Young people who commit suicide using a gun are often introduced to guns through family traditions and use the family gun to commit suicide, according to results of novel “psychological autopsy study” of loved ones of youth who died by gun-related suicide.
Yet, families don’t always recognize the danger firearms pose to a young person with suicide risk factors, even when there is young person in the house with a mental health condition, the data show.
Perhaps most importantly, many parents indicated that they would have removed firearms from the home if it had been suggested by their healthcare professional.
The study was presented at the American Psychiatric Association (APA) 2023 Annual Meeting.
The message is very clear: Clinicians need to ask about guns and gun safety with patients and families, said study investigator Paul Nestadt, MD, with Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
“It’s never illegal to ask about gun access and it’s medically relevant. Just do it,” he said during a briefing with reporters.
Grim Statistics
Suicide rates have been climbing in the United States for the majority of the past 20 years. Suicide is the second most common cause of death among youth.
Nestadt noted that overall only about 8% of suicide attempts result in death, but when an attempt involves a firearm the percentage jumps astronomically to 90%.
Research has shown that for every 10% increase in household firearms in a given community there is a 27% increase in youth suicide deaths.
“In the world of public health and mental health, we think about having access to firearms as an important risk factor for completed suicide. But in the United States, guns have become an important part of how many Americans see themselves,” Nestadt told reporters.
Research has shown that half of gun owners say owning a gun is central to their identity and three quarters say it’s essential to their freedom, he noted.
To explore these attitudes further, Nestadt and colleagues did 11 “psychological autopsy interviews” with the loved ones of nine young people aged 17-21 who died by gun-related suicide. They interviewed six mothers, three fathers, one sibling, and one close friend.
Most of the families had some level of “familial engagement” with firearms, Nestadt reported.
In more than two thirds of the families, the youth used a family-owned firearm to commit suicide.
Notably, over three quarters of the youth had received mental health care before taking their lives, with many receiving care in the weeks prior to their suicide; 44% had made a prior suicide attempt.
In many cases, parents shared that they had not considered their family-owned firearms to be sources of danger and indicated that had their clinician expressed concern about the gun in the home, they may have acted to reduce the risk by removing it.
Several also shared that they would have considered using Maryland’s Extreme Risk Protective Order Law if it had existed at the time and they had been made aware of it.
Extreme risk protection order (ERPO) laws, or “red flag laws,” prohibit individuals at risk for harming themselves or others from purchasing or owning a firearm.
Nestadt said youth suicide interventions “must acknowledge culturally embedded roots of identity formation while rescripting firearms from expressions of family cohesion to instruments that may undermine that cohesion.”
“Courageous Study”
Nestadt also noted that while this study was challenging on many fronts, it took no convincing to get these grieving families to participate.
“They wanted to talk to us, especially because they were hopeful that our work could help prevent future suicides, but also they wanted to talk about their loved ones,” he said.
“When you lose someone to cancer, people give you hugs and flowers. When you lose someone to suicide, people don’t discuss it. Suicide has a stigma to it.”
Briefing moderator Howard Liu, MD, MBA, chair of the Department of Psychiatry, University of Nebraska Medical Center, Omaha, praised the study team for their “courageous study that really required a tremendous amount of vulnerability from the research team and clearly from the survivors as well.”
This is an “important and timely public health discussion,” said Liu, chair of the APA Council on Communications.
“We’re all facing this challenge of how do we reduce suicide across all ages, from youth to adults as well. This is a really vital discussion and such an important clue about access and trying to reduce access in a moment of impulsivity,” he added.
The study had no commercial funding. Nestadt and Liu report no relevant financial relationships.
American Psychiatric Association (APA) 2023 Annual Meeting: Poster P10-046. Presented May 20, 2023.
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