Symposia
Suicide and Self-Injury
Aleksandrs T. Karnick, M.P.H., M.A.
Graduate Student
University of Southern Mississippi
Hattiesburg, Mississippi
Allison Bond, M.A.
Graduate Student
Rutgers University
Titusville, New Jersey
Elinore Kaufman, MD, MSHP
Assistant Professor
Perelman School of Medicine, the University of Pennsylvania
Philadelphia, Pennsylvania
Mike Anestis, PhD
Executive Director
New Jersey Gun Violence Research Center
West Piscataway, New Jersey
Dan Capron, PhD
Associate Professor
University of Southern Mississippi
Hattiesburg, Mississippi
Despite representing fewer than 5% of suicide attempts, firearms account for over half of suicide deaths. Yet, there is little clinical information regarding firearm attempts, particularly survivors. This study assessed clinical factors differentiating firearm suicide survivors from decedents, firearm attempters from other methods, and firearm attempters from similarly injured patients.
In this study, data were collected from the National Trauma Data Bank. Participants included 3,980 firearm attempters (1,341 decedents), 10,193 attempters by other methods, and 7,960 matched controls. Controls were matched using exact matching on ventilator status and Abbreviated Injury Scale-Head, with nearest neighbor matching by Mahalanobis distance on Injury Severity Score, Glasgow Coma Scale, systolic blood pressure, and pulse rate. Logistic regression compared groups of interest (i.e., firearm suicide survivors and decedents, firearm suicide attempters and suicide attempters by other methods, firearm suicide attempters and matched controls) and multinomial regression assessed predictors of the type of firearm used in the suicide attempt and discharge destination following trauma admission for suicide attempt by firearm.
Older age and being uninsured were associated with increased mortality among firearm attempters and differences were found by primary injury location. Older age, White race, male sex, and being uninsured were associated with firearm use. Major psychiatric disorders were associated with attempting with a firearm and using a rifle or shotgun. Major psychiatric disorders, female sex, and smoking were associated with discharge to a psychiatric facility, while Black race had lower odds. Black and other race patients had increased odds of being discharged to law enforcement. Uninsured patients had lower odds of discharge to long-term care or skilled nursing facilities, psychiatric facilities, or rehabilitation facilities.
This study identifies factors associated firearm suicide and includes indicators of disparities in health service delivery to patients at high risk of death by suicide. As the first comprehensive analysis of firearm suicide admissions to include a large population of decedents and survivors with extensive data on factors associated with these injuries, we identified risk factors and disparities in outcomes among firearm attempters. These findings carry implications for understanding the impact of socioeconomic and racial disparities in access to quality health and mental health services.