State handgun purchase age minimums in the US and adolescent suicide rates: regression discontinuity and difference-in-differences analyses

Abstract

ObjectiveTo evaluate the association between US state policies that establish age 18 or 21 years as the minimum purchaser age for the sale of handguns and adolescent suicide rate.DesignRegression discontinuity and difference-in-differences analyses.Setting46 US states without policy changes between 2001 and 2017; Missouri and South Carolina, which lowered the age for handgun sales in 2007 and 2008, respectively; and West Virginia and Wyoming, which increased the age for handgun sales in 2010.ParticipantsAdolescents aged 13 to 20 years(554 461 961 from 2001 to 2017) in the regression discontinuity analysis, and adolescents aged 18 to 20 years (168 934 041 from 2002 to 2014) in the main difference-in-differences analysis.Main outcome measureSuicide rate per 100 000 adolescents.ResultsIn the regression discontinuity analysis, state policies that limited the sale of handguns to those aged 18 or older (relative to 21 or older) were associated with an increase in suicide rate among adolescents aged 18 to 20 years equivalent to 344 additional suicides in each state where they were in place between 2001 and 2017. In the difference-in-differences analysis, state policies that limited the sale of handguns to those aged 21 or older were associated with 1.91 fewer suicides per 100 000 adolescents aged 18 to 20 years (95% confidence interval −3.13 to −0.70, permutation adjusted P=0.025). In the difference-in-differences analysis, there were 1.83 fewer firearm related suicides per 100 000 adolescents (−2.66 to −1.00, permutation adjusted P=0.002), with no association between age 21 handgun sales policies and non-firearm related suicides. Separate event study estimates indicated increases in suicide rates in states that lowered the age of handgun sales, with no association in states that increased the age of handgun sales.ConclusionsA clear discontinuity was shown in the suicide rate by age at age 18 in states that limited the sale of handguns to individuals aged 18 or older. State policies to limit the sale of handguns to individuals aged 21 or older were associated with a reduction in suicide rates among adolescents. Increases in suicide rates were observed after states lowered the age of handgun sales, but no effect was found in states that increased the age of handgun sales.

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“…All mortality data is drawn from WHO [6]. The three civil forms of violent lethal whenever or wherever used and known to be associated with young adult suicides in the USA, [7][8][9][10][11]. Moreover, this link between suicide and easy access of guns has long been known to be associated with gun bearing occupations in other Western countries [18][19][20] made especially dangerous by the impetuosity of Youth.…”

“…Several American studies have shown that at State level there is a strong correlation between access to guns and deaths [9,[23][24]. Whilst in most American States eighteenyears old can legally purchase guns [10,25]. which reflects the fact that there are more guns in the USA than people-1205per 100,000…”

“…But there is another `public health' aspect. Most 15-24-year-old suicide and homicide victims will have parents, who will have experienced the reality of every parent's nightmarethat their child should pre-deceases them, creates a massive mental health burden [10,[13][14][15]. To evoke change in the USA strong factbased language is needed.…”

“…We build upon an earlier study that examined the extent of gun violence in the USA, with a special focus upon Youths aged 15-24 years old [4], as it is known this is an age of peak violence both as victims and perpetrators [5][6]. Moreover, it is known firearms are a major method of completed suicide in America even including under 18-year-olds [7][8][9][10][11][12]. The juxtaposition of transport deaths, seen here as a form of violent death may be challenged as such deaths were unintentional, yet it…”

Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death

“…However, some of the policies with a meaningful demonstration of reducing adolescent suicide are state policies that promote safe firearm ownership and reduce access to those at risk of suicide. Higher minimum ages for firearm ownership and concealed carry (> 21), permit-to-purchase laws, minimum waiting periods for purchase, and child access prevention laws are associated with lower rates of adolescent suicide [ 97 – 99 ]. Many professional medical, surgical, and trauma societies support the implementation of such policies that have the potential to meaningfully reduce suicide through policies promoting safe firearm ownership [ 100 ].…”