Fatal Police Shootings of Victims with Mental Health Crises: A Descriptive Analysis of Data from the 2014-2015 National Violent Death Reporting System.

One in five fatal police shooting victims may have been experiencing a mental health crisis (MHC) at the time of their death [1]. We use data on fatal police shootings from the National Violent Death Reporting System (2014-2015) to (a) identify incidents where the victim is reported to have experienced an MHC at the time of their death, (b) describe the characteristics of these incidents, and (c) compare the characteristics of MHC to fatal police shootings where the victim was not experiencing an MHC at the time of their death. We systematically coded 633 fatal police shootings from 27 states. Descriptive statistics characterized fatal police shootings, including victim characteristics; their mental health status; and contextual information regarding the police encounter (e.g., reason for police call). Overall, 203 of 633 fatal police encounters (32%) involved victims who showed signs of an MHC at the time of their death. Victims were predominantly white, male, and in possession of a firearm. In 3 of 4 cases, the MHC manifested as suicidal ideation despite any relevant documented history among most victims. Among half of suicidal victims, suicidal ideation was expressed verbally and in-person to a family member/intimate partner who subsequently called the police. Dispatch was aware of the MHC in 1 of 4 of total police calls. Overall, fatal police encounters involving those experiencing an MHC accounted for 1 in 3 of our caseloads. Approximately, 3 of 4 mental health calls involved a suicidal person who mainly expressed intent to a loved one in-person.

Suicide by sodium nitrite poisoning: Findings from the National Violent Death Reporting System, 2018-2020.

OBJECTIVES: Suicide by sodium nitrite may be an emerging trend in the United States. Our mixed-methods study aims to: (1) describe the rates of suicides secondary to sodium nitrite self-poisoning in the United States between 2018 and 2020 and (2) characterize the use of sodium nitrite as a suicide method. METHODS: Using NVDRS data, descriptive statistics, population-based incident rates/year and incidence estimates across 50 states were calculated. An inductive thematic analysis characterized the use of sodium nitrite as a suicide method on review of medical examiner and law enforcement reports. RESULTS: 260 incidents were identified as suicides secondary to self-poisoning with sodium nitrite/nitrate across 37 states and 1 territory-69% of which occurred in 2020. The typical victim was a white male student with a known depressive disorder and a history of suicidal thoughts (n = 120). The annual suicide rate using sodium nitrite increased from 0.01-0.09/100,000 person-years over the three-year period. Online forums were used to share knowledge on the procurement and preparation of sodium nitrite poisoning. CONCLUSIONS: Sodium nitrite self-poisoning is an increasingly used planned suicide method among young people. Further studies are required to identify the impact of means safety interventions on the incidence of sodium nitrite self-poisoning incidents.

Beliefs Among Veteran Firearm Owners Regarding Whether Clinicians Should Discuss Firearm Safety With Patients.

Importance: Veterans are at increased risk of suicide, and guidelines recommend assessing firearm access and counseling to reduce access among patients with elevated suicide risk. How veterans view such discussions is critical to the effectiveness of these interactions. Objective: To assess whether veteran firearm owners believe clinicians should deliver firearm counseling when patients or their family members are being cared for in specific clinical contexts that suggest heightened risk of firearm injury. Design, Setting, and Participants: In this cross-sectional study, data were from a probability-based online survey of self-identified veterans who reported owning at least 1 firearm (National Firearms Survey, July 1 to August 31, 2019) and were weighted to generate nationally representative estimates. Data were analyzed from June 2022 to March 2023. Main Outcomes and Measures: Participants were asked, "As part of routine care, should physicians and/or other health care professionals talk with their patients about firearms and firearm safety if their patient or their patient's family member (is at risk of suicide; has mental health or behavioral problems; is abusing or addicted to alcohol or drugs; is a victim of domestic violence; has Alzheimer's disease or another dementia; or is going through a hard time)." Response options included "No," "Yes, sometimes," and "Yes, always." In addition, responses were dichotomized as "Yes, at least sometimes" and "No." Results: Of 4030 adults who completed the survey (65% completion rate), 678 (mean [SD] age, 64.7 [13.1] years; 638 [92.9%] male) identified as veteran firearm owners. Across the 6 clinical contexts, support for clinicians "at least sometimes" discussing firearm safety as part of routine care ranged from 73.4% (95% CI, 69.1%-77.3%) when someone is "going through a hard time" to 88.2% (95% CI, 84.8%-90.9%) when someone has "mental health or behavioral problems." When a patient or family member is at risk for suicide, 79.4% (95% CI, 75.5%-82.8%) of veteran firearm owners responded that clinicians should "at least sometimes" discuss firearms and firearm safety. Conclusions and Relevance: This study's findings suggest that most veteran firearm owners believe that clinicians should provide firearm counseling during routine care when a patient or family member is at heightened risk of firearm injury. These findings belie concerns that discussing firearm access with veteran firearm owners is an unacceptable practice.

