Sex and age modify the relationship between life circumstances and use of a firearm in suicide deaths across 17 U.S. states

Background: Suicides are of growing public health concern in the United States. Although the demographics of firearm suicides are well established, the sex and age differences in the role that life circumstances play in the risk for firearm suicide are not known. Methods: We used suicide deaths from the National Violent Death Reporting System from 2003 to 2011 in 17 U.S. states to assess the difference in the relation between six life circumstances and risk of firearm versus non-firearm suicides across sex and age groups. Mixed effect logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). Results: The risk of using a firearm as compared to other means for suicide were greater among white, male, non-Hispanic, older (>50 years of age), and currently married U.S. residents. Among all age and sex groups, the odds of firearm use were 21–29% greater in the presence of a recent crisis. Having a financial problem was significantly associated with firearm use among younger men (OR = 1.14, 95% CI = 1.07–1.21), younger women (OR = 1.19, 95% CI = 1.02–1.39), and older women (OR = 1.21, 95% CI = 1.05–1.39), while physical health issues were associated with risk of firearm suicide among older men (OR = 1.78, 95% CI = 1.65–1.92). Limitations: Misclassification due to multiple data sources. Conclusion: The life circumstances associated with a preference of using firearm for suicide differ by sex and by age.