Permitless open carry laws may lead to more firearm-related suicides

Key Takeaways 

• Suicide by firearm rates increased 18% in nine years in states that began allowing firearm owners to openly carry a firearm without a permit, a new study finds.  
• U.S. rates of firearm-related suicide rose from 21,175 in 2013 to 26,328 in 2021, an increase that may be related to more permissive open carry laws. 

CHICAGO: In states that relaxed firearm laws to allow openly carrying a loaded firearm in public without a permit, significantly more people died by firearms and suicide than in states without permitless open carry laws, according to study findings published in the Journal of the American College of Surgeons (JACS). 

In this study of death data from all 50 states, researchers found that a change to permitless open carry laws within the nine-year study period also was strongly associated with increases in both the rate of firearm-related suicide and the total suicide rate. Most suicides each year were due to firearms, the investigators reported. 

“Our analysis suggests that because of the change in the law, which provides easier access to firearms, we saw an increased firearm suicide rate and total suicide rate,” said principal study author Jose J. Diaz, MD, FACS, trauma medical director at Tampa General Hospital. Dr. Diaz is also a professor of surgery at the University of South Florida, Tampa, where the study was conducted. 

Multiple studies have shown associations between specific firearm laws and their impact on firearm-related deaths. For example, requiring a permit to purchase a firearm is associated with a decrease in firearm-related homicide, and universal background checks and ammunition background checks are associated with a decrease in total firearm mortality.¹ Dr. Diaz said he and his research team focused their study on permitless open carry laws because these laws have become more common in the U.S. but remain understudied. 

For this study, the researchers evaluated states’ annual rates of total firearm-related deaths, total suicides, and total homicides from 2013 to 2021. Death statistics came from the Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System. 

The investigators also performed a causal analysis to estimate the effects of a state’s policy change to open carry laws that require no permit. The researchers excluded states that enacted permitless open carry before 2013. Therefore, they compared data from states that changed to permitless open carry during the study with states that maintained laws banning permitless or all open carry. 

Key Findings 

• During the study period, five states switched to permitless open carry laws, 19 states prohibited open carry or required a permit, and the other 26 states already allowed permitless open carry before 2013. 
• Total firearm deaths in all 50 states increased from 33,636 in 2013 to 48,830 in 2021, a 45% increase. 
• Analyses showed significant associations between a change to permitless open carry laws and total rates of firearm fatalities and suicides. 
• Among states that changed to permitless open carry laws, causal analysis found an approximately 57% increase in total suicide rates and an 18% increase in suicides by firearm during the study period. 

The causal analysis found no association between permitless open carry laws and firearm-related homicides. 

Caution in Interpreting Results 

“Because the study was retrospective, meaning it used past data, we cannot say that changing to more permissive open carry laws was a definitive cause of increased rates of suicide by firearm,” Dr. Diaz said. 

Additionally, Dr. Diaz noted that the COVID-19 pandemic may have influenced their findings. He cited the widely reported social isolation and poorer mental health observed during and after the pandemic.²  

However, past studies support their results by showing an association between ease of access to firearms and increased risk of firearm-related suicide,³ according to the article. 

The bottom line, Dr. Diaz said, is that “changes in firearm laws have potential repercussions that we do not anticipate.” 

The American College of Surgeons (ACS) Committee on Trauma supports firearm injury prevention initiatives, including legislation that increases mandatory background checks for firearm ownership and that increases federal funding for research to prevent firearm injuries. The ACS also has information on safe firearm use and storage. 

Study coauthors are Emily A. Grimsley, MD; Johnathan V. Torikashvili, MD; Haroon M. Janjua, MS; Meagan D. Read, MD; and Paul C. Kuo, MD, MS, MBA, FACS. Mr. Janjua is now with Brown University. 

The study authors have no disclosures. 

This study is published as an article in press on the JACS website. 

Citation: Grimsley EA, Torikashvili JV, Janjua HM. Transition to Permitless Open Carry and Association With Firearm-Related Suicide. Journal of the American College of Surgeons, 2024. DOI: 10.1097/XCS.0000000000000959 

Presented at the Southern Surgical Association 135th Annual Meeting, Hot Springs, Va., December 3-6, 2023. 

References 

1. References 7 and 11 cited in the study.
2. Xiong J, Lipsitz O, Nasri F, et al. Impact of COVID-19 pandemic on mental health in the general population: a systematic review. J Affect Disord. 2020 Dec 1;277:55-64. DOI:10.1016/j.jad.2020.08.001
3. References 36 and 37 cited in the study.

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About the American College of Surgeons 

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 90,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons. 

The Journal of the American College of Surgeons (JACS) is the official scientific journal of ACS. Each month, JACS publishes peer-reviewed original contributions on all aspects of surgery, with the goal of providing its readership the highest quality rapid retrieval of information relevant to surgeons.  

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