Two Decades of Suicide Prevention Laws: Lessons from National Leaders in Gun Safety Policy

988 Suicide & Crisis Lifeline

If you or someone you know is in crisis, please call or text 988, or visit 988lifeline.org/chat to chat with a counselor from the 988 Suicide and Crisis Lifeline, previously known as the National Suicide Prevention Lifeline. The 988 Suicide and Crisis Lifeline provides 24/7, free, and confidential support to people in suicidal crisis or emotional distress anywhere in the US.

Key Findings

• Gun suicide has been rising consistently in the US since 1999. 
• But residents of some states have fared far better than others. In states with the strongest gun safety laws, gun suicide rates decreased over the past two decades, while states with the weakest laws saw a 39 percent increase.  
• If all US states had experienced the same trend in their gun suicide rate from 1999 to 2022 as the eight states with the strongest gun safety laws, approximately 72,000 fewer people would have died by gun suicide. 
• Strong gun laws, some that restrict access to guns for individuals in crisis, have not resulted in increases in suicide using other methods. This challenges the notion that individuals intent on attempting suicide, when gun access is blocked, will find another way to die.
• In states with the most protective secure gun storage laws, the rate of gun suicide among young people ages 10 to 24 was lower in 2022 than in 1999. In states with no secure storage laws, the rate increased 36 percent. 
• Just over half of adult suicides in the US are with a gun. For children and minors ages 10 to 17 years old, that proportion is 43 percent—not nearly as low as one might expect given that minors cannot legally buy or own handguns. 

Gun Suicides Are on the Rise, but Not Everywhere: Gun Safety Policies Matter

Nearly six in 10 gun deaths in the United States are suicides—accounting for the majority of fatal incidents of gun violence each year.¹Everytown Research analysis of Centers for Disease Control and Prevention, National Center for Health Statistics. WONDER Online Database, Provisional Mortality Statistics. Average: 2018 to 2022. Today, the rate of firearm suicides is at an all-time high.²Johns Hopkins Bloomberg School of Public Health, “CDC Provisional Data: Gun Suicides Reach All-time High in 2022, Gun Homicides Down Slightly from 2021,” July 27, 2023, https://publichealth.jhu.edu/2023/cdc-provisional-data-gun-suicides-reach-all-time-high-in-2022-gun-homicides-down-slightly-from-2021. Over the last two decades, the rate of gun suicides in the US overall increased by 29 percent.³Everytown Research analysis of CDC, WONDER, 1999–2022. Age-adjusted rate. However, this trend is not consistent across US states. What is driving these increases, and where are they occurring? 

The dynamics of suicide are complex and there is no one single cause. But research has increasingly confirmed that a combination of several risk factors is often present in the lead up to suicide. These known risk factors are current life stressors, such as relationship problems, unemployment or financial problems, bullying, alcohol and substance use disorders, or mental health conditions; historical risk factors, such as childhood abuse or trauma, a previous suicide attempt, or a family history of suicide; and access to lethal means of harm such as firearms.⁴American Foundation for Suicide Prevention, “Risk Factors and Warning Signs,” accessed August 3, 2023, https://afsp.org/risk-factors-protective-factors-and-warning-signs/. Suicide risk greatly increases when these three factors coincide to create a sense of hopelessness and despair. 

Out of all the various ways to address these risks, removing access to firearms is one of the easiest and quickest ways to intervene—by keeping guns out of the hands of people experiencing crises.

In order to understand the wide variability in state-level firearm suicide rates, Everytown has examined the role of state gun safety policies. In this research, suicide data comes from the Centers for Disease Control and Prevention (CDC)⁵Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Mortality 1999–2020 and Provisional Mortality 2018–2022 on CDC WONDER Online Database, accessed on August 8, 2023. and the status of state gun safety laws comes from Everytown’s Gun Law Rankings. These rankings, updated annually, score every state based on the strength of 50 key gun safety policies and group states into five categories, from strongest to weakest: (1) national leaders, (2) making progress, (3) missing key laws, (4) weak systems, and (5) national failures.

