Articles
Compliance With Recommendations to Remove Firearms in Families Participating in a Clinical Trial for Adolescent Depression

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ABSTRACT

Objective

To assess the rate and correlates of compliance with clinicians' recommendations to remove firearms from the homes of depressed adolescents participating in a clinical trial.

Method

The parents of 106 adolescents with major depression who participated in a randomized psychotherapy clinical trial were asked systematically about firearms in the home. Those who answered affirmatively were given information about the suicide risk conveyed by guns in the home and urged to remove them. The rates of gun removal and acquisition were assessed at the end of the treatment and over the subsequent 2-year naturalistic follow-up.

Results

Of those who had guns at intake, 26.9% reported removing them by the end of the acute trial. Retention was associated with urban origin, marital dissatisfaction, and paternal psychopathology. Of those who did not have guns at intake, 17.1% reported acquiring them over 2-year follow-up. Living in a 2-parent household and marital dissatisfaction were associated with gun acquisition.

Conclusions

Families of depressed adolescents may frequently be noncompliant with recommendations to remove guns from the home despite compliance with other aspects of treatment. More efficacious interventions to reduce access to guns in the homes of at-risk youths are needed.

Section snippets

Sample

Subjects were adolescents between the ages of 13 and 18 years with major depressive disorder, defined by DSM-III-R (American Psychiatric Association, 1987), who agreed to enter a randomized clinical psychotherapy trial for the treatment of major depression. Of 122 eligible subjects, 107 entered the study (87.7%). The treatment outcome of this sample has been reported previously Birmaher et al., 2000, Brent et al., 1997, Brent et al., 1998, Brent et al., 1999b, Renaud et al., 1998. Demographic

Comparison of Those With and Without Reported Firearms in the Home

Those with firearms in the home at intake (n = 29, 27.4%) were quite similar to those without firearms in the home (n = 77, 72.6%) on almost all demographic, clinical, and family-environmental variables. Patients with guns in the home were more likely to be male (37.9% [11/29] versus 19.5% [15/77], χ2 = 3.87, df = 1, p = .05, ES = 0.2), but guns in the home were not associated with age, race, socioeconomic status, county, or family constellation. Those with guns in the home, compared with those

DISCUSSION

This study documents that parent education about firearms in the context of the treatment of adolescent depression results in the removal of guns in only about one fourth to one third of cases. Moreover, another 5% of parents, who did not receive any education, obtained guns over the relatively brief 3-month period of the acute treatment phase of the study, and about 1 in 6 acquired guns over the 2-year course of follow-up. The implications of these results will be discussed after putting them

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    This work was supported by NIMH grants MH46500 and MH55123. The expert assistance of Beverly Sughrue in preparation of the manuscript is appreciated.

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