Safe Firearm Storage Research Articles

Traumatic Brain Injury-Related Deaths From Firearm Suicide: United States, 2008-2017.

Objectives. To document the increasing influence of firearm suicide on the incidence of traumatic brain injury (TBI)-related death in the United States.Methods. We used national vital statistics data from 2008 to 2017 to identify TBI-related deaths, overall and by cause, among US residents. National counts stratified by year, sex, and age group (to facilitate age adjustment) were merged with corresponding population estimates to calculate incidence rates.Results. During the 10-year period beginning in 2008, when it became the leading cause of TBI-related death in the United States, firearm suicide accounted for nearly half (48.3%) of the increase in the absolute incidence of TBI-related death when combining all injury categories showing absolute increases. Rates of TBI-related firearm suicide increased among both males and females.Conclusions. Safe storage of firearms among people at risk and training of health care providers and community members to identify and support people who may be thinking of suicide are part of a comprehensive public health approach to suicide prevention.Public Health Implications. States, communities, and health care systems can save lives by prioritizing comprehensive suicide prevention.

Emergent Mental Health Visits to a Pediatric Hospital: Impact on Firearm Storage Practices.

The aims of this study were to describe firearm storage practices in homes of patients evaluated for mental health (MH) complaints at a tertiary care children's hospital and to describe storage practice changes after treatment. We surveyed families of children with MH complaints presenting to the emergency department or psychiatry unit who stored firearms in their homes between February 12, 2016, and January 14, 2017. Patients and families received standard care, including routine counseling on limiting access to methods of suicide. Participants completed surveys at baseline, 7, and 30 days after discharge. The primary outcome was triple safe firearm storage-storage of firearms unloaded, locked, and with ammunition stored and locked separately. Ninety-one household members of MH patients who stated they had firearms were enrolled at baseline. Seventy-seven (85%) completed at least 1 follow-up survey, and 63 (69%) completed both. At baseline, 21% (19/91) of participants reported engaging in triple safe firearm storage, 26% had an unlocked firearm, 23% had a loaded firearm, and 65% stored ammunition either unlocked or with their firearm. Triple safe storage rates increased to 31% at both 7 days and 30 days. Ten (17%) of 59 (P < 0.01) participants who did not report triple safe storage at baseline and completed a follow-up survey changed to reporting triple safe storage on follow-up. The majority of firearm-storing family members of children with MH complaints do not follow triple safe storage practices. Storage practices modestly improved after an emergent MH visit, but over two thirds of participants reported unsecured or partially secured firearms 7 and 30 days later.

Applying Behavioral Economics to Enhance Safe Firearm Storage.

Behavioral economics applies key principles from psychology and economics to address obstacles to behavior change. The important topic of pediatric firearm injuries has not yet been explored through a behavioral economic lens. Pediatric firearm-related injuries are a significant public health problem in the United States. Despite American Academy of Pediatrics guidelines advising that firearms be stored unloaded, in a locked box or with a locking device, and separate from ammunition, estimates suggest that ∼4.6 million children live in homes with at least 1 loaded and unlocked firearm. In this article, we use behavioral economic theory to identify specific cognitive biases (ie, present bias; in-group, out-group bias; and the availability heuristic) that may influence parental decision-making around firearm storage. We illustrate situations in which these biases may occur and highlight implementation prompts, in-group messengers, and increased salience as behaviorally informed strategies that may counter these biases and subsequently enhance safe firearm storage. We also describe other opportunities to leverage the behavioral economic tool kit. By better understanding the individual behavioral levers that may impact decision-making around firearm storage, behavioral scientists, pediatric providers, and public health practitioners can partner to design and test tailored interventions aimed at decreasing pediatric firearm injuries. Further empirical study is warranted to identify the presence of specific biases and heuristics and determine the most effective behavior change strategies for different subpopulations.

