A multi-state evaluation of the association between mental health and firearm storage practices

Abstract

Firearm storage method is a potentially modifiable risk factor for suicide. Using data from a large, multi-state survey, we sought to determine whether there is an association between mental health and household firearm storage practices, and characterize that association by state of residence. Participants who endorsed the presence of a household firearm and answered the mental health questions in the 2016-2017 Behavioral Risk Factor Surveillance System from eight states were included (n=26,949). Exposures were recent poor mental health (≥14 vs. 0-13 days/past month), and diagnosis of depression. Outcomes were household firearm storage practices (loaded, and both loaded and unlocked). Using Poisson regression, we calculated adjusted prevalence ratios (aPR) overall and stratified by state of residence. Of adults endorsing a household firearm, 35.1% reported storing a firearm loaded, and of those, 53.4% reported that the firearm was both loaded and unlocked. Neither recent poor mental health nor depression was associated with loaded (aPR 1.14 [95% CI: 0.95-1.37] and aPR 0.94 [95% CI 0.80-1.09], respectively) or loaded and unlocked (aPR 1.08 [95% CI 0.88-1.42] and aPR 1.04 [95% CI 0.88-1.22], respectively) firearm storage. In the setting of highly prevalent loaded firearm storage, no differences in storage practices by mental health indicators were observed across eight states despite disparate firearm policies and local culture. The lack of difference in storage practices by mental health indicators across several states highlights an opportunity to improve means safety counseling practices, and the need for dedicated evaluation of state-level firearm storage policies.

Keywords: Injury prevention; firearm; means safety; mental health; suicide.

Figure 1.

Number of respondents who answered each of the firearm module questions, Behavioral Risk Factors Surveillance System (BRFSS), 2016-2017. Per the BRFSS questionnaire, those who responded “No” to a question in the firearm module were asked no further questions in the module.

Figure 2.

Association of recent poor mental health and depression diagnosis with presence of a loaded household firearm (n=26,627), Behavioral Risk Factors Surveillance System, 2016-2017. Numbers represent weighted prevalence of individuals reporting the presence of a loaded household firearm for each exposure group. Prevalence ratios (aPR) adjusted for age, sex, race/ethnicity, education level, employment status, marital status, veteran status, health insurance status, and presence of at least one child in the household.

Figure 3.

Association of recent poor mental health and depression diagnosis with presence of a loaded and unlocked household firearm, among those reporting presence of a loaded household firearm (n=8,810), Behavioral Risk Factors Surveillance System, 2016-2017. Numbers represent weighted prevalence of individuals reporting the presence of a loaded and unlocked household firearm for each exposure group. Prevalence ratios (aPR) adjusted for age, sex, race/ethnicity, education level, employment status, marital status, veteran status, health insurance status, and presence of at least one child in the household.