Rising Rates of Adolescent Firearm Suicide and the Clinician's Role in Addressing Firearms

Suicide is a leading cause of death of 10- to 19-year-olds in the United States.¹ Firearms were used in 48% of suicides of 15- to 19-year-olds and in 38% of suicides of 10- to 14-year-olds in 2020.¹ During the COVID-19 pandemic, gun sales surged, leading to increases in household firearm ownership,² a known risk factor for suicide.³ There are many ways in which adolescents access firearms. Most commonly, adolescents encounter firearms owned by an adult in the home. One study showed that one-third of adolescents reported they could access a loaded household gun in less than 5 minutes, even in households where parents did not believe that their child could access a household firearm.⁴ Another study found that 39% of parents who reported that their children did not know the location of household guns, and 22% of parents who reported that their children had never handled a household gun, were contradicted by their children's reports.⁵Adolescents can legally own rifles or shotguns if gifted to them by a parent. Federal law (18 U.S.C. 922) prohibits possession of handguns by minors less than 18 years of age; however, there are no federal minimum age requirements for possession of long guns (shotguns, rifles).Social media contributes to adolescent gun culture. TikTok users have created and viewed popular videos about guns,⁶ including videos with instructions on building guns from hardware store materials or via 3D printing. Adolescents can purchase kits online to assemble fully functional handguns. No federal restrictions or background check requirements exist on who can purchase "ghost gun" kits.⁷Child and adolescent mental health providers often assess suicide risk with a screening tool such as the Columbia-Suicide Severity Rating Scale, with a clinical assessment, or with a combination of both. Either way, the assessment should include asking about access to lethal means, including firearms. Many adolescent suicide attempts are impulsive; completed suicides may be prevented if access to firearms is limited during periods of crisis.⁸ However, many clinicians do not talk about firearms with patients even when clinically relevant.⁹ This may be due to assumptions that adolescents do not have access to firearms, or to lack of comfort with this topic. One study surveying medical residents reported the most common barriers to providing firearm counseling were not knowing how to ask about firearm access and not knowing how to respond to patients' answers about firearm access.⁹Once identifying an adolescent at risk for suicide, clinicians can intervene by providing evidenced-based interventions tailored to each situation. In this article, we present steps adapted from the BulletPoints Project for clinicians to intervene with adolescents at risk for firearm suicide.