Variation in completeness of coding external cause of injuries under ICD-10-CM.

INTRODUCTION: Information about causes of injury is key for injury prevention efforts. Historically, cause-of-injury coding in clinical practice has been incomplete due to the need for extra diagnosis codes in the International Classification of Diseases-Ninth Revision-Clinical Modification (ICD-9-CM) coding. The transition to ICD-10-CM and increased use of clinical support software for diagnosis coding is expected to improve completeness of cause-of-injury coding. This paper assesses the recording of external cause-of-injury codes specifically for those diagnoses where an additional code is still required. METHODS: We used electronic health record and claims data from 10 health systems from October 2015 to December 2021 to identify all inpatient and emergency encounters with a primary diagnosis of injury. The proportion of encounters that also included a valid external cause-of-injury code is presented. RESULTS: Most health systems had high rates of cause-of-injury coding: over 85% in emergency departments and over 75% in inpatient encounters with primary injury diagnoses. However, several sites had lower rates in both settings. State mandates were associated with consistently high external cause recording. CONCLUSIONS: Completeness of cause-of-injury coding improved since the adoption of ICD-10-CM coding and increased slightly over the study period at most sites. However, significant variation remained, and completeness of cause-of-injury coding in any diagnosis data used for injury prevention planning should be empirically determined.

Intimate partner violence and suicide mortality: a cross-sectional study using machine learning and natural language processing of suicide data from 43 states.

INTRODUCTION: Intimate partner violence (IPV) is associated with suicidal ideation, yet it remains unclear how often IPV precipitates suicide mortality. To overcome limitations with national data, we applied novel methods to: (1) document the prevalence of IPV-related suicide in the USA and (2) identify correlates for IPV-related suicide. METHODS: Using National Violent Death Reporting System data (NVDRS, 2015-2019, n=1 30 550), we recorded IPV circumstances (yes/no) by leveraging prior textual reviews of death narratives and applying a validated natural language processing tool. We could not systematically differentiate IPV perpetration versus victimisation given limited details in NVDRS. Logistic regression compared IPV-related suicides with referent group suicides (no evidence of IPV), stratified by sex. RESULTS: 7.1% of suicides were IPV related (n=9210), most were isolated suicide events (82.8%, n=7625; ie, not homicide suicide). There were higher odds of IPV circumstances when the decedent had civil legal problems (aOR for men: 3.6 (3.3 to 3.9), aOR for women: 2.6 (2.2 to 3.2)), criminal legal problems (aOR men: 2.3 (2.2 to 2.5), aOR for women: 1.7 (1.4 to 2.1)), or used a firearm (aOR men: 1.9 (1.8 to 2.0), aOR for women: 1.9 (1.7 to 2.1)). There were lower odds of IPV circumstances when the decedent had a current mental health problem (aOR men: 0.7 (0.7 to 0.8), aOR for women: 0.7 (0.6 to 0.8)). CONCLUSIONS: IPV circumstances contribute to a notable proportion of suicides. IPV-related suicides are distinct from other suicide deaths. Targeted suicide screening and intervention in IPV settings may be beneficial for prevention.

Associations between feelings of safety, concerns about firearms on campus and suicidal thoughts and behaviours among college students.

BACKGROUND: Perceptions of safety on campus may be related to a variety of factors such as concerns about campus violence, especially firearm violence, and mental health, particularly suicidal thoughts and behaviours (STBs). The present analyses aim to describe associations between feelings of safety, concerns about firearms on campus and STBs among college students. METHODS: This study uses data from the American College Health Association-National College Health Assessment wave III (n=24 682 participants across k=29 schools). Multilevel logistic regressions and cumulative link mixed models examine the associations between feelings of safety, concerns about firearm violence on campus and presence of STBs in the past year. RESULTS: Participants who reported being concerned about firearm violence felt significantly less safe. Feeling unsafe at night was significantly associated with suicidal ideation and suicide attempts. Individuals with concerns about firearm safety on campus were up to 42% more likely to report suicidal ideation compared with those reporting they were not at all concerned about campus firearm violence. DISCUSSION: With associations highlighting increased risk of STBs among those with reduced safety feelings and heightened concerns about firearms, there is a need for college campuses to intervene and promote campus safety, with particular consideration for the presence of firearms on campus and the implications of allowing such weapons to be present in environments with increasing instances of firearm violence.