Overall in the United States, gun suicide has been tragically increasing, with the rate rising from 6.0 to 7.7 gun suicides per 100,000 from 1999 to 2022.⁶CDC, WONDER, 1999–2022. Age-adjusted rate. Against this national increase, Everytown found that a state’s gun suicide rate depends heavily on the strength of its gun safety policies. The eight states with the strongest gun safety laws—those ranked as national leaders—saw a 4 percent decrease over this period.⁷CDC, WONDER, 1999–2022. Age-adjusted rate. Everytown’s Gun Law Rankings are updated annually. In its 2023 rankings, used in this analysis, national leaders were: California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, and New York. These states currently have a core group of foundational laws proven to reduce gun suicide in place, including background checks and/or purchase permitting on all gun sales, Extreme Risk laws, and secure gun storage requirements. Background checks for gun sales by unlicensed sellers and some type of secure storage legislation have been in place since at least 1999 for all eight states (except for New York, which adopted a secure storage policy in 2019 and Illinois in 2000). Most of these states have also had strong minimum age requirements (21 years) for handgun possession for at least two decades (New York, New Jersey, Massachusetts, Illinois, and Maryland) and five have required waiting periods for handgun sales (California, Hawaii, Illinois, Maryland, and New Jersey), since at least 1999. Extreme Risk laws are newer; Connecticut adopted the first of these laws in 1999; the next Extreme Risk law adopted by a national leader (California) took effect in 2016. In sharp contrast, the 14 states with the weakest gun safety laws—those ranked as national failures—experienced a consistent rise in their gun suicide rate, with a 39 percent climb overall from 1999 through 2022.⁸Everytown Research analysis of CDC, WONDER, 1999–2022. Age-adjusted rate. National failures include Alaska, Arizona, Arkansas, Georgia, Idaho, Kansas, Kentucky, Mississippi, Missouri, Montana, New Hampshire, Oklahoma, South Dakota, and Wyoming. Only one of these 14 states has even one of the core group of foundational laws—including background checks and/or purchase permitting, Extreme Risk laws, and secure gun storage requirements.

Policy Matters: Comparing Gun Suicide Rates in States with Strong vs. Weak Gun Safety Laws

Source: CDC, WONDER, age-adjusted rates, 1999–2022 (accessed August 8, 2023); Everytown for Gun Safety Support Fund’s Gun Law Rankings, 2023.

Nearly all of the states ranked as national leaders have had bedrock gun safety laws in place since at least 1999—including laws requiring background checks on all gun sales and some type of secure gun storage policy. Most have also had strong minimum age requirements for handgun possession and waiting period laws for over two decades. These four types of laws are among the most promising for reducing suicides.⁹RAND Corporation, “How Gun Policies Affect Suicide,” updated January 10, 2023, https://www.rand.org/research/gun-policy/analysis/suicide.html. In contrast, the states with the weakest gun safety laws—the 14 national failure states—lack all of these basic gun safety measures. 

72,000

If all US states had the same gun suicide trend as states with the strongest gun laws, 72,000 fewer lives would have been taken by gun suicide over the past two decades.

Everytown Research calculations using CDC WONDER annual percentage change in unadjusted gun suicide rate among national leaders from 1999–2022 for each state. Number of additional deaths equals number of observed deaths minus number of projected deaths.

Failing to take action on common-sense gun safety legislation has implications for the number of  lives taken by suicide. If all US states had experienced the trend of national leaders from 1999 through 2022, over 72,000 fewer people would have died by gun suicide during this two-decade period.¹⁰Everytown Research calculations applying the annual percentage change in the unadjusted gun suicide rate among national leaders from 1999 to 2022 to each state. First, the change from 1999 to 2000 was applied to each state’s rate in 1999. Then subsequent percentage changes among national leaders were applied to this rate to further project state trends through 2022. The number of observed and projected deaths were calculated from annual rates and population counts. The number of additional deaths (i.e., 72,000) equaled the number of observed deaths minus the number of projected deaths. If in a given year the observed state rate was lower than the projected rate, the projected rate was set equal to the observed rate.

