Data Systems

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The absence of information about gun ownership has been a major

stumbling block for ecological and individual-level studies of suicide as well

as for studies of homicide and other gun-related crime. In order to better

understand these associations, it would be useful to collect individual-level

information about gun ownership in studies of suicidal behavior, as well as

information about suicidal behavior in studies of legal and illegal gun use.

Indeed, because FS/S should not be used as a proxy measure for gun ownerFIREARMS

ship in ecological studies of suicide, the further understanding of the association

between firearms and suicide will be particularly dependent on the

availability of direct information about gun ownership. Potentially valuable

state-level information could be made available through the regular inclusion

of gun ownership questions in the Behavioral Risk Factor Surveillance

System, and a better understanding of the possible linkage between household

gun ownership and adolescent risk-taking might come from the regular

inclusion of household gun ownership questions, in addition to the

existing adolescent gun use questions, in the Youth Risk Behavior Surveillance

System.

At the moment, the U.S. vital statistics system is the only source of

nationally representative information about lethal self-injuries. This system

sets important limitations on present knowledge. The proposed National

Violent Death Reporting System, now being piloted in six states with funding

from the Centers for Disease Control and Prevention, could provide

more information about demographic background, intent, circumstances,

precipitants, method of injury, and source of the firearm (in the case of gun

suicides) than is presently available. In this regard, it may be a much more

significant improvement for the study of suicide than for the study of

homicide, for which similar national data systems are already available.

But there are potential problems that should be considered in the planning

of such a system, which might affect the overall usefulness of the final

result (see Chapter 2 for further details). Data systems that collect information

about a series of cases (such as the recording of injuries or deaths)

cannot be used without an appropriate comparison group to make valid

inferences about the association between exposures and outcomes. Will the

data be collected in a way that would permit such comparisons? This might

be accomplished by using the injury surveillance system in the way that

cancer registries are now used, as a source of cases for case-control or

record-linkage studies of the risk factors for the designated outcome. Will

the data system collect sufficiently complete and reliable information about

relevant exposures? It would be helpful to develop the NVDRS system with

several specific research questions in mind, to ensure that the system will

actually be usable, and will actually be used.

Improved Individual-Level Studies

The committee recommends further individual-level studies of the link

between firearms and both lethal and nonlethal suicidal behavior. It would

be useful to have an ongoing, longitudinal study that determines both

predictors of gun ownership and other known risk factors for suicidal

thoughts, nonlethal suicidal behaviors, and completed suicide. Added detail

about method choice and correlates of gun ownership would help to clarify

the possible link between household gun ownership and intentional injury.

In light of findings from previous case-control studies, sources of ascertainment

bias, factors influencing impulsivity, and confounding and modifying

factors other than psychiatric diagnosis should receive special attention.

Several strategies might be used to overcome sources of reporting bias in

psychological autopsy study designs. Administrative and medical records

may be used to supplement individual interviews, and questionnaire designs

and computer-assisted interview strategies developed to investigate sensitive

topics, such as illegal drug use and adolescent sexual behavior, may

serve as models.