Original Articles
Adolescent suicide and household access to firearms in Colorado: results of a case-control study

https://doi.org/10.1016/S1054-139X(99)00064-6Get rights and content

Abstract

Purpose: To determine whether, compared with age- and sex-matched controls who did not commit suicide, adolescents who committed suicide by firearms were more likely to have had household access to firearms (after adjusting for significant risk factors for adolescent suicide).

Methods: A case-control study design was used; case subjects were Colorado adolescents who committed suicide between 1991 and 1993; controls were sex- and age-matched adolescents who were randomly selected from the same school the subjects had attended. Interviews were conducted with the parent or guardian of cases and controls.

Results: Of the 36 case subjects in this study, 67% committed suicide using a gun obtained from their home. Adolescent suicide victims who committed suicide by firearms were significantly more likely to have a firearm in their home (72%) than age- and sex-matched community controls (50%), after adjusting for significant risk factors. Conduct disorder and previous mental health treatment were also found to be independent risk factors for adolescent firearm suicide.

Conclusions: Two types of public health interventions to prevent adolescent firearm suicides are likely to be successful: (a) limiting household access to firearms, and (b) identifying adolescents at high risk of firearm suicide.

Section snippets

Methods

Case subjects were identified using death certificates and were defined as any Colorado resident <18 years of age who committed suicide with a firearm in Colorado between 1991 and 1993. A letter soliciting participation in the study was mailed to the parent or guardian at least 6 months after the date of death. If the parent or guardian did not return a form declining participation in the study, he or she was contacted by telephone to complete a questionnaire. In cases where there was more than

Results

Ninety-seven Colorado residents <18 years of age committed suicide between 1991 and 1993. Of those, 17 of their families could not be located. Of the 80 families who were contacted, 21 refused to participate in the study. For five of the remaining 59 suicides, a suitable control could not be located. This was because certain schools which had been attended by case adolescents were not willing to participate in the study and identify a suitable control from the same school. Excluding adolescents

Discussion

Although household firearm access was prevalent in both the case (72%) and control (50%) groups in this study, adolescents who committed suicide by firearms were significantly more likely to have a firearm in their home than were age- and sex-matched school controls. These findings are consistent with the findings in a case-control study by Brent et al. (14), who found household access to firearms to be a risk factor for all types of adolescent suicide. In an effort to build upon that study, we

Acknowledgements

The authors thank Sue Dunn and Sallie Thoreson for the many hours they spent interviewing the families to collect the data for this study, Dr. Dennis Lezotte for his assistance with the statistical analysis, and Dr. Patrick O’Carroll for his assistance developing the survey instrument used in this study. This work was partially funded by a grant from the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (Grant U17/CCU811122), and by Preventive

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      Given that unintentional firearm injuries disproportionately affect children (Centers for Disease Control and Prevention, 2018; Cunningham et al., 2018), and over 75% of adolescent firearm suicide completers obtained the firearm from their home or that of a relative (Grossman et al., 1999; Johnson et al., 2010; Brent et al., 1991; Shah et al., 2000; Wright et al., 2008), our data highlights the need to provide storage counseling to older adult firearm owners as this may be an important source of unintended child/adolescent firearm access. Research has consistently identified a lower risk of self-inflicted injury and death in households practicing locked storage (Conwell et al., 2002; Brent et al., 1991; Shah et al., 2000; Brent et al., 1993a; Grossman et al., 2005; Brent et al., 1993b; Shenassa et al., 2004). Further, behavioral counseling has demonstrated efficacy increasing locked storage when employing motivational interviewing approaches paired with the provision of safety devices (Barkin et al., 2008; Carbone et al., 2005; Grossman et al., 2012).

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