Understanding firearm-related suicide mortality in the national violent death reporting system: A study of circumstantial social determinants.

OBJECTIVE: To investigate the association between social determinants of health (SDoH), mental health history, and the propensity of firearm usage in suicide in the United States from 2003 to 2022. METHODS: Using retrospective data from the National Violent Death Reporting System, we analyzed 348,112 suicide deaths, identifying differences in circumstantial, sociodemographic and mental health characteristics across those who used firearms versus other lethal methods. RESULTS: Documentation of any adverse health care access SDoH or adverse social context-related SDoH was significantly associated with increased odds of suicide by firearm (adjusted odds ratio [aOR] = 1.88 and 1.45, respectively) while any adverse neighborhood and built environment SDoH was inversely associated (aOR = 0.49). Decedents of suicide by firearm were less likely to have documented mental health problems (aOR = 0.83), to have recently received mental health treatment or have a prior suicide attempt (aOR = 0.50) compared to non-firearm suicides, though rates of depressed mood were similar (32.86% vs. 31.27%). CONCLUSIONS: These findings suggest that structural and environmental stressors may influence lethal means selection and amplify suicide risk beyond individual mental health profiles.