September 12, 2025 — Interventions to address firearm accessibility and related dangers should account not only for direct exposure to violence but also for complex psychosocial pathways through which firearms affect mental health across populations , according to a systematic scoping review published in the September/October issue of Harvard Review of Psychiatry , part of the Lippincott portfolio from Wolters Kluwer .
Rodolfo Furlan Damiano, MD, PhD, of the Institute of Psychiatry at the University of São Paulo in Brazil, and colleagues are the first to comprehensively examine data on the mental health effects of firearm ownership, violence, and policies. They conclude, "A whole-government approach that prioritizes mental health screenings, firearm safety, evidence-based policies, and socioeconomic equity could significantly reduce the prevalence of firearm-related psychological harm."
Global review included research from criminology, public health, and sociology
The researchers conducted a systematic literature search of multiple databases, including PubMed, Scopus, Web of Science, and PsycInfo, from inception to March 1, 2023. Any study related to firearms that had mental health outcomes was eligible for consideration. There were no language or geographic limitations.
In a scoping review, the researchers then explored relationships among firearm access, aggressive behavior, substance abuse, and societal violence, and their influences on mental health. The hierarchical screening protocol prioritized studies with direct mental health outcomes and included those with established mental health implications from adjacent fields (criminology, public health, sociology). Ultimately, data were extracted from 467 studies.
The vast majority of studies (81%) were conducted in the US, 6% in Western Europe, 4% in Australia, and 3% in Canada, with a few other countries contributing one or two studies. Suicide was by far the most studied outcome (61% of studies), followed by firearm access, firearm violence (7.3%), and depression/fear (each 2.4%). The analysis demonstrated considerable research gaps on mental health consequences, such as posttraumatic stress disorder, sleep disturbances, intimate partner violence, anxiety disorders, and substance use disorders.
Firearms affect mental health across ecological levels
The scoping review revealed three fundamental psychological mechanisms through which firearms affect mental health:
- Firearms enable impulsive action during psychological distress. Evidence showed they increase suicide risk three- to five-fold, regardless of prior mental health status.
- Firearms are "psychological amplifiers" that magnify aggression, simultaneously increase (rather than alleviate) fear and anxiety, and exacerbate trauma symptoms among those exposed to gun violence. "This cycle creates feedback loops whereby firearms worsen the very distress they're intended to relieve," the researchers note.
- Firearms serve as potent symbols that transform power dynamics and perceptions of vulnerability. This phenomenon was particularly notable in the context of intimate partner violence, where firearms were found to increase controlling behaviors via documented associations with hypermasculinity.
"These interconnected mechanisms account for some of why firearms—which are deeply ingrained in society and perceived as symbols of power and freedom—have such significant consequences for mental health outcomes," the authors explain.
Cultural reliance on firearms extends beyond physical danger, they emphasize. The complex psychosocial pathways that heighten risk of impulsive action simultaneously generate population-level psychological effects, which explain why multilevel interventions are necessary.
