Access to Firearms Among Patients Screening Positive for Suicide Risk in Pediatric Emergency Departments

Introduction:  More than 2,000 American youth, aged 10-24 years, die by an intentional self-inflicted gunshot wound each year.  This accounts for nearly half of all suicide deaths in this age group. Notably, when a firearm is used in a suicide attempt, nearly 90% of attempters die. The lethality of other means, such as overdosing on prescription drugs, is markedly lower, underscoring that being at risk for suicide and having access to a gun is a particularly volatile mix.

An emergency department (ED) is a promising venue for detecting youth at risk for suicide. Youth who screen positive for suicide risk on validated instruments such as the Ask Suicide-Screening Questions (ASQ) can then be assessed for access to lethal means, including firearms as an important, preventative measure. Utilizing data from the ASQ multisite study, the aim of this presentation is to describe self-reported access to firearms in the home among youth who screen positive for suicide risk when presenting to pediatric EDs for medical/surgical or psychiatric concerns.

Methods: As part of the ASQ study, structured interviews were conducted with  patients aged 10-21 years that included a question about firearms in the home (“Are any guns kept in or around your home?”). Follow-up questions assessed knowledge of gun storage (“Do you know how to access these guns?”) and access to bullets (“Are the bullets kept in or around your home locked and separate from your guns?”). A positive screen on either the Suicidal Ideation Questionnaire (SIQ) or the Ask Suicide-Screening Questions (ASQ) instrument indicated positive for suicide risk. Descriptive analyses were run to describe rates of access to firearms in the home.

Results: A total of 524 patients across three sites were screened for suicide risk [56.9% female; 50.4% white; mean age 15.2±2.6]. Among the 151 youth determined at risk for suicide, 17.2% (26/151) reported guns in or around their home [61.5% female; 76.9% white; mean age 14.1±2.1y]. Of these youth, 30.8% (8/26) knew how to access the guns [37.5% female; 100% white; mean age 15.6±2.5y], 30.8% (8/26) reported access to bullets [62.5% female; 75% white; mean age 13.3±1.7y], and 15.4% (4/26) reported access to both guns and bullets [50.0% female; 100% white; mean age 14.3±1.3y].

Conclusions: A considerable number of youth at risk for suicide in pediatric EDs reported having access to firearms in their home.