RESEARCH HIGHLIGHT: The Experience of Survivors of Firearm Suicide Attempts: A Retrospective Case Series
background
Firearm-related suicides are a significant public health issue in the United States, accounting for more than half of all suicide deaths. Firearm suicides are more lethal than other methods, with a 90% fatality rate for those who attempt using firearms. Most people who die by firearm suicide have never previously attempted suicide, and many do not have a formal mental health diagnosis. While there have been efforts to reduce firearm suicides through behavioral health services, there are many factors beyond mental health that may also play a role in a person’s risk.
We aimed to identify a group of patients who survived firearm suicide attempts and explore the factors leading to those attempts. Specifically, we were looking to understand the acute stressors (such as relationship issues, work stress, or financial problems), substance use (alcohol or other drugs), and any pre-existing mental health conditions that might have contributed to these suicide attempts. By studying survivors, we hoped to gain insight into the factors that could help prevent future firearm suicides.
hypothesis
We hypothesized that individuals who attempted suicide by firearm experienced a combination of acute stressors (such as relationship issues, work or school stress, financial troubles) and substance use (particularly alcohol) at the time of their attempt. We also hypothesized that although these individuals may have suffered from chronic mental health conditions, the acute stressors and intoxication played a significant role in their decision to attempt suicide.
project description
We reviewed medical records from two affiliated Level 1 Trauma Centers between 2000 and 2019 to identify patients who were treated for and survived self-inflicted, intentional gunshot wounds to the head. We then gathered demographic and qualitative data about each patient including demographics, any stressors they faced before the attempt (like relationship issues or financial problems), whether they were intoxicated at the time (alcohol or other substances), and if they had a history of mental health conditions.
project findings
Our study found that most patients in the cohort were male (88%) and had a mean age of 44 years. Many had acute stressors leading up to their suicide attempt, with the most common stressors being relationship problems (53%), work or school stress (32%), and financial issues (12%). Over half of the patients (56%) were intoxicated with alcohol at the time of the attempt, and 41% had used other substances like benzodiazepines or opioids. Many patients (82%) had chronic mental health conditions, such as depression or a history of substance use disorder.
conclusions & future directions
While most patients had chronic mental health conditions, including depression and substance use disorder, these were not always the main triggers for the suicide attempt. Our study suggested that acute stressors combined with substance intoxication could have played a significant role in the decision to attempt suicide. These findings could provide insights into factors contributing to firearm suicide attempts, which could inform prevention strategies.
This research advances what we already know by focusing on individuals who survive firearm suicide attempts, a rare and understudied group. Most current literature only examines patients who die from firearm suicide and thus are unable to contribute to qualitative research related to firearm suicide risk. This research provides new insights into how common, everyday stressors, combined with substance intoxication, can significantly contribute to the risk of firearm suicide attempts. This information can help clinicians better identify at-risk individuals by considering both mental health and situational factors, improving prevention strategies and interventions.
Our study recommends that clinicians assess not just for chronic mental health conditions, but also for recent life stressors and substance use when evaluating suicide risk. Additionally, limiting access to lethal means like firearms during times of crisis may be an important preventive measure.
link to article
AUTHOR: Jeffrey Savarino, MD is a fourth-year emergency medicine resident and Chief Resident at Brown Emergency Medicine Residency.
FACULTY REVIEWER: Michelle Myles, MD is an attending physician and clinician educator at Brown Emergency Medicine.