Firearm storage practices in households with children: A survey of community-based firearm safety event participants

Safe firearm storage is associated with lower risk of unintentional and intentionally self-inflicted firearm injuries among children and adolescents. Ten community-based firearm safety events were conducted across Washington state from 2015 to 2018. We sought to describe characteristics of event participants and assess whether presence and age of children in the household were associated with household firearm locking practices. We assessed demographic characteristics and baseline firearm storage behaviors of participants using a 13-item survey. Multivariable Poisson regression models were used to estimate prevalence ratios (PR) and corresponding confidence intervals (CI) for the association of presence and age of children in households with prevalence of storing a household firearm unlocked. Of 2956 participants, 58.3% were male and 57.9% lived with an individual under 18 years. Among the 89.8% participants living with firearms, 40.1% stored at least one firearm unlocked and 39.1% stored at least one firearm loaded. In adjusted analyses, there was no statistically significant difference in prevalence of storing a household firearm unlocked between those living with no children (reference group) and those living with a child <11 years (PR = 0.91; 95% CI: 0.80,1.04), or a child aged 11–18 years (PR = 0.94; 95% CI: 0.81,1.09). A high proportion of participants stored a firearm unlocked or loaded at home and neither living with young children nor adolescents was associated with safe locking practices. In comparison with firearm safety interventions conducted in clinic settings, a majority of the participants in these community-based interventions were male and owned firearms.

Use of lethal means restriction counseling for suicide prevention in pediatric primary care

Suicide is the second-leading cause of death for adolescents in the United States. Counseling patients and families on safe storage of firearms and medications is an effective method of suicide prevention. We sought to determine the self-reported frequency of lethal means restriction (LMR) counseling among primary care pediatric providers working with adolescents who are at risk for suicide as well as factors associated with consistently employing LMR counseling. An anonymous, self-report, electronic survey was conducted of primary care pediatricians in the Washington, DC metropolitan area of LMR counseling for suicide prevention. The survey was conducted over 10 weeks in autumn of 2017. Stepwise, multivariate logistic models were used to determine factors associated with firearm screening and LMR counseling for patients at risk for suicide. Response rate was 11% (n = 1546). Over a range of suicide risk scenarios, few respondents reported consistently screening for firearms (21.9%) or employing LMR counseling (19.4%). When adjusting for confounding, five or more years in practice was associated with higher odds of screening for firearms (aOR 4.6 [1.3–16]). Previous LMR training was strongly associated with consistent LMR counseling (aOR 8.3 [1.8–38.4]). While LMR counseling can reduce risk for completed suicide, most respondents do not consistently employ it. Those who have received training are more likely to counsel. Thus, LMR counseling should be a standard part of medical education for pediatricians.

Parents' Perspectives on Safe Storage of Firearms.

Firearms contribute substantially to leading causes of death among US children ages 10-19 (suicide and homicide). Safe storage of guns is important but poorly adopted. This study sought to understand knowledge, attitudes, beliefs, and firearm storage practices among parents living in households with firearms. Focus groups (FG) were conducted with gun-owning parents/guardians in three US states with high firearm ownership. Participants also completed an anonymous survey which included demographic characteristics, previous gun education, purpose of gun ownership, and storage practices. Eight FG were conducted with 57 parents. 74% of participants stored at least one firearm unlocked, with many loaded. Overall risk perception for firearm injury was low. Many participants believed modeling responsible use within the family would demystify the presence of a firearm and decrease accidental shootings. There was strong perception that safe storage interferes with personal protection needs, especially for handguns. Trigger locks were considered a nuisance and rarely used. Parents were confident in their youth's ability to handle guns safely and did not believe that safe storage would deter suicide. Preferred messengers for safe storage education were military or law enforcement rather than physicians. Participants advocated for safe storage education paired with hands-on use education. Gun-owning parents supported safety education and endorsed education from nonmedical sources. Education about suicide prevention may improve adoption of safe storage by parents. These results will inform the development of a firearm safe storage campaign with improved acceptability for communities with high firearms use and ownership.

Promoting Safe Firearm Storage in an Urban Neighborhood: The Views of Parents Concerning the Role of Health Care Providers.

Pediatric clinics are uniquely positioned to assess and advocate for the health and safety of Chicago's children in relation to accidental firearm-related injury and death. The best means of counseling families should be tailored to the individual community and patient population. We aimed to determine rates of firearm ownership and attitudes towards counseling about firearms in a community on the west side of Chicago with high rates of gun violence. An anonymous survey about gun ownership was administered at a federally qualified health center. The survey was completed by 206 adults with children less than 18 living in the home. A minority of participants (8.3%; n = 17) indicated that a gun was kept in or around the home. The majority of firearm owners reported using safe storage practices. However, just over half of the gun owners and non-gun owners had a favorable opinion of counseling about firearm safety in healthcare settings. Other strategies in addition to physician counseling will be required to promote safe firearm storage in this neighborhood with high rates of community violence.

