A recent study in JAMA Network Open adds to the evidence that gun ownership, of both handguns and long guns, is associated with youth suicide rates. Researchers examined the rates of youth suicide in Missouri before and after changes in firearm laws that loosened restrictions on buying and carrying firearms.

Figure. Missouri gun dealers-such as Joe Gilbert, shown in the gun shop he manages in Columbia, Missouri-are being enlisted in new state efforts to reduce suicide, as six of every 10 suicides in Missouri involve a firearm. Gilbert has attended training on how to spot suicidal customers and displays brochures with safety and hotline information. Photo by Cristina M. Fletes / (C) St Louis Post-Dispatch / Polaris.

In 2007 Missouri removed a requirement that individuals obtain a permit to purchase before buying firearms. This loosening of state control over gun ownership was followed in 2011 by a lowering of the minimum age requirement from 23 to 21 years. In 2014, legislators lowered it further to 19 years, meaning anyone 19 years and older can own and carry a firearm without a permit.

The researchers found that suicide rates among adolescents in Missouri, which had declined between 1999 and 2009, began to rise in 2010. The rate increased rapidly from 2.63 per 100,000 adolescents in 2009 to 9.23 per 100,000 in 2018. The repeal of the permit-to-purchase law was associated with a 22% increase in firearm suicides and the lowered age requirement was associated with a 32% increase, regardless of educational level, economic status, or whether the person lived in a rural or urban area. The researchers controlled for factors associated with adolescent suicide, such as suicidal ideation, symptoms of depression, and drug and alcohol misuse.

Firearms are the most lethal method of suicide. A 2019 Annals of Internal Medicine study of suicide case-fatality rates found that, while one in 12 acts of suicide were fatal overall, nine in 10 were fatal when a firearm was used. Suicide nationwide is on the rise among children and young adults ages 10 to 24-the rate increased 57% from 2007 to 2018, according to the Centers for Disease Control and Prevention. The authors of the Missouri firearm study note that the time between thinking of suicide and the suicidal act can be as short as 10 minutes; thus, easy access to a weapon can be the difference between life and death for a distressed young person.

The American Academy of Pediatrics continues to advocate for "the strongest possible legislative and regulatory approaches to prevent firearm injuries and deaths" (in a 2012 policy statement that was reaffirmed in 2016) and recommends that all health care professionals counsel parents about the danger guns pose to children inside and outside the home.-Karen Roush, PhD, RN, FNP-BC, news director