Gun Violence Restraining Order Laws and Firearm Suicide among Older Adults: A Longitudinal State-Level Analysis

Background: Previously it was noted that firearm use by nurses in suicide was changing. The Center for Disease Control and Prevention suicide dataset contains investigation narratives that no researcher has analyzed and may provide context to inform suicide prevention.Objective: Explore firearm deaths in nurse suicide. Second, test topic modeling techniques to analyze investigation narratives.Methods/Statistical Analysis: Mixed-method retrospective analysis of 739 nurse versus 94,838 nonnurse suicides. Odds ratios (OR) were calculated to determine relative incidence. After tokenization and stop word removal, Latent Dirichlet Analysis and Latent Semantic Indexing topic modeling techniques were applied.Topics were evaluated for clinical significance and content analysis performed.Results: Aim 1: Female nurses used firearms significantly less often than other females between 2003 and 2013 (OR: 0.71; p < .001; 95% confidence interval [CI]: 4.23%-9.83%). A rise in nurse firearm use occurred between 2014 and 2017; with rates now similar to nonnurse females (OR: 0.98; p = .7574; 95% CI: −2.68 to 3.49).Clinically relevant topics identified by topic modeling: preventable deaths, chronic pain, and job loss before suicide. Conclusions:From this research we know that work-related issues in nurse suicides by firearms center around chronic pain, substance use, and job loss. The codes tied to suicidal ideation, previous attempt and/or depression, represented preventable deaths because it is known that if a weapon is removed from the home in these situations a suicide can be aborted. The change in firearm use warrants nurse education regarding firearm safety and suicide prevention. Topic modeling holds promise in focusing analyses of suicide investigations.

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“…9,10 Decreasing availability of firearms in depressed older adults has been demonstrated to decrease suicide incidence in this population. 11…”

Section: Background On Firearm Suicidementioning

confidence: 99%

Exploring nurse suicide by firearms: A mixed‐method longitudinal (2003–2017) analysis of death investigations

Davidson

Deskins

et al. 2020

Nursing Forum

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“…The study showed that the total number of firearm laws was negatively associated with firearm-related suicide and the total number of suicides among both age groups. Similarly, ERPOs were associated with a reduction in firearm suicides (> 2 % for both age groups) and a reduction in total suicide deaths in both age groups [58].…”

Section: Population-based Interventionsmentioning

confidence: 82%

“…The promise of state firearm laws as it relates to firearm suicides in the elderly is marred by several limitations [56][57][58][59][60][61]. First, most studies on firearm laws and suicides do not exclusively focus on the elderly population, a major limitation given the unique socioeconomic and lifestyle circumstances of the elderly.…”

Section: Population-based Interventionsmentioning

confidence: 99%

“…In the case of firearms and elderly suicides, there are several potential loopholes such as: individuals with serious mental illnesses or substance use disorders can still access guns, the databases with records on individuals with serious mental illness may be incomplete, there are multiple laws and databases that lack coordination and individuals slip through the cracks, physicians and law enforcement officials may not always have the ability or knowledge to utilize firearm laws to help remove firearms from elderly individuals at risk of suicide, firearm prohibitions for mental illness or substance use disorders do not last for a lifetime, the scope of existing firearm laws remains narrow and these laws are frequently challenged in courts. [12,16,17,37,40,[56][57][58][59][60][61].…”

Section: Population-based Interventionsmentioning

confidence: 99%

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Firearm Suicides in the Elderly: A Narrative Review and Call for Action

