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#6 - Suicide et ARMES À FEU - 4 novembre 2011

Les statistiques le démontrent : les pays ayant un contrôle plus serré des armes à feu présentent un taux de suicide par arme à feu inférieur aux pays qui n’en ont pas. Depuis 1991, le Canada s’est doté d’une loi sur le contrôle des armes à feu : cette loi comporte des conditions d’acquisition et d’entreposage des armes, des restrictions sur certains types d’armes ainsi qu’un registre de ceux qui les possèdent. Les recherches canadiennes – et d’ailleurs dans le monde – indiquent que les armes à feu sont utilisées moins fréquemment comme moyen de mettre fin à ses jours. D’autre part, il semble que ces mesures ont également un effet sur les homicides et autres crimes commis avec des armes à feu. Il est évident que ces lois ne préviendront pas tous les suicides et crimes, mais il serait dommage que, pour des motifs administratifs ou idéologiques, ces acquis soient remis en question.

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Gagné, M., Robitaille, Y., Hamel, D., & St-Laurent, D. (2010). Firearms regulation and declining rates of male suicide in Quebec . Injury Prevention, 16(4), 247-253.
Résumé: Objectives: To examine whether significant changes in method-specific male suicide rates occurred in the province of Quebec after stronger firearms regulations were introduced in Canada in 1991; to ascertain whether more stringent firearms regulations influence firearms and total suicide trends among men and to determine whether different results are obtained according to the statistical methods used. Study design: Descriptive analyses of time trends in method-specific suicide rates for men from 1981 to 2006 using Joinpoint regression models and pre-post firearms regulation analyses. Setting: Quebec (Canada). Patients or Subjects: Men who have commited suicide aged 15-34, 35-64 and 65 years and over, based on the Quebec mortality database, 1981-2006. Interventions: A national firearms control initiative enacted in 1991. Results: The Joinpoint regression models suggest that firearm suicide rates declined towards the end of the 1990s. Since 1996, the pace of decline was twice as great in men aged 15-34 years (annual percentage change (APC) -11.1%) compared with men aged 35-64 years (APC -5.6%). Total suicide rates also declined among men aged 15-34 and 35-64 years during this period. Pre-post firearms regulation Poisson regression analyses failed to detect the specific point in time when significant changes in the trend occurred. Conclusions: Male firearm suicide rates declined following the introduction of restrictive firearms regulations in Canada. Whether this represents a causal relationship requires further study.

Andres, A. R., & Hempstead, K. (2011). Gun control and suicide: The impact of state firearm regulations in the United States, 1995-2004 . Health Policy, 101(1), 95-103.
Résumé: OBJECTIVE: To empirically assess the impact of firearm regulation on male suicides. METHOD: A negative binomial regression model was applied by using a panel of state level data for the years 1995-2004. The model was used to identify the association between several firearm regulations and male suicide rates. RESULTS: Our empirical analysis suggest that firearms regulations which function to reduce overall gun availability have a significant deterrent effect on male suicide, while regulations that seek to prohibit high risk individuals from owning firearms have a lesser effect. CONCLUSIONS: Restricting access to lethal means has been identified as an effective approach to suicide prevention, and firearms regulations are one way to reduce gun availability. The analysis suggests that gun control measures such as permit and licensing requirements have a negative effect on suicide rates among males. Since there is considerable heterogeneity among states with regard to gun control, these results suggest that there are opportunities for many states to reduce suicide by expanding their firearms regulations.

Lubin, G., Werbeloff, N., Halperin, D., Shmushkevitch, M., Weiser, M., & Knobler, H. Y. (2010). Decrease in suicide rates after a change of policy reducing access to firearms in adolescents: A naturalistic epidemiological study . Suicide and Life-Threatening Behavior, 40(5), 421-424.
Résumé: The use of firearms is a common means of suicide. We examined the effect of a policy change in the Israeli Defense Forces reducing adolescents' access to firearms on rates of suicide. Following the policy change, suicide rates decreased significantly by 40%. Most of this decrease was due to decrease in suicide using firearms over the weekend. There were no significant changes in rates of suicide during weekdays. Decreasing access to firearms significantly decreases rates of suicide among adolescents. The results of this study illustrate the ability of a relatively simple change in policy to have a major impact on suicide rates.

