Three leading suicide methods in the United States, 2017–2019: Associations with decedents' demographic and clinical characteristics

Abstract

Background and aimsThe U.S. suicide data show that use of lethal methods, specifically firearms and hanging/suffocation, has been increasing among young and middle-aged adults of both sexes over the past decades. In this study, we examined demographic and clinical correlates of use of firearms, hanging/suffocation, and poisoning as suicide methods among suicide decedents age 18+.MethodsData came from the 2017-2019 National Violent Death Reporting System (NVDRS; N = 94,454, age ≥ 18 at the time of suicide; 74,042 men and 20,412 women). We fit generalized linear models (GLMs) for a Poisson distribution with a log link to examine (1) changes in four suicide methods (firearms, hanging/suffocation, poisoning, and other) during the study period, controlling for sex and age group; and (2) correlates of firearms, hanging/suffocation, and poisoning use.ResultsIn all age groups, 55% of men and 30% of women used firearms; 28% of men and 29% of women hanging/suffocation; 9% of men and 32% of women poisoning, and 8% of men and 9% of women “other” methods. Men age < 45 had higher likelihood of firearm and/or hanging/suffocation use than those age 45–64. Women age<45 also had higher likelihood of hanging/suffocation than those age 45–64. Prior suicide attempt history was associated with higher likelihood of poisoning in both sexes and hanging/suffocation in men; mental disorders/SUD were associated with higher likelihood of hanging/suffocation and poisoning in both sexes; physical health problems were associated with higher likelihood poisoning in both sexes and firearm use in men; relationship problems were associated with higher likelihood of firearm use; legal problems and job/financial/housing problems were associated with higher likelihood of hanging/suffocation in both sexes; and more crises were associated with higher likelihood of firearm use in both sexes.ImplicationsThe findings call for the following suicide prevention strategies: (1) restricted access to firearms; (2) improved access to mental health/substance use treatment; (3) improved long-term and palliative care services for those (mostly older adults) with physical health problems; (4) financial/housing support policies to mitigate economic hardship; and (5) more research to identify effective strategies to curtail the increasing use of firearm and hanging/suffocation among young and middle-aged adults.

Individual-level risk factors for suicide mortality in the general population: an umbrella review

“… 2 When meta-analyses examined the association between a given risk factor and multiple suicide-related outcomes (commonly ideation, attempt, and death), we only included the data specifically relating to suicide mortality (although in a secondary analysis, we compared effect sizes for these different outcomes when reported in the same meta-analysis). Reviews that solely focused on suicide deaths by a specific method (eg, hanging, poisoning, or firearms) were excluded because these are differentially associated with specific demographic and clinical factors, 11 , 12 which would limit generalisability (eg, compared with other methods, people who die by firearms are less likely to have a history of suicide attempts or mental illness).…”

Firearm use risk factors and access restriction among suicide decedents age 75 and older who disclosed their suicidal intent

“…been attributed to the fact that they engage in suicidal behaviors with greater premeditation, lethality of intent, and lethality of method, firearms in particular, than do younger adults (4,5). While firearms are the most and second most frequently used suicide method among all adult males and females, respectively, in the US, older adults are far more likely to use firearms than younger adults (6)(7)(8)(9). A study of suicide decedents in the 2017-2019 National Violent Death Reporting System (NVDRS) showed that firearms were used in 55 and 30% of all adult male and female suicides, respectively, but they were used in 75 and 34% of male and female suicides, respectively, in the 65+ age group (6).…”

“…While firearms are the most and second most frequently used suicide method among all adult males and females, respectively, in the US, older adults are far more likely to use firearms than younger adults (6)(7)(8)(9). A study of suicide decedents in the 2017-2019 National Violent Death Reporting System (NVDRS) showed that firearms were used in 55 and 30% of all adult male and female suicides, respectively, but they were used in 75 and 34% of male and female suicides, respectively, in the 65+ age group (6). Among older male suicide decedents, 70.2, 88.8, and 80.3% of those age 65-74, 75-84, and 85+, respectively, used firearms (6).…”

“…A study of suicide decedents in the 2017-2019 National Violent Death Reporting System (NVDRS) showed that firearms were used in 55 and 30% of all adult male and female suicides, respectively, but they were used in 75 and 34% of male and female suicides, respectively, in the 65+ age group (6). Among older male suicide decedents, 70.2, 88.8, and 80.3% of those age 65-74, 75-84, and 85+, respectively, used firearms (6). Firearm suicides among those age 65+, disproportionately affecting non-Hispanic white males, increased by 49% between 2010 and 2018, from 4,276 in 2010 to 6,375 in 2018, and continued to increase further in 2020 and 2021 (5,10,11), showing that 18 older adults die by firearm suicide every day.…”

“…We then described firearm access restriction attempts, or lack thereof, by family members, as noted in the coroner/medical examiner and law enforcement agency reports. Our focus on those age 75+ was based on the fact that the suicide rates among males in this age group continued the increasing trend despite the brief dip in suicide rates among all other age groups in 2020 (36) and that this age group has the highest rates of using firearms as the suicide method (6). This study's findings will provide insights into firearm use among suicide decedents age 75 who disclosed their suicide intent and the role of family in restricting firearm access.…”