Regional differences in firearm ownership, storage and use: results from a representative survey of five US states.

BACKGROUND: Firearm access and storage practices influence risk for injury and death; however, prior research has considered only national and regional differences on these variables, overlooking state-level differences. OBJECTIVES: To analyse and describe statewide differences in firearm ownership, storage and use in a representative sample of five US states. DESIGN: Variables were assessed via an online self-report survey administered between 29 April 2022 and 15 May 2022. SETTING: Surveys were completed online. PARTICIPANTS: Participants (n=3510) were members of knowledge panel, a probability-based sample recruited to be representative of US adults. All participants were aged 18+ and resided in one of five states: Colorado, Minnesota, Mississippi, New Jersey or Texas. MEASUREMENTS: We used χ2 tests to examine state differences in firearm ownership, childhood firearm experiences and purchasing. A series of analyses of covariance were then used to assess differences in firearm storage, firearms owned and carrying behaviours while adjusting for pertinent demographic characteristics. RESULTS: We found significant differences in firearm ownership across states. There were significantly more first-time firearm purchasers during the firearm purchasing surge in New Jersey. Both Mississippi and Texas have elevated rates of unsecure storage practices and firearm carrying outside of the home. LIMITATIONS: Results are cross-sectional and self-report. Findings may not generalise beyond the five states assessed in this survey. CONCLUSIONS: Public health messaging around firearm safety should account for differences in key firearm behaviours related to ownership, storage and use to ensure effective communication and reduce the risk of gun injury and death across states.

Intersection of adverse childhood experiences, suicide and overdose prevention.

Adverse childhood experiences (ACEs), suicide and overdose are linked across the life course and across generations and share common individual-, interpersonal-, community- and societal-level risk factors. The purpose of this review is to summarise the shared aetiology of these public health issues, synthesise evidence regarding potential community- and societal-level prevention strategies and discuss future research and practice directions.Growing evidence shows the potential for community- and societal-level programmes and policies, including higher minimum wage; expanded Medicaid eligibility; increased earned income tax credits, child tax credits and temporary assistance for needy families benefits; Paid Family Leave; greater availability of affordable housing and rental assistance; and increased participation in the Supplemental Nutrition Assistance Program (SNAP), to contribute to ACEs, suicide and overdose prevention. Considerations for future prevention efforts include (1) expanding the evidence base through rigorous research and evaluation; (2) assessing the implications of prevention strategies for equity; (3) incorporating a relational health perspective; (4) enhancing community capacity to implement, scale and sustain evidenced-informed prevention strategies; and (5) acknowledging that community- and societal-level prevention strategies are longer-term strategies.

Association of veteran suicide risk with state-level firearm ownership rates and firearm laws in the USA.

BACKGROUND: Veterans have higher suicide rates than matched non-veterans, with firearm suicides being especially prevalent among veterans. We examined whether state firearm laws and state firearm ownership rates are important risk factors for suicide among veterans. METHODS: US veteran's and demographically matched non-veteran's suicide rates, 2002-2019, are modelled at the state level as a function of veteran status, lethal means, state firearm law restrictiveness, household firearm ownership rates and other covariates. RESULTS: Marginal effects on expected suicide rates per 100 000 population were contrasted by setting household firearm ownership to its 75th versus 25th percentile values of 52.3% and 35.3%. Ownership was positively associated with suicide rates for both veterans (4.35; 95% credible interval (CrI): 1.90, 7.14) and matched non-veterans (3.31; 95% CrI: 1.11, 5.77). This association was due to ownership's strong positive association with firearms suicide, despite a weak negative association with non-firearm suicide. An IQR difference in firearm laws corresponding to three additional restrictive laws was negatively associated with suicide rates for both veterans (-2.49; 95% CrI: -4.64 to -0.21) and matched non-veterans (-3.19; 95% CrI: -5.22 to -1.16). Again, these differences were primarily due to associations with firearm suicide rates. Few differences between veterans and matched non-veterans were found in the associations of state firearm characteristics with suicide rates. DISCUSSION: Veterans' and matched non-veterans' suicide risk, and specifically their firearm suicide risk, was strongly associated with state firearm characteristics. CONCLUSIONS: These results suggest that changes to state firearm policies might be an effective primary prevention strategy for reducing suicide rates among veterans and non-veterans.

