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Individual and Community-level Predictors of Suicide Method using Violent Death Reporting System from a Rural State
Lucero G. Paredes
*1, Anya Cutler
2, Jamie A. Wren
3, Christopher G. Turner
11Surgery, Maine Medical Center, Portland, ME; 2Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME; 3Margaret Chase Smith Policy Center, University of Maine, Orono, ME
Background: Suicide rates are highest in rural areas. Maine is one of the most rural states in the country and has a firearm suicide rate that outpaces the national average. Little is known about the relationship between various risk factors (individual and community-level) for firearm suicide vs other means across urban-rural differences.
Methods: The Maine Violent Death Reporting System was queried for all adults who died by single suicide from 2015-2022. Individual risk factors assessed included demographics (age, race/ethnicity, sex, veteran status, and marital status), mental health history (current mental health problem, current mental illness treatment, substance use problem, prior suicide attempt), and precipitating circumstances (physical health problem, legal problem, financial problem, job /school problem, intimate partner problem, other relationship problem, and crisis within 2 weeks prior to injury). Area Deprivation Index (ADI) decile for each decedent was determined using the University of Wisconsin’s ADI Database. Rurality was designated using Rural Urban Commuting Area Codes. We performed multivariable logistic regression controlling for demographics to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for individual and community-level risk factors. Additional analysis was conducted using an interaction term to assess for urban-rural differences among significantly associated risk factors.
Results: A total of 1990 decedents (1593 male [80.1%]; 1905 White [95.7%]; mean [SD] age, 50.8 [18.4] years) were included in this study. The leading mechanisms were firearm (1101 [55.3%], hanging/strangulation (463 [23.3%]), and poisoning (300 [115.1%]). Those who died by firearm were more likely to be older (OR, 1.83 [95% CI, 1.25-2.67]), male (OR, 2.92 [95% CI, 2.22-3.86]), veterans (OR, 1.74 [95% CI, 1.3-2.32]), and have an intimate partner problem (OR, 1.33 [95% CI, 1.03-1.73]). Firearm suicide was associated with decreased odds of substance use problem (OR, 0.69 [95% CI, 0.55-0.86]), mental health problem (OR, 0.71 [95% CI, 0.55-0.92]), and prior suicide attempt (OR, 0.39 [95% CI, 0.29-0.51]). Rurality (OR, 1.26 [95% CI, 1.05-1.54]) and national ADI decile (OR, 1.07 [95% CI: 1.02-1.14]) were found to be predictors of firearm suicide. Urban-rural differences were not significant on subgroup analysis.
Conclusion: High-risk characteristics for firearm suicide include older age, male gender, veteran status, intimate partner problem, and residing in a neighborhood with high deprivation. Predictors of non-firearm suicide include substance use, current mental health problem, and prior suicide attempt. These factors did not differ across rurality. Our findings support targeted prevention initiatives for high-risk populations to reduce both firearm and non-firearm suicides across the state of Maine.
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