Adolescent Predictors of Firearm Suicide Over Four Decades of Life in U.S. Men

Introduction: There are meager individual-level data on long-term predictors of firearm suicide. Methods: This was an analysis of males (N=189,558) in the Project Talent cohort, a national probability sample of high school schools in 1960 when students completed a baseline Project Talent self-report inventory. Mortality follow-up was contingent on survival until 1979, the onset of the National Death Index when the cohort had a mean age of 35.7 years. Mortality follow-up continued until death or age 75 years, reached by all surviving members by 2018. Analyses were conducted in 2022, with the main outcome being firearm suicide deaths (n=479). Factor analyses of Project Talent items yielded three key factors: (1) interests in firearm-related professions (i.e., military service, police force), (2) interests in hunting or fishing and knowledge of long guns, and (3) stereotypic masculinity. Results: Survival analyses showed that long-term risk for firearm suicide was associated with 1-SD increases in firearm-related vocational interests in adolescence (adjusted hazard ratio [95% CI]=1.23 [1.09, 1.40]) and masculinity (adjusted hazard ratio [95% CI]=1.15 [1.04, 1.28]). Decreased long-term firearm suicide risk was associated with increased hunting interests and knowledge of long guns in adolescence (adjusted hazard ratio [95% CI]=0.86 [0.77, 0.96]) and competitive sports participation, an exploratory variable (adjusted hazard ratio [95% CI]=0.89 [0.80, 0.99]). Conclusions: Prevention efforts are needed to lower long-term firearm suicide risk among adolescent males with high stereotypic masculinity and those interested in military or police service. Potential protective effects of competitive sports participation and socialization to long guns through hunting require further study.