Black Household gun ownership and black suicide rates across U.S. States.

INTRODUCTION: Ecologic studies have examined the relationship across states between levels of household gun ownership and suicide rates using household gun ownership data from the Behavioral Risk Factor Surveillance System (BFRSS) or proxies. However, no study has examined how race-specific survey-based or proxy measures of gun ownership are related to race-specific suicide rates. METHODS: We use cross-sectional state-level race-specific data to examine how well various proxies correlate with race-specific BRFSS gun ownership rates. We examine whether BRFSS measures of household gun ownership are correlated with firearm suicide, non-firearm suicide, and total suicide rates, for Black and for White adults, and repeat these assessments with select proxies. The core BRFSS only included gun questions in 2001, 2002, and 2004, but not since; mortality data are collapsed 2001-2010. RESULTS: Among a set of proxies, the race-specific fraction of suicides that are firearm suicides (FS/S) is the measure most highly correlated with BRFSS household gun ownership. Across states, White adult BFRSS household gun ownership levels are highly correlated with White adult firearm suicide rates (correlation coefficient .82) and moderately correlated with White overall suicide rates (.63). However, for Black adults, we find that while the state-level Black gun ownership levels are moderately correlated with Black firearm suicide rates (.67)-more strongly for older (.70) than for younger (.47) Black adults-Black BRFSS gun ownership levels are only weakly correlated with Black overall suicide rates (.17) owing to a moderate inverse correlation with Black non-firearm suicide rates (-.45). For Black adults, the relationship between FS/S and suicide is similar to the relation between BRFSS and suicide. CONCLUSION: For White adults, states with higher levels of measured household gun ownership have higher overall suicide rates. This relationship does not hold for Black adults, largely due to a more attenuated correlation between these measures of firearm availability and firearm suicide rates coupled with a more substantial countervailing (inverse) relationship between these measures and non-firearm suicide rates. Future efforts using individual level data might help determine why this puzzling difference exists, especially for young Black adults.

Classifying Firearm Injury Intent in Electronic Hospital Records Using Natural Language Processing.

