Abstract
Since 2004, the suicide rate among US Army soldiers has exceeded the rate of death from combat injury. It is critical to establish factors that increase the risk of acting on suicidal thoughts to guide early intervention and suicide prevention. To assess whether firearm ownership, use, storage practices, and accessibility are associated with increased risk of suicide. In this case-control study, suicide cases (n = 135) were defined as US Army soldiers who died by suicide while on active duty between August 1, 2011, and November 1, 2013. Next-of-kin and Army supervisors of soldiers who died by suicide (n = 168) were compared with propensity-matched controls (n = 137); those soldiers with a suicidal ideation in the past year (n = 118) provided structured interview data. Data were analyzed from April 5, 2018, to April 2, 2019. Firearm ownership, storage, and accessibility were assessed by using items from the World Health Organization Composite International Diagnostic Interview screening scales along with items created for the purpose of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) study. Among the 135 suicide decedents, next-of-kin reported that they had greater accessibility to firearms compared with propensity-matched controls. Specifically, suicide decedents were more likely to own 1 or more handguns compared with propensity-matched controls (odds ratio [OR], 1.9; 95% CI, 1.0-3.7; χ21 = 4.2; false discovery rate [FDR] P = .08), store a loaded gun at home (OR, 4.1; 95% CI, 1.9-9.1; χ21 = 12.2; FDR P = .003), and publicly carry a gun when not required for military duty (OR, 3.2; 95% CI, 1.4-7.3; χ21 = 7.4; FDR P = .02). The combination of these 3 items was associated with a 3-fold increase in the odds of suicide death (OR, 3.4; 95% CI, 1.2-9.4; χ21 = 5.4; FDR P = .05). Storing a loaded gun with ammunition at home or publicly carrying a gun when not on duty was associated with a 4-fold increase in the odds of suicide death (OR, 3.9; 95% CI, 1.9-7.9; χ21 = 14.1; FDR P = .002). In this study, in addition to gun ownership, ease and immediacy of firearm access were associated with increased suicide risk. Discussion with family members and supervisors about limiting firearm accessibility should be evaluated for potential intervention.
Highlights
The suicide rate among soldiers in the US Army increased substantially during the Afghanistan-Iraq wars, peaked in 2012, and continues to exceed the rate of combat deaths.[1,2] The rise in suicides among US Army soldiers reflects a national issue that extends beyond the military population.[3]
Suicide decedents were more likely to own 1 or more handguns compared with propensity-matched controls
Key Points Question To what extent do firearm ownership, use, accessibility, and storage practices increase suicide risk among US Army soldiers?. In this case-control, psychological autopsy study of 135 soldiers who died by suicide, firearm accessibility was associated with a significant increase in the risk of suicide
Summary
The suicide rate among soldiers in the US Army increased substantially during the Afghanistan-Iraq wars, peaked in 2012, and continues to exceed the rate of combat deaths.[1,2] The rise in suicides among US Army soldiers reflects a national issue that extends beyond the military population.[3]. Since many military service personnel own firearms, keep them in their homes, carry them, and use them regularly, we sought to assess whether increased accessibility to firearms is associated with increased risk of suicide. Among methods used during suicides, firearms are associated with the highest rates of suicide mortality. Hilton et al[6] studied Navy suicides between 1999 and 2007 and reported that accessibility to firearms appeared to influence method selection, given that 69% of decedents with access to military firearms used such a weapon in their fatal suicide attempt compared with 52% of decedents without such access. The authors suggested the importance of firearm training, and they found that 69% of individuals who had received military weapons training used a firearm compared with 49% of those without such training
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