Treatment-Seeking and Suicidality by Suicide Method

A recent study looked at treatment-seeking and suicidality among people who died by firearm suicide compared to those who died by other suicide methods.

Using data from the National Violent Death Reporting System (NVDRS), researchers studied 234,652 people who died by suicide between 2003 and 2018. Comparing those who died by firearms to those who used other methods, the researchers examined history of mental health or substance use treatment, suicidal thoughts or plans, suicide attempts, and disclosure of suicidal thoughts or plans.

Study participants were mostly male (77.8%) and white (87.8%) with a mean age of 46. In this sample, firearms were the most frequently used suicide method (49.9%), followed by hanging, strangulation, or suffocation (26.7%), and poisoning (15.3%). Most participants were not receiving mental health or substance use treatment when they died, had not sought treatment in their lifetime, did not have a lifetime history of suicidal thoughts or plans or suicide attempts, and had not disclosed suicidal thoughts or plans in the month before they died. Those whose highest level of education was a high school diploma made up the largest percentage of deaths across all methods of suicide.

The analysis found that individuals with a history of mental health or substance use treatment or suicide attempts were significantly less likely to die by firearms than other methods. Those who recently disclosed suicidal thoughts or plans had higher odds of dying by firearms but were not more likely to have a previous history of suicidal thoughts or plans. These findings were consistent for both male and female participants ages 18 to 84. Compared to individuals who died by poisoning, those who died by firearms were significantly more likely to have a history of suicidal thoughts or plans and to have recently disclosed suicidal thoughts or plans. Compared to people who died by hanging, those who used firearms were more likely to have recently disclosed suicidal thoughts or plans.

Study participants who died by firearm suicide were less likely to seek mental health treatment or to have attempted suicide compared to those who died by other methods, suggesting many likely died on their first attempt. These individuals may be less likely to be identified through evidence-based suicide interventions that take place in mental health care settings. Those who died by firearms were also more likely to have disclosed suicidal thoughts or plans to someone in the month before their death, but they were not more likely to have a history of suicidal thoughts or plans. These findings highlight the need for more universal prevention strategies to raise awareness of suicide risk factors, warning signs, and prevention strategies in the general population. Among potential upstream interventions, the authors note safe storage of firearms is associated with decreased firearms suicide. To increase their effectiveness, they recommend programs that promote safe storage practices reflect the language and culture of firearms owners.

Limitations of this study include the homogeneity of the sample and the lack of specifics about the mental health services used and the nature and recipients of suicidal disclosure. Individuals who did disclose thoughts or plans represented a small subset of those who used firearms, an indication that disclosure is rare. During the study, the dataset expanded from 6 states in 2003 to 32 states in 2018. The earlier data account for a disproportionate number of deaths in this sample and may not represent more recent socio-demographic trends or changes.

Bond, A. E., Bandel, S. L., Rodriguez, T. R., Anestis, J. C., Anestis, M. D. (2022). Mental health treatment seeking and history of suicidal thoughts among suicide decedents by mechanism, 2003-2018. JAMA Network Open, 5(3): e222101. doi:10.1001/jamanetworkopen.2022.2101