Predicting potential underreporting of firearm ownership in a nationally representative sample.

PURPOSE: This study utilized demographic and intrapersonal variables to identify individuals who may have falsely denied firearm ownership and determined if individuals can be divided into meaningful subgroups. METHODS: Participants were United States residents (N = 3500) recruited from January to June 2020. matched to the 2010 census data for age, race, sex, income, and education level. A Zero-Inflated Negative Binomial (ZINB) regression was utilized to determine potential underreporting of firearm ownership, and a latent class analysis was utilized to determine unique subgroups of those who were identified as underreporting firearm ownership in the ZINB. RESULTS: Participants (N = 1306) were identified as underreporting firearm ownership (excess zeros) based on a model that included demographic and intrapersonal variables. A latent class analysis indicated that among excess zeros, three unique subgroups exist. CONCLUSIONS: Determining who may be underreporting firearm ownership will allow for a more comprehensive understanding of firearm ownership in the US and more targeted safe storage messages that may reach those who own firearms and are at risk for firearm-related injury and death.

Female military service members and veterans: Understanding treatment seeking behavior and previous suicide risk among suicide decedents.

To examine the differences in treatment seeking behaviors, previous suicidal thoughts, previous suicide attempts, and disclosure of suicidal thoughts among female service members (SM)/Veteran suicide decedents who used a firearm and those who used another method. Data was acquired from the National Violent Death Reporting System which is maintained and monitored by the Center for Disease Control and Prevention. Data included in the present study were from suicide deaths that occurred between 2003-2018. Female SM/Veterans who died by firearm suicide had lower proportions of current mental health or substance use treatment, lifetime mental health or substance use treatment, and previous suicide attempts compared to those who used another method. Female SM/Veterans who die by firearm suicide are less likely to encounter mental health services than those who use another method. Conversations on secure firearm storage need to occur outside of the health care setting.

Determining who healthcare providers screen for firearm access in the United States.

Healthcare providers are well positioned to screen for firearm access to reduce risk of suicides, yet there is a limited understanding of how often and for whom firearm access screening occurs. The present study examined the extent to which providers screen for firearm access and sought to identify who has been screened in the past. The representative sample included 3510 residents from five US states who reported whether they have been asked about their access to firearms by a healthcare provider. The findings demonstrate that most participants have never been asked by a provider about firearm access. People who have been asked were more likely to be White, male, and firearm owners. Those with children under 17 years old in the home, that have been in mental health treatment, and report a history of suicidal ideation were more likely to be screened for firearm access. Although there are interventions for mitigating firearm related risks in healthcare settings, many providers may be missing the opportunity to implement these because they do not ask about firearm access.

Public Perception of Gun Violence-Related Headline Accuracy and the Credibility of Media Sources.

The present study sought to determine the extent to which the message or messenger is more important for news media portrayal of gun violence prevention. Exploratory analyses also examined factors related to Fox News and MSNBC credibility. Participants (N = 3,500) were US adults matched to the 2010 US Census on several demographic variables. Two mock headlines were presented: "Gun violence is result of mental health problems" and "Storing firearms in a safe can help prevent suicides." Headlines were reported to be from either Fox News or MSNBC. Participants then rated accuracy of the headline and credibility of the news source. Headline content did not predict perceived accuracy of the headline. Perceived credibility of the messenger was associated with perceived accuracy for both mock headlines. Exploratory analyses indicated several demographic factors related to Fox News and MSNBC credibility. Regardless of the content of a headline, the degree to which participants perceived it as accurate was associated with how credible they believed the source to be. These findings highlight the importance of credible media portrayal of accurate information on gun violence prevention.

Demographic differences in the type of firearm and location of bodily injury in firearm suicide decedents.

This study describes the type of firearm used and location of bodily injury among demographic subgroups of suicide decedents. Data on those who died by suicide via firearm from the National Violent Death Reporting System (N = 117,126) between the years 2003-2018 was utilized. A series of five logistic regression analyses examining the age of decedent, type of firearm, location of wound site, loaded vs. unloaded firearms, and locked vs. unlocked storage, using predictors including gender, race, who owns the firearm and age were performed. Findings have important public health implications. Increasing safe storage or removing the specific types of firearms one is likely to use in their death from the home during a time of crisis may decrease risk of suicide.

Examining characteristics and experiences of Black firearm owners.

