Behavioral Health Care And Firearm Suicide: Do States With Greater Treatment Capacity Have Lower Suicide Rates?

Goldstein, Evan V.; Prater, Laura; Wickizer, Thomas M.

doi:10.1377/hlthaff.2019.00753

Cited by 31 publications

(17 citation statements)

References 34 publications

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“…Increasing social integration of the elderly can help reduce many of the stressors that can help precipitate suicidal behaviors, especially in older males who are not good at reaching out and requesting assistance. State welfare policies (e.g., spending on public education, food for the needy, and healthcare expenditures) and poverty levels have a very modest impact on the prevalence rates or reduction of suicides [45][46][47]. Again, it must be emphasized that these effects are often not specific to elderly firearm suicides.…”

Section: Individual-level Interventionsmentioning

confidence: 99%

“…Mental healthcare needs to be a part of primary healthcare, and for the elderly, there is a necessity for social services integration as well. While the effects are not specific to the elderly or firearms, greater healthcare services and state spending on mental healthcare have been associated inversely with the risk of suicides [45][46][47]51]. Focusing not just on the quantity of the workforce, but the quality of the workforce, with special emphasis on behavioral health training and geriatric practice to address the unmet mental health needs of the elderly, can have multiplicative effects on the health and wellbeing of the elderly which may alleviate suicidal ideation or behaviors [10,11,16,10,11].…”

Section: Individual-level Interventionsmentioning

confidence: 99%

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

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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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Section: Individual-level Interventionsmentioning

confidence: 99%

Section: Individual-level Interventionsmentioning

confidence: 99%

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

Price

Khubchandani

2021

J Community Health

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“…If meaningful firearm safety and control policies continue to be elusive and if increasing the country's capacity to provide behavioral health services has at best a small effect on firearm suicide, 11 then physicians, and their representative associations, should be encouraged to play a greater role in the collective campaign to reduce firearm suicide. Despite legal opposition to physicians intervening in their patients' firearm-related affairs, a 2017 opinion issued by the US Court of Appeals for the Eleventh Circuit ruled that physicians can inquire about firearm-related risk factors and attempt to protect their patients from firearmrelated injury.…”

Section: Reflecting and Proposing A Course Of Actionmentioning

confidence: 99%

“…10 When taken in the context of firearm suicide, however, evidence shows that additional behavioral health treatment capacity has only a small protective effect. 11 Improving firearm safety and strengthening evidencebased regulations pertaining to the purchase of firearms may provide superior protective effects against suicide. Addressing firearm control through public policy at the federal level, however, has been nearly impossible.…”

Section: Introductionmentioning

confidence: 99%

The Firearm Suicide Crisis: Physicians Can Make a Difference

et al. 2020

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Firearm suicide receives relatively little public attention in the United States, however, the United States is in the midst of a firearm suicide crisis. Most suicides are completed using a firearm. The age-adjusted firearm suicide rate increased 22.6% from 2005 to 2017, and globally the US firearm suicide rate is 8 times higher than the average firearm suicide rate of 22 other developed countries. The debate over how to solve the firearm suicide epidemic tends to focus on reducing the firearm supply or increasing access to behavioral health treatment. Ineffectual federal firearm control policies and inadequate behavioral health treatment access has heightened the need for primary care physicians to play a more meaningful role in firearm suicide prevention. We offer suggestions for how individual physicians and the collective medical community can take action to reduce mortality arising from firearm suicide and firearm deaths.

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“…Suicide is a major public health concern with 800,000 people die by suicide annually, and even more attempt it (GBD 2017 Causes of Death Collaborators, 2018 ). Suicide is now the 10th leading cause of death in the United States, increasing by 30% since 1999 (Centers for Disease Control & Prevention, 2007 ), and appears to continue to be increasing particularly among veterans and youths (Goldstein et al., 2019 ; Hoffmire et al., 2015 ; Smith et al., 2019 ; Steelesmith et al., 2019 ). Globally, suicide ranks as the 18th leading cause of death across the lifespan, the second cause of death among those aged 15–29 years, and occurs at a startling rate of one person every 40 s (World Health Organization, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Effects of somatic treatments on suicidal ideation and completed suicides

et al. 2021

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Objective: This work was undertaken to define and characterize the role of currently available somatic treatments in psychiatry in either increasing or reducing the risk for suicide.Methods: Members of the Suicide Prevention Task Group of the National Network of Depression Centers performed a literature review of somatic treatments known to increase or reduce the risk for suicide. The reviews ventured to include all relevant information about the risk for both suicide ideation and completed suicides.Results: Lithium and clozapine are the only two somatic treatments that have highquality data documenting their antisuicide effects in mood disorders and schizophrenia, respectively. Lithium discontinuation is also associated with increased suicide risk.Ketamine and esketamine may have a small, but immediate, antisuicide effect. Despite the recent Food and Drug Administration approval of esketamine use in depressed suicidal patients, the small disproportional overrepresentation of suicide in subjects who had received esketamine versus placebo (3 vs. 0 among > 3500 subjects) requires ongoing evaluation. The purported antisuicide effect of electroconvulsive therapy is based on low-quality data. The effect of antidepressants is not at all clear. There appears to be direct evidence for antidepressants increasing suicidal ideation and the risk for suicide over the short-term in young people, but indirect (low quality) evidence that antidepressants reduce suicide risk over the long term. Conclusions:Clinicians have an expanding pharmacopeia to address suicide potential in their patients. Some of the agents with documented antisuicide effects may also increase suicidality under specific circumstances.

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Behavioral Health Care And Firearm Suicide: Do States With Greater Treatment Capacity Have Lower Suicide Rates?

Cited by 31 publications

References 34 publications

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

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

The Firearm Suicide Crisis: Physicians Can Make a Difference

Effects of somatic treatments on suicidal ideation and completed suicides

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