Mental and Physical Health-Related Risk Factors Among Females Who Died by Firearm Suicide.

Importance: Firearm suicide among females has increased in the past decade; routes for prevention remain unclear. Objective: To identify classes of firearm suicide decedents among females based on preceding mental and physical health-related risk factors for suicide. Design, Setting, and Participants: This cross-sectional retrospective study of females who died by firearm suicide between January 2014 and December 2018 used state-based surveillance data from the National Violent Death Reporting System Restricted Access Database representing 1 or more years of data from all 50 US states, the District of Columbia, and Puerto Rico; data were analyzed from March 2022 to September 2023. A latent class analysis was used to identify and characterize categories of mental and physical health-related factors among females (ie, classes). Exposure: Known mental and physical health-related risk factors for suicide. Main Outcome and Measure: The numbers (percentages) of females who died by firearm suicide across various factors. Results: Of the 8318 female decedents in our sample (mean [SD] age, 47.2 [17.0] years), more than half (4816 of 8318 [57.9%]) had more than 1 risk factor endorsed. Among this subgroup, a 4-class model was identified: (1) alcohol use disorder or substance use disorder (1273 [26.4%]); (2) depression and suicidal thoughts (2289 [47.5%]); (3) physical health problems and pain (1054 [21.9%]); and (4) all conditions (multimorbid; 200 [4.2%]); 3502 (42.1%) could not be classified. Black females made up a higher proportion (244 of 3502 [7.0%]) of the females with a 0 or 1 risk factor endorsed than of the females with multiple risk factors (184 of 4816 [3.8%]). Mental health problems were apparent in 51.7% of the full sample (4303 of 8318), with 28.6% (n = 2376) demonstrating evidence of mental health treatment. More than one-fifth (1766 of 8318 [21.2%]) had physical health problems. More than one-fourth of the full sample (2239 of 8318 [26.9%]) and nearly 40% (505 of 1273 [39.7%]) in class 1 had intimate partner problems before their death. Conclusions and Relevance: In this cross-sectional study of females who died by firearm suicide, meaningfully distinct groups of female firearm suicide decedents were identified. Given the high proportion of females without mental health and physical health problems, it is plausible that many female firearm suicide decedents did not frequently intersect with the health care system before their death. Results suggest opportunities for preventing firearm suicide among females through nonmedical care settings.