IMPORTANCEFirearm ownership is associated with increased risk for suicide. OBJECTIVE To examine patterns of associations among suicidal thoughts and behaviors among gun owners and non-gun owners in the US. DESIGN, SETTING, AND PARTICIPANTS In this survey study, cross-sectional online survey data were collected from March to April 2020 from US adults recruited via Qualtrics Panels. Quota sampling was used to approximate US census demographics. MAIN OUTCOMES AND MEASURESThe primary outcomes were past-year passive suicidal ideation, active suicidal ideation, suicidal planning, suicidal behaviors, and nonsuicidal self-injury as measured by items from the Self-Injurious Thoughts and Behaviors Interview-Revised (SITBI-R).Simple latent class analysis (LCA) was used to assign participants to separate classes based on posterior probabilities, and multigroup LCA was used to assess whether the same construct was measured in specified groups. RESULTSOf 65 079 adults invited to participate, 10 625 (16.3%) completed the survey; 9153 responded "yes" or "no" to the firearm ownership item and were included in the analysis. Of these 9153 respondents (4695 [51.3%] male; mean [SD] age, 46.7 [16.8] years), 2773 (30.3%) reported owning a gun and 6380 (69.7%) reported not owning a gun. Compared with non-gun owners, gun owners were more likely to be male (1779 [64.2%] vs 2916 [45.7%]; χ 2 1 , 263.3; P < .001) and White (2090 [75.4%] vs 3945 [61.8%]; χ 2 5 , 232.9; P < .001) and to have served in the military (772 [27.8%] vs 609 [9.5%]; χ 2 1 , 571.4; P < .001).Five distinct patterns of SITBI-R item endorsement were extracted using simple LCA. Multigroup LCA indicated that the probability of SITBI-R item endorsement differed between gun owners and non-gun owners across subgroups. Among gun owners, the probability of past-month nonfatal suicide attempts was highest in class 4 (ranging from 16.8% for reaching out for help to 27.2% for starting, then changing one's mind). Gun owners in class 4 were characterized by high probabilities of endorsing thoughts about specific ways or methods to attempt suicide (100%) and preparatory behavior (100%). Among non-gun owners, the probability of nonfatal suicide attempts was highest in class 5 (ranging from 14.9% for reaching out for help to 29.7% for starting, then changing one's mind). Non-gun owners in class 5 were characterized by high probabilities of endorsing passive suicidal ideation (84.0%-100%), active suicidal ideation (86.7%-95.0%), and thoughts about specific ways or methods to attempt suicide (97.4%) and a specific place (92.1%) to attempt suicide. CONCLUSIONS AND RELEVANCEIn this study, in subgroups with lower probabilities of suicide attempt, gun owners and non-gun owners showed similar patterns of suicide risk item endorsement, but when the probability of a suicide attempt increased, gun owners were less likely than non-gun (continued) Key Points Question Do survey item response patterns for suicidal ideation and behaviors differ between adult gun owners and non-gun owners in the US? ...

Introduction Although the distinction between passive and active suicidal ideation is well accepted by suicide researchers and clinicians, there has been very little empirical investigation into this distinction. The current study addressed this gap by examining the latent structure of suicidal ideation based on thought content. Method Participants from two distinct samples of U.S. adults (n1 = 6200; n2 = 10,625) completed a self‐report assessment of eight commonly experienced suicidal thoughts using the Self‐Injurious Thoughts and Behaviors Interview‐Revised. Exploratory structural equation modeling was used to examine the latent structure of suicidal thoughts. Results The two‐factor model demonstrated significantly better fit than the one‐factor solution across both samples. Thoughts typically classified as passive ideation strongly loaded onto one factor, whereas thoughts typically classified as active ideation loaded onto the second factor. The two factors were highly correlated and some suicidal thoughts exhibited meaningful cross‐loading. Conclusion Our results suggest that passive and active ideation are two distinct constructs. Although they often co‐occur, passive and active ideation are not nested constructs and should not be viewed as gradients of one underlying construct. Our findings suggest that at a minimum both passive and active ideation should be included in all suicide risk assessments and screenings.

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Suicide risk factors such as hopelessness and psychiatric disorders can predict suicide ideation (SI) but cannot distinguish between those with SI and those who attempt suicide (SA). The fluid vulnerability theory of suicide posits that a person's activation of the suicidal mode is predicated on one's predisposition, triggers, and baseline/acute risks. This study compared guilt, shame, self-anger, and suicidal beliefs based on recent SI and lifetime SA. In a total of 2222 primary care patients in this cross-sectional, observational study reported no recent SI or lifetime SA (SI−SA−), 161 reported recent SI only (SI−SA+), 145 reported lifetime SA only (SI+SA−), and 56 reported both recent SI and lifetime SA (SI+SA+). Kruskal-Wallis test showed that the four risk factors were the highest for SI+SA+, followed by SI+SA−, then SI−SA+, and lastly SI−SA−. The study shows that risk factors may be worse in those with recent SI than those with SA history.