Substance Use, Firearm Availability, Depressive Symptoms, and Mental Health Service Utilization Among White and African American Suicide Decedents Aged 15 to 64 Years

Purpose We investigated whether the substance use problems of excessive alcohol consumption and marijuana use, firearm availability, depressive symptoms, and mental health service utilization, differed among white and African American suicide decedents compared with natural cause-of-death decedents. Methods The subjects were a representative sample of 22,957 deceased individuals aged 15 years or older from the 1993 US National Mortality Followback Survey (NMFS). A matched case–control study was constructed for suicide decedents aged 15 to 64 years, with natural death controls frequency matched to cases by age and gender. Conditional logistic regression analysis was used to examine the associations of risk factors with suicide by race. Results When compared with natural causes of death, suicide deaths among white decedents were associated with use of mental health services, heavy drinking, marijuana use, depression symptoms, and firearm availability. Suicides by African American decedents were associated only with use of mental health services, marijuana, and firearm availability. The interaction of mental health service use and marijuana use was significant only for white suicide decedents. Conclusion This study contributes to the limited understanding of how risk factors unique to suicide differ, and possibly interact, among African American and white decedents. Similarities and differences in risk factors should be considered in suicide prevention planning efforts.