The Association of Suicidal Ideation With Firearm Purchasing During a Firearm Purchasing Surge

This survey study assesses the frequency of suicidal ideation among individuals who purchased firearms during the 2020 to 2021 purchasing surge with other firearm owners and non–firearm owners.


Introduction
Throughout 2020 and 2021, the US experienced multiple tumultuous events, including a pandemic, contentious presidential and state elections, and a racial justice movement that arose in response to police brutality toward Black, Indigenous, and other racial and ethnic minority communities.
During and perhaps in response to these events, the US also experienced a surge in firearm sales.
Although it is difficult to determine national firearm sales figures accurately, various groups have provided estimates. For instance, based on background check data, an estimated 2 million firearms were purchased in March 2020, 1 and more than 2.5 million Americans became first-time gun owners during the early months of 2020. 2 The surge in firearm sales continued throughout 2020, with an estimated 23 million firearms sold, 3 an increase from 2019 (13.9 million firearms sold) and 2018 (13.8 million firearms sold). 4 This surge is not only notable because of its scale but also because firearm access is associated with gun violence-related outcomes, including suicide. [5][6][7] Background check data provide a measurement of many legal firearm purchasing efforts; however, they do not necessarily equate to sales, thereby highlighting the need for data that more directly assesses purchasing behavior. Along these lines, a 2021 nationally representative study 8 found that 6% of US residents purchased a firearm between March and mid-July 2020 (individuals purchasing firearms during the surge period), and of these, 34% were first-time purchasers, a rate higher than what is typical. Additionally, research to date examining individuals who purchased firearms for the first time during the surge period has found that nearly 40% of these individuals store at least 1 firearm unlocked, 9 a concerning finding given the risk that accompanies unsafe storage (eg, suicide, unintentional shootings, theft). 10 Notably, a prior study conducted by our team found that individuals purchasing firearms during the surge period had higher rates of lifetime, past-year, and past-month suicidal ideation relative to other firearm owners and non-firearm owners. 11 To our knowledge, this is the only study to date examining this association, and the study did not differentiate between those who did and did not purchase firearms for the first time during the surge. The present study seeks to replicate and expand upon these findings. Specifically, the present study examined rates of lifetime, past-year, and pastmonth suicidal ideation among surge firearm purchasers, other firearm owners, and non-firearm owners. This work extended the findings of our previous survey primarily by comparing the frequency of suicidal thoughts between surge purchasers who acquired their first firearm and surge purchasers who acquired additional firearms. In doing so, the present study examines whether risk is not evenly distributed across all individuals purchasing firearms during the purchasing surge. The present study extends beyond previous work by examining a much larger sample comprising data from 3 specific states: Mississippi, Minnesota, and New Jersey. The states were chosen because they differ widely in geography, demographics, political climate, firearm ownership rates, firearm purchasing laws, gun violence rates, and culture. [12][13][14] Our analyses thus allow for consideration of suicidal thoughts among various firearm owners who live in diverse environments, which are not concentrated in population centers often more heavily represented in national samples. As a secondary, exploratory aim, we will also examine firearm storage practices across firearm ownership groups to determine if surge purchasers overall and first-time firearm owners, in particular, are more prone to unsafe firearm storage. Should our findings demonstrate increased rates of suicidal ideation among surge purchasers more broadly and particularly among first-time firearm owners who purchased during the surge, this would highlight a trend of increasing environmental risk (ie, firearm access) among individuals at greater risk of developing suicidal thoughts.

Methods
This survey study followed the American Association for Public Opinion Research (AAPOR) reporting guideline. All procedures were approved by the institutional review board at Rutgers University Health Sciences. Participants provided informed consent by selecting a box online indicating they understood the information in the consent document and agreed to participate, and they were compensated in the form and amount they agreed upon when they joined the panel (eg, airline miles, points at preferred retail outlets, cash, gift cards).

Participants and Procedures
Participants included 6404 US residents recruited from 3 states-New Jersey (n = 3197), Minnesota (n = 1789), and Mississippi (n = 1418)-between January and June 2021 using Qualtrics Panels, an online survey platform that maintains a database of millions of US residents. Potential participants were informed that the primary aims of the study were to examine methods individuals use to keep themselves and their loved ones safe and to understand factors that influence the decision to obtain a firearm.

Measures Demographics
Demographic information was collected via items examining age, sex, race, annual household income, employment status, and status as an essential worker. Race and ethnicity were classified by participants and defined by the investigators. These variables were included to help assess the representativeness of the sample. Essential worker status was assessed by asking if they had been considered an essential worker at any point during COVID-19. We then asked participants to indicate what profession caused them to be labeled an essential worker. Essential worker status was included to control for the frequency with which individuals were required to spend time outside of their home and thereby potentially exposed to 1 or more of the events that characterized 2020 and the first half of 2021 (eg, COVID-19, the presidential election, racial justice protests, and increases in gun violence).

Firearms
Firearm ownership was assessed using a single item asking if they currently owned a firearm. Surge purchasing status was assessed using a single item that asked if they had purchased a firearm since March 2020. An additional question was asked to individuals who had purchased a firearm during the surge-was the firearm(s) purchased since March 2020 the first firearm(s) they had ever acquired.
Firearm storage practices were assessed by asking firearm owners which of the following storage procedures they used for the firearms currently located in or around their homes. Answer choices included a gun safe, a locking device (eg, trigger lock or cable lock), hidden in closet or drawer unloaded, and hidden in closet or drawer loaded.