Betz, M. E., Barber, C., & Miller, M. (2011). Suicidal behavior and firearm access: Results from the Second Injury Control and Risk Survey . Suicide and Life-Threatening Behavior, 41(4), 384-391.
Résumé: The association between home firearms and the likelihood and nature of suicidal thoughts and plans was examined using the Second Injury Control and Risk Survey, a 2001-2003 representative telephone survey of U.S. households. Of 9,483 respondents, 7.4% reported past-year suicidal thoughts, 21.3% with a plan. Similar proportions of those with and without a home firearm reported suicidal thoughts, plans, and attempts. Among respondents with suicidal plans, the odds of reporting a plan involving a firearm were over seven times greater among those with firearms at home, compared with those without firearms at home. The results suggest people with home firearms may not be more likely to be suicidal, but when suicidal they may be more likely to plan suicide by firearm.

Slater, G. Y. (2011). The missing piece: A sociological autopsy of firearm suicide in the United States . Suicide and Life-Threatening Behavior, 41(5), 474-490.
Résumé: Social, economic, violence, political, and gun access predictors of suicide and gun suicide were examined via sociological autopsy. The model predicting suicide rates overall had the best results, indicating an excellent fit of the data and theoretical model. The model explained 76% of the variance in state suicide rates and was a significantly better predictor than one could expect by chance. All path coefficients were significant predictors of suicide with the exception of violence climate, which was not included. This study contributes to the theoretical knowledge by adding a comprehensive framework of analysis and model useful for prevention.

Barber, C., & Hemenway, D. (2011). Too many or too few unintentional firearm deaths in official U.S. mortality data? Accident Analysis and Prevention, 43 (3), 724-731.
Résumé: We examined the accuracy of data on unintentional firearm fatalities in the United States. We began with data from the National Violent Death Reporting System (NVDRS) and examined every firearm death reported as an accident by any NVDRS data source - the NVDRS abstracter, the State Vital Statistics Registry (i.e., the ICD-10 Underlying Cause of Death code and manner of death from the death certificate), the medical examiner or coroner report, and the police Supplementary Homicide Report. After carefully reading the information from all sources, we then classified each case as either unintentional or intentional using NVDRS definitions. Comparing our classification with that of the NVDRS abstracter, we conclude that NVDRS data accurately report unintentional firearm deaths. We then compared our classification with that of the State Vital Statistics Registry based on the ICD-10 Underlying Cause of Death code and found great inaccuracy . Thirty-eight percent of true cases were missed and 42% of reported cases were false positives. As has been previously reported in the literature, over half of unintentional shootings that were inflicted by another person were classified as homicides, not accidents. This is a particular problem for the data on young victims. What was unexpected, however, was the opposite problem: we found many unambiguous suicides and homicides that were reported as accidents. We believe this is due to the ICD-10 coding practice of assigning injury deaths to the "accident" category when manner of death is "pending" or left blank. Finally, at the state-level, we compared our overall results for each state and year with the official National Vital Statistics System count (reported on CDC's WONDER website). We found evidence of even greater over-reporting of unintentional firearm deaths there. In answer to the question, "Are there too many or too few unintentional firearm deaths in official mortality data?" the best answer is, "Both." Many true accidents are missed, while many suicides and homicides are mistakenly reported as accidents. By contrast, the NVDRS applies a case definition for unintentional firearm deaths with consistency and accuracy.

Callanan, V. J., & Davis, M. S. (2011). Gender differences in suicide methods . Social Psychiatry and Psychiatric Epidemiology, [ePub].
Résumé: INTRODUCTION: Gender differences in suicide completion rates have been attributed to the differences in lethality of suicide methods chosen by men and women, but few empirical studies have investigated factors other than demographic characteristics that might explain this differential. METHODS: Data from the 621 suicides in Summit County, Ohio during 1997-2006 were disaggregated by gender to compare known correlates of suicide risk on three methods of suicide-firearm, hanging and drug poisoning. RESULTS: Compared to women, men who completed suicide with firearms were more likely to be married and committed the act at home. Unmarried men were likelier to hang themselves than married men, but unmarried women were less likely to hang themselves than married women. Men with a history of depression were more likely to suicide by hanging, but women with depression were half as likely to hang themselves compared to the women without a history of depression. Men with a history of substance abuse were more likely to suicide by poisoning than men without such history, but substance abuse history had no influence on women's use of poisoning to suicide. For both sexes, the odds of suicide by poisoning were significantly higher for those on psychiatric medications.

