The Impact of Job Strain on Occupational Access to Firearms and Firearm‐Related Suicide Among US Workers

INTRODUCTION: Firearm-related suicide rates are notably high among workers such as police officers and farmers. One risk factor is occupational access to firearms, but other occupational characteristics, such as job strain, are less understood. This study examined the impact of job strain on the association between occupational access to firearms and firearm-related suicide. METHODS: This cross-sectional study used National Violent Death Reporting System data for 2013-2019 (n = 81,196). The outcome was firearm-related suicides, which were compared to suicides by other lethal means. The exposures included workers who used firearms as part of their job. Job strain was measured through the combination of job demand and job control measures. Job strain served as an effect modifier of the association between occupational access to firearms and firearm-related suicide. Adjusted odds ratios with 95% confidence intervals were estimated using multivariable logistic regression models, with stratified analyses for biological sex. RESULTS: Working in a high-strain job (characterized by high job demands and low job control) significantly increased the odds of firearm-related suicide for both male (OR = 2.4, 95% CI: 1.9, 3.0) and female (OR = 4.0, 95% CI: 2.4, 6.5) decedents, compared to those with no occupational access to firearms and working in low-strain jobs (characterized by low job demands and high job control). DISCUSSION: Reducing job strain in occupations with access to firearms may help decrease firearm-related suicides. Future research should explore the role of social support and additional individual-level factors, including access to personal firearms and the temporality of psychosocial factors related to occupation.