By Julie E. Angerhofer; Maricela Cruz, Jennifer Shaw, Christine Stewart,  Artie Runkle, Erika Wolter, et al.

Firearms are the most common means of suicide in the United States and a leading cause of death among all persons aged 10–64 years. Most persons who die by suicide see a clinician in the year preceding their death; thus, health care encounters are important opportunities for suicide prevention. Persons who die by firearm suicide differ demographically and clinically from those who die by other suicide means, suggest ing that opportunities for prevention might also differ between these groups. This report examined patterns of health care use in the year preceding suicide death to identify potential oppor tunities for prevention among persons who died by firearm suicide and those who died by other means of suicide. State cause-of-death records for 2020–2022 were linked to electronic health records from health systems in Alaska (Southcentral Foundation) and Colorado and Washington (both Kaiser Permanente). Quarterly past-year health care use preceding death was examined across service settings, including primary care, outpatient mental health specialty care, emergency care, and inpatient care. During 2020–2022, across the three health systems, 683 persons died by suicide. The majority of these deaths (54.6%) occurred by firearm. Patterns of past-year health care use preceding suicide were similar for persons who died by firearm and other suicide means, with the exception of mental health care, which was significantly lower in specialty and primary care settings. These findings suggest that many persons who die by firearm suicide do not access mental health care before their death. Suicide prevention practices in health care, designed to help identify and engage persons at risk in supportive care, need to reach beyond mental health encoun ters, particularly for firearm suicide prevention. 

By Jason Corburn, Yael Nidam and Amanda Fukutome-Lopez

Urban gun violence is a critical human health and social justice issue. Strategies to reduce urban gun violence are increasingly being taken out of the domain of police and into community-based programs. One such community-driven gun violence reduction program analyzed here is called Advance Peace. Advance Peace (AP) uses street outreach workers as violence interrupters and adult mentors to support the decision making and life chances of those at the center of urban gun violence. We reported on the impact Advance Peace had on gun violence and program participants in the City of Sacramento, California, from 2018–2019. Using an interrupted time series model, we attributed a gun violence reduction of 18% city wide and up to 29% in one of the AP target neighborhoods from the intervention. We also found that of the 50 participants in the Advance Peace Sacramento program 98% were alive, 90% did not have a new gun charge or arrest, 84% reported an improved outlook on life, all received cognitive behavioral therapy, and 98% reported that their AP outreach worker was one of the most important adults in their life. Advance Peace is a viable community-driven, urban gun violence, and healing-focused program.