Wasserman, I., & Stack, S. (2011). Race, urban context, and Russian roulette: findings from the National Violent Death Reporting System, 2003-2006 . Suicide and Life-Threatening Behavior, 41(1), 33-40.
Résumé: Previous work on Russian roulette has focused on data from large cities. It is unclear if the epidemiological patterns based on large cities will replicate for the nation as a whole, and if the influence of minority status will be moderated by urban context. The present investigation fills these gaps by providing descriptive epidemiological data on Russian roulette for 17 states, and testing a hypothesis on urbanism as a moderator of the race-Russian roulette relationship. Data were taken from the National Violent Death Reporting System (2003-2006). They refer to 71 Russian roulette cases and a matched control group of 284 males who committed suicide by a gunshot wound to the head. Russian roulette suicides were more apt to be of minority status, younger, had a lower incidence of mental health problems, and were more likely to be utilizing alcohol than the controls. Differentiating the sample into larger and smaller urban areas, it was found that the risk of Russian roulette for African Americans was higher in larger urban areas. Epidemiological patterns in previous research on large city samples are largely replicated. The moderating influence of urban context is related to differential opportunity structures for risk-taking behavior.

Bridge, J. A., Greenhouse, J. B., Sheftall, A. H., Fabio, A., Campo, J. V., & Kelleher, K. J. (2010). Changes in suicide rates by hanging and/or suffocation and firearms among young persons aged 10-24 years in the United States: 1992-2006 . Journal of Adolescent Health, 46(5), 503-505.
Résumé: We examined changes in suicide rates among 10-24-year-olds in the United States from 1992 to 2006. The overall suicide rate and the rate by firearms, poisoning, and other methods declined markedly, whereas the hanging/suffocation rate increased significantly from 1992 to 2006. This increase occurred across every major demographic subgroup, but was most dramatic for females.

Kim, N., Mickelson, J. B., Brenner, B. E., Haws, C. A., Yurgelun-Todd, D. A., & Renshaw, P. F. (2010). Altitude, gun ownership, rural areas, and suicide . American Journal of Psychiatry, 168(1), 49-54.
Résumé: Objective: The authors recently observed a correlation between state altitude and suicide rate in the United States, which could be explained by higher rates of gun ownership and lower population density in the intermountain West. The present study evaluated the relationship between mean county and state altitude in the United States and total age-adjusted suicide rates, firearm-related suicide rates, and non-firearm-related suicide rates. The authors hypothesized that altitude would be significantly associated with suicide rate. Method: Elevation data were calculated with an approximate spatial resolution of 0.5 km, using zonal statistics on data sets compiled from the National Geospatial-Intelligence Agency and the National Aeronautics and Space Administration. Suicide and population density data were obtained through the Centers for Disease Control and Prevention (CDC) WONDER database. Gun ownership data were obtained through the CDC's Behavioral Risk Factor Surveillance System. Results: A significant positive correlation was observed between age-adjusted suicide rate and county elevation. Firearm and non-firearm suicide rates were also positively correlated with mean county elevation. Conclusions: When altitude, gun ownership, and population density are considered as predictor variables for suicide rates on a state basis, altitude appears to be a significant independent risk factor. This association may be related to the effects of metabolic stress associated with mild hypoxia in individuals with mood disorders.

Warren-Gordon, K., Byers, B. D., Brodt, S. J., Wartak, M., & Biskupski, B. (2010). Murder followed by suicide: A newspaper surveillance study using the New York Times Index . Journal of Forensic Sciences, 55(6), 1592-1597.
Résumé: Murder–suicide is a relatively uncommon event but as reported by the New York Times, it has occurred and continues to occur yearly. Previous research has indicated that those who commit murder–suicides tend to be men, are in or have been in an intimate relationship with the victim, victims tend to be women, and a firearm is most likely to be used. This study uses a newspaper surveillance methodology to examine such cases. Articles from the New York Times as found in the New York Times Index were coded, analyzed, and examined. The cases, 166 in total, support the findings from prior research. The trend data was examined by cross tabulations and chi-square analysis. The findings suggest that murder–suicides are rare events and when they occur they usually involve a male perpetrator and an intimate partner victim who is either a wife or girlfriend with the event occurring in a private home. A firearm is the most commonly used method for both murders and suicides, particularly if there was more than one murder victim. The authors conclude by suggesting that future research should focus on using the forthcoming data resource in the CDC’s National Violent Death Reporting System (NVDRS) to examine the occurrence of murder–suicide.

