Almost 20% of Suicidal Teens Live in Home With a Gun

Neil Canavan

May 08, 2013

Nearly a third of children and adolescents screened in an emergency department program are at risk for suicide, and of these, 17% report knowledge of a gun in or around their home.

"Nearly half of youth suicides involve firearms, and 90% of individuals who attempt suicide with guns kill themselves," said study author Stephen Teach, MD, from the Children's National Medical Center in Washington, DC.

Suicide is among the leading causes of death in young people aged 10 to 24 years.

Researchers say the emergency department may be an excellent screening opportunity to assess teens for suicide risk because this is sometimes the only consistent source of medical care for young people.

"This is particularly true for the most disadvantaged adolescents in our nation," said Dr. Teach, explaining the rationale for his program here at the Pediatric Academic Societies 2013 Annual Meeting.

Dr. Teach and his team developed a simple instrument based on the gold standard, the Suicidal Ideation Questionnaire. They distilled the questionnaire down to its most critical elements.

"It's a fairly simple thing to administer in the hurly burly of a busy emergency department," Dr. Teach said. The Ask Suicide-Screening Questions has only 4 points:

1. In the past few weeks, have you wished you were dead?

2. In the past few weeks, have you felt that you or your family would be better off if you were dead?

3. In the past week, have you been having thoughts about killing yourself?

4. Have you ever tried to kill yourself?

For the current study, the researchers enrolled 524 patients with a mean age of 15 years. Of these, 344 patients presented with medical complaints — 180 for mental health reasons. All of the participants were white, and the majority of patients were on public insurance.

Teens at risk for suicide were asked follow-up questions about guns in their homes, whether they have access to them, and where the bullets are stored.

The study showed that 151 of the adolescents screened positive for suicide risk. Of these, 26 teens reported guns in or around their home. A third of them said they have access to the weapon, and a smaller number still said they have access to both the gun and the ammunition.

The questionnaire demonstrated high sensitivity (96.9%), specificity (87.6%), and an "impressive" negative predictive value (99.7% and 96.9% for medical patients, and psychiatric patients).

"It's clear that emergency department clinicians can play an important role in identifying both youth at risk for suicide, and lethal means available among these at-risk youth," said Dr. Teach, adding that he has previously published on the feasibility of this approach, and that was widely accepted by prospective participants.

"We asked young people, 'Hey, does this bother you? Do you find this uncomfortable?' But in fact it was nearly universally accepted. Young people were delighted that we would ask," he said.

As for emergency doctors, Dr. Teach admitted that many are uncomfortable asking about guns. However, he said he anticipates this trepidation will lessen as more data about adolescent suicide rates, and the prevalence of firearms in the homes of individuals at risk, becomes widely known.

Is it really a doctor's place to be asking about guns?

"Absolutely," Thomas McInerny, MD, president of the American Academy of Pediatrics (AAP), told Medscape Medical News. "It's no different than talking to kids and their parents about wearing bicycle helmets, using seats belts, having a smoke detector in the house — those are all safety measures to try to keep children safe and healthy."

AAP Takes a Stand

In fact, this approach is already a part of the AAP's Bright Futures initiative, which instructs on how the well-child or health assessment visit should be conducted.

"It specifies the sorts of things you should ask patients at different ages," said Dr. McInerny. "And part of what Bright Futures recommends is to ask parents if they have guns in the house, and if they do, are they locked and unloaded, and are the bullets locked in another place."

According to the AAP, gunshot wounds account for 1 in 25 admissions to pediatric trauma centers in the United States.

"Screening for suicide risk in this manner was very much in line with nation-wide programs already in place to identify individuals with HIV, substance abuse problems, obesity, and other issues," Dr. Teach pointed out.