Are We Missing Something Pertinent? A Bias Analysis of Unmeasured Confounding in the Firearm-Suicide Literature

Epidemiologic Reviews
M MillerD Azrael

Abstract

Despite the magnitude and consistency of risk estimates in the peer-reviewed literature linking firearm availability and suicide, inferring causality has been questioned on the theoretical basis that existing studies may have failed to account for the possibility that members of households with firearms differ from members of households without firearms in important ways related to suicide risk. The current bias analysis directly addresses this concern by describing the salient characteristics that such an unmeasured confounder would need to possess in order to yield the associations between firearm availability and suicide observed in the literature when, in fact, the causal effect is null. Four US studies, published between 1992 and 2003, met our eligibility criteria. We find that any such unmeasured confounder would need to possess an untenable combination of characteristics, such as being not only 1) as potent a suicide risk factor as the psychiatric disorders most tightly linked to suicide (e.g., major depressive and substance use disorders) but also 2) an order of magnitude more imbalanced across households with versus without firearms than is any known risk factor. No such confounder has been found or even suggested. The...Continue Reading

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Citations

Feb 26, 2016·Epidemiologic Reviews·Daniel W WebsterPhilip J Cook
Feb 13, 2016·American Journal of Epidemiology·Magdalena Cerdá
Sep 15, 2018·Journal of Nursing Scholarship : an Official Publication of Sigma Theta Tau International Honor Society of Nursing·Therese S Richmond, Matthew Foman
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Dec 20, 2017·Injury Epidemiology·Emily C ClevelandMatthew Miller
Jul 16, 2020·Injury Prevention : Journal of the International Society for Child and Adolescent Injury Prevention·Carmel SalhiMatthew Miller
May 16, 2020·Injury Prevention : Journal of the International Society for Child and Adolescent Injury Prevention·Sonja A SwansonMatthew Miller
Dec 21, 2021·Annals of Internal Medicine·Matthew MillerDeborah Azrael

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