OBJECTIVE: The present study sought to better understand the characteristics of those who own firearms in the Black community; and to understand how Black firearm owners differ from nonfirearm owning Black individuals on a variety of variables related to safety, threat concerns, and suicide risk. METHODS: Two samples were utilized in this study. The first was a subsample of those who identified as Black from a nationally representative sample (N = 502) seeking to understand firearm ownership within the United States. The second used a subsample of those who identified as Black (N = 1086) from a representative sample from New Jersey, Minnesota, and Mississippi. Variables related to safety and threat concerns were included in the second sample. RESULTS: In both samples, multiple demographic variables, such as being a woman and having higher education, predicted firearm ownership. In the second sample, experiences of everyday discrimination and crime experiences were associated with firearm ownership. Additionally, Black firearm owners reported significantly more suicidal ideation than Black nonfirearm owners. CONCLUSION: The findings demonstrate the unique characteristics and experiences of Black firearm owners and show that firearm ownership is associated with increased suicide risk factors for Black adults. Findings should be used to advocate for the creation of more culturally relevant suicide prevention and firearm means safety strategies.

Differences in suicide risk correlates and history of suicide ideation and attempts as a function of disability type.

BACKGROUND: Disability status is associated with correlates of suicide risk (perceived burdensomeness, thwarted belongingness, negative future disposition, felt stigma, suicidal ideation, and suicide attempts). AIMS: This study aimed to examine whether suicide-related correlates differ significantly as a function of disability type. METHODS: Individuals with mobility and vision disabilities (N = 102) completed semistructured interviews and online-based questionnaires. Analysis of variance/analysis of covaiance and Fisher's exact tests were conducted to examine whether mean levels of suicide-related correlates differed significantly between individuals with blindness/low vision (n = 63) versus mobility-related (n = 39) disabilities. RESULTS: No significant between-group differences were observed for most outcomes; however, individuals with vision disabilities reported higher mean levels of felt stigma and positive future disposition than those with mobility-related disabilities. LIMITATIONS: The limited representation of disabilities among participants precludes generalization to individuals with other forms of disability and the cross-sectional design prevents inference about causality. CONCLUSIONS: Interventions targeting cognitive processes that underlie suicide risk may be applicable to people with mobility and vision disabilities.

Older Adults' Preferences Regarding Firearm Locking Device Use: Results of a National Survey.

OBJECTIVES: Use of firearm locking devices may reduce the risk of suicide and injury among older adults. This study describes older adults' preferences when choosing a firearm locking device. METHODS: We conducted a secondary analysis of a nationally representative survey of US adult firearm owners (N = 2,152). We compared older adults (≥65y) with relatively younger adults (<65y), stratified by self-reported gender. RESULTS: The top three factors cited as impacting firearm locking device selection included speed (53.6%) and ease of firearm access from device (52.4%), and cost of the device (28.7%). These top factors were comparable for all adults across genders. A larger proportion of older vs younger males reported that a primary preference was whether the device allows the firearm to remain loaded with ammunition; smaller proportions of older vs younger males reported strength of device (device durability) and costs. CONCLUSIONS: Preference among older adults, particularly older males, for locking devices that maintain the firearms easy to access - especially, loaded with ammunition - might impact firearm injury prevention efforts for this high-risk group. CLINICAL IMPLICATIONS: For harm reduction, use of any firearm locking device may reduce the risk of firearm injury or death. Clinicians are encouraged to explore reasons for locking device selection within motivational interviewing frameworks.

Lethal Means Counseling, Distribution of Cable Locks, and Safe Firearm Storage Practices Among the Mississippi National Guard: A Factorial Randomized Controlled Trial, 2018-2020.

Objectives. To examine whether lethal means counseling and provision of cable locks prompt safe firearm storage relative to control among firearm-owning members of the Mississippi National Guard.Methods. This randomized controlled trial utilized a 2 × 2 factorial design (lethal means counseling vs control, provision of cable locks vs no cable locks). Follow-up assessments took place at 3 and 6 months after baseline. Data were collected (n = 232; 87.5% male; mean age = 35.01 years; 77.2% White) from February 2018 through July 2020.Results. Relative to control, lethal means counseling and provision of cable locks resulted in greater adoption of several safe storage methods over time. Lethal means counseling outperformed control (3 months: 55.0% vs 39.0%; odds ratio [OR] = 1.91). Cable locks outperformed control at 3 and 6 months on number of storage methods (1.41 vs 1.11; d = 0.29 and 1.34 vs 1.16; d = 0.15, respectively) and locking devices (59.8% vs 29.9%; OR = 3.49 and 58.4% vs 35.8%; OR = 2.52, respectively)Conclusions. Lethal means counseling and cable locks can result in sustained changes in firearm storage.Public Health Implications. The military may benefit from lethal means counseling, perhaps administering at point of entry.Trial Registration. Clinical Trials.gov identifier: NCT03375099.

An examination of preferred messengers on firearm safety for suicide prevention.