Importance: International Classification of Diseases-coded hospital discharge data do not accurately reflect whether firearm injuries were caused by assault, unintentional injury, self-harm, legal intervention, or were of undetermined intent. Applying natural language processing (NLP) and machine learning (ML) techniques to electronic health record (EHR) narrative text could be associated with improved accuracy of firearm injury intent data. Objective: To assess the accuracy with which an ML model identified firearm injury intent. Design, Setting, and Participants: A cross-sectional retrospective EHR review was conducted at 3 level I trauma centers, 2 from health care institutions in Boston, Massachusetts, and 1 from Seattle, Washington, between January 1, 2000, and December 31, 2019; data analysis was performed from January 18, 2021, to August 22, 2022. A total of 1915 incident cases of firearm injury in patients presenting to emergency departments at the model development institution and 769 from the external validation institution with a firearm injury code assigned according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM), in discharge data were included. Exposures: Classification of firearm injury intent. Main Outcomes and Measures: Intent classification accuracy by the NLP model was compared with ICD codes assigned by medical record coders in discharge data. The NLP model extracted intent-relevant features from narrative text that were then used by a gradient-boosting classifier to determine the intent of each firearm injury. Classification accuracy was evaluated against intent assigned by the research team. The model was further validated using an external data set. Results: The NLP model was evaluated in 381 patients presenting with firearm injury at the model development site (mean [SD] age, 39.2 [13.0] years; 348 [91.3%] men) and 304 patients at the external development site (mean [SD] age, 31.8 [14.8] years; 263 [86.5%] men). The model proved more accurate than medical record coders in assigning intent to firearm injuries at the model development site (accident F-score, 0.78 vs 0.40; assault F-score, 0.90 vs 0.78). The model maintained this improvement on an external validation set from a second institution (accident F-score, 0.64 vs 0.58; assault F-score, 0.88 vs 0.81). While the model showed some degradation between institutions, retraining the model using data from the second institution further improved performance on that site's records (accident F-score, 0.75; assault F-score, 0.92). Conclusions and Relevance: The findings of this study suggest that NLP ML can be used to improve the accuracy of firearm injury intent classification compared with ICD-coded discharge data, particularly for cases of accident and assault intents (the most prevalent and commonly misclassified intent types). Future research could refine this model using larger and more diverse data sets.

Parental Perceptions of Their Children's Access to Household Firearms.

OBJECTIVES: To provide a nationally representative estimate of the proportion of gun owners who report a child has independent access to one of their guns, and to describe characteristics of these gun owners relative to other gun-owning parents. STUDY DESIGN: We conducted a cross-sectional analysis of online survey data collected in 2019 from a nationally representative sample of US adults in households with firearms (n = 4030, response 65%). The sample comprised gun-owning respondents living in homes with children (n = 689) who were asked questions about their firearms, including how they were stored, and about who other than themselves had access to their guns: "If you were not there, who in your household could get one of your guns (and load it if it is not loaded already) if they needed to?" RESULTS: Twelve percent of US gun owners in homes with children report that a child has independent access to one of their guns (about one-fifth of those having children under age 12 years only). Gun owners who reported child access were more likely than those who reported no child access to store guns unlocked and loaded, but still one-fifth of those reporting access stored all guns locked and unloaded. CONCLUSIONS: We find that more than 10% of gun owners with children report that a child can independently access one of their guns, including parents who store all guns locked and unloaded suggesting that guidance to parents should focus on access in addition to firearm storage.

Selection and Use of Firearm and Medication Locking Devices in a Lethal Means Counseling Intervention.

Background: While some suicide prevention initiatives distribute locking devices for firearms and medication, little evidence exists to guide the selection of devices. Aims: This study aimed to describe safety standards for locking devices and compare parental acceptance rates for different types of devices. Method: As part of the larger SAFETY Study, behavioral health clinicians provided free locking devices to parents whose child was evaluated in the emergency department (ED) for a suicide-related or behavioral health-related problem. For logistical reasons, we changed the specific devices offered midstudy. Data on device use came from follow-up interviews with 226 parents. Results: Few effective standards exist for locking devices for home use; we could easily break into some. At follow-up, twice as many gun-owning parents were using ED-provided handgun lockboxes as cable locks (28% vs. 14%, p = .02). Overall, 55% of parents reported using an ED-provided medication lockbox, with more using the drawer-sized lockbox than the larger, steel toolbox (60% vs. 42%, p < .01). Limitations: Storage outcomes are from parents' self-report and from one state only. Conclusion: Parents appeared to prefer some devices over others. Our findings suggest the need for (a) effective safety standards, (b) affordable devices meeting these standards, and (c) further research on consumer preferences to ensure use.

Identifying Occupation Groups for Suicide Prevention: A Statewide Data Linkage Study.