A randomized controlled trial of public messaging to promote safe firearm storage among U.S. military veterans

BackgroundThe objectives of this study were to determine whether short-term exposure to firearm safety messaging significantly improved (1) firearm storage practices, and (2) attitudes of safe firearm storage behaviors among U.S. veterans, a group at elevated risk for firearm suicide. DesignA three-arm, parallel-group RCT was conducted online in the U.S. nationwide from December 2015 to January 2016. SettingA national random sample of U.S. veterans (N = 358) was recruited from the GfK KnowledgePanel, a probability-based internet panel representative of U.S. adults. All study activities were administered online over a three-week study period. InterventionParticipants were randomized and exposed three times (once per week) to either (a) firearm safety message only (n = 115); (b) firearm safety and mental health promotion messages (n = 133); or (c) active control group exposed to mental health promotion message only (n = 110). Each message was less than two minutes long. MeasuresAssessments were completed at baseline (pre-randomization) and at end-of-trial. Changes in awareness of risk for injuries, attitudes/beliefs related to safe storage practices, behavioral intentions, and storage practices were measured using self-reported surveys. Linear mixed effect models with weighted generalized estimating equations were used to test for exposure effects. Analyses were conducted February 2018. ResultsAnalyses restricted to those with baseline firearm access (n = 195) identified no significant changes for intentions or safe storage practices across exposure groups. At baseline, participants’ attitudes and beliefs were generally supportive of safe firearm storage. The Firearm Safety message yielded small increases in agreement with the concept that secure storage is “important during emotional or stressful times” (0.36; 95% CI = 0.08, 0.64). Other significant changes in awareness and beliefs were found, but across all study conditions. ConclusionResults reinforce the critical need for considerable research and testing prior to the widespread implementation of public messages to increase the likelihood for desired exposure effects.

Perspectives from firearm stakeholders on firearm safety promotion in pediatric primary care as a suicide prevention strategy: a qualitative study.

The primary objective of the current study was to examine the perspective of firearm stakeholders, including firearm safety course instructors, members of law enforcement, and firearm retailers, with regard to the implementation of an evidence-based approach to firearm safety promotion, the Firearm Safety Check, as a universal suicide prevention strategy in pediatric primary care. Twelve firearm stakeholders participated in semi-structured interviews. Using an integrated analytic approach, several themes emerged from the interviews. With regard to acceptability of the intervention, participants generally found counseling caregivers to store firearms safely and the provision of firearm locking mechanisms to be acceptable, but expressed concern about screening for firearm ownership in health systems. Participants identified distinct roles of responsibility for firearm advocacy groups, firearm owners, healthcare clinicians, and caregivers with regard to the promotion and execution of safe firearm storage. Participants called for partnerships between healthcare systems and firearm stakeholders, and also identified potential threats to these partnerships, including lack of trust firearm owners may have in health systems and the government. Finally, participants suggested strategies for preventing firearm-related suicides. Findings support a growing body of literature suggesting the value in researchers, health systems, and firearm stakeholders partnering around a shared agenda of firearm safety promotion as a strategy to prevent suicide.

Preferences for Firearm Locking Devices and Device Features Among Participants in a Firearm Safety Event.

IntroductionSafe firearm storage is associated with a lower risk of firearm-related injury and death. Although providing firearm locking devices is a key component of firearm safety interventions, little is known about the types and characteristics of devices preferred by firearm users or others who make decisions about firearm storage. The aim of this study was to describe preferences for firearm locking devices and device features among firearm safety event participants.MethodsWe conducted a cross-sectional survey in the State of Washington in 2016 that assessed participants’ preferences for five firearm locking devices (eg, trigger lock) and seven device features (eg, quick access). We categorized respondents (n=401) as adults in households with 1) all firearms locked, 2) at least one unlocked firearm, and 3) no firearms. We analyzed data in 2017.ResultsDevice ownership and feature preferences varied substantially but were similar across the three household categories. Of those residing with unlocked firearms, 84% reported they would consider using or definitely use a lock box, whereas 11% reported they would never use a trigger lock. Additionally, of those residing with unlocked firearms, 80% and 89% reported that the ability to lock a firearm while loaded and unlock it quickly were, respectively, “very important” or “absolutely essential.”ConclusionParticipants had differing preferences for firearm locking devices and device features, although preferences were largely similar across households with locked, unlocked, or no firearms. At least eight in ten participants reported “great importance” regarding the ability to lock a firearm while loaded and unlock it quickly, which is likely related to perceptions about the utility of safely stored firearms for household protection. Designing firearm safety interventions to match the needs and preferences of those who make firearm storage decisions may improve their effectiveness.