This study sought to determine differences in preferred messengers on the topic of safe firearm storage and suicide prevention between firearm owners and non-firearm owners, and among firearm owners of different racial groups and sexes. Participants were 6200 United States residents recruited via Qualtrics Panels to complete an online survey. Data were collected during March 2020. The total sample and all subsamples ranked law enforcement, current military personnel, and military veterans as the top three most credible sources to discuss firearm safety for suicide prevention. Significant differences existed among the mean ranking of sources between firearm owners and non-firearm owners as well as between several subgroups of firearm owners. The identical ranking of the top three sources indicates that these groups agree on the relative credibility of multiple sources, although the average level of credibility for particular sources may vary. These findings highlight that the effectiveness of messaging on safe firearm storage may hinge on the identity of the individual delivering the message and provide an initial roadmap for how to consider packaging specific messages.

Differentiating suicide decedents who died by firearm verse hanging.

This present study sought to examine how demographics and the availability of means for suicide converge to impact method selection between firearms and hanging, which are the two most lethal and commonly used methods for suicide in the United States. Data were collected as part of a larger online study that gathered information about suicide decedents and the circumstances around their death from family members and friends; the most common sources being parents, friends, and other family members. This study used data from those who died by suicide by firearm or hanging (n = 149); and was restricted to those who identified as male and white. The study examined if age, education, marital status, military affiliation, and firearm ownership impacted method selection. Results indicated that age and owning a firearm were associated with using a firearm in a suicide death. Additionally, those who used a firearm were significantly younger and more likely to own a firearm than those who used another method; and those who died by hanging were significantly younger than those who used another method. Findings from this study can be leveraged to improve the effectiveness of means safety efforts and create more personalised public health messages on firearm safe storage.

Essential workers: Past month suicidal ideation and COVID-19 stress.

OBJECTIVE: This study examined if essential workers (EW) reported higher past month suicidal ideation (SI) and coronavirus-19 (COVID-19) stress than non-EW, explored if the association between EW status and SI is indirect through COVID stress, and tested whether EW who identified as black, indigenous, and people of color (BIPOC) experienced more past month SI and COVID stress than white EW. METHODS: Participants (N = 3500) were predominately white and female. COVID-19 was assessed with the COVID-19 subscale. RESULTS: EWs reported higher past month ideation and COVID-19 stress than non-EWs. EWs who identified as BIPOC reported higher past month ideation and higher fears about economic consequences and compulsive checking and reassurance seeking subscales compared to White EWs. CONCLUSION: EWs experience higher rates of SI and stress than non-EW; and BIPOC EWs experience higher SI and stress than White EWs. Accessibility of support should be a priority for this group at high risk for both the physical and emotional burden of COVID-19.

Examining Relationships between Gender, Opioid Dependence, and Distress Tolerance among Patients in Substance Use Disorder Treatment.

Background: Opioid abuse/dependence is associated with multiple negative outcomes relative to other forms of substance abuse/dependence, including relapse. Research identifying modifiable characteristics associated with opioid dependence and associated negative outcomes may inform the development of targeted interventions for this high-risk population. One factor warranting investigation is low distress tolerance (DT). Purpose/Objectives: In a sample of patients in substance use disorder (SUD) treatment, the present study examined DT levels among patients with current opioid dependence versus no history of opioid dependence, as well as the moderating role of gender. We predicted that patients with opioid dependence would exhibit lower DT than those without a history of opioid dependence, and that women with opioid dependence would exhibit lower levels of DT than men with opioid dependence. Methods: A sample of 203 patients in residential SUD treatment were administered a series of diagnostic interviews and a behavioral measure of DT. Results: DT did not differ significantly as a function of opioid dependence. However, there was a significant opioid dependence by gender interaction, such that men with current opioid dependence exhibited significantly lower levels of DT than women with opioid dependence and men without a history of opioid dependence. Conclusions/Importance: Findings highlight a modifiable characteristic associated with opioid dependence among men that may be targeted in interventions.

Firearm legislation and statewide suicide rates: The moderating role of household firearm ownership levels.

Firearm legislation is associated with statewide suicide rates; however, prior research has often relied upon older data and categorical legislative grades while also failing to consider the nuanced role of firearm ownership. Therefore, the robust literature base on legislation and suicide has not directly examined regarding the extent to which the value of legislation hinges upon the rate of firearm ownership in a given state. The current study examined 2015 US statewide firearm legislation strength scores from Giffords Law Center to Prevent Gun Violence and 2016 statewide suicide rates from the Centers for Disease Control and Prevention. Firearm legislation strength was inversely associated with statewide overall and firearm suicide rates, but not with non-firearm suicide rates. Firearm ownership rates moderated the association between firearm legislation strength and statewide overall suicide rates. Specifically, firearm legislation strength was inversely associated with statewide overall suicide rates at mean and high levels of firearm ownership. Findings support the potential utility of firearm legislation as part of a national effort to decrease US suicide deaths, particularly in areas with higher firearm ownership rates.

Do physical disabilities differentiate between suicidal ideation and attempts? An examination within the lens of the ideation to action framework of suicide.