Price

Khubchandani

2021

J Community Health

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Firearm suicides are one of the leading causes of death for older Americans. The purpose of this review is to explore the risk factors associated with suicides in the elderly, provide an overview of the epidemiology of firearm-related suicides in older Americans, and explore methods of preventing firearm suicides in the elderly. The vast majority (70 %) of elderly suicides in the U.S were committed using a firearm. Elderly firearm suicides have increased by 49 % between 2010 and 2018, disproportionately affecting white males. Yearly firearm suicides in the elderly ranged from 4,276 in 2010 to 6,375 in 2018. In 2018, the rate of elderly male firearm suicides was 24.96/100,000 compared to a rate of 1.92/100,000 for elderly females, a rate ratio of 13 to 1 for males compared to females. The primary risk factors for elderly firearm suicides seem to be physical illnesses, mental illnesses, and social factors. Older Americans engage in suicidal behaviors with greater planning and lethality of intent than do young adults. Of all the strategies to prevent suicides with firearms, the most efficacious measures based on current research seem to be state firearm legislation and improving mental healthcare, but these effects are not specific to the elderly. Strengthening state firearm laws and improving mental healthcare for the elderly may have promise in preventing elderly firearm-related suicides. Additional implications for practice and research are discussed in this review.

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“…36,37 A recent longitudinal study showed that GVROs could be effective in decreasing suicides in elderly males; the same population that we found to be highest risk in our study. 38 More prospective studies that can comprehensively compare gun legislation, suicide screening programs, and GVROs as interventions in different regions, counties, states in the U.S should be performed to investigate the effectiveness of these strategies in the prevention of firearm suicides.…”

Section: Discussionmentioning

confidence: 99%

Self-Inflicted Gun Shot Wounds: A Retrospective, Observational Study of U.S. Trauma Centers

Quenzer¹,

Givner²,

Dirks³

et al. 2021

WJEM

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Introduction Intentional self-harm (suicide) by firearms is a growing problem in the United States. Currently, there are no large studies that have identified risk factors for patients who die from self-inflicted gunshot wounds. Our objectives are to 1) identify risk factors for patients with the highest morbidity and mortality from self-inflicted gunshot wounds (SIGSWs) at trauma centers 2) present the outcomes of victims of SIGSW by handguns (HG) versus all other specified guns (AOG) and 3) compare the presentations and outcomes of victims with head or face (HF) injuries to other regions of the body. Methods We performed a retrospective analysis from the National Trauma Database (NTDB) data between 2012 and 2013 of all SIGSW patients who presented to trauma centers. Categorical data included patient characteristics upon presentation and outcomes which were compared between patients with HG injury versus AOG injury using the Chi-Squared test, where AOG includes shotguns, hunting rifles, and military firearms. Additionally, analysis of head and face (HF) injuries versus other bodily injuries (OBI) were compared between the HG group versus AOG group using Chi-squared test. Results There were 7,828 SIGSWs, of those, 78% (6,115) were white and 84.3% (6,600) were male. There were 5,139 HG injuries, 1,130 AOG injuries, and 1,405 unidentified gun injuries. The HG group was likely to be older (>55 years old), hypotensive (systolic blood pressure < 90), have a lower Glasgow Coma Score (GCS < 9), use illegal, or use prescription drugs. In comparing HF injuries (4,799) versus other bodily injuries (OBI) (3,028), HF group was more likely to use handguns, expire in ED, require ICU, and have a higher percent of overall mortality. Of the total OBI, the thorax, upper extremities, and abdomen were the most commonly injured. Conclusion In our retrospective study of SIGSWs, we were able to demonstrate that SIGSW by handguns are associated with higher rates of mortality versus all other types of firearms. SIGSWs in older white males with handguns are the most at-risk for severe complications. Future efforts should improve screening methods for handguns in suicidal patients and at developing prevention programs.

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Gun Violence Restraining Order Laws and Firearm Suicide among Older Adults: A Longitudinal State-Level Analysis

Cited by 5 publications

References 18 publications

Exploring nurse suicide by firearms: A mixed‐method longitudinal (2003–2017) analysis of death investigations

Exploring nurse suicide by firearms: A mixed‐method longitudinal (2003–2017) analysis of death investigations

Firearm Suicides in the Elderly: A Narrative Review and Call for Action

Self-Inflicted Gun Shot Wounds: A Retrospective, Observational Study of U.S. Trauma Centers

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