OBJECTIVE: To identify suicide rates by occupation category in Utah and describe the hospital history and circumstances of suicide decedents in the occupation category that had the state's highest rate and highest number of suicides: Construction and Extraction. METHOD: We used data on suicide decedents from the National Violent Death Reporting System (NVDRS) for 2005-2015 (n = 4,590) to calculate sex- and occupation-specific suicide rates among adults 18-65 years old in Utah. For working-age men who died by suicide during the years 2014-2015 (n = 623), we linked NVDRS data with decedents' hospital histories. RESULTS: One in five working-age men who took their life in Utah worked in Construction and Extraction, the single Bureau of Labor Statistics occupation category with both the highest number (n = 719) and rate of suicides (86.4/100,000 men vs. a range of 15.3-66.2 for other occupations). For females, there was no occupation group that had both high rates of suicide and high numbers of suicides compared with other occupations, so there was no clear occupation group to focus on in the same way there was for men. Using linked data for 2014-2015 deaths, 58% of men in Construction and Extraction who died by suicide had been diagnosed in the hospital in the past three years with a substance abuse or mental health problem, and a quarter (25%) tested positive for opioids on post-mortem examination. Nearly half (48%) of 2014-2015 male suicide decedents in Construction and Extraction were reported to have intimate partner problems, about a quarter (26%) had a criminal problem, a quarter (25%) were unemployed, and over half (54%) died by gunshot. CONCLUSIONS: Linked data identified Construction and Extraction as a potentially high-impact occupation group for suicide prevention and suggested potential contexts for intervention.HIGHLIGHTSConstruction and Extraction stands out as an occupation group with a very high number and rate of suicides.Two-thirds of male decedents in Construction and Extraction had a substance abuse problem.For Utah females, there were no occupations with both high rates and high numbers of suicides.

Assessment of the Accuracy of Firearm Injury Intent Coding at 3 US Hospitals.

Importance: The absence of reliable hospital discharge data regarding the intent of firearm injuries (ie, whether caused by assault, accident, self-harm, legal intervention, or an act of unknown intent) has been characterized as a glaring gap in the US firearms data infrastructure. Objective: To use incident-level information to assess the accuracy of intent coding in hospital data used for firearm injury surveillance. Design, Setting, and Participants: This cross-sectional retrospective medical review study was conducted using case-level data from 3 level I US trauma centers (for 2008-2019) for patients presenting to the emergency department with an incident firearm injury of any severity. Exposures: Classification of firearm injury intent. Main Outcomes and Measures: Researchers reviewed electronic health records for all firearm injuries and compared intent adjudicated by team members (the gold standard) with International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM) codes for firearm injury intent assigned by medical records coders (in discharge data) and by trauma registrars. Accuracy was assessed using intent-specific sensitivity and positive predictive value (PPV). Results: Of the 1227 cases of firearm injury incidents seen during the ICD-10-CM study period (October 1, 2015, to December 31, 2019), the majority of patients (1090 [88.8%]) were male and 547 (44.6%) were White. The research team adjudicated 837 (68.2%) to be assaults. Of these assault incidents, 234 (28.0%) were ICD coded as unintentional injuries in hospital discharge data. These miscoded patient cases largely accounted for why discharge data had low sensitivity for assaults (66.3%) and low PPV for unintentional injuries (34.3%). Misclassification was substantial even for patient cases described explicitly as assaults in clinical notes (sensitivity of 74.3%), as well as in the ICD-9-CM study period (sensitivity of 77.0% for assaults and PPV of 38.0% for unintentional firearm injuries). By contrast, intent coded by trauma registrars differed minimally from researcher-adjudicated intent (eg, sensitivity for assault of 96.0% and PPV for unintentional firearm injury of 93.0%). Conclusions and Relevance: The findings of this cross-sectional study underscore questions raised by prior work using aggregate count data regarding the accuracy of ICD-coded discharge data as a source of firearm injury intent. Based on our observations, researchers and policy makers should be aware that databases drawn from hospital discharge data (most notably, the Nationwide Emergency Department Sample) cannot be used to reliably count or characterize intent-specific firearm injuries.