OBJECTIVES: This study examined histories of suicidality among those with and without physical disabilities. Physical disabilities were anticipated to differentiate those with a history of suicide attempts from those with a history of ideation only after accounting for the presence of health conditions and other correlates. METHODS: Participants were 374 adults (M age = 36.08; 55.61% female; 84 with at least one physical disability) who completed a series of online questionnaires. Multinomial logistic regressions were conducted to examine the effect of the presence of physical disabilities on states of suicidality. RESULTS: The presence of a physical disability was associated with significantly increased odds of suicide attempts when compared to those with suicidal ideation only. This association was no longer significant when chronic pain conditions were classified as health conditions. CONCLUSION: Physical disability may be a factor differentiating between ideators and attempt survivors.

Military personnel compared to multiple suicide attempters: Interpersonal theory of suicide constructs.

The current study aimed to address the discrepancy between suicide rates in the military and general population by comparing facets of the interpersonal theory of suicide between civilians with multiple suicide attempts and U.S. military personnel. Military personnel exhibited higher levels of capability for suicide but lower levels of perceived burdensomeness and thwarted belongingness than civilian multiple attempters. When comparing only personnel endorsing ideation and civilian multiple attempters, the significant difference for capability remained, but the differences for perceived burdensomeness and thwarted belongingness became nonsignificant. Results suggest the emergence of ideation places personnel at a greater risk for suicide than many civilian multiple attempters.

Handgun Legislation and Changes in Statewide Overall Suicide Rates.

OBJECTIVES: To examine the extent to which 4 laws regulating handgun ownership were associated with statewide suicide rate changes. METHODS: To test between-group differences in statewide suicide rate changes between 2013 and 2014 in all 50 states and the District of Columbia with and without specific laws, we ran analyses of covariance. RESULTS: We found significant differences in suicide rate changes from 2013 to 2014 in states with mandatory waiting periods and universal background checks relative to states without such laws. States with both laws differed significantly from those with neither. No significant differences in rate changes were noted for open carry restrictions or gun lock requirements. CONCLUSIONS: Some state laws regulating aspects of handgun acquisition may be associated with lower statewide suicide rates. Laws regulating handgun storage and carrying practices may have a smaller effect, highlighting that legislation is likely most useful when its focus is on preventing gun ownership rather than regulating use and storage of guns already acquired. Public Health Implications. The findings add to the increasing evidence in support of a public health approach to the prevention of suicide via firearms, focusing on waiting periods and background checks.

Rising longitudinal trajectories in suicide rates: The role of firearm suicide rates and firearm legislation.

Firearms account for approximately half of all US suicide deaths each year despite being utilized in only a small minority of suicide attempts. We examined the extent to which overall suicide rates fluctuated relative to firearm and non-firearm suicide rates across a period of 16years (1999-2015). We further tested the notion of means substitution by examining the association between firearm suicide rates and non-firearm suicide rates. Lastly, we examined the extent to which the presence of specific laws related to handgun ownership previously shown cross-sectionally to be associated with lower suicide rates (universal background checks, mandatory waiting periods) were associated with an attenuated trajectory in suicide rates across the study period. As anticipated, whereas decreases in firearm suicide rates were associated with decreases in overall suicide rates (b=0.46, SE=0.07, p<0.001), decreases in firearm suicides were not associated with off-setting increases in suicides by other methods (b=-0.04, SE=0.05, p=0.36). Furthermore, the absence of universal background check (b=0.12, SE=0.05, p=0.028) and mandatory waiting period (b=0.16, SE=0.06, p=0.008) laws was associated with a more steeply rising trajectory of statewide suicide rates. These results mitigate concerns regarding means substitution and speak to the potential high yield impact of systematically implemented means safety prevention efforts focused on firearms.

The association between specific combat experiences and aspects of the Interpersonal Theory of Suicide.

BACKGROUND: Studies examining the relationship between combat exposure and suicide risk typically focus on combat exposure overall, combining numerous different combat experiences. Our study expands upon prior research by examining the association between specific combat experiences and components of both suicidal desire and the capability for suicide. METHOD: We hypothesized that most combat experiences would be associated with capability for suicide. Furthermore, we hypothesized that experiences that involved direct exposure to death and injury (e.g. personally witnessing the death or injury of other soldiers) would be associated with higher levels of thwarted belongingness, perceived burdensomeness, and suicidal ideation. Participants were 400 service members drawn largely from the Army National Guard who had been deployed at least once and endorsed having experienced combat. RESULTS: Consistent with hypotheses, combat experiences involving direct exposure to injury or death exhibited a more pronounced pattern of associations with suicide risk factors than did other experiences. However, only a minority of combat experiences were associated with the capability for suicide. DISCUSSION: These results, while preliminary, indicate that different combat experiences are associated with different outcomes and that, in this sense, not all combat experiences are created equal with respect to suicide risk.