Weaker gun state laws are associated with higher rates of suicide secondary to firearms

Rodrigo F. Alban, Miriam A Nuno, Ara Ko, Galinos Barmparas, Azaria V. Lewis, Daniel R. Margulies

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background Firearm-related suicides comprise over two-thirds of gun-related violence in the United States, and gun laws and policies remain under scrutiny, with many advocating for revision of the regulatory map for lawful gun ownership, aiming at restricting access and distribution of these weapons. However, the quantitative relationship between how strict gun laws are and the incidence of firearm violence with their associated mortality is largely unknown. We therefore, sought to explore the impact of firearm law patterns among states on the incidence and outcomes of firearm-related suicide attempts, utilizing established objective criteria. Methods The National Inpatient Sample for the years 1998-2011 was queried for all firearm-related suicides. Discharge facilities were stratified into five categories (A, B, C, D, and F, with A representing states with the most strict and F representing states with the least strict laws) based on the Brady Campaign to prevent Gun Violence that assigns scorecards for every state. The primary outcomes were suicide attempts and in-hospital mortality per 100,000 populations by Brady state grade. Results During the 14-year study period, 34,994 subjects met inclusion criteria. The mean age was 42.0 years and 80.1% were male. A handgun was utilized by 51.8% of patients. The overall mortality was 33.3%. Overall, 22.0% had reported psychoses and 19.3% reported depression. After adjusting for confounding factors and using group A as reference, there were higher adjusted odds for suicide attempts for patients admitted in group C, D, and F category states (1.73, 2.09, and 1.65, respectively, all P < 0.001). Conclusions Firearm-related suicide attempt injuries are more common in states with less strict gun laws, and these injuries tend to be associated with a higher mortality. Efforts aimed at nationwide standardization of firearm state laws are warranted, particularly for young adults and suicide-prone populations. Level of evidence III. Study type Trauma Outcomes study.

Original languageEnglish (US)
Pages (from-to)135-142
Number of pages8
JournalJournal of Surgical Research
StatePublished - Jan 1 2018
Externally publishedYes


  • Brady state scorecard
  • Firearms
  • Gun laws
  • Mortality
  • Suicide

ASJC Scopus subject areas

  • Surgery


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