Trend in Loaded Handgun Carrying Among Adult Handgun Owners in the United States, 2015‒2019.

Objectives. To determine the frequency of loaded handgun carrying among US adult handgun owners overall and by state concealed carry law status. Methods. Using a nationally representative survey of US firearm-owning adults in 2019, we asked handgun owners (n = 2389) about their past-month handgun carrying behavior. Results. A total of 30.3% (95% confidence interval [CI] = 28.0%, 32.6%) of handgun owners carried handguns monthly, of whom 38.1% (95% CI = 33.6%, 42.7%) did so daily. In permitless carry states, 29.7% (95% CI = 25.9%, 33.9%) of handgun owners carried handguns in the past month, compared with 33.1% (95% CI = 29.9%, 36.3%) in shall issue states and 19.7% (95% CI = 14.9%, 25.5%) in may issue states. Of handgun owners without a permit, 7.5% (95% CI = 4.1%, 13.3%) of those in may issue states and 11.5% (95% CI = 8.5%, 15.4%) of those in shall issues states carried handguns in the past month. Conclusions. In 2019, about 16 million US adult handgun owners carried handguns in the past month (up from 9 million in 2015), and approximately 6 million did so daily (twice the 3 million who did so in 2015). Proportionally fewer handgun owners carried handguns in states where issuing authorities had substantial discretion in granting permits. (Am J Public Health. 2022;112(12):1783-1790. https://doi.org/10.2105/AJPH.2022.307094).

Reprint of "Using multiple imputation by super learning to assign intent to nonfatal firearm injuries".

The number of nonfatal firearm injuries in the US by intent (e.g., due to assault) is not reliably known: First, although the largest surveillance system for hospital-treated events, the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS), provides accurate data for the number of nonfatal firearm injuries, injury intent is not coded reliably. Second, the system that reliably codes intent, the CDC's National Electronic Injury Surveillance System - Firearm Injury Surveillance Study (NEISS-FISS), while large enough to produce stable estimates of the distribution of intent, is too small to produce stable estimates of the number of these events. Third, a large proportion of cases in NEISS-FISS, notably in early years of the system, are coded as of "undetermined intent." Trends in the proportion of nonfatal firearm injuries by intent in NEISS-FISS thus depend on whether these cases are treated as a distinct category, or, instead, can be re-classified through imputation. We contrast the distributions of nonfatal firearm injury by intent generated using multiple imputation with those generated using complete-case analyses and analyses that consider "undetermined intent" as a distinct category. We produce estimates of the annual number of firearm injuries by intent in a two-step process. First, we impute intent for cases coded as "undetermined" using Multiple Imputation by Super Learning (MISL). Second, we apply MISL-derived distributions to aggregate count data from HCUP-NEDS. The proportion of non-fatal firearm assaults appears to increase over time when injuries coded as undetermined are included as a category. By contrast, the proportion of assaults remains relatively constant over time in complete-case and multiply imputed analyses. Differences between complete-case and multiple imputation approaches become apparent in subgroup analyses. Trends in the number of nonfatal firearm injuries by intent, 2006-2016, derived in our two-step process, are relatively flat. Multiple imputation strategies recovered intent distribution trends that differed from trends derived using methods that are not designed to account for the multiple complex relationships of missingness present in NEISS - FISS data. When applied to NEISS - FISS, MISL imputation produces plausible distributional estimates of firearm injury by intent.

Perceptions of Firearm Accessibility and Suicide Among US Adults Living in Households With Firearms.

This survey study of US adults living in households with firearms uses a counterfactual question to assess whether respondents believed restricting access to firearms might prevent death by suicide.

Using multiple imputation by super learning to assign intent to nonfatal firearm injuries.

