawn shop firearm dealer density was associated with firearm self-harm (RD: 0.02, 95% CI: 0.003, 0.04) but pawn shop firearm dealer and alcohol outlet densities were not. Secondary analyses revealed a relationship between firearm sales density and firearm self-harm (RD: 0.07, 95% CI: 0.04, 0.10). There were no additive interactions between measures of firearm and alcohol availability. Among older white men, generally the same exposures were related to self-harm as in the overall population, but point estimates were substantially larger. Findings suggest community-level approaches to reducing firearm sales may help mitigate suicide risk.     

Suicide among Hispanics--United States, 1997-2001

By 2020, Hispanics are expected to represent 17% of the U.S. population and to surpass all other racial/ethnic minority populations in size. In 1996, the U.S. Department of Health and Human Services established the Hispanic Agenda for Action initiative; a major goal of this initiative is to identify health problems that affect Hispanics. In 2001, although the overall age-adjusted suicide rate per 100,000 population among Hispanics was lower than the U.S. national rate (10.7), suicide was the third leading cause of death among young (i.e., aged 10-24 years) Hispanics and the seventh leading cause of years of potential life lost before age 75 years. To identify demographic groups at risk for suicide and to help guide prevention efforts, CDC analyzed mortality data for 1997-2001. This report summarizes the results of that analysis, which indicated that, among Hispanics, the largest proportion of suicides occurred among young persons; suicide rates were higher among males; and the most common method of suicide was by firearms. To reduce the number of suicides, additional prevention strategies are needed, including 1) improving methods for collecting data about suicides, suicide attempts, and related behaviors; 2) expanding evaluation of prevention efforts aimed at reducing suicidal behaviors; and 3) examining how effective interventions can be modified for diverse and culturally specific populations.