Claire Houtsma

The Association Between State Laws Regulating Handgun Ownership and Statewide Suicide Rates

OBJECTIVES We examined the impact of 3 state laws (permit to purchase a handgun, registration of handguns, license to own a handgun) on suicide rates. METHODS We used 2010 data from publicly available databases and state legislatures to assess the relationships between our predictors and outcomes. RESULTS Results largely indicated that states with any of these laws in place exhibited lower overall suicide rates and suicide by firearms rates and that a smaller proportion of suicides in such states resulted from firearms. Furthermore, results indicated that laws requiring registration and license had significant indirect effects through the proportion of suicides resulting from firearms. The latter results imply that such laws are associated with fewer suicide attempts overall, a tendency for those who attempt to use less-lethal means, or both. Exploratory longitudinal analyses indicated a decrease in overall suicide rates immediately following implementation of laws requiring a license to own a handgun. CONCLUSIONS The results are thus supportive of the potential of handgun legislation to have an impact on suicide rates.

Firearms matter: the moderating role of firearm storage in the association between current suicidal ideation and likelihood of future suicide attempts among United States Military personnel

The relationship between firearm ownership and suicide is well documented. This study hypothesized that how soldiers store their firearms would moderate the relationship between suicidal ideation and the self-reported likelihood of engaging in a future suicide attempt, and that this relationship would be explained by fearlessness about death. There were 432 military personnel (91.3% men, 74.2% White, Mage = 27.60) who endorsed current ownership of a private firearm and who were recruited from a military base in the southeastern United States (94.5% National Guard). Firearm storage moderated the relationship between suicidal ideation and the self-reported likelihood of engaging in a future suicide attempt, but this relationship was not explained by fearlessness about death. Individuals who reported keeping their firearms loaded and stored in an unsecure location exhibited higher mean levels of fearlessness about death. Findings highlight the need for research examining contributors to suicide risk in the context of firearm storage, and provide support for suicide prevention efforts involving restricting means.

Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence-based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population-level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability-centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population-level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence-based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.

The Association Between Gun Ownership and Statewide Overall Suicide Rates

An extensive body of research has demonstrated an association between gun ownership and suicide that extends beyond the effects of a range of covariates. We aimed to expand on extant research by examining the extent to which gun ownership predicts statewide overall suicide rates beyond the effects of demographic, geographic, religious, psychopathological, and suicide-related variables. By extending the list of covariates utilized, considering those covariates simultaneously, and using more recent data, we sought to present a more stringent test. Gun ownership predicted statewide overall suicide rates, with the full model accounting for more than 92% of the variance in statewide suicide rates. The correlation between firearm suicide rates and the overall suicide rate was significantly stronger than the correlation between nonfirearm suicide rates and the overall suicide rate. These findings support the notion that access to and familiarity with firearms serves as a robust risk factor for suicide. Therefore, means safety efforts aimed at reducing accessibility and increasing safe storage of firearms would likely have a dramatic impact on statewide overall suicide rates.

Posttraumatic Stress Disorder Symptom Clusters and the Interpersonal Theory of Suicide in a Large Military Sample.

Prior studies examining posttraumatic stress disorder (PTSD) symptom clusters and the components of the interpersonal theory of suicide (ITS) have yielded mixed results, likely stemming in part from the use of divergent samples and measurement techniques. This study aimed to expand on these findings by utilizing a large military sample, gold standard ITS measures, and multiple PTSD factor structures. Utilizing a sample of 935 military personnel, hierarchical multiple regression analyses were used to test the association between PTSD symptom clusters and the ITS variables. Additionally, we tested for indirect effects of PTSD symptom clusters on suicidal ideation through thwarted belongingness, conditional on levels of perceived burdensomeness. Results indicated that numbing symptoms are positively associated with both perceived burdensomeness and thwarted belongingness and hyperarousal symptoms (dysphoric arousal in the 5-factor model) are positively associated with thwarted belongingness. Results also indicated that hyperarousal symptoms (anxious arousal in the 5-factor model) were positively associated with fearlessness about death. The positive association between PTSD symptom clusters and suicidal ideation was inconsistent and modest, with mixed support for the ITS model. Overall, these results provide further clarity regarding the association between specific PTSD symptom clusters and suicide risk factors.

