Household firearm access, storage, perceptions, and discussions among U.S. military veterans: population-based estimates from the 2022 ASCEND survey

Abstract Background Firearm injury remains the leading method of suicide among U.S. veterans. Knowledge of the prevalence of firearm access, storage, and beliefs about firearms and suicide risk among veterans is necessary to inform firearm-related suicide prevention initiatives. Methods A 2022 population-based survey of veterans (ASCEND), with responses weighted to the veteran population. Results In 2022, 57.4% (95% CI: 56.4–58.4) of veterans had access to firearms in their home; of those, 53.7% (95% CI: 52.3–55.1) stored at least some household firearms unlocked and 49.0% (95% CI: 47.6–50.4) stored at least some firearms loaded with ammunition. The most common reason for having household firearms was protection against people (74.3%; 95% CI: 73.2–75.3). The majority of veterans reported agreement with beliefs regarding firearm access impacting suicide risk (e.g., that having a firearm in the home increases risk; 55.2%–71.0%) and indicated willingness to alter their access if thinking about suicide (74.9%–84.6%). Veterans reported the most willingness to discuss firearms with a family member (88.4% willing; 95% CI: 87.7–89.1), compared to friends (84.0%; 95% CI: 83.1–84.7) or providers (72.4%; 95% CI: 71.4–73.4). Although most were willing to discuss firearms with a primary care or mental health provider, only 12.9% (95% CI: 12.1–13.6) indicated that a healthcare provider had ever asked them about their firearm access. Firearm risk perceptions, willingness to change firearm access and discuss firearms, and prior discussions with a healthcare provider differed based on household firearm access responses: those who declined to respond (7.7%; 95% CI: 7.2–8.4) reported the least agreement with firearm risk statements (34.4%–57.7%) and the least willingness to change firearm access (54.5%–73.6%) or discuss firearms with others (75.5% family; 69.0% friends), particularly healthcare providers (35.0%; 95% CI: 31.1–39.0). Conclusions More than half of veterans have access to firearms in their home, an important risk factor for suicide. Results suggest a preference to include family in firearm suicide prevention efforts and a need to increase provider firearm discussions in healthcare settings. Additionally, as veterans who decline to respond to firearm access questions appear to differ in their firearm risk perceptions and willingness to reduce firearm access when risk is elevated, better understanding these veterans is essential.