Loaded and Not Locked: The Link Between Firearms Access and Youth Suicide

AFFIRM Research

Every day, three young people between the ages of 10 and 19 die by firearm-related suicide.1 Also concerning is that 7.4% of students in grades 9 through 12 say that they have attempted suicide in the last year.2

Most suicides take place at home, and 81% of adolescents who die by firearm suicide use a parent’s or relative’s firearm.3 In fact, the risk of dying by suicide is 4 to 10 times greater in a home with guns.4

“The availability of firearms is contributing to an increase in the actual number of suicides, not just leading youth to substitute other means of suicide for guns,” says emergency medicine resident and AFFIRM leader Dr. Anita Knopov, the lead author of a study on the topic published in the American Journal of Preventive Medicine.1 The study found that the strongest single predictor of a state’s youth suicide rate is the number of homeowners who own guns in that state.1

Suicide rates among children and young adults are climbing and many are using firearms as the means to an end. Safer gun storage can help stop this trend.


What Can We Do?

Nearly 2 million children in the United States live in homes in which firearms are left loaded or unlocked – or both.4 It’s important for clinicians, parents, educators, legislators, community members, and other stakeholders to fully understand the association between household gun ownership and youth suicide. Limiting firearm access in homes with children and young adults – particularly those with a history of self-harm and mental illness – is essential.

Strategies for reducing access to firearms during high-risk periods include:5

  • Storing firearms in another home during times that a family member is at risk for suicide
  • Storing firearms safely at home if it is not possible to move them somewhere else
  • Working with leaders in the gun community to develop educational messages about relocating or safely storing guns
  • Increasing screening for and counseling about access to guns among high-risk patients by health professionals and other gatekeepers


What Does Safer Storage Look Like?

Experts recommend that firearms be kept unloaded and stored away from locked ammunition, or that each firearm be locked using a firearm cabinet, lockbox, or cable or trigger locks.6 There are several types of trigger locks, but in general, a trigger “shoe” fastens around the trigger or its housing to prevent it from being used.7 Cable locks block the part of the gun that loads, fires, and unloads the ammunition.7 Research shows providing these devices free to firearms owners improves storage practices.6 Much like providing free medication or immunizations, providing free firearm safety devices also improves consumer compliance.


What Parents Can Do

If you have guns in your home, ensure that they are stored safely, away from children. Here’s how:4, 8

  • Unloaded firearms should be stored in a locked cabinet, safe, gun vault, or storage case. Take the necessary measures to ensure children and teens cannot access the keys or combinations to these locations.
  • If you choose to keep a firearm for security, you will want to be able to reach it quickly but prevent others from using it. Biometric safes or cases that only open with your fingerprint or other physical identifier are acceptable options.
  • Gun-locking devices make firearms unusable and can be used in addition to locking up guns. Cable locks should not be used as a substitute for safer firearm handling and storage methods. While these locks try to prevent young children from using the gun, they are not highly secure devices.
  • If firearms are taken apart, parts should be kept locked in separate places.
  • Ideally, ammunition should be stored and locked away from guns.
  • Double-check that firearms are unloaded when you remove them from storage.
  • Do not keep loaded, unlocked guns in your car.
  • Just as you would ask another parent about pools or allergens in their home, you can help protect your child at playdates by asking about access to unsecured guns.


What Clinicians Can Do

A growing number of physicians have committed to asking their patients about the presence of guns in the home.9 There currently is no federal or state legislation that prevents physicians from asking about firearms if that information is related to the safety of the patient or others.10 Research shows that patients are more open to discussions about firearm safety when clinicians focus on the safety of children in the home.10 Conversations should be respectful and tailored to involve the family, taking into consideration any local cultural norms.10 The goal is not just to ask, but to inform.

Researchers advise adding context to discussions. For example, adding a safer storage question to your routine screening for household hazards or risky behaviors. Here’s a sample dialog:10

“Are any firearms kept in or around your home?”

If the answer is “Yes,” two follow-up questions are important:

  • “Do any of these firearms belong to you personally?”
  • “Are any of these firearms stored loaded and not locked away?”

Teen suicide is often an act of opportunity. Physicians can help prevent a rash decision from resulting in loss of life by educating patients and parents about the risks associated with having unlocked guns in the home. Together, we can help stop this trend.


Key Statistics

  • Three young people between the ages of 10 and 19 die by firearm-related suicide every day.3
  • More than 7% (7.4%) of students in grades 9 through 12 say have attempted suicide.4
  • The risk of dying by suicide is 4 to 10 times greater in a home with guns.6
  • Nearly 2 million children in the United States live in homes in which firearms are left loaded or unlocked – or both.6



  1. Langbecker, Richard. “Youth Suicides More Prevalent in States with Higher Gun Ownership: SPH: Boston University.” School of Public Health, January 17, 2019. https://www.bu.edu/sph/2019/01/17/youth-suicides-more-prevalent-in-states-with-higher-gun-ownership/.
  2. “Suicide Statistics.” American Foundation for Suicide Prevention, April 16, 2019. https://afsp.org/about-suicide/suicide-statistics/.
  3. Johnson, Renee M., Catherine Barber, Deborah Azrael, David E. Clark, and David Hemenway. “Who Are the Owners of Firearms Used in Adolescent Suicides?” Suicide and Life-Threatening Behavior 40, no. 6 (December 2010): 609–11. https://doi.org/10.1521/suli.2010.40.6.609.
  4. Schaechter, Judy. “Guns in the Home.” HealthyChildren.org, June 5, 2018. https://www.healthychildren.org/english/safety-prevention/at-home/pages/handguns-in-the-home.aspx.
  5. “Reducing Suicides by Firearms.” American Public Health Association, November 13, 2018. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/28/reducing-suicides-by-firearms.
  6. Rowhani-Rahbar, Ali, Joseph A. Simonetti, and Frederick P. Rivara. “Effectiveness of Interventions to Promote Safe Firearm Storage.” Epidemiologic Reviews, January 13, 2016, mxv006. https://doi.org/10.1093/epirev/mxv006.
  7. Horman, B. G. (2016, April 14). 6 Ways to Safely Store Your Firearms. Retrieved October 17, 2019, from https://www.nrafamily.org/articles/2016/4/14/6-ways-to-safely-store-your-firearms/.
  8. Project ChildSafe, Inc. (2018). Safe Storage. Retrieved from https://www.projectchildsafe.org/safety/safe-storage.
  9. Annals of Internal Medicine. (n.d.). What You Can Do to Stop Firearm Violence. Retrieved from https://annals.org/aim/pages/commitment-to-stop-firearm-violence.
  10. Wintemute GJ, Betz ME, Ranney ML. Yes, You Can: Physicians, Patients, and Firearms. Ann Intern Med. 2016;165:205–213. https://doi: 10.7326/M15-2905.

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