Only states with the strongest gun safety laws saw a decrease in gun suicide rates.

Another essential conclusion from these trends is that while the rates of total suicide and gun suicide differed markedly among leading and failing states, rates of suicide by all other means did not. There is a common misperception that if one means for suicide is unavailable or restricted, a suicidal individual will find an alternative means. This perspective misses research showing that suicidal crises are often short-lived, with the vulnerable period lasting sometimes only minutes or an hour.¹¹Harvard T.H. Chan School of Public Health, “Duration of Suicidal Crises,” accessed August 4, 2022, https://www.hsph.harvard.edu/means-matter/means-matter/duration/. If there is no access to the most lethal method of suicide—a gun—a life could be saved. Nearly all other methods (such as hanging, poisoning, or drug overdose) are less lethal, making an attempt less likely to result in death. Of suicide attempts using a gun, 90 percent result in death; by comparison, only 4 percent of suicide attempts by other means are fatal.¹²Andrew Conner, Deborah Azrael, and Matthew Miller, “Suicide Case-Fatality Rates in the United States, 2007 to 2014: A Nationwide Population-Based Study,” Annals of Internal Medicine 171, no. 12 (2019): 885–95, https://bit.ly/3mvEhj6. And the vast majority of those who survive a suicide attempt do not go on to die by suicide.¹³Robert Carroll, Chris Metcalfe, and David Gunnell, “Hospital Presenting Self-Harm and Risk of Fatal and Non-Fatal Repetition: Systematic Review and Meta-Analysis,” PLOS ONE 9, no. 2 (February 28, 2014): e89944, https://doi.org/10.1371/journal.pone.0089944; David Owens, Judith Horrocks, and Allan House, “Fatal and Non-Fatal Repetition of Self-Harm: Systematic Review,” British Journal of Psychiatry 181, no. 3 (2002): 193–99, https://doi.org/10.1192/bjp.181.3.193.

Strong gun laws, some that restrict access to guns for individuals in crisis, have not resulted in increases in suicide using other methods.

Our finding that in states with the strongest gun safety laws—some that block access to guns for people in crisis—people do not then die by another means of suicide, reinforces the conclusion of other researchers: that laws that keep guns out of the hands of those experiencing crises are some of the quickest and most effective ways to reduce suicide in America.¹⁴Cassandra K. Crifasi et al., “Effects of Changes in Permit-to-Purchase Handgun Laws in Connecticut and Missouri on Suicide Rates,” Preventive Medicine 79 (2015): 43–49, https://doi.org/10.1016/j.ypmed.2015.07.013; Aaron J. Kivisto and Peter Lee Phalen, “Effects of Risk-Based Firearm Seizure Laws in Connecticut and Indiana on Suicide Rates, 1981–2015,” Psychiatric Services 69, no. 8 (August 2018): 855–62, https://doi.org/10.1176/appi.ps.201700250; Jeffrey W. Swanson et al., “Implementation and Effectiveness of Connecticut’s Risk-Based Gun Removal Law: Does It Prevent Suicides?” Law and Contemporary Problems 80 (2017): 179–208; Daniel W. Webster et al., “Association Between Youth-Focused Firearm Laws and Youth Suicides,” Journal of the American Medical Association 292, no. 5 (2004): 594–601; Michael D. Anestis, Joye C. Anestis, and Sarah E. Butterworth, “Handgun Legislation and Changes in Statewide Overall Suicide Rates,” American Journal of Public Health 107, no. 4 (April 2017): 579–81, https://doi.org/10.2105/AJPH.2016.303650; Michael Luca, Deepak Malhotra, and Christopher Poliquin, “Handgun Waiting Periods Reduce Gun Deaths,” Proceedings of the National Academy of Sciences of the United States of America 114, no. 46 (14 2017): 12162–65, https://doi.org/10.1073/pnas.1619896114. Put simply, strong gun safety laws reduce the overall suicide rate.

