February 22, 2018

Pediatrician-researcher discusses teens and gun safety

Depression screening and treatment provide a natural opportunity for pediatricians to ask about access to household firearms

Youth suicide was three times more common in 2014 than in 1999, and currently more than 1,000 10- to 19-year-old Americans die from suicide by guns every year.

But many of these heartbreaking cases could potentially be prevented by better identifying and treating teenagers with depression and substance abuse problems, and storing guns more safely.

David C. Grossman, MD, MPH

We interviewed David C. Grossman, MD, MPH, a senior investigator at Kaiser Permanente Washington Health Research Institute and a pediatrician at Washington Permanente Medical Group, who recently authored an editorial — Reducing Youth Firearm Suicide Risk — in the March issue of Pediatrics about opportunities to reduce youth firearm suicide.

What are we learning about gun safety and teen suicide?

In the editorial, I discuss a study also published in the March issue of Pediatrics by John Scott, PhD, of Florida Atlantic University; Deborah Azrael, PhD, of the Harvard T.H. Chan School of Public Health; and Matthew Miller, MD, MPH, ScD, of Northeastern University in Boston. This study, Firearm Storage in Homes with Children with Self-Harm Risk Factors, reports that parents of children and adolescents with high-risk conditions like depression and substance abuse were just as likely to store guns unlocked and loaded as were other families whose children didn’t have these conditions. Our research team had found the same thing in a study with a smaller sample size in 2017.

The Boston team conducted a national survey that is representative of American households with children, teens, or both. The study found that in all families, whether or not the families had youth at risk for self-harm:

  • Guns were present in 4 in 10 of all households
  • Only 1 in 3 families with guns stored them safely (locked and unloaded)
  • What about families whose teens have depression or substance abuse?

    These gun-safety strategies are especially important for families with teenagers who have depression or substance abuse because these teens are at higher risk for suicide.

    More research is needed. We must test more ideas and find more practical solutions. But in the meantime, we all can be more aware and take action when appropriate.

    What’s the most promising way to prevent teen suicide by gun?

    As a pediatrician-researcher, I focus on keeping children and teens safe. When they intentionally harm themselves, these acts tend to be more impulsive compared to adult self-harm. Teens’ urge to die may be fleeting, so deterring them from taking impulsive action with a highly lethal method (like firearms) can save their lives. Health care providers should:

    • Routinely screen all teens for depression, which often goes undiagnosed and is the most important risk factor for suicide.
    • Get them effective treatment and long-term care to treat depression and substance abuse and help them reduce their risk of harming themselves.
    • Use depression screening and treatment as a natural opportunity to raise parents’ awareness of potential risks from unlocked guns at home, especially for teens with depression or substance abuse.
    • Explain to parents that controlling the household environment, such as storing handguns and rifles in lockboxes and safes, tends to be more effective than relying on behavioral controls, such as setting household rules about not handling guns.
    • Engage families in discussion about storing guns safely at home — or discussing whether to remove them.
    • How can we keep guns safe at home?

      Our research team published Gun Storage Practice and Risk of Youth Suicide and Unintentional Firearm Injuries in 2005 in the Based on many research findings including that study, we advise that, if parents or guardians choose to own a gun and keep it in a household where teens and children live or visit, they should:

      • Keep the gun locked and unloaded.
      • Keep the ammunition locked — and stored in a location separate from the gun.
      • We found each of these storage practices for handguns, rifles and shotguns were associated with much reduced risk of suicide and accidental firearm injuries among children and teens.

        Youth who lived in homes where guns were locked and/or unloaded were about 70 percent less likely to commit suicide or self-harm by a gun compared to youth in homes where guns were stored unsafely.  That level of protection is similar to seatbelt use in a car. Homes where the ammunition was locked and/or kept separately from household guns were also less likely to be linked to a gun injury or death by self-harm or accident.