Firearms and Suicide Completion Among Persons Recently Released from Psychiatric Hospitalization

Background and Purpose: There is a high risk for suicide completion among persons recently released from psychiatric hospitalization. Firearm-related suicide and firearm violence is the leading cause of death among adults in the United States. In this study, we use the most comprehensive, restricted database available for firearm-related fatalities to examine associations with suicide completion among persons who were released from a psychiatric hospital less than 30 days prior to their death.

Method: Data is from the National Violent Death Reporting System (NVDRS), which includes all violent deaths from 44 states and territories in the U.S., between the years 2003 and 2019. NVDRS data includes reports from death certificates, coroners, law enforcement, and toxicology reports. Our sample included persons that were released from a psychiatric hospital no more than 30 days prior to their death (N = 2,556). Suicide completion was a binary measure, constructed from information available in death certificates, responding officer reports, and coroner reports. Demographic measures included gender, age, race/ethnicity, education level, and marital status. Circumstances associated with death included firearm use, prior drug or alcohol use problems, prior diagnosis for a major depressive disorder, history of suicidal thoughts, and history of suicide attempts. A logistic regression model examined associations with suicide completions following release from a psychiatric hospital.

Results: Results showed that odds of suicide completion, compared to other manners of death, were higher when a firearm was involved (OR = 1.82, p < .01). Among demographics, odds of suicide completions were higher among men (OR = 1.87, p < .01), persons older in age (OR = 1.01, p < .05), and those with higher levels of education (OR = 1.98, p < .05). Odds of suicide completions were higher among those with a prior diagnosis for a major depressive disorder (OR = 1.65, p < .01), history of suicidal thoughts (OR = 2.87, p < .01), and history of suicide attempts (OR = 2.04, p < .01). Odds of suicide completions were lower among persons with prior drug or alcohol use problems (OR = 0.34, p < .01). Marital status was not associated with suicide completion. Follow up analyses showed handguns (opposed to shotguns or rifles) were involved in 73% of all firearm-related suicide completions, and firearms used in suicide completions belonged to the decedent in only slightly more than half of all cases.

Conclusion and Implications: Among persons recently released from a psychiatric hospital, suicide completion was more likely to include the use of a firearm than any other type of death. These results underscore the importance of addressing gun violence in the United States, especially among persons with psychiatric disabilities. Social work researchers and practitioners can address this issue through the analysis of, and advocacy for, policies that limit access to firearms. Recent policies on the subject include state/federal “red flag” policies which limit people in crisis from accessing firearms and implements universal standard assessment of access to firearms prior to psychiatric discharge.