Circumstantial variables preceding firearm suicide among females with and without mobility disability in the USA: comparative analysis using data from the National Violent Death Reporting System.

BACKGROUND: Mobility disability impacts approximately 12% of the US population; females are overrepresented among persons with mobility disability. Those with mobility disability are at increased risk of suicide compared with their non-disabled counterparts. Suicide using a firearm has increased among females in the last two decades. This study aims to describe and explore significant circumstantial variables (eg, socio-demographic, health indicators) preceding firearm suicide among females with mobility disability as compared with females without mobility disability. METHODS: This is a secondary comparative, retrospective analysis of the narrative data from the National Violent Death Reporting System Restricted Access Database. Persons with mobility disability were identified through text mining and manual review and subsequently analysed with a summative form of content analysis. Pearson/Fisher's X2 or t-tests were used to assess differences in the circumstantial variables between those with and without mobility disabilities. RESULTS: Among female firearm suicide decedents, persons with mobility disability were more commonly older (p<0.001), identified as a homemaker (p<0.001), were perceived to be in a depressed mood before death (p<0.05), had a history of suicidal thoughts (p<0.05) and were perceived to have physical pain (p<0.001); they less commonly had relationship problems (p<0.05). CONCLUSIONS: Females with mobility disability who die by firearm suicide may be differentiated from suicide decedents without mobility disability by age, employment status, depressive mood, relationship problems and physical pain. The significance of these variables as independent risk factors for firearm suicide may be tested with prospective study designs, which in turn may inform the development of targeted or disability-inclusive prevention strategies.

Evaluation of the risk relationship between average alcohol volume consumed and suicide in the USA: an analysis of mortality linked cohort data.

OBJECTIVE: Alcohol use disorder is an established risk factor for suicide; however, it is largely unknown whether subclinical levels of drinking may also contribute to the risk of suicide. The objective was to evaluate the relationship between average alcohol volume consumed per day and suicide. METHODS: Data from the annual, cross-sectional National Health Interview Survey, 1997-2018 in the USA, was obtained and linked to the 2019 National Death Index. The association between average alcohol volume consumed in grams per day (g/day) and suicide was quantified using Cox proportional hazards model (multiplicative) and Aalen's additive hazard model. All analyses were stratified by sex, and adjusted for education, marital status, psychological distress, race and ethnicity, and survey year. RESULTS: On the multiplicative scale, for males, former drinkers and those who consumed on average >40-60 g/day had about 43% (HR=1.43, 95% CI 1.03, 2.01) and 72% (HR=1.72, 95% CI 1.14, 2.60) greater risk of dying by suicide, compared with lifetime abstainers, respectively. There was no significant association found for former or current drinkers among females, on the multiplicative scale. On the additive scale, for males, drinking >40-60 g/day on average was associated with 22.7 (95% CI 6.0, 39.4) additional deaths per 100 000 person-years, while for females, being a former drinker and drinking >0-20 g/day on average was associated with 5.5 (95% CI 0.7, 10.4) and 1.9 (95% CI 0.2, 3.5) additional deaths per 100 000 person-years, compared with lifetime abstainers. The level of education was not found to modify the focal relationship for males or females. CONCLUSIONS: The findings suggest that the relationship between average alcohol volume consumed per day and suicide is nuanced. Additional research on the respective relationship is needed, including repeated measures of average alcohol consumption over time.

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.

Locked and loaded: correlates of in-home firearm storage beliefs and behaviours.

