摘要：Objectives. To characterize firearm ownership and storage practices in Washington State and assess their relationship with suicide risk factors. Methods. Using Washington State Behavioral Risk Factor Surveillance System data for 2013 to 2016, we conducted survey-weighted multivariable Poisson regression models to obtain prevalence ratios (PRs) and confidence intervals (CIs). Results. Of 34 884 adult respondents, 34.3% (95% CI = 33.7%, 35.0%) reported a firearm in their household, among whom 36.6% (95% CI = 35.4%, 37.7%) stored their firearm locked and unloaded. There were no differences in mental health indicators by firearm ownership or storage practice status. Binge and chronic alcohol use were somewhat more prevalent among adults from firearm-owning households (PR = 1.2; 95% CI = 1.1, 1.3; PR = 1.2; 95% CI = 1.1, 1.4, respectively) and among those living in households not practicing safe storage (PR = 1.4; 95% CI = 1.2, 1.7; PR = 1.9; 1.5, 2.3, respectively). Conclusions. Variability in mental health does not explain the substantial increased suicide risk among individuals in firearm-owning households. Greater prevalence of alcohol misuse among adults in firearm-owning households not practicing safe storage highlights the need for suicide prevention interventions. In the United States, suicide is a leading cause of death, with nearly half of those deaths involving a firearm. 1 Several ecological studies have found a relationship between population-level firearm ownership and suicide rates. 2–4 Using varying levels of aggregation in defining geographic regions, these studies have found an association at state and US census region levels. At the individual level, multiple case–control studies have identified strong associations between home firearm ownership and suicide for all members of the household. 5,6 Some have raised the possibility that the increased suicide risk among individuals from firearm-owning households may be mainly attributable to their differential baseline suicide risk, rather than the presence of a firearm in the home. 7 Numerous studies have indirectly addressed this concern by examining potential differences in suicide risk factors between homes with and those without firearms. 8–14 Several of those studies have found no significant differences in mental illness or substance use between members of firearm-owning versus nonowning households, 8–11 although a few studies have observed some differences. 12–14 Methodological work has shown that any such observed differences are insufficient to fully explain the strong association (i.e., an overall 300%–400% increased risk) between living in a firearm-owning household and suicide. 15 Some of these studies focused explicitly on adults with children in the home. 12 Other investigations used data from the General Social Survey, National Comorbidity Survey Replication, and Primary Care Research in Substance Abuse and Mental Health for the Elderly study from the early 1990s to the mid-2000s, all of which found no relationship between mental health and firearm ownership. 9,11,14 Among firearm-owning households, unsafe storage practices (keeping firearms unlocked or loaded) have been associated with a greater risk of firearm suicide among both youths and adults. 5,16,17 Less is known about the relationship between safe storage practice and suicide risk factors. A few studies observed that home firearm access and unsafe storage practices were similarly common among households with youths who had and those who did not have mental illness, 10,18 suggesting that efforts are not being taken to limit these young people’s access to lethal means. Although 1 study found a negative association between safe storage laws and rates of firearm suicide at the state level, 19 our knowledge of the relationship between firearm storage practices and mental illness among adults is severely limited. Suicide is known to be an impulsive decision, with 1 study finding that nearly half of suicide attempt survivors reported less than 10 minutes between the first occurrence of a thought of suicide and their subsequent attempt. 20 Although adults likely have the ability to unlock or load household firearms, delaying an individual’s access to lethal means may be beneficial in preventing suicide. 21 To our knowledge, the most recent Behavioral Risk Factor Surveillance System (BRFSS) data used to examine the relationship between firearm ownership and suicide risk factors date to 2004, 22,23 and the relationship between storage practice and suicide risk factors has not been previously studied using these data. Using data from BRFSS in Washington State, we conducted an investigation to (1) characterize adult residents by their household firearm ownership and storage practice status, (2) provide an updated analysis of the association of household firearm ownership with suicide risk factors, and (3) examine associations between household firearm storage practices and suicide risk factors. On the basis of previous studies, we postulated that the scope and nature of firearm ownership can meaningfully vary by factors such as urbanicity, veteran status, and the presence of children in a home. Because these factors themselves are potentially associated with the risk of suicide, we sought to examine the prevalence of suicide risk factors by firearm ownership status across levels of these variables. Previous studies have also indicated that firearm ownership and the risk of suicide can vary by sociodemographic characteristics; male gender, middle age, unemployment, and living alone are all associated with increased rates of suicide. 2,24–26 Our overarching goal was to add contemporary information to the literature about the association of firearm ownership and storage practices with suicide risk factors. This information can in turn further inform the policy and practice pertaining to suicide prevention.