The number of nonfatal firearm injuries in the US by intent (e.g., due to assault) is not reliably known: First, although the largest surveillance system for hospital-treated events, the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS), provides accurate data for the number of nonfatal firearm injuries, injury intent is not coded reliably. Second, the system that reliably codes intent, the CDC's National Electronic Injury Surveillance System - Firearm Injury Surveillance Study (NEISS-FISS), while large enough to produce stable estimates of the distribution of intent, is too small to produce stable estimates of the number of these events. Third, a large proportion of cases in NEISS-FISS, notably in early years of the system, are coded as of "undetermined intent." Trends in the proportion of nonfatal firearm injuries by intent in NEISS-FISS thus depend on whether these cases are treated as a distinct category, or, instead, can be re-classified through imputation. We contrast the distributions of nonfatal firearm injury by intent generated using multiple imputation with those generated using complete-case analyses and analyses that consider "undetermined intent" as a distinct category. We produce estimates of the annual number of firearm injuries by intent in a two-step process. First, we impute intent for cases coded as "undetermined" using Multiple Imputation by Super Learning (MISL). Second, we apply MISL-derived distributions to aggregate count data from HCUP-NEDS. The proportion of non-fatal firearm assaults appears to increase over time when injuries coded as undetermined are included as a category. By contrast, the proportion of assaults remains relatively constant over time in complete-case and multiply imputed analyses. Differences between complete-case and multiple imputation approaches become apparent in subgroup analyses. Trends in the number of nonfatal firearm injuries by intent, 2006-2016, derived in our two-step process, are relatively flat. Multiple imputation strategies recovered intent distribution trends that differed from trends derived using methods that are not designed to account for the multiple complex relationships of missingness present in NEISS - FISS data. When applied to NEISS - FISS, MISL imputation produces plausible distributional estimates of firearm injury by intent.

Receipt of clinician-delivered firearm safety counseling among U.S. Veterans: Results from a 2019 national survey.

OBJECTIVE: Seventy percent of suicides among U.S. veterans are due to firearm injury. Because discussions about firearm access are an important component of evidence-based suicide prevention programs, we sought to quantify the proportion of U.S. veterans who have discussed firearm safety with a healthcare provider. METHODS: Data come from a probability-based, nationally representative online survey of U.S. adults living in households with firearms in 2019 (response 65%). In this study, we include only self-identified veteran firearm owners. Respondents were asked, "Has a physician or other healthcare practitioner ever spoken to you about firearm safety?" Analyses were stratified by self-reported use of Veterans Health Administration (VHA) healthcare services. RESULTS: Overall, 31.5% (95% CI 27.5-35.8) reported using VHA services and 9.2% (95% CI 6.8-12.3) reported that a clinician had ever spoken with them about firearm safety (14.3% among VHA users, 6.8% among non-users). Of those who reported a discussion, nearly three quarters reported it was with an outpatient primary care physician or medical specialist. CONCLUSIONS: A large majority of veteran firearm owners have not had, or do not recall having had, a firearm safety discussion with a clinician, suggesting that additional efforts to facilitate such discussions in the VHA and elsewhere are needed.

Who owned the gun in firearm suicides of men, women, and youth in five US states?

One way to reduce firearm suicide is to keep household guns away from a person at risk for suicide. To learn who owned (and presumably controlled access to) the guns used in suicide and which broad gun type they were, we examined National Violent Death Reporting System (NVDRS) data from 2015 to 2017 for five US states that supplied information on gun owner in over 80% of firearm suicides (AK, IA, NH, UT, WI). For adult males, 88% used their own gun; for women, 52% used their own gun and 32% used their partner's gun; for youth ages 18-20, 42% used their own gun, 43% used a family member's, and 8% used a friend's; for children, 19% used their own gun (usually a long gun) and 79% used a family member's gun. Almost 3/4 of firearm suicides involved a handgun, ranging from 62% for youth to 92% for women. In times of suicide risk, interventions for a youth should address not only the parents' guns, but those of other family members and the youth's own rifle or shotgun. For a woman, interventions need to address her own and her partner's guns. For a man, locking guns alone will confer little protection if he controls the keys or combination. Storing firearms-or a critical component-away from home or having someone else control the locks may be safer. Five NVDRS states provided useful data on who owned the gun used in firearm suicides. More NVDRS states should follow suit.