What I have is what I am: Differences in demographics, suicidal thoughts and behaviors, and firearm behavior and beliefs between firearm owners who do and do not primarily identify as firearm owners

Non-legislative forms of means safety (i.e., safe firearm storage practices) have been promoted as a way to reduce elevated suicide risk found among firearm owners. However, evidence suggests that some firearm owners are less willing than others to engage in these practices. The current study aimed to understand factors that differentiate firearm owners’ beliefs and behaviors that are relevant to suicide risk by examining differences between individuals for whom firearm ownership represents a central aspect of identity (i.e., primary firearm owners) versus firearm owners who primarily identify with some other demographic or occupational characteristic. Results of main analyses revealed that primary firearm owners were more likely to be male, were less likely to have experienced suicidal ideation, were less likely to store their firearms safely across a number of storage methods, and were less open to means safety across all storage methods. These findings highlight demographically which firearm owners may be more likely to view firearm ownership as central to their identity and also suggest that this identification may be associated with beliefs and behaviors that increase suicide risk. Future firearm suicide prevention efforts should focus on culturally competent discussions and messaging to find common ground with firearm owners and to increase the salience of suicide among firearm owners.

Association of Increased Safe Household Firearm Storage With Firearm Suicide and Unintentional Death Among US Youths

Firearm injury is the second leading cause of death in the United States for children and young adults. The risk of unintentional and self-inflicted firearm injury is lower when all household firearms are stored locked. To estimate the reduction in youth firearm suicide and unintentional firearm mortality that would result if more adults in households with youth stored household guns locked. A modeling study using Monte Carlo simulation of youth firearm suicide and unintentional firearm mortality in 2015. A simulated US national sample of firearm-owning households where youth reside was derived using nationally representative rates of firearm ownership and storage and population data from the US Census to test a hypothetical intervention, safe storage of firearms in the home, on youth accidental death and suicide. Data analyses were performed from August 3, 2017, to January 9, 2018. Observed and counterfactual household-level safe firearm storage (ie, storing all firearms locked), the latter estimated by varying the probability that a hypothetical intervention increased safe firearm storage beyond that observed in 2015. Observed and counterfactual counts of firearm suicide and unintentional firearm mortality among youth aged 0 to 19 years, the latter estimated by incorporating an empirically based estimate of the mortality benefit expected from additional safe storage (beyond that observed in 2015). A hypothetical intervention among firearm owners residing with children with a 20% probability of motivating these owners to lock all household firearms was significantly associated with a projected reduction in youth firearm mortality (median incidence rate ratio = 0.90; interquartile range, 0.87-0.93). In the overall model, 6% to 32% of deaths were estimated to be preventable depending on the probability of motivating safer storage. Results of this modeling study suggest that a relatively modest uptake of a straightforward safe storage recommendation-lock all household firearms-could result in meaningful reductions in firearm suicide and unintentional firearm fatalities among youth. Approaches that will motivate additional parents to store firearms safely are needed.

ObGyn Physician Knowledge, Comfort, and Current Practices of Firearm Safety Counseling [35F

INTRODUCTION: Homicide and suicide are two of the leading causes of maternal mortality in the United States, with firearms in the setting of intimate partner violence (IPV) responsible for the majority of these deaths. There is no published research evaluating ObGyn physicians' current practices related to firearm safety counseling. METHODS: We performed a pre- and post-test evaluation of ObGyn physicians following a one-hour educational intervention that reviewed maternal mortality due to gun violence, CT State Firearm Law, and best practices for safe storage and use of firearms. IRB approval was obtained through UCONN Health. RESULTS: A total of 78 ObGyn physicians (45 attendings, 30 residents, 3 fellows) completed the educational intervention. Of the study participants, 28.5% reported having had a patient that was killed by a firearm, with IPV accounting for 50% of these reported deaths. Only 13.5% of providers had previously received education related to firearm safety. Following the intervention, providers reported that in the setting of IPV they were more likely to change their practice knowing that there was a firearm in the home (P=.001). Additionally, the educational intervention increased provider comfort with firearm safety counseling (P&lt;.001), knowledge of CT State Firearm Law (P&lt;.001), and knowledge of safe storage and use of firearms (P&lt;.001); which corresponded to the major barriers identified by providers in implementing firearm safety counseling. CONCLUSION: Our educational intervention increased ObGyn physician knowledge and comfort related to firearm safety counseling. Consideration should be given to incorporating education on firearm safety counseling into ObGyn graduate and continuing medical education.