Karch, D. L., Logan, J., & Patel, N. (2011). Surveillance for violent deaths --- national violent death reporting system, 16 States, 2008 . MMWR Surveillance Summary, 60(10), 1-54.
Résumé: Problem/Condition: An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 U.S. states for 2008. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. Reporting Period Covered: 2008. Results: For 2008, a total of 15,755 fatal incidents involving 16,138 deaths were captured by NVDRS in the 16 states included in this report. The majority (58.7%) of deaths were suicides, followed by homicides and deaths involving legal intervention (i.e. deaths caused by police and other persons with legal authority to use deadly force, excluding legal executions) (26.4%), deaths of undetermined intent (14.5%), and unintentional firearm deaths (0.4%). Suicides occurred at higher rates among males, American Indians/Alaska Natives, non-Hispanic whites, and persons aged 45--54 years. Suicides occurred most often in a house or apartment (70.6%) and involved the use of firearms (51.5%). Suicides were precipitated primarily by mental health (45.4%), intimate partner (30.9%), or physical health problems (22.6%), or by a crisis during the preceding 2 weeks (27.9%). The majority of homicides involved the use of a firearm (65.8%) and occurred in a house or apartment (52.5%) or on a street/highway (21.3%). Interpretation: This report provides a detailed summary of data from NVDRS for 2008. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected adults aged <55 years, males, and certain minority populations. For homicides and suicides, relationship problems, interpersonal conflicts, mental health problems, and recent crises were among the primary precipitating factors. Public Health Action: For the occurrence of violent deaths in the United States to be better understood and ultimately prevented, accurate, timely, and comprehensive surveillance data are necessary.

Sillito, C. L., & Salari, S. (2011). Child outcomes and risk factors in U.S. homicide-suicide cases 1999–2004 . Journal of Family Violence, 26 (4), 285-297.
Résumé: Intimate partner homicide-suicide (IPHS) represents the most severe form of domestic violence, and often results in multiple fatalities. This paper examines outcomes of children in households that experience IPHS. Reports of 325 IPHS cases among adults age 18–44 in the U.S. between 1999 and 2004 were collected and examined. Results indicate children were often fatally wounded, but were most likely to witness the event then be absent or killed. Difficult financial conditions during times of economic downturn may increase the possibility of stress related suicide, and subsequent familicide. Children with a suicidal parent are at increased risk of harm, so identification is of vital importance. Children are most likely harmed or killed by a primarily suicidal male perpetrator, who is usually their biological father. Firearms were used more than other methods in IPHS events. Even those perpetrators with protective orders more often utilized a firearm, which reflected a weakness in Violence Against Women Act gun ban enforcement. In this research, regions of the U.S. with less stringent firearm regulations were disproportionately likely to contain IPHS events. Findings illustrate the importance of making distinctions among perpetrators of IPHS, and assessing firearms policies, in order to improve child death prevention efforts.

Johnson, R. M., Frank, E. M., Ciocca, M., & Barber, C. W. (2011). Training mental healthcare providers to reduce at-risk patients' access to lethal means of suicide: evaluation of the CALM Project . Archives of Suicide Research, 15(3), 259-264.
Résumé: The objective of this study was to evaluate the "CALM" (Counseling on Access to Lethal Means) training, in which community-based mental health care providers were trained to work with at-risk clients and their families to assess and reduce access to lethal means of suicide, including firearms. In 2006, CALM trainers conducted workshops in 7 community-based mental health care centers in New Hampshire towns. Participants completed a post-test immediately after the workshop and a follow-up questionnaire approximately 6 weeks later. At follow-up, 65% reported that they had counseled clients' parents about access to lethal means (n = 111). Findings also indicate that the workshop influenced participants' attitudes, beliefs, and skills regarding conducting lethal means counseling.

Khubchandani, J., Wiblishauser, M., Price, J. H., & Thompson, A. (2011). Graduate Psychiatric Nurse's Training on Firearm Injury Prevention. Archives of Psychiatric Nursing, 25(4), 245-252.
Résumé: Psychiatric nurses should be uniquely positioned for helping to prevent firearm suicides and homicides among the mentally ill. This study assessed the prevalence of firearm injury prevention training in graduate psychiatric nursing training programs through a three-wave mail survey of program directors. Most (87%) of the directors reported that they had not seriously thought about providing firearm injury prevention training. Almost half (48%) reported they did not routinely screen patients for firearm ownership. In addition, most (66%) thought that the American Psychiatric Nurses Association (APNA) should provide curriculum guidelines regarding firearm injury prevention training. Leadership is needed by the APNA to help reduce firearm violence in the mentally ill.

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