Firearm-Specific Suicide Preparatory Behavior Among Young Adults Experiencing Homelessness

Background/Purpose: Young adults experiencing homelessness (YAEH) endure suicidal crises at disproportionately higher rates than their housed peers. Engaging in preparatory behavior involving a specific suicide method, such as trying to access the method during a crisis, is an indicator of heightened risk—a signal that one is closer to using the method in a suicide attempt. Given that 90% of suicide attempts involving a firearm result in death, it is especially important to determine how common it is for individuals in a given population to engage in firearm-specific preparatory behavior. This may be even more critical among YAEH as they tend to have easy access to firearms, and thus firearm-specific suicide plans may be enacted without the same opportunity for preventive interventions. This study had two aims: (1) describe the rate of firearm-specific suicide preparatory behavior and (2) identify correlates of preparatory behavior.

Methods: A sample of 615 YAEH (aged 18-25) were recruited from drop-in homelessness-service centers in Los Angeles, California and St. Louis, Missouri, and then completed a face-to-face, researcher-administered, computer-assisted anonymous survey. For Aim 1, descriptive statistics were used to assess preparatory behavior, which included seeking information about firearm use for suicide, trying to access a firearm during a crisis, or loading/handling a firearm during a crisis (0= no preparatory behavior; 1= any preparatory behavior). For Aim 2, a multiple logistic regression analysis was used to explain preparatory behavior. Independent variables included demographic (age, race, gender identity), mental health (mental health diagnosis/ treatment, suicide attempt history), homelessness (time spent homeless), and firearm variables (firearm access, attitudes, and carriage). Given the study aims, only participants with a history of suicidal ideation (n=352) were included in the analysis.

Results: Thirty-six percent of participants with a history of suicidal ideation considered firearms as a suicide method. With respect to Aim 1, 28% had engaged in firearm-specific preparatory behavior. With respect to Aim 2, females (OR= .27, p<.001) and trans, non-binary or gender neutral individuals (OR= .47, p=.041) had lower odds of preparatory behavior than males. Suicide attempt survivors had higher odds of preparatory behavior than those without a suicide attempt history (OR= 1.48, p<.001). Individuals with a history of carrying firearms had higher odds of preparatory behavior than those without a firearm carriage history (OR= 1.91, p=.022).

Conclusions/Implications: That so many participants considered firearms as a suicide method and engaged in firearm-specific preparatory behavior is highly concerning. This suggests a potential vulnverability to firearm suicide in this population that has yet to be documented or accounted for in practice. That suicide attempt survivors were more likely to engage in preparatory behavior may be due to greater acquired capability for suicide, which could manifest as contemplation of more lethal methods. Relatedly, firearm carrying behavior may be a mechanism whereby firearm-specific acquired capability is developed. Hence, suicide attempt history and firearm carriage may be treated as tentative markers for firearm-specific suicide susceptibility among YAEH, which could inform population-centered suicide prevention programming and related policy (e.g., firearm-specific lethal means counseling).