Dataset Information

Handgun Divestment and Risk of Suicide.

ABSTRACT:

Background

Firearm ownership is strongly related to suicide risk, yet little is known about how much risk declines when ownership ends ("divestment").

Methods

Using data from 523,182 handgun owners, we estimated the effect of divesting and remaining divested versus never divesting on the risk of suicide and firearm-specific suicide. We used pooled logistic regression with inverse probability weighting, adjusting for demographic and area-level measures.

Results

The 5-year risk of suicide death was 25.6 (95% confidence interval [CI] = 15.1, 37.2) per 10,000 persons with divestment and 15.2 (95% CI = 13.2, 17.3) per 10,000 persons with no divestment, corresponding to a risk difference of 10.4 (95% CI = 0.7, 21.1) per 10,000 persons. The 5-year risk of firearm-specific suicide death was 6.3 (95% CI = 1.4, 11.9) per 10,000 persons with divestment and 12.9 (95% CI = 11.0, 14.6) per 10,000 persons with no divestment, corresponding to a risk difference of -6.6 (95% CI = -11.4, -0.1) per 10,000 persons. Comparing divestment to no divestment, risks were elevated for deaths due to other causes proposed as negative control outcomes; we incorporated these estimates into a series of bias derivations to better understand the magnitude of unmeasured confounding.

Conclusions

Collectively, these estimates suggest that divestment reduces firearm suicide risk by 50% or more and likely reduces overall suicide risk as well, although future data collection is needed to fully understand the extent of biases such as unmeasured confounding.

SUBMITTER: Swanson SA

PROVIDER: S-EPMC9719800 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Handgun Divestment and Risk of Suicide.

Swanson Sonja A SA Studdert David M DM Zhang Yifan Y Prince Lea L Miller Matthew M

Epidemiology (Cambridge, Mass.) 20220921 1

<h4>Background</h4>Firearm ownership is strongly related to suicide risk, yet little is known about how much risk declines when ownership ends ("divestment").<h4>Methods</h4>Using data from 523,182 handgun owners, we estimated the effect of divesting and remaining divested versus never divesting on the risk of suicide and firearm-specific suicide. We used pooled logistic regression with inverse probability weighting, adjusting for demographic and area-level measures.<h4>Results</h4>The 5-year ri ...[more]

PMID: 36455249

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Project description:ImportanceEvidence suggests that limiting access to firearms among individuals at high risk of suicide can be an effective means of suicide prevention, yet accurately identifying those at risk to intervene remains a key challenge. Firearm purchasing records may offer a large-scale and objective data source for the development of tools to predict firearm suicide risk.ObjectiveTo test whether a statewide database of handgun transaction records, coupled with machine learning techniques, can be used to forecast firearm suicide risk.Design, setting, and participantsThis prognostic study used the California database of 4 976 391 handgun transaction records from 1 951 006 individuals from January 1, 1996, to October 6, 2015. Transaction-level random forest classification was implemented to predict firearm suicide risk, and the relative predictive power of features in the algorithm was estimated via permutation importance. Analyses were performed from December 1, 2020, to May 19, 2022.Main outcomes and measuresThe main outcome was firearm suicide within 1 year of a firearm transaction, derived from California death records (1996-2016). With the use of California's Dealer's Records of Sale (1996-2015), 41 handgun, transaction, purchaser, and community-level predictor variables were generated.ResultsThere are a total of 4 976 391 transactions in the California's Dealer's Record of Sale database representing 1 951 006 individuals (1 525 754 men [78.2% of individuals]; mean [SD] age, 43.4 [13.9] years). Firearm suicide within 1 year occurred in 0.07% of handgun transactions (3278 transactions among 2614 individuals). A total of 38.6% of observed firearm suicides were among transactions classified in the highest-risk ventile (379 of 983 transactions), with 95% specificity. Among the small number of transactions with a random forest score above 0.95, more than two-thirds (24 of 35 [68.6%]) were associated with a purchaser who died by firearm suicide within 1 year. Important features included known risk factors, such as older age at first purchase, and previously unreported predictors, including distance to firearms dealer and month of purchase.Conclusions and relevanceThis prognostic study presented the first large-scale machine learning analysis of individual-level handgun transaction records. The results suggested the potential utility of such records in identifying high-risk individuals to aid suicide prevention efforts. It also identified handgun, individual, and community characteristics that have strong predictive relationships with firearm suicide and may warrant further study.

