Carrying Firearms and Suicide Risk Among Adolescents.

Importance: Firearms are the most lethal method of suicide across all ages, with case fatality rates exceeding 90%, warranting urgent public health concern. Understanding how carrying of firearms by adolescents and suicide risk vary by race and ethnicity and by stringency of state firearm laws may inform prevention strategies. Objective: To determine whether the carrying of firearms is associated with suicide attempts among adolescents and whether this association differs by race and ethnicity and by strength of state firearm laws. Design, Setting, and Participants: This secondary data analysis of a cross-sectional study of the 2023 state-level combined high school Youth Risk Behavior Survey (YRBS) was performed from August 19 to October 26, 2025. Data were collected during the 2023 YRBS administration, fielded between Fall of 2022 and Fall of 2023, with most state surveys conducted during Spring 2023. Participants included adolescents from 15 states who self-reported firearm carrying, suicide attempts, and race and ethnicity. States with greater than 30% missing data on firearm carrying or 100% missing suicide attempt data were excluded. All percentages are survey weighted to reflect the complex sampling design. Main Outcomes and Measures: The main outcome was self-reported suicide attempt in the past 12 months (any attempt vs no attempt). Results: A total of 23 232 high school students (mean [SD] age, 15.8 [1.2] years; 50.5% female; 29.8% Hispanic, 9.7% non-Hispanic Black, 46.6% non-Hispanic White, and 13.9% other race or ethnicity) from 15 US states were included in the analysis. Of these, 1161 adolescents (5.0%) reported carrying a firearm and 2236 (9.6%) reported a past-year suicide attempt. Among firearm carriers, 284 (27.4%) reported a suicide attempt compared with 1952 of 22 071 noncarriers (9.4%). After adjustment for race and ethnicity and state firearm law strength, the adjusted odds ratio for suicide attempts among adolescents who carried firearms was 3.48 (95%, CI, 2.59-4.69) (P < .001). Each 10-point increase in strength of state firearm law was associated with 6.7% lower odds of suicide attempts (adjusted odds ratio, 0.93 [95% CI, 0.87-0.99]; P = .03). The YRBS did not capture means used in attempts; carrying of firearms was associated with increased risk of suicide attempts by any method. Conclusions and Relevance: In this cross-sectional study of 23 232 high school students from 15 US states, firearm carrying was associated with suicide attempts by any method, independent of sex, grade in school, race and ethnicity, and state firearm laws. The disproportionately high prevalence among Black adolescents who carried firearms raises urgent health equity concerns, underscoring the need for multilevel prevention.