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'Volatile mix': Kids at risk for suicide can get guns, report finds

As many as one in five children who are at risk of suicide live in homes where they can get hold of guns -- the single most effective means to killing themselves -- researchers reported on Monday.

They said their findings show it’s extremely important to screen children for suicide risk, and to educate parents about how to keep guns out of their hands if they are. And early treatment is also vital.

The researchers, who presented their findings at the Pediatric Academic Societies meeting in Washington, D.C., say they don’t want their results to get mixed up in the current debate over firearms regulation. They just want to keep kids safe.

“A lot of kids, surprisingly, don’t have a history of mental illness but they attempt suicide,” says Dr. Stephen Teach, an emergency room doctor at Children’s National Medical Center in Washington, D.C.

Suicide is the No. 3 cause of death for children and youths aged 10 to 24, according to the Centers for Disease Control and Prevention. About 4,600 kids and young adults kill themselves each year, and 45 percent of them use guns. Another 40 percent suffocate or strangle themselves and 8 percent poison themselves.

“Guns are the most lethal method that is commonly used in suicide attempts,” says Dr. Matt Miller, an injury control expert at the Harvard School of Public Health. People who try to commit suicide using pills or by cutting themselves complete the suicide just 3 percent of the time, he said.

Teach and colleagues made their discovery while trying to come up with an easy, short questionnaire for emergency room doctors to use while seeing children for a range of troubles. Their study included 524 patients ages 10 to 21 being seen at three pediatric emergency rooms.

“When we were asking kids these questions, we also asked kids questions about firearms and bullets. To our surprise, one-fifth reported firearms in the home,” Teach said in an interview. “That’s a pretty volatile mix. Nearly half of all completed suicides involve firearms, which is pretty scary.”

They found 151 of the kids, or 29 percent of them, were at risk for suicide, and 17 percent of them reported guns in or around the home. Of those at risk for suicide and who knew guns were in their home, 31 percent knew how to get the guns, 31 percent knew how to find the bullets, and 15 percent knew how to access both the guns and the bullets.

Other studies show that suicide is usually an impulsive act. If a person tries but fails to commit suicide, he or she is unlikely to try again. So taking away a quick and lethal method could save many lives.

One in 10 kids who were not in the emergency department for psychiatric complaints also screened positive for suicide risk. “It is frighteningly common in this age group,” Teach said.

So, number one, says Teach -- it’s important to identifiy children who might be thinking about suicide. “Once you identify the kids, be willing to engage in a conversation about access to firearms,” he said.

The four questions are simple:

  • In the past few weeks, have you wished you were dead?
  • In the past few weeks, have you felt that you or your family would be better off if you were dead?
  • In the past week, have you been having thoughts about killing yourself?
  • Have you ever tried to kill yourself?

"It works. It identifies the kids (at risk)," Teach said. He says the conversation does not seem to put ideas into the kids’ heads.

“What we found, to our surprise, was that kids really want to be asked,” he said. “The reactions were positive. They said, ‘I am glad you asked’.”

The key signs for parents to look for: Withdrawal from friends, substance abuse, differences in performance in school, changing their group of friends, says Teach.  Changes in appetite, dropping hobbies, and just appearing sad are also warning signs.

“If you feel sad around your kids, it may be a sign,” he said. “If they bum you out, they are probably bummed out.”

Such conversations are very difficult, Teach said. “This is on the list of hard things to talk about, like sex and drugs,” he said. “It’s all dialogue, dialogue, dialogue. Don’t be afraid to ask.”

And if kids are at risk, they need to be kept safe from guns, pediatricians at the meeting agreed. “Between 1999 and 2010 there were 22,193 suicides among children 5 to 19,” Miller said.

Miller says suicide rates overall are much higher in states with higher gun ownership.

“Where there are more guns in the United States, there are more people dying,” he told a session at the meeting.

He said people with guns need to learn more about how to protect their children from them.

“There are 300 million firearms in civilian hands in the United States,” Miller said.  He said the latest statistics showed 1.5 million children lived in homes with loaded and unlocked guns.

The issue can be political, but Teach is clear he does not want to get into a political argument about gun ownership. “This is not really a story about who has guns. The issue is a significant proportion of kids at risk for suicide have access to firearms,” Teach said.