OBJECTIVES: To understand how crime and victimisation fears and risks operate alongside social status threats and motivations to shape unsafe in-home firearm storage practices and beliefs. METHODS: Using data from firearm owners identified in a nationwide sample surveyed in 2023, this study examined how in-home loaded firearm accessibility, firearm storage practice and firearm safety beliefs are associated with: fear of crime and victimisation; perceived and personal victimisation; racial resentment; cultural and status threats; and masculinity threats. Regression models also accounted for the role of gender, race, marital status, political affiliation, geographic region and protective motivation for firearm ownership. RESULTS: Over 40% of firearm owners reported having a loaded firearm 'always accessible' at home, and almost half think homes with firearms are safer than those without. About one-third of owners reported storing firearms locked but still loaded. Crime and victimisation fears and threats were unrelated to firearm storage behaviours and beliefs; however, firearm owners who experience higher levels of sociocultural anxiety are more likely to always have a loaded firearm accessible at home, store firearms locked and loaded, and believe that firearms make homes safer. CONCLUSIONS: Identifying the barriers to safer storage beliefs and behaviours is essential for refining and enhancing effective firearm injury prevention strategies. Sociocultural anxieties may not reflect concrete threats to physical safety, but they can be experienced as feelings of insecurity, instability and distress that-for some Americans-may be managed by knowing they have a (loaded) firearm within reach.

Law enforcement and firearms: understanding firearm ownership and storage habits.

OBJECTIVE: This study seeks to better understand firearm ownership among law enforcement officers (LEO), with the goal of informing future firearm injury and suicide prevention efforts. We describe the frequency and sociodemographic correlates of firearm ownership and storage practices among, and examine the association between suicidal ideation and current firearm storage practices. METHODS: The present study used data from a large online study (n=6410) and included data from individuals who were currently or previously being employed as an LEO (n=369; M (SD) age=39.2 y (15.8 y), 75.2% male, 66.7% white). Self-report measures were used to assess for firearm ownership, storage habits and suicidal ideation. Descriptive statistics were used to describe the frequency of firearm ownership and logistic regressions were used to examine the extent to which demographic characteristics and suicidal ideation were associated with firearm ownership. RESULTS: Overall, 70.5% (n=261) of the sample reported firearm ownership. LEO who were older had significantly lower odds of reporting firearm ownership. Those who were married and those who reported lifetime suicidal ideation had significantly greater odds of reporting firearm ownership. Whereas firearm-owning LEO who reporting storing a firearm locked had significantly lower odds of reporting lifetime suicidal ideation, those who reported storing a firearm unloaded had significantly greater odds of reporting lifetime suicidal ideation. CONCLUSION: Findings have important public health implications and can be used to increase adherence with secure storage recommendations. Increasing secure storage may help reduce suicide risk among LEO, a sample at heightened risk for suicide.

Suicide poisoning mortality: a comparison of the national poison data system and centers for disease control national dataset.

The America's Poison Centres National Poison Data System (NPDS) is set up for the active surveillance of voluntarily reported poisoning cases in near real-time. The Centres for Disease Control and Prevention (CDC)'s Wide-ranging Online Data for Epidemiologic Research (WONDER) database is final national mortality data from state registries. We compared suicide poisoning deaths in both datasets from 2000 to 2020 and tested their relationship using a simple linear regression model. Mean annual suicide poisoning deaths during the review period were 699 (SD 145) in NPDS, and 6150 (SD 577) in WONDER. NPDS annual cases averaged 11% of cases recorded in WONDER (SD 2%; Range 8%-16%). The regression coefficient for the linear relationship between annual deaths recorded in both datasets was 0.18 (p-value<0.001, R2=0.51). The rapidly available NPDS data on fatal self-poisoning may provide sentinel surveillance regarding self-poisonings, but do not reliably predict final national data on suicide poisoning.

Pregnancy-associated homicide, suicide and unintentional opioid-involved overdose deaths, North Carolina 2018-2019.

