Rising longitudinal trajectories in suicide rates: The role of firearm suicide rates and firearm legislation

- Decrease in firearm suicide associated with decreasing overall suicide rate
- Decrease in firearm suicide not offset by increases in suicide by other methods
- States with background checks laws have less severe trajectories of suicide rates.
- States with waiting period laws have less severe trajectories of suicide rates.
- Legislation may mitigate risk for increasing suicide rates at the state level.

Firearms account for approximately half of all US suicide deaths each year despite being utilized in only a small minority of suicide attempts. We examined the extent to which overall suicide rates fluctuated relative to firearm and non-firearm suicide rates across a period of 16 years (1999-2015). We further tested the notion of means substitution by examining the association between firearm suicide rates and non-firearm suicide rates. Lastly, we examined the extent to which the presence of specific laws related to handgun ownership previously shown cross-sectionally to be associated with lower suicide rates (universal background checks, mandatory waiting periods) were associated with an attenuated trajectory in suicide rates across the study period. As anticipated, whereas decreases in firearm suicide rates were associated with decreases in overall suicide rates (b = 0.46, SE = 0.07, p < 0.001), decreases in firearm suicides were not associated with off-setting increases in suicides by other methods (b = − 0.04, SE = 0.05, p = 0.36). Furthermore, the absence of universal background check (b = 0.12, SE = 0.05, p = 0.028) and mandatory waiting period (b = 0.16, SE = 0.06, p = 0.008) laws was associated with a more steeply rising trajectory of statewide suicide rates. These results mitigate concerns regarding means substitution and speak to the potential high yield impact of systematically implemented means safety prevention efforts focused on firearms.