Guns

The 15-year-old boy described in the vignette has a history of depression and aggressive behavior and is at risk for suicide. His parents need to know that this risk is markedly increased by the presence of a gun in their home.

There are guns in almost 50% of all United States households. Approximately 36% of the guns owned by Americans are rifles, 34% are handguns, 25% are shot guns, and 5% are other long guns. Many of these guns, including the majority of handguns, are kept loaded, unlocked, and ready for use. Handguns account for the majority of firearm- elated injuries and deaths. Almost 75% of handgun owners have cited self-protection as the primary reason for ownership, but ironically, the presence of a gun in the home increases the risk of a domestic homicide threefold and the risk of suicide fivefold.

Firearm safety issues should be a routine part of injury and violence prevention counseling. Pediatricians should provide information to parents about the dangers of guns, especially handguns, in their homes, schools, and communities. Gun-free homes should be encouraged, but where this is not acceptable, safety measures need to be discussed to attempt to reduce the risks associated with the presence of a gun. Guns should be stored unloaded and  locked, and ammunition should be kept locked in a different location. Safety mechanisms such as trigger locks, although yet of unproven benefit, may reduce unintentional injuries and deaths and domestic homicides.

Parents need to understand that the presence of a gun in the home increases the possibility that an impulsive or well- thought out suicide attempt will involve a gun and be lethal. More than 90% of suicide attempts with a gun are fatal, supporting a clear recommendation of removing firearms from homes of at-risk children and adolescents, especially those who have a history of aggressive or violent behavior, previous suicide attempts, and/or depression. Two thirds of successful suicides have involved firearms, and 70% of the guns involved in adolescent suicides have been handguns. Firearms have become the most frequently used method for both males and females who commit suicide. Reported suicide rates for males are six times greater than for females among adolescents 15 to 19 years of age.

Most homicides occur on impulse during interpersonal conflict and involve guns. More than 75% of adolescent homicides attributed to firearms involve handguns.  The case fatality of a gun shot injury is 10 times higher than the rate for a stabbing. Many firearm-related deaths occur before arrival at a hospital.

References:
American Academy of Pediatrics Committee on Adolescents. Suicide and
suicide attempts in adolescents. Pediatrics. 2000;105:871-874
American Academy of Pediatrics Committee on Injury and Poison
Prevention. Firearm-related injuries affecting the pediatric population.
Pediatrics. 2000;105:888-895
Rivara FP, Grossman D. Injury control. In: Behrman RE, Kliegman RM,
Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia,
Pa: WB Saunders Co; 2000:236-237