Locking Families into Care: A PRISMA Scoping Review of Lethal Means Interventions That Incorporate Families into...

This PRISMA-Scoping Review (ScR) is the first of its kind to examine the efficacy of interventions incorporating the family unit in lethal means counseling and their outcomes to reduce accidental death or suicide.

Following PRISMA-ScR guidelines, researchers systematically searched databases (i.e., Ovid Medline, Ovid PsycINFO, EBSCO Social Services Abstracts, and Web of Science Core Collection) and compiled relevant studies. Results were independently screened by two reviewers. Conflicts in reports were resolved by a third reviewer. Out of 4,693 articles identified, 30 were included. All were primary analyses of controlled research trials of lethal means counseling in which family members were actively involved in the intervention itself, with studies reporting on suicide, safety, or feasibility outcomes. Two team members extracted information, and two additional team members provided revisions.

All 30 articles described the administration of lethal means safety counseling involving family members, with the majority of studies targeting adolescents. Most studies found that counseling improved patients' suicidal ideation and behavior, increased outpatient treatment seeking, or decreased the rate of hospitalization relative to control groups. Of the 14 studies that assessed the feasibility of treatment, all demonstrated feasibility.

This review provides preliminary evidence that family-based lethal means and safety counseling interventions, especially those targeting adolescents and children, are both feasible and effective at decreasing access to firearms. Future research is needed to better understand family involvement in lethal means safety for adults, as well as demographic contextualization of those who benefit from this form of intervention. Future research in lethal means safety counseling should expand beyond firearms to include medications.