OBJECTIVE: Rates of death due to homicide, suicide and overdose during pregnancy and the first year postpartum have increased substantially in the USA in recent years. The aims of this study were to use 2018-2019 data on deaths identified for review by the North Carolina Maternal Mortality Review Committee (NC-MMRC), data from the North Carolina Violent Death Reporting System (NC-VDRS) and data from the Statewide Unintentional Drug Overdose Reporting System (NC-SUDORS) to examine homicide, suicide and unintentional opioid-involved overdose deaths during pregnancy and the first year postpartum. METHODS: We linked data from the 2018-2019 NC-MMRC to suicide and homicide deaths among women ages 10-50 years from the 2018-2019 NC-VDRS and to unintentional opioid-involved overdose deaths among women ages 10-50 years from the 2018-2019 NC-SUDORS. We conducted descriptive analyses to examine the prevalence of demographic characteristics and the circumstances surrounding each cause of death. RESULTS: From 2018 to 2019 in North Carolina, there were 23 homicides, nine suicides and 36 unintentional opioid-involved overdose deaths (9.7, 3.8 and 15.1 per 100 000 live births, respectively) during pregnancy and the first year postpartum. Most homicide deaths (87.0%) were by firearm, and more than half (52.5%) were related to intimate partner violence. More than two-thirds of women who died by suicide had a current mental health problem (77.8%). Less than one-fourth (22.2%) of those who died by unintentional opioid-involved overdose had a known history of substance use disorder treatment. CONCLUSION: Our approach to quantifying and describing these causes of pregnancy-associated death can serve as a framework for other states to inform data-driven prevention.

Violent deaths among individuals subject to domestic violence protection orders in King County, Washington, USA, 2014-2020.

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.

Epidemiological analysis of fatal and non-fatal firearm injuries occurring in gun establishments in the United States, 2015-2022.

BACKGROUND: Firearm-related injury represents a significant public health problem in the USA. Firearm purchasing has risen nationwide and there has been increased efforts to deploy injury prevention initiatives within gun establishments. However, firearm-related risks and harms that may occur inside these high-exposure settings are not well characterized. METHODS: This secondary analysis leveraged Gun Violence Archive data to quantify firearm injury prevalence rates within different types of gun establishments from 1 January 2015 to 31 December 2022. Data were restricted to incidents that occurred in gun ranges, gun shops, and public and private ranges. The following incident characteristics were available in the individual-level data: date, location, injury count, fatality count, victim demographics (age, sex), shooting intent (suicide/self-inflicted, assault/homicide, unintentional, undetermined) and establishment type. RESULTS: Over 7 years, 445 non-fatal and 183 fatal shooting events occurred across 576 unique establishments. Non-fatal, unintentional injuries predominated in stand-alone firing ranges whereas fatal, self-inflicted injuries concentrated in retail shops with accompanying firing ranges. Firearm-related assaults were prevalent among stand-alone retail shops. CONCLUSION: Overall, this secondary analysis underscores that the prevalence of firearm injury in gun establishments across the USA is low, and these settings should continue to be studied as important contexts for intervention. Interweaving public health interventions into gun establishments presents an opportunity to potentially reduce associated harms to consumers interacting within these environments.

Association between state minimum wage and firearm suicides in the USA, 2000-2020.

BACKGROUND: Firearm suicides constitute a major public health issue. Policies that enhance economic security and decrease community-level poverty may be effective strategies for reducing risk of firearm suicide. This study examined the association between state minimum wage and firearm suicide. METHODS: State minimum wage, obtained from Temple's Law Atlas and augmented by legal research, was conceptualised using the modified Kaitz Index and a continuous variable centred on the federal minimum wage. State-level suicide counts were obtained from 2000 to 2020 multiple-cause-of-death mortality data from the National Vital Statistics System. Log-linear regressions were conducted to model the associations between state minimum wage and firearm suicides, stratifying by demographic groups. Analyses were conducted in 2023. RESULTS: A one percentage point increase in a state's modified Kaitz Index was associated with a 0.3% (95% CI -0.6% to -0.0%) decrease in firearm suicides within a state. A US$1.00 increase in a state's minimum wage above the federal minimum wage was associated with a 1.4% (95% CI -2.1% to -0.6%) decrease in firearm suicides. When stratified by quartile of firearm ownership, the modified Kaitz Index was associated with decreases in firearm suicides most consistently in the two lowest quartiles. CONCLUSION: Increasing a state's minimum wage may be a policy option to consider as part of a comprehensive approach to reducing firearm suicides. These findings expand the evidence base for how economic policies may be leveraged to reduce firearm suicides.

Financial barriers and facilitators to secure firearm and medication storage among veterans with elevated suicide risk: a qualitative study.