Secure Storage Laws and Youth Gun Suicides

Firearms are the leading cause of death among American youth, and firearm suicides account for more than 4 in 10 of these deaths.¹⁵Everytown Research analysis of CDC, WONDER, Provisional Mortality Statistics, 2022. Gun suicides account for 43 percent of all suicides among youth 10–17 and 52 percent of all suicides among young people 10–24. The Everytown Gun Law Rankings used above provide a score based on 50 gun safety laws. Secure storage laws in particular have great promise for decreasing gun suicide among young people. There is evidence that these laws reduce gun suicides, specifically among youth, by holding gun owners accountable for failing to store their firearms securely, with the goal of preventing children from accessing them.¹⁶RAND Corporation, “The Effects of Child-Access Prevention Laws,” updated January 10, 2023, https://www.rand.org/research/gun-policy/analysis/child-access-prevention.html.   

While the provisions in secure gun storage laws vary from state to state, in 2023, over half of US states had some form of secure storage law, which creates liability for gun owners when children can or do access an unsecured gun. These states can be grouped into two categories based on the strength of their secure storage laws—from most protective to least: 

1. laws that require a gun owner to secure their firearms at all times when they are not in their immediate possession or control¹⁷Not in possession: Massachusetts (1998). For the purposes of this analysis, states were categorized into groups based on the timing of their secure storage law in relation to the time period of interest (1999–2022), rather than on the basis of current policy. or if a child may or is likely to access¹⁸Likely to access: California (does access 1992–2013, likely to access 2014), District of Columbia (not in possession at least since 1990, likely to access 2009), Minnesota (1993), Virginia (1991). For the purposes of this analysis, states were categorized into groups based on the timing of their secure storage law in relation to the time period of interest (1999–2022), rather than on the basis of current policy. an unsecured gun; and
2. laws that penalize a gun owner if a child does access an unsecured gun.¹⁹Does access: Nevada (does access 1991–2018, likely to access 2019), Connecticut (does access 1990–2022, not in possession2023), Delaware (1994), Florida (1989), Hawaii (1992), Illinois (2000), Iowa (1990), Maryland (does access 1992–2022, likely to access 2023), New Hampshire (2001), New Jersey (1992), North Carolina (1993), Rhode Island (1995), Texas (1995), Wisconsin (1992). For the purposes of this analysis, states were categorized into groups based on the timing of their secure storage law in relation to the time period of interest (1999–2022), rather than current policy.

Several other states have laws that apply only if a gun owner intentionally or recklessly gives a child access to a gun. These laws are not considered secure storage laws because they apply in such limited circumstances. These states are grouped with the remaining states, which have no law at all.²⁰Reckless/intentional or no law: Alabama, Alaska, Arizona, Arkansas, Colorado (likely to access 2021), Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Maine, Michigan (does access 2023), Mississippi, Missouri, Montana, Nebraska, New Mexico (does access 2023), New York (likely to access 2019), North Dakota, Ohio, Oklahoma, Oregon (not in possession 2021), Pennsylvania, South Carolina, South Dakota, Tennessee, Utah, Vermont (does access 2023), West Virginia, Washington (does access 2019), Wyoming. 

CDC data tells us that the firearm suicide rate increased by 30 percent for young people ages 10 to 24 from 1999 through 2022.²¹Everytown Research analysis of CDC, WONDER, 1999–2022. However, this trend was not experienced consistently across the US. The youth firearm suicide rate for this age group increased by 36 percent from 1999 through 2022 in states with no or only reckless access storage laws, whereas in states with the most protective laws, the youth gun suicide rate was 1 percent lower in 2022 than in 1999. If these laws proven to protect young people from accessing guns were in place in every state, it is likely that thousands of families would have been spared the devastation of having a child taken by firearm suicide.  