Perspectives on clinician-delivered firearm safety counseling during routine care: Results of a national survey.

Only 7.5% of United States (U.S.) adults report ever having spoken with a clinician about firearm safety. One reason that clinicians may infrequently counsel patients about firearm safety is that they are unsure whether patients are open to these discussions. The aim of this study was to assess public opinion about whether clinicians should provide firearm safety counseling for patients in specific clinical contexts. We conducted a cross-sectional analysis of online survey data collected in 2019 from a nationally representative sample of U.S. adults residing in households with firearms (n = 4030, response 65%). Participants were asked "As part of routine care, should physicians and/or other health care professionals talk with their patients about firearms and firearm safety if their patient or their patient's family member (is at risk of suicide; has mental health or behavioral problems; is abusing or addicted to alcohol or drugs; is a victim of domestic violence; has Alzheimer's disease or another dementia; is going through a hard time)?" Across the six contexts, 76-89% of adults reported that clinicians should "sometimes" or "always" discuss firearm safety with patients. These findings demonstrate that a large majority of U.S. adults who live in households with firearms believe that clinicians should discuss firearm safety when patients or their family members are experiencing specific clinical scenarios. Clinicians' and healthcare systems' concerns that patients might object to discussing firearm safety in these contexts should not impede efforts to integrate such interventions into routine care.

Hospital visit histories of suicide decedents: a study in Utah.

The study aims to describe the 3-year hospital visit histories of suicide decedents in Utah grouped by the suicide method they used. Hospital visit histories from the Utah Office of Health Care Statistics were linked to a census of suicide mortality data from the National Violent Death Reporting System in 2014 and 2015. Overall, 14% of suicide decedents had visited a hospital for deliberate self-harm (DSH) and 49% for a behavioural health issue (BHI), including DSH, suicidal ideation, mental health and substance abuse, prior to their death. Firearms suicide decedents made up over half of all suicides but were the least likely to have a history of DSH or BHI prior to their death (8% and 41%, respectively). Few suicide decedents visited a hospital for DSH prior to their death, although half had visits for BHI. Hospital-based interventions that aim to prevent suicide should not be limited to visits for DSH.

Child Access Prevention Laws and Firearm Storage: Results From a National Survey.

INTRODUCTION: Child Access Prevention Negligent Storage (CAP-NS) laws seek to reduce pediatric firearm injury by imposing sanctions on gun owners if children gain access to unlocked guns. Whether these laws affect the storage behavior they aim to encourage is not known because historical panel data on firearm storage do not exist. As a result, assessing how much, if at all, firearm storage changed because of CAP-NS laws requires an indirect approach. METHODS: Data for this study came from a web-based survey conducted by the research firm Ipsos from July 30, 2019 to August 11, 2019. Respondents were adult gun owners drawn from an online sampling frame comprising approximately 55,000 U.S. adults recruited using address-based sampling methods to be representative of the U.S. POPULATION: The primary outcome was the proportion of gun owners in CAP-NS versus non-CAP-NS states who had ≥1 unlocked firearm. Estimates are presented by CAP-NS status, for gun owners overall and for those who live with children, before and after adjusting for potential confounders. Data were analyzed in 2021. RESULTS: In adjusted analyses, gun owners in CAP-NS states were no more likely to lock firearms than were those in states without these laws. In addition, most gun owners reported not knowing whether they lived in a state with a CAP-NS law. CONCLUSIONS: CAP-NS laws have at best modest effects on firearm storage. If the storage effect is as small as this study indicates, the mortality benefits previously attributed to CAP-NS laws are overstated. As such, developing interventions that effectively reduce firearm mortality by reducing access to firearms remains an urgent clinical and public policy priority.