February 27, 2018
3 min read

Suicide by firearm less likely in people with substance use, mental disorders

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Jennifer M. Boggs

People with mental disorders were less likely to commit suicide by firearm than by other means, study findings suggest.

“Approximately 50% of all suicide deaths occur by firearm. Identifying general medical disorders that may be significant risk factors for suicide is important to inform suicide risk detection,” Jennifer M. Boggs, MSW, from Institute for Health Research, Kaiser Permanente Colorado, and colleagues wrote. “Identifying patients at risk of suicide in general medical settings is challenging. Recent evidence suggests that relying solely on pre-existing psychiatric diagnoses or an expectation that patients will spontaneously volunteer risk symptoms is problematic.”

Researchers compared demographic and clinical risk among patients who committed suicide with a firearm or by other means (including poisoning, hanging and suffocation) with those of matched patients who did not die by suicide to better understand the groups of patients most at risk for suicide. They conducted a case-control study in 2016 from eight health care systems within the Mental Health Research Network, that matched 2,674 suicide cases from 2010 to 2013 to a control group of 267,400 patients.

“The link between mental health disorders and suicide is well-documented. But little is known about the relationship between suicide and medical disorders,” Boggs told Healio Psychiatry. “We looked at the link between suicide and medical disorders as well as the types of lethal means used for suicide – firearms or other means, like overdose or hanging.”

Along with demographic characteristics, researchers also assessed the association between suicide by firearm or other means with mental disorders and general medical disorders, such as asthma, back pain, traumatic brain injury, cancer, diabetes, heart disease, HIV/AIDS, hypertension, epilepsy, migraine, multiple sclerosis, osteoporosis, Parkinson’s disease, psychogenic pain, renal disorders and stroke.

Of 2,674 cases of death by suicide, 1,298 (49%) were carried out by firearm and 1,376 (51%) by other means. Men accounted for 77% of suicide death cases, with a higher proportion of cases involving a firearm (89%) compared with other means (66%). Overall, 61% of cases involved at least one mental disorder, most commonly alcohol use, anxiety, depression or sleep disorders. Suicide by firearm was associated with being older, being male, having lower education or having lower incomes; there were similar patterns for other suicide means, but there was no difference in education between those who died by suicide and the control group.

In total, 14 general medical disorders were linked to greater odds of suicide by firearm, including traumatic brain injury (OR = 23.53), epilepsy (OR = 3.17), psychogenic pain (OR = 2.82), migraine (OR = 2.35) and stroke (OR = 2.2); and 15 with higher chance of suicide by other means, particularly for TBI (OR = 7.74), epilepsy (OR = 3.28), HIV/AIDS (OR = 6.03) and migraine (OR = 3.17).

“The findings indicate a need to expand screening for suicide to those with TBI and other high-risk medical disorders,” Boggs told Healio Psychiatry.

Furthermore, men with two or more general medical disorders were more likely to commit suicide by firearm compared with those with no general medical disorders (OR = 1.94); however, this did not increase the odds of suicide by other means. In contrast, women with two or more general medical disorders had greater odds of suicide by other means compared with those without a general medical disorder (OR = 2.41); however, this did not increase the odds of death by firearm.

“We do not assume that our results indicate a direct causal association between general medical disorders and suicide; instead, we suggest that the associations established here between suicide and general medical disorders indicate which of these disorders may co-occur with mental disorders and increase risk of suicide,” Boggs and colleagues wrote. “Our results illuminate which general medical disorders should trigger additional risk screening. General medical and mental health providers may wish to consider providing suicide risk assessment and means restriction counseling for several novel groups of patients, in addition to those with a recorded mental disorder.” – by Savannah Demko

Disclosures: Boggs reports no relevant financial disclosures. Please see the full study for other authors’ relevant financial disclosures.