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Project description:ImportanceThe Veterans Health Administration (VHA) implemented the Comprehensive Suicide Risk Evaluation (CSRE) in 2019 to standardize suicide risk assessment across the health care system. Identifying CSRE responses associated with suicide could inform risk management and prevent suicide.ObjectiveTo identify CSRE responses associated with subsequent suicide.Design, setting, and participantsThis cohort study examines acute (within 30 days) and chronic (within 365 days) suicide risk after 269 374 CSREs were administered. Participants included US VHA patients undergoing CSRE evaluation between November 1, 2019, and December 31, 2020. Data collection and analysis were performed from April 5 to August 20, 2024.ExposuresCSRE responses, including suicidal ideation, behaviors, warning signs, risk factors, and protective factors.Main outcome and measureSuicide per death certificate data from the Department of Veterans Affairs and Department of Defense Mortality Data Repository. Outcomes were analyzed using multivariable Cox proportional hazards regression.ResultsA total of 153 736 patients with 269 374 valid CSREs (86.26% male; mean [SD] age, 50.48 [15.26] years) were included in the multivariable-adjusted analyses of suicide. Suicidal ideation (hazard ratio [HR], 3.14; 95% CI, 1.51-6.54), firearm access (HR, 2.62; 95% CI, 1.49-4.61), making preparations for a suicide attempt (HR, 2.15; 95% CI, 1.27-3.62), seeking access to lethal means (HR, 2.04; 95% CI, 1.11-3.75), anxiety (HR, 1.80; 95% CI, 1.16-2.81), and psychiatric hospitalization history (HR, 1.63; 95% CI, 1.02-2.61) were associated with increased suicide risk within 30 days, whereas anger (HR, 0.50; 95% CI, 0.30-0.85) was associated with decreased risk. Suicidal ideation (HR, 1.63; 95% CI, 1.20-2.21), firearm access (HR, 1.55; 95% CI, 1.13-2.13), making preparations for a suicide attempt (HR, 1.56; 95% CI, 1.09-2.23), reckless behaviors (HR, 1.40; 95% CI, 1.00-1.95), and history of psychiatric hospitalization (HR, 1.68; 95% CI, 1.32-2.13) were associated with increased suicide risk within 365 days, whereas anger (HR, 0.56; 95% CI, 0.44-0.71), preexisting risk factors (eg, trauma; HR, 0.77; 95% CI, 0.62-0.96), and recent transition from the military (HR, 0.39; 95% CI, 0.22-0.70) were associated with decreased risk in multivariable-adjusted analyses. Suicide risk within 365 days was elevated among patients identified by clinicians to be at intermediate acute risk (HR, 1.39; 95% CI, 1.13-1.71), intermediate chronic risk (HR, 1.34; 95% CI, 1.01-1.77), and high chronic risk (HR, 1.74; 95% CI, 1.22-2.47) of suicide compared with patients at low risk in multivariable-adjusted analyses.Conclusions and relevanceIn this cohort study of suicide following risk assessments, findings suggest that only a few constructs are associated with subsequent suicide, particularly suicidal ideation, firearm access, and preparatory behaviors. Developing risk prediction algorithms including CSRE responses may enhance clinical evaluation.

Dataset Information

Handgun Divestment and Risk of Suicide.

Background

Methods

Results

Conclusions

Publications

Handgun Divestment and Risk of Suicide.

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