Youth from rural communities at increased risk for firearm-related suicide

Interventions that help limit youth access to handguns during moments of crisis may especially benefit rural-remote communities, according to results of a cross-sectional study published in JAMA Network Open.

“Firearms are very lethal, so a suicide attempt with a firearm is much more likely to end in death,” co-author Ashley Brooks-Russell, PhD, MPH, director of the Injury and Violence Prevention Center at Colorado School of Public Health, University of Colorado Anschutz Medical Campus, told Healio Psychiatry. “Not much is known about youth access to firearms in the U.S. We used a state-funded surveillance system, with a newly added question about perceived access to handguns, to look at regional variation of firearm access in Colorado and how it correlates to suicidality.”

Brooks-Russell and colleagues analyzed data of 59,556 students who participated in the 2019 Healthy Kids Colorado Survey, which was conducted at 256 high schools in Colorado. Although most (56.8%) schools were rural or in small towns, more (57.8%) students participated from urban and suburban schools. The researchers used urban-centric locale according to a seven-level continuum as the exposure, with school location geocoded for spatial analysis. Weighted prevalence for easy handgun access and four measures of previous-year mental health and suicidality served as main outcomes and measures.

Results showed increasing rurality coincided with prevalence of perceived easy access to handguns. A total of 36.2% (95% CI, 35.2-37.1) of students in rural schools reported easy access compared with 18.2% (95% CI, 17.3-19.1) for city schools. Although the spatial distribution of easy handgun access and suicidality measures had little overlap, the researchers noted an association at school-level between easy handgun access and considering suicide, planning suicide and attempting suicide in the previous year. A total of 21 schools, 81% of which were rural, composed the highest quartile for prevalence of both perceived easy access to handguns and planning suicide in the previous year.

“Given that suicide attempts can be unpredictable, to best protect our teenagers we have to protect them from lethal means of suicide attempts, specifically access to firearms,” Brooks-Russell said. “Knowing where risk is the highest can help with targeting limited prevention resources. States with similar public health surveillance systems may be able to take a similar approach and understand the distribution of risk.”

In a related editorial, Eric W. Fleegler, MD, MPH, of the division of emergency medicine at Boston Children’s Hospital, Harvard Medical School, highlighted the overall limited knowledge surrounding youth suicide risk.

“We need to avoid the fallacy of assuming we know when youth are at high risk of suicide,” Fleegler wrote. “Pediatricians and parents alike need to realize that we do not always know when youth are in crisis. We need to recognize that mental health crises can happen to anyone, anytime, and that one of the best ways to reduce the risk of suicide is to eliminate the access to firearms before it is too late.”