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Breaking the Deadly Link Between Suicide Ideation and Accessible Guns

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Breaking the Deadly Link Between Suicide Ideation and Accessible Guns
July 31, 2024

Dorothy R. Novick MD, and Joel A. Fein, MD, MPH

Youth suicide has reached devastating proportions in the United States, increasing by more than 50% since 2007. Analyses by age and race show the most dramatic increases among young children, ages 10 to 14 years old, and among Black youth, where numbers have risen by an astounding 78% since 2000. Black children ages 5 to 12 years old are now twice as likely to die from suicide as their white counterparts.

The American Academy of Pediatrics has declared a national state of emergency in children’s mental health and has called on policymakers to “strengthen emerging efforts to reduce the risk of suicide in children.” Youth suicide has become a crisis of overwhelming magnitude. As pediatricians and violence prevention advocates, we are working to be part of the solution.

When we examine root causes of youth suicidality, we find close correlation with environmental factors and the social determinants of health. Factors such as socioeconomic stress, community violence, and housing insecurity have all been tied to suicidality, and these effects are greater in Black youth than in their white peers. Gun violence is a particular concern—exposure to gun violence is well-proven to have crushing mental health consequences, and Black youth are overrepresented in areas of the country where gun violence is heavily concentrated.

As pediatric healthcare providers, we know that early recognition and treatment is key. We also know that means matter. Suicidal thoughts in young people can rise up within minutes and resolve just as quickly. Given time and space to contemplate, most young people will not go on to take their own lives. But when firearms are involved, all too often there is no such contemplative opportunity. Those who attempt suicide using firearms are 20 times more likely to die than those who use other methods—tragically, 9 of 10 are dead before they can reconsider or call for help. This is of particular concern when it comes to the rising suicide rates in Black male youth, for whom firearms are the leading method.

Where do the firearms used in youth suicide come from? Not surprisingly, more than 80% belong to a family member. This is why one of the most crucial and impactful things pediatric healthcare providers can do to protect our young patients is counsel families to make firearms inaccessible. This means either removing firearms from the home, or when this is not an acceptable option, ensuring they are kept locked, unloaded, and separate from the ammunition. While many providers worry that conversations about firearms are too sensitive for the exam room, studies demonstrate high levels of acceptability among parents and guardians. The data also show that we have the greatest impact when we distribute free gun locking devices along with this counseling.

At Children’s Hospital of Philadelphia, we have embarked on an evidence- based, large-scale initiative to incorporate safe storage counseling and gun locking device distribution into the care we deliver. This effort, which is supported by the Center for Violence Prevention as well as a Department of Pediatrics Chair’s Initiative, consists of several key components:

  • screening and documentation tools that are built into many of our electronic health record templates
  • gun locks and patient education materials now stocked at multiple sites across our institution
  • an educational session for healthcare providers that helps fill knowledge gaps and offers practical tips for talking with families

Currently, CHOP pediatricians, nurse practitioners, mental health providers, injury prevention educators, and security personnel are counseling families around safe firearm storage and distributing education and gun locking devices at multiple care locations across the institution. These include primary care practices, Emergency Departments, subspecialty practices, security hubs, select inpatient areas, and our Safety Center. As this initiative continues to expand, we distribute more gun locks and reach more families with safe storage guidance every day.

CHOP is also participating in a national health campaign that encourages parents to ask about firearms in other places where their children spend time, such as friends’ and relatives’ homes. This campaign, It Doesn’t Kill to Ask, guides parents through what can often feel like sensitive conversations about firearms, through role play videos and examples of nonconfrontational language.

Feeling unsafe in one’s neighborhood is a critical social determinant of health and drives many community members to purchase firearms for their own protection. Firearm sales have skyrocketed over the last several years, and studies unfortunately show that fewer than half of firearm owners practice safe storage. As healthcare providers, we can make a difference in youth suicide. We can work at all levels, and at all costs, to reduce unsupervised access to firearms—because when it comes to the lives of children, no cost is too high.

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