Social workers\u2019 determination of when children\u2019s access or potential access to loaded firearms constitutes child neglect

BackgroundPediatric firearm-related deaths and injuries are a serious societal problem. Our study’s objective was to determine social workers’ assessment of child neglect with respect to access or potential access to a loaded firearm.MethodsStudy invitations were delivered by e-mail to National Association of Social Workers members designating their practice as “Child/Family Welfare” (N = 4933) in October/November, 2015. Demographics, attitudes regarding child access prevention (CAP) laws, and the ages (4–14 years) at which social workers deemed several scenarios as child neglect were determined. Descriptive (frequencies) and bivariate (chi square) analyses were performed.Results485 of 4933 social workers completed the survey (9.8%). Of these, most agreed or strongly agreed (≥92%) there should be laws in place requiring firearms to be stored so unwanted access cannot be obtained by a child, even up to 15 years of age. In a scenario where a child had potential access to a loaded firearm, but never gained access, the presence of a CAP law pertinent to the child in the scenario increased the likelihood respondents would find the situation child neglect for all ages (p < 0.0001 for each age comparison). Moreover, 10.3% felt they could not deem the situation child neglect without the presence of a CAP law, no matter the age of the child. In a scenario where a child gained access to a loaded firearm, the vast majority found this to be child neglect (82–99%, with the percentage varying by the age of the child involved), regardless of the presence or absence of a CAP law and/or an injury being sustained. In addition, when a CAP law was in place, social workers were more likely to find neglect if the child had sustained a firearm-related injury as well (p values ranged from 0.016–0.0081 for age comparisons).ConclusionsThe vast majority of child/family welfare social workers surveyed found it to be child neglect when youth accessed or had potential access to a loaded, unsecured firearm. Results of the study provide support for the passage of universal CAP laws to help protect children equally across states and ensure the safe storage of firearms in homes.

Stakeholder Perspectives on Implementing a Firearm Safety Intervention in Pediatric Primary Care as a Universal Suicide Prevention Strategy

The rate of youth suicide has increased steadily over the past several decades due, in part, to an increase in suicide by firearm. Implementation of evidence-based approaches to increase safe firearm storage practices are important for reducing youth suicide. To assess the needs of stakeholders who would be affected by implementing an evidence-based approach to firearm safety promotion-Firearm Safety Check, which includes screening for the presence of firearms in the home, brief motivational interviewing-informed counseling regarding safe firearm storage, and provision of free firearm locks-in pediatric primary care settings. In this qualitative study, 58 stakeholders were interviewed over a 7-month period across 9 stakeholder groups from 2 large and diverse health systems. Participants included parents of youth; physicians; nurses and nurse practitioners; leaders of pediatric primary care practices, behavioral health, and quality improvement; system leaders; third-party payers; and members of national credentialing bodies. Data analysis were conducted from September 2017 to April 2018. Interview guides were informed by the Consolidated Framework for Implementation Research. An integrated analysis approach was used in which a priori attributes of interest were identified (Consolidated Framework for Implementation Research constructs, eg, intervention characteristics), and an inductive approach was used with regard to new themes that emerged. A total of 58 stakeholders were interviewed (mean [SD] age, 48.38 [10.65] years; 27 men and 31 women). Stakeholders indicated that firearm safety promotion is a health system priority and reported favorable perceptions of the Firearm Safety Check approach for suicide prevention. The importance of leveraging existing infrastructures, such as electronic health record systems and brevity, were frequently noted. Distribution of firearm locks was endorsed as the most complicated component to implement. By including multiple service system stakeholder perspectives, these results support the development of implementation strategies to change clinician, organization, and system behaviors around firearm safety promotion in pediatric primary care as a universal suicide prevention strategy.

Acceptability and Use of Evidence-Based Practices for Firearm Storage in Pediatric Primary Care

ObjectivePromoting safe firearm storage in pediatric primary care is one way to address youth suicide by firearm. The study objective was to determine the perspectives of primary care physicians (PCPs) and leaders of primary care practices regarding the acceptability and use of screening, counseling, and firearm locks—all components of an adapted evidence-based intervention known as the Firearm Safety Check. MethodsIn 2016, an online survey was conducted in two large US health systems. PCPs (n = 204) and leaders (n = 57) from 83 clinics were invited to participate. Respondents included 71 clinics (86%), 103 PCPs (50%