Background: Firearm ownership is strongly related to suicide risk, yet little is known about how much risk declines when ownership ends ("divestment"). Methods: Using data from 523,182 handgun owners, we estimated the effect of divesting and remaining divested versus never divesting on the risk of suicide and firearm-specific suicide. We used pooled logistic regression with inverse probability weighting, adjusting for demographic and area-level measures. Results: The 5-year risk of suicide death was 25.6 (95% CI: 15.1 to 37.2) per 10,000 persons with divestment and 15.2 (95% CI: 13.2 to 17.3) per 10,000 persons with no divestment, corresponding to a risk difference of 10.4 (95% CI: 0.7 to 21.1) per 10,000 persons. The 5-year risk of firearm-specific suicide death was 6.3 (95% CI: 1.4 to 11.9) per 10,000 persons with divestment and 12.9 (95% CI: 11.0 to 14.6) per 10,000 persons with no divestment, corresponding to a risk difference of -6.6 (95% CI: -11.4 to -0.1) per 10,000 persons. Comparing divestment to no divestment, risks were elevated for deaths due to other causes proposed as negative control outcomes; we incorporated these estimates into a series of bias derivations to better understand the magnitude of unmeasured confounding. Conclusions: Collectively, these estimates suggest that divestment reduces firearm suicide risk by 50% or more, and likely reduces overall suicide risk as well, though future data collection is needed to fully understand the extent of biases such as unmeasured confounding. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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