Methods
Participants were 378 firearm-owning US National Guard personnel (mean [SD] age = 27.4 [8.4] years; 91.0% male; 74.6% white; 68.0% deployment history; 62.7% active duty; 97.1% Army). A convenience sample was recruited from a joint forces training center in the southern US; units were drawn from across the country, and some were actively demobilizing from deployment. Participants provided written informed consent. Study procedures were approved by the university’s institutional review board and the Department of Defense Human Research Protection Office, and the data were collected from November 2013–June 2014.
We assessed suspected TBI via the self-report Traumatic Brain Injury-4 (TBI-4), which has moderately high specificity (0.77) against a structured clinical interview for establishing a TBI diagnosis. Per recommendations, we classified service members as having a suspected TBI if they responded affirmatively to item 2 (“Have you ever been knocked out or unconscious following an accident or injury?”). We examined the TBI-4 summed score (α = .77) as an index of the severity of a suspected TBI history. We assessed firearm storage practices via a structured self-report questionnaire and classified firearms as stored (1) unsafely (ie, loaded, non-secure location), (2) safely (ie, unloaded, secure location), or (3) mixed-secureness (ie, loaded, secure location or unloaded, non-secure location). Participants who owned more than one firearm were instructed to report on their least secure firearm. We used χ tests of independence and logistic regression analyses.
Results
Overall, 27.0% (n = 102) of firearm-owning service members screened positive for a suspected TBI. Service members with a suspected TBI, compared with those without, were significantly more likely to report storing their firearms unsafely (26.5% vs 14.9%; χ21 = 6.81, P = .009). By contrast, service members with a suspected TBI were less likely than those without a suspected TBI to store their firearms safely (35.3% vs 48.9%; χ21 = 5.58, P = .018). The severity of a suspected TBI history was positively associated with storing a firearm unsafely (OR = 2.06, 95% CI = 1.19–3.58, P = .010) and negatively associated with storing a firearm safely (OR = 0.57, 95% CI = 0.36–0.91, P = .019). There were no significant differences in mixed-secureness of firearms regarding suspected TBI status or severity of suspected TBI history (Ps > .05).
Discussion
Findings of this initial investigation suggest that suspected TBI is associated with unsafe firearm storage practices among military personnel. Neuropsychiatric sequelae of TBI, such as impaired executive functioning and attendant impulsivity, may present challenges for the initiation and maintenance of safe firearm storage practices. Other potential confounders include psychiatric comorbidity associated with unsafe firearm storage practices (eg, posttraumatic stress disorder) and sociodemographic factors (eg, education level). Limitations of this study include a lack of examination of confounders, reliance on a brief self-report TBI screener, use of a non-representative sample, and cross-sectional design. Pending future studies that address these limitations, interventions that promote secure firearm storage practices may need to be attentive to the unique needs of individuals with a TBI.