OBJECTIVE: To explore financial barriers and facilitators to promoting secure firearm and medication storage among patients at risk for suicide. METHODS: Veterans seeking care in Veterans Affairs emergency care settings (N=28) participated in qualitative interviews on barriers and facilitators to adopting secure firearm and medication storage behaviours. Thematic analysis with inductive and iterative coding was used to identify themes pertaining to financial barriers and facilitators. Interviews were double-coded for reliability. RESULTS: We identified four themes-two related to financial barriers and two to financial facilitators. Barrier-related themes included: (1) the high cost of firearms and medications made owners less likely to dispose of medications, relinquish ownership of firearms or pursue out-of-home storage for firearms; (2) the high cost of out-of-home storage and preferred locking devices were barriers to secure storage. Facilitator-related themes included: (1) no-cost services or locking devices may help motivate secure firearm and medication storage and (2) preferences varied for no-cost locking devices versus coupons for devices. CONCLUSIONS: Addressing financial barriers and leveraging financial facilitators may motivate secure storage of lethal means, which could enhance suicide prevention efforts.

Quantifying relational change in community organisations participating in a Veteran suicide prevention learning collaborative: a social network analysis.

BACKGROUND: Veteran suicide remains a significant issue, as 17.5 Veterans die by suicide each day. The US Department of Veteran Affairs (VA) has implemented a robust suicide prevention program within its integrated behavioural health system. Further, the VA has increasingly contributed to suicide prevention in community settings, where a large proportion of Veterans receive health care and social services. One component integral to preventing suicide among Veterans receiving community services is ensuring that organisations are equipped with the latest evidence-based Veteran-specific suicide prevention strategies. METHODS: The Patient Safety Center of Inquiry-Suicide Prevention Collaborative piloted a Veteran suicide prevention learning collaborative in the Denver/Colorado Springs, CO region, spanning 16 months as a multimodal initiative to integrate community organisations and assist them in implementing Veteran suicide prevention strategies used within VA. Agencies completed social network analysis surveys at baseline (T1), year 1 (T2) and 16 months (T3) to examine social networks, partnerships and collaborations among community organisations and the VA over time. RESULTS: The quantity of learning collaborative relationships increased from 30 at T1 to 41 at T3 while the quality of relationships deepened over time from awareness and cooperative to more coordinated and integrated. CONCLUSION: Improvement in relationship quantity and quality facilitates community organisation engagement in collaborating to strengthen their Veteran suicide prevention programming. Learning collaboratives work with the individual organisation for intraorganisational facilitation of implementing suicide prevention strategies and engage and enhance interorganisational partnerships. This multimodal intervention can engage community organisations and provide a stronger safety net for Veterans at risk for suicide.

Relationship between family history of mandatory boarding school experiences and suicide risk in US reservation-based Native American youth: a cross-sectional analysis.

INTRODUCTION: Suicide is a leading cause of death among Native American youth and adolescents in the USA. A myriad of factors have been correlated with risk for suicide ideation (SI)/suicide attempt (SA), including historical trauma; however, accurate measurement of historical trauma has been inconsistent. OBJECTIVE: To examine the association of family history of a negative mandatory boarding school experience with SI and SAs. METHODS: An anonymous online survey was conducted with 288 Native youth aged 15-24 years from the Fort Peck Reservation in Montana. Multinomial regression was applied adjusting for other known risk and protective factors of SI and SAs. RESULTS: Thirty-five percent reported past SAs and 15% reported ideation without prior attempt. Of the 129 (45%) reporting a family history of mandatory boarding school experiences, 28% perceived the experience as positive while 22% as negative. After adjusting for risk and protective factors, both SI and SAs were associated with a family history of negative mandatory boarding school experiences (adjusted OR (AOR)=4.8 and 4.3, respectively) and polydrug use (AOR=3.6 and 2.3). SAs were also associated with post-traumatic stress disorder (AOR=2.6) and depressive symptoms (AOR=3.6). CONCLUSION: The association between family history of negative mandatory boarding school experiences and SI and SAs implies that culturally responsive interventions are needed to reduce the intergenerational impacts of historical trauma.

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 χ2 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.