Investigating the Relationship Between Social and Economic Policy Views, Firearm Ownership, and Death by Firearm in a Sample of Suicide Decedents

Extant literature provides evidence for the frequent use and lethality of firearms in suicide and the ability of means safety measures to prevent suicides; however, little evidence exists to provide an understanding of the characteristics that differentiate suicide decedents who die by firearm from those who die by other methods. In this study, we build on prior findings regarding the characteristics of those who die by firearms by examining the relationship between social and economic policy views and both firearm ownership and death by firearm in a sample of 160 American suicide decedents. We hypothesized that individuals with more conservative social and economic policy views would have higher rates of firearm ownership and would be more likely to die by firearm than would individuals with more liberal social and economic policy views. Furthermore, we hypothesized that differences in the likelihood of dying by a firearm would be accounted for by firearm ownership, providing preliminary evidence for a specific mechanism through which risk for death by firearm is conferred. As expected, suicide decedents with conservative social and economic policy views owned firearms at higher rates than did decedents with moderate or liberal views. The use of a firearm, the most common method across all decedents, was higher in individuals with conservative policy views. These results represent a novel angle from which to consider the importance of means safety efforts focused on firearm ownership and storage and limit concerns that firearm specific suicide research has relied too heavily on samples that are not representative of typical American suicide decedents.

Support Systems: How Post-Deployment Support Impacts Suicide Risk Factors in the United States Army National Guard

Suicide rates within the military have continued to rise in recent years, resulting in re-doubled efforts to understand and remedy this trend. In an attempt to clarify unique pathways to suicide risk in this population, the current study examined the relationship between length of time since most recent deployment and several suicide risk factors (hopelessness, suicidal ideation, and resolved plans and preparations). Furthermore, this study examined the moderating influence of post-deployment social support in the prediction of suicide risk. Results indicated that the interaction of time since deployment and post-deployment support predicted both hopelessness and resolved plans and preparations, but did not predict suicidal ideation. These findings suggest that the negative effects of time spent away from recognized military support may be compounded by the isolating effect of decreased access to alternative supports at home, resulting in increased hopelessness and/or resolved plans and preparations. Implications for the necessity of improved post-deployment programs are discussed.

Perceptions of Firearms and Suicide: The Role of Misinformation In Storage Practices and Openness to Means Safety Measures

BACKGROUND Firearm ownership and unsafe storage increase risk for suicide. Little is known regarding factors that influence storage practices and willingness to engage in means safety. METHODS Utilizing Amazons Mechanical Turk program, we recruited an online sample of 300 adults living in the US who own at least one firearm. Firearm storage practices and openness to means safety measures were assessed using items designed for this study. Data were collected and analyzed in 2017. RESULTS Firearms stored in non-secure locations and without a locking device were associated with lower beliefs in the relationship between firearm storage and suicide risk. Fearlessness about death moderated the association between current secure versus non-secure storage and beliefs regarding firearm storage and suicide risk, in that storage practices and beliefs were more strongly related at higher levels of fearlessness about death. For both secure and locked storage of a firearm, there was a significant indirect effect of current storage practices on willingness to engage in means safety in the future through current beliefs regarding the relationship between firearm storage and suicide risk. Unsafe storage practices were largely associated with an unwillingness to store firearms more safely or to allow a trusted peer to temporarily store the firearm outside the home in order to prevent their own or someone elses suicide. LIMITATIONS Self-report and cross-sectional data were used. Results may not generalize to non-firearm owners. CONCLUSIONS Firearm owners are prone to inaccurate beliefs about the relationship between firearms and suicide. These beliefs may influence both current firearm storage practices and the willingness to engage in means safety.

Firearm suicide: pathways to risk and methods of prevention

Firearms are utilized in approximately half of all US suicides, making them a serious public health concern and a target of suicide prevention efforts. Practical capability influences the transition from suicidal ideation to action and is particularly relevant to firearm suicide. Firearm ownership, experience using firearms, unsafe firearm storage, and high cultural acceptability of firearms increase risk for death by firearm suicide. Means safety strategies, which emphasize the reduction of practical capability for suicide through the limitation of access to and safe storage of firearms, are effective in preventing suicide and include interventions such as lethal means counseling, firearm legislation, and promoting safe storage practices. Public health interventions aimed at reducing firearm suicide are critical topics for continued research.

The Impact of Aggression on the Relationship Between Betrayal and Belongingness Among US Military Personnel

The suicide rate among U.S. military personnel, particularly within the Army National Guard, is significantly higher than the rate found among the general population. To better understand why the Army National Guard has elevated rates of suicide, the current study examined how deployment-related moral injury interacts with interpersonal factors to predict suicide risk. Specifically, this study hypothesized that deployment-related betrayal, a facet of the Moral Injury Events Scale, would predict thwarted belongingness and that this relationship would be moderated by several types of aggression (physical aggression, verbal aggression, hostility, and anger). The current sample comprised 562 military personnel who had experienced at least 1 previous deployment. Results revealed that betrayal predicted thwarted belongingness in the presence of high but not low or mean levels of aggression among military personnel. This indicates that aggressive individuals who experience perceived betrayal while deployed may be at high risk for development of thwarted belongingness, an important risk factor for suicide. These results suggest the need for better assessment and treatment of betrayal among military personnel, as well as the need for programs to help soldiers manage aggression.