Fellow Stanford University School of Medicine Stanford, California, United States
Background: The rate of firearm suicide in young people has increased by 53% in the US over the last decade. The increased risk of suicide that results from a child living in a home with a gun has been estimated by a handful of psychological autopsy studies from the 1990s. These studies determined firearm exposure by asking next of kin about the presence of guns in the home. We mitigate the potential reporting bias by using administrative data about lawful adult handgun ownership. Objective: This case-control study estimates the odds that a child who lives in a home with a handgun will die by suicide compared with a child who lives in a handgun-free home. Design/Methods: We conduct a case-control study with cases consisting of minors in California who died by suicide between 2005 and 2021. Controls consist of California minors who died of malignancies during the same period. Official individual-level firearm purchasing records were used to assess whether the child resided in a home with one or more handgun owners. We report mortality odds ratios from logistic regression models that adjusted for children’s sex, race, and age, as well as the rurality, socio-economic status, and crime rate in the minor’s place of residence. Results: [Analyses completed to date are from 2005 to 2016 and include approximately 1/2 of the total sample size.] The preliminary analytic sample comprised 749 cases (mean age 15.9 years, 47.5% white, 68.2% male) and 1826 controls (mean age 9.8 years, 35.0% white, 54.4% male). Among the cases, 204 were firearm suicides. Children living in homes with handguns were at higher risk of suicide (Odds Ratio [OR] 1.7; 95% Confidence Interval [CI], 1.2 to 2.4). This elevated risk was attributable to higher odds of firearm suicide (OR 4.5; 95% CI, 2.9 to 7.1); odds of suicide by other methods did not differ between the two groups (OR 0.9; 95% CI, 0.6 to 1.5).
Conclusion(s): Children living in homes with handguns were almost twice as likely to die by suicide, compared with children in homes without handguns, and more than 4 times as likely to die by firearm suicide. Greater awareness of this risk could motivate passage of gun safety legislation, particularly child access prevention laws. It may also prompt adults living in homes with children to divest or refrain from purchasing firearms. Slide1.jpeg