And again, the trend for suicide by all other means did not diverge nearly as much across states with secure storage laws compared to those without.²²Everytown Research analysis of CDC, WONDER, 1999–2022. Furthermore, for young people, the suicide rate by other means actually decreased during the COVID-19 pandemic.²³Everytown Research analysis of CDC, WONDER, 1999–2022. In contrast, during the pandemic—when youth were more often at home and a record number of families, many for the first time, purchased a firearm²⁴NORC, “One in Five American Households Purchased a Gun During the Pandemic,” press release, March 24, 2022, https://www.norc.org/research/library/one-in-five-american-households-purchased-a-gun-during-the-pande.html.—the gun suicide rate increased to well above 5 per 100,000 young people, higher than ever.²⁵Everytown Research analysis of CDC, WONDER, 1999–2022.

Over the last two decades, states with reckless access or no secure storage laws saw a far greater increase in their gun suicide rate among young people than states with the most protective secure storage laws.

Source: CDC, WONDER, 1999–2022 (accessed August 8, 2023); Everytown for Gun Safety Support Fund’s analysis of secure storage laws. Some states changed laws between 1999 and 2022. One state adopted a “not in possession” law: Oregon (2021). States that adopted a “likely to access” law include California (2014), Nevada and New York (2019), and Colorado (2021). States that adopted a “does access” law include Illinois (2000), New Hampshire (2001), Washington (2019), and Maine (2021). Since 2022, the end year of this analysis, several states have passed new secure storage laws: Connecticut (not in possession, 2023), Maryland, (likely to access, 2023), Michigan (does access, 2023), New Mexico (does access, 2023), and Vermont (does access, 2023).

Conclusion

In 2022, the most recent year of official data on suicide in America, more than half (55 percent) of adult suicides were with a gun; 45 percent were with other methods.²⁶Everytown Research analysis of CDC, WONDER, Provisional Mortality Statistics, 2022. Ages 18 and older. Given this, one would expect that a population that cannot legally purchase or own a handgun—children and young adults up to age 18—would have far lower rates.²⁷Federal law requires a person to be 21 years old to purchase a handgun or 18 to purchase a long gun from a licensed firearm dealer. For purchases from unlicensed sellers, there is an 18-year-old minimum age for handguns and no minimum age for long guns. There are certain limited circumstances in which a child may own a handgun (e.g. a child under 18 may inherit title to a handgun and own the gun but generally cannot have it in their possession until they turn 18). Yet 43 percent of all youth suicides were with a gun.²⁸Everytown Research analysis of CDC, WONDER, Provisional Mortality Statistics, 2022. Ages 10–17. Far too many children and minors can access something they cannot legally buy or own. 

Every year in the United States, more than 25,000 people die from suicide with a firearm—a gun suicide death every 21 minutes.²⁹Everytown Research analysis of CDC, WONDER, Provisional Mortality Statistics. Average: 2018 to 2022. Yet we see from this research that states that have invested in and passed proven gun violence prevention policies— among them, background checks on all gun sales, waiting periods, and secure gun storage laws—are stemming the tide of this skyrocketing public health emergency. More recently, Extreme Risk laws enacted in 21 states as well as many of the provisions in the 2022 federal Bipartisan Safer Communities Act, which provide critical support to states and local communities to prevent firearm suicide, all hold great promise for interrupting the upward firearm suicide trend. By preventing access to the most lethal form of suicide for people during a crisis, and because the vast majority of people who survive a suicide attempt do not go on to die from a later attempt, these policies give people in crisis a second chance at life. 

Acknowledgments

Everytown for Gun Safety Support Fund would like to gratefully acknowledge Ali Rowhani-Rahbar of the University of Washington for his insightful review of this report.