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Relaxing of Missouri Firearm Laws Linked to Increased Youth Suicide Rates


A loosening of Missouri’s permit-to-purchase and concealed carry firearm laws may have contributed to increased rates of firearm suicides among young residents, according to a recent study published in JAMA Network Open.

A loosening of Missouri’s permit-to-purchase (PTP) and concealed carry firearm laws may have contributed to increased rates of firearm suicides among young residents, according to a recent study published in JAMA Network Open.

CDC data show suicide was the second leading cause of death for children and young adults aged 10 to 24 years in 2017, while rates of mood disorders and suicide-related outcomes have been on the rise among this age group over the last decade.

In 2017, Missouri ranked sixth in the nation in firearm deaths. Over 58% of suicide deaths also involve firearms. “Firearm-related deaths are the second leading cause of death in Missouri children aged 1 to 17 years,” the authors wrote, adding, “In 2018, every 4 days a young person in Missouri died by suicide via firearm.”

Missouri currently has some of the least restrictive gun laws in the United States. For example, private possession of firearms is permitted without a license, although it is unlawful to sell or give a firearm to any individual under the age of 18 without parental consent. In addition, buyers of firearms in private sales are not required to pass official background checks before taking possession of a firearm, there is no established waiting period for a firearm purchase to be completed, and current regulations do not have written specifications for safe storage of private firearms and ammunition, the authors explained.

In 2007, the state removed a requirement for gun owners to have a state PTP license for concealable firearms, while in 2011, Missouri lowered the legal age to obtain a concealed carry permit from 23 to 21. That age limit was further reduced to 19 in 2014. “Finally, in 2017, a law was enacted that allowed for permit-less carry for all gun owners in most public places. Currently in Missouri, any person at least age 19 years may carry a firearm in plain view (ie, open carry) or in hidden view (concealed carry) in most places without a permit," the authors noted.

To evaluate the association of the repeal of the PTP law and changes in the concealed carry law with firearm-related suicides, the researchers conducted a cross-sectional study on young Missouri residents.

Two separate analyses were carried out to investigate firearm suicide rates between those aged 14 to 18 (youth/adolescent) and those aged 19 to 24 (young adults). Analyses considered the pre-intervention period as all years before a firearm law change for which data were available. Outcomes that took place in postintervention years (or until the next law change) were also evaluated.

Individually reviewed state laws were used to determine control states in the analyses. Death certificate data were gleaned from the CDC Web-based Injury Statistics Query and Reporting Systems. Both age group analyses were controlled for state-level factors such as rurality, unemployment rates, and education attainment.

Overall, the researchers found:

  • From 1999 to 2009, firearm suicide rates in the adolescent group were steadily declining in Missouri, starting at 5.58 per 100,000 individuals in 1999 down to 2.63 in 2009
  • From 2010 to 2018, firearm suicide rates in the adolescent group steadily increased to 9.23 per 100,000 in 2018
  • From 2014 to 2017, rates of suicide by firearms increased, peaking at 16.22 per 100,000 people in 2017
  • Repeal of the PTP law was associated with a 21.8% increase in firearm suicide rates in young adults
  • Lowering the minimum age of concealed carry to 19 years in Missouri was associated with a 32.0% increase in firearm suicide rates and a 29.7% increase in nonfirearm suicide rates in adolescents aged 14 to 18 years
  • Minimum age lowering was also associated with a 7.2% increase in firearm suicide rates in young adults aged 19 to 24 years

Previous studies have found an association between gun ownership and youth suicide rates. In particular, “handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm, [and] 82% of firearm-related suicides among young people involved a household member’s firearm.”

Furthermore, a recent report published in Injury Epidemiology documented the high prevalence of long gun (rifle and shotgun) use in youth and rural suicide rates. The study found that from 2003 to 2018, 28.4% of gun suicides in Maryland resulted from long guns. That proportion jumped to 51.6% in rural counties compared with just 16.8% in urban counties.

In the current study, repeal of the PTP license law may have led to increased access to firearms among those living with young, high-risk individuals, prompting the sudden increase in firearm suicide rates and reduction in nonfirearm suicide rates observed in the young adult group, the researchers hypothesized. These individuals may have been otherwise screened out at the local sheriff’s office.

The law changes may have also inspired younger individuals to purchase firearms because they could now carry a concealed weapon, leading to increased numbers of guns in circulation. “For many individuals attempting suicide, the time between suicidal ideation and attempt can be as little as 10 minutes,” authors wrote. “Increased access to lethal means during periods of distress or impulsivity may unfortunately lead to a completed suicide in this age group.”

The researchers noted they cannot be certain about other policies in the control states related to firearms, public health, or mental health that may have impacted suicide rates, marking a limitation to the study. Covariates in the young adult cohort related to depression or substance use were also not reflected in the study.

“Our findings show that changes in Missouri’s PTP law and concealed carry law were associated with increases in firearm suicide rates in young Missouri residents aged 14 to 24 years,” the authors concluded.


Bhatt A, Wang X, Cheng A, et al. Association of changes in Missouri firearm laws with adolescent and young adult suicides by firearms. JAMA Netw Open. 2020;3(11):e2024303. doi:10.1001/jamanetworkopen.2020.24303

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