Suicidal Ideation
Suicidal ideation was assessed via the self-report version of the Self-injurious Thoughts and Behaviors Interview-Revised (SITBI-R). 15 The SITBI-R assesses suicidal ideation by asking participants which, if any, of 8 different suicide-related thoughts they have experienced in their lifetime, the past  year, and the past month. An individual was considered to have experienced suicidal ideation for a specific period if they endorsed any of the 8 suicide-related thoughts during that timeframe.

Statistical Analysis
Between-group differences on lifetime, past-year, and past-month suicidal ideation rates were examined first in a series of χ 2 analyses and then in a series of binary logistic regressions. In 1 series of regressions, surge firearm purchasers, other firearm owners, and non-firearm owners were compared for each of the 3 outcomes. In the second series of regressions, established firearm owners who purchased additional firearms during the surge were compared with first-time firearm owners who purchased during the surge on each of the 3 outcomes. Covariates included age, sex, Black racial identity, White racial identity, annual household income, past 12-month job loss, and status as an essential worker. Differences in storage practices were assessed using a series of χ 2 analyses, with φ serving as an effect size index.

Discussion
The primary aim of this study was to examine rates of suicidal ideation among first-time and established surge firearm purchasers, other firearm owners, and non-firearm owners. Additionally, we aimed to examine this within 3 states that vary widely in terms of their residents' demographic and cultural backgrounds, geographic location, the strictness of their firearm legislation, and their rates of firearm ownership and gun violence. Our results were largely consistent with our hypotheses and thus highlight that individuals who purchased firearms since March 2020-in contrast to other firearm owners and non-firearm owners-were associated with experiencing suicidal thoughts at an elevated frequency.
These findings echo those from our prior study, 11 but expand upon them in several ways. First, we differentiated between established firearm owners who purchased additional firearms during the purchasing surge and those who became firearm owners for the first time during that timeframe.
Across all analyses, first-time owners were more likely than established owners to report lifetime and past-year suicidal thoughts in both univariate (φ, 0.21-0.35) and multivariate (OR, 2.12-4.12) analyses.
However, this difference only held for past-month suicidal thoughts in the univariate analyses. Abbreviation: OR, odds ratio. a Given differences between the 3 states in terms of rurality, zip code data was recoded to calculate population density, which was then used to categorize rural or urban status. In univariate analyses, rural or urban status was associated with all 3 suicidal ideation outcomes as well as with the firearm groups. Primary analyses were rerun including this variable as a covariate. In these multivariate analyses, the results were unchanged, and rural or urban status was not associated with any outcome. Thus, the variable in the primary analyses was not included.
These findings suggest that individuals who decided to become firearm owners during the 2020 to 2021 purchasing surge exhibit a higher risk for suicidal thoughts than typical firearm owners.
As such, the introduction of environmental risk (ie, the presence of a firearm) becomes substantially more dangerous because the odds of within-individual risk (active suicidal thoughts) coinciding with that environmental risk become far greater over time. The fact that suicidal thoughts were particularly common among surge purchasers who became first-time firearm owners is an important consideration given data demonstrating an elevated suicide rate in the months following the first acquisition of a firearm. 16 Thus, these findings speak to several vital points for intervention. First, a heavy emphasis on safe firearm storage and temporary firearm storage away from home during times of stress must be articulated to the customer at the point of sale to prompt behavior that mitigates environmental risk. This approach, which emphasizes harm reduction, needs to be supplemented with practical tools, such as information about safe firearm storage options, incentives for both retailer and consumer to purchase safe storage equipment, and information about where firearm owners can legally and temporarily store firearms outside the home. 17,18 In terms of policy, lawmakers may want to consider safe storage bills. A study by the RAND Corporation reported that implementation of child access laws, a specific form of safe storage legislation, exhibited a particularly strong association with subsequent decreases in firearm deaths. 19 Additional policy-based changes worth considering in light of these findings include purchasing delays (eg, waiting periods) and mandating suicide risk screening questions during firearm purchases.
Furthermore, these findings highlight the potential value in incentivizing the acquisition of alternative modes of home protection (eg, home alarm systems). This approach, which emphasizes upstream prevention, would acknowledge the motivation for feeling safe at home while offering options that include lower risk profiles.
In our exploratory analyses, we examined storage practices across firearm ownership groups.
Surge purchasers were more likely than other firearm owners to use locking devices (eg, cable locks, trigger locks) and less likely to store unloaded firearms hidden in a closet or drawer. Among surge purchasers, first-time firearm owners were more likely than established firearm owners to use locking devices and less likely to store loaded firearms hidden in a closet or drawer or to use gun safes. These results cannot provide a comprehensive picture of storage habits because we could not assess the complete storage tendencies for each firearm owned by each participant. Nonetheless, the picture that emerged from these data does not indicate that first-time or established firearm owners who purchased during the surge period were associated with storing their firearms less safely than other firearm owners. Considered within the context of the suicidal ideation findings, our findings suggest that those most vulnerable to suicidal thoughts are not maintaining the most ready access to their firearms. However, it is worth noting that all groups of firearm owners endorsed fairly low rates of safe firearm storage, thereby highlighting the importance of increasing the implementation of safe storage practices across firearm ownership communities.

Limitations
This study had limitations. First, using quota sampling rather than probability-based sampling limits generalizability and precludes us from providing estimates of firearm purchasing rates in each state.
Second, these findings are based on self-report and have not been validated. Third, we were unable to determine whether the firearms purchasers during the surge represented the first firearms in the home or merely represented the first firearm that the respondents considered to be their own. This information has implications for how to design interventions and prevention efforts.

Conclusions
In this study, individuals who purchased a firearm during the 2020 to 2021 purchasing surge were more likely than other firearms owners and non-firearm owner to have experienced suicidal thoughts. We believe the results of this survey study provide important information that highlights