Firearm Storage and Carrying Practices and Suicidal Behaviors in US Army Service Members.

Importance: Suicide is a critical public health crisis for military personnel; firearms are the predominant suicide method among military service members. Objective: To examine associations of firearm storage and carrying behaviors with suicidal behaviors within a large, cross-sectional sample of US Army soldiers who own personal firearms, after controlling for known suicide risk factors. Design, Setting, and Participants: This cross-sectional study used data from participants in the Army Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study Wave 2 (STARRS-LSWS) survey (collected April 2018 to July 2019). Analyses were conducted from June 2022 through January 2025. Main Outcome and Measures: Self-reported suicidal behaviors were assessed with the Columbia-Suicide Severity Rating Scale. Firearm storage and carrying practice survey items were created for the STARRS-LSW2. Stressful life events items were adapted from the Life Events Questionnaire and the US Department of Defense Health-Related Behaviors Survey. Sociodemographic, Army career, and mental health disorders data were obtained from the military medical record. Multivariable logistic regression examined 30-day, 12-month, and lifetime suicidal ideation and suicide attempt. Analyses used weighted samples to account for oversampling, underrepresentation, and nonresponse. Results: The total sample of 12 022 soldiers consisted of 6561 firearm owners (54.5%) and 5461 soldiers who did not own firearms (45.4%). Participants were primarily male (10 096 [83.6%]), with a mean (SD) age of 32 (7) years. Unsecured firearm storage (loaded and unlocked) compared with secure storage (eg, unloaded) was associated with increased suicide ideation risk across all time frames: 30-day (odds ratio [OR], 1.63; 95% CI, 1.27-2.10), 12-month (OR, 1.61; 95% CI, 1.27-2.03), and lifetime (OR, 1.44; 95% CI, 1.22-1.70). Firearm owners with unsecured storage were more likely to report a suicide attempt in the past 12 months (OR, 4.93; 95% CI, 1.80-13.51). Carrying a weapon other than a firearm (eg, a knife, mace, or a club) was also associated with increased suicide attempt risk in the past 12 months (OR, 10.42; 95% CI, 2.89-37.54). Conclusions and Relevance: In this retrospective cross-sectional study, unsecured firearm storage practices were significantly associated with increased suicide risk across all time frames, after controlling for lifetime mental health disorders and history of stressful life events. Carrying a weapon other than a firearm was also associated with heightened suicide risk. The findings suggest firearm storage and carrying behavior of any weapon, not just firearms, may indicate heightened suicide risk among military service members.