Veteran suicide rates mirror, but do not account for, elevated suicide rates among the general population in US cultures of honor

Introduction: Veteran total and firearm suicide rates are higher compared to the general population. Among the general population, total and firearm suicide rates are higher in US states deemed cultures of honor compared to non-honor states, likely because honor states have higher firearm ownership rates and fewer firearm laws. Considering that veterans tend to live in states with fewer firearm laws and that veteran population rates predict both statewide total and firearm suicide rates, it is possible that the elevated suicide rates seen in honor states in part due to those states having a greater presence of veterans compared to non-honor states. Method: Publicly available databases were used to obtain total and firearm suicide rates (per 100 k) for veterans and non-veterans, as well as our covariates (e.g., rurality). Results: Veteran population proportions were higher in honor states than non-honor states. Veteran and non-veteran total and firearm suicide rates were higher in honor states compared to non-honor states. Statewide differences in all four suicide rates were indirectly explained by honor states having higher firearm ownership than non-honor states. Conclusions: These findings add to a growing body of literature showing that enacting firearm regulations may be a viable public health approach for preventing suicide.