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Suicide By Firearm In The Greater Houston Area: An Analysis Of Age-Related Risk Factors
Jeffrey Carter1, Elisa Benavides2, Marie Kasbaum2, Cary Cain2, Ned Levine3, Lisa Pompeii2, Michal Pierce4, Dwayne Wolf5, *Bindi Naik-Mathuria2
1Texas Children's Hospital, HOUSTON, TX;2Baylor College of Medicine, HOUSTON, TX;3none (private consultant), HOUSTON, TX;4Harris country institute of forensic medicine, HOUSTON, TX;5Harris country institute of forensic sciences, HOUSTON, TX

Background: Suicide by firearm is a growing problem in adolescents and an already significant problem in adults. The purpose of this study is to compare characteristics of adolescent and adult suicide decedents to identify risk factors for suicide prevention.
Methods: Retrospective review of county Medical Examiner records of firearm suicide deaths between January 2018 and October 2019. Demographics, shooting details, and narratives were compared using chi square analysis and binomial and OLS logistic regression modeling.
Findings: Firearm death due to suicide was significantly less common in adolescents compared to adults (14/63, 22% vs 493/1102, 44%, p<0.001). The adolescent median age was 16y (range 14-17) and adult was 42y (18-91). In both groups, the majority were male (86% vs 85%) and non-Hispanic White (64% vs 61%); although younger adults were more likely to be Hispanic. Home was most common shooting location for both (71% vs 77%). Guns were accessed from locked safes by 2/14 (20%) of adolescents. Mental illness was higher in adolescents, but not significantly (65% vs 40%); depression being most common. Known suicidal ideation was low in both groups (14% vs 28%, p>0.05). Adults were more likely to have alcohol abuse (52% vs 0%, p<0.01); however, this was no longer significant in logistic regression. Drug use was similar (26% vs 21%). Personal stressors prior to suicide varied among adolescents and adults (Table).
Conclusions: Adolescent suicide by firearm is less common than in adults in an urban setting; however, demographics, mental illness history, drug use, and suicide location are similar. Known suicidal ideation is rare, and personal stressors differ. Out-of-home or secure firearm storage could have prevented the majority of these deaths.

Most common personal stressors prior to suicide
Adolescents (n=14)Adults (n=493)
Argument with parents: 21%Romantic relationship issue (break up/argument): 29%
Bullying: 14%Chronic medical issue: 23%
Death of loved one: 14%Other (legal issue, job stress, etc): 23%
Academic issue: 7%Financial issue: 10%
Difficulty making friends: 7%Death of loved one: 10%


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