Body of Abstract: Introduction and Objectives. Firearms account for over 50% of suicide deaths within the United States and are the most lethal method, with an 85-95% fatality rate. Firearm suicide rates are highest for those 75 years old and older. Research across all age groups has shown that only 26.6% of individuals who died by firearm suicide had ever sought mental health treatment, and those who died by firearm suicide were significantly less likely to seek treatment than those who died by other methods. Previous research specifically examined this treatment-seeking in older adults. Our goal was to examine in detail suicide risk and treatment-seeking behavior among older adults who died by firearm suicide compared to those who died by suicide via another method.
Methods. We used data on deaths in all 50 US states from the National Violent Death Reporting System (NVDRS) from 2003-2022. We examined suicide death among adults aged ≥60. Previous suicidal ideation, suicide attempts, disclosure of suicidal thoughts and plans, current treatment seeking, and previous treatment seeking in NVDRS were obtained from medical record reviews, family interviews, and crime scene data. In line with the requirements from the Center for Disease Control and Prevention, this NVDRS project did not require an individual IRB submission.
Results. During the study period, 95,785 adults aged >60 died by suicide. Of those who died, 65.22% used a firearm. Older adults who died by firearm suicide were significantly less likely to have a history of suicidal ideation (OR = 0.77 [0.75, 0.79]) and past suicide attempts (OR = 0.24 [0.23, 0.25]) compared to those who died by another method. Additionally, those who died by firearm suicide were significantly less likely to be in mental health or substance use treatment at the time of their death (OR = 0.44 [0.42, 0.45]) or ever in the life (OR = 0.43 [0.42, 0.45]) compared to those who used another method. Regarding disclosure of suicide risk, those who died by firearm suicide were significantly more likely to disclose their thoughts or plans to an intimate partner (OR = 1.28 [1.20,1.36]) or “other” source (OR = 1.43 [1.25, 1.64]), and significantly less likely to disclose thoughts or plans to a health care worker (OR = 0.42 [0.37, 0.48]) than those who died by suicide via another method.
Conclusion. The study found that older adults who die by firearm suicide were less likely to have a history of suicidality and are less likely to seek mental health treatment in their lifetime. This suggests that suicide prevention efforts targeting this population need to be expanded beyond mental health care, perhaps including community outreach. The insight that individuals who die by firearm suicide are more likely to disclose suicidal thoughts or plans to intimate partners and less likely to disclose to health care providers also offers opportunities to develop prevention strategies.
Learning Objectives:
To provide information on the background of firearms and suicide.
To examine previous risk factors and mental health treatment among older adults who die by firearm suicide verses another method.
To discuss how these findings align with suicide prevention efforts and can be used to reduce risk among older adults.
