Nearly 20 percent of suicidal youths have guns in their home
Nearly one in five children and teens found to be at risk for suicide report that there are guns in their homes, and 15 percent of those at risk for suicide with guns in the home know how to access both the guns and the bullets, according to a study to be presented Monday, May 6, at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC.
Suicide is the second leading cause of death among young people ages 10 to 24 years in the United States, according to Centers for Disease Control and Prevention data. Nearly half of youths who die by suicide use a firearm.
Researchers conducted a study to create a suicide risk screening tool that health care professionals in emergency departments (EDs) could use to figure out which youths need further mental health evaluation to keep them from harming themselves. As part of that study, researchers asked youths about access to guns in or around their home and about gun/bullet storage.
“For more than 1.5 million adolescents, the ED is their primary point of contact with the health care system, which makes the ED an important place for identifying youth at risk for suicide,” said Stephen J. Teach, MD, MPH, FAAP, associate chief in the Division of Emergency Medicine at Children’s National Medical Center in Washington, DC, and co-author who will be presenting the study at the PAS meeting.
Many clinicians and parents do not know how to ask youth about suicide, so they require screening tools to assist in detection, added study senior author Lisa M. Horowitz, PhD, MPH, staff scientist/pediatric psychologist at the National Institute of Mental Health, National Institutes of Health, Bethesda, Md. “According to our data, when asked their opinion, nearly all of the kids in our study were in favor of suicide screening in the ED. Our study shows that if you ask kids directly about suicide, they will tell you what they are thinking.”
Study participants included 524 patients ages 10 to 21 who were seen for medical/surgical or psychiatric complaints at one of three pediatric EDs. They were asked to fill out a 17-item questionnaire that the researchers used to develop the Ask Suicide-Screening Questions (ASQ), a four-question screening tool that can be used for all pediatric patients visiting the ED. The ASQ has been validated against a longer more in-depth suicide assessment tool.
“While many youths who kill themselves have mental health disorders, up to 40 percent of youths who kill themselves have no known mental illness,” said co-author and youth suicide expert Jeffrey A. Bridge, PhD, principal investigator at The Research Institute at Nationwide Children’s Hospital and associate professor of pediatrics at The Ohio State University. “Therefore, it is important to screen all children and adolescents for suicide, regardless of the reason they are visiting the ED.”
Of the patients who completed the screening tools, 151 (29 percent) were found to be at risk for suicide, and 17 percent of them reported guns in or around the home. Of those at risk for suicide and reporting guns in the home, 31 percent knew how to access the guns, 31 percent knew how to access the bullets, and 15 percent knew how to access both the guns and the bullets.
Youth and Suicide
Adolescence is a time of dramatic change. The journey from child to adult can be complex and challenging. Young people often feel tremendous pressure to succeed at school, at home and in social groups. At the same time, they may lack the life experience that lets them know that difficult situations will not last forever. Mental health problems commonly associated with adults, such as depression, also affect young people. Any one of these factors, or a combination, may become such a source of pain that they seek relief in suicide.
“This study highlights the importance of parents understanding the risks of having guns in their homes,” said Dr. Bridge. “Being at risk for suicide and having access to firearms is a volatile mix. These conversations need to take place in the ED with families of children at risk for suicide.”
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The research was supported by the Intramural Research Program of the National Institute of Mental Health, the National Institutes of Health (Drs. Horowitz & Pao); institutional research funds from the Research Institute at Nationwide Children’s Hospital and grant K01 MH-69948 from the National Institute of Mental Health (Dr. Bridge); institutional research funds from the Program for Patient Safety and Quality at Boston Children’s Hospital Boston (Dr. Wharff).
Some Myths About Suicide
Myth: Young people rarely think about suicide.
Reality: Teens and suicide are more closely linked than adults might expect. In a survey of 15,000 grade 7 to 12 students in British Columbia, 34% knew of someone who had attempted or died by suicide; 16% had seriously considered suicide; 14% had made a suicide plan; 7% had made an attempt and 2% had required medical attention due to an attempt.
Myth: Talking about suicide will give a young person the idea, or permission, to consider suicide as a solution to their problems.
Reality: Talking calmly about suicide, without showing fear or making judgments, can bring relief to someone who is feeling terribly isolated. A willingness to listen shows sincere concern; encouraging someone to speak about their suicidal feelings can reduce the risk of an attempt.
Myth: Suicide is sudden and unpredictable.
Reality: Suicide is most often a process, not an event. Eight out of ten people who die by suicide gave some, or even many, indications of their intentions.
Myth: Suicidal youth are only seeking attention or trying to manipulate others.
Reality: Efforts to manipulate or grab attention are always a cause for concern. It is difficult to determine if a youth is at risk of suicide All suicide threats must be taken seriously.
Myth: Suicidal people are determined to die.
Reality: Suicidal youth are in pain. They don’t necessarily want to die; they want their pain to end. If their ability to cope is stretched to the limit, or if problems occur together with a mental illness, it can seem that death is the only way to make the pain stop.
The Pediatric Academic Societies (PAS) are four individual pediatric organizations that co-sponsor the PAS Annual Meeting – the American Pediatric Society, the Society for Pediatric Research, the Academic Pediatric Association, and the American Academy of Pediatrics. Members of these organizations are pediatricians and other health care providers who are practicing in the research, academic and clinical arenas. The four sponsoring organizations are leaders in the advancement of pediatric research and child advocacy within pediatrics, and all share a common mission of fostering the health and well-being of children worldwide.
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Susan Stevens Martin
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American Academy of Pediatrics