State gun policies affect veteran and civilian suicide rates differently

Veterans die by suicide with firearms at 1.5 times the rate of civilians. State firearm policies show variable effectiveness, but their differential impact on veteran populations remains unclear. Understanding differential associations is critical given veterans' unique firearm relationships.

Analysis used state-level data from 2003 to 2022 examining 12 firearm policies across 49 states. Data sources included CDC WISQARS, National Veteran Suicide Prevention Annual Report, and RAND State Firearm Law Database. Mixed-effects models with state random effects and time trends assessed policy impacts on suicide rates. Interaction analyses (Policy × Population) tested differential associations. State-level analysis examined relationships between policy comprehensiveness and veteran-civilian mortality gaps. Bonferroni correction was applied (α=0.00417).

The analysis included 821 state-year observations from 49 states (2003-2022). Veterans demonstrated higher suicide rates (36.3 per 100,000) compared with the general population (20.1 per 100,000) and greater firearm involvement (67.6% vs. 53.0%). Interaction analysis revealed limited differential policy associations between populations. Only 2 of 12 policies demonstrated differential associations after Bonferroni correction (α=0.00417): local selective preemption showed harmful associations among veterans (+10.11 percentage points, p<0.001), while firearm tracing requirements demonstrated protective associations in the general population (+4.39 percentage points, p=0.001). Geographic disparities in veteran-civilian suicide gaps ranged from 14% (Hawaii) to 162% (Rhode Island). However, no significant correlation was observed between state-level policy comprehensiveness and veteran-civilian gaps (r=.08, 95% CI, -.21 to .35, p=0.583).

Most state firearm policies demonstrated similar associations with suicide rates in both populations, and only 2 of 12 policies showed differential associations. The absence of correlation between policy comprehensiveness and veteran-civilian gaps indicates that policy quality and contextual factors matter more than aggregate policy counts. While evidence-based firearm policies benefit both populations, elevated veteran suicide rates persist across all policy environments, indicating that effective prevention requires integration of policy-level interventions with veteran-specific clinical approaches. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).

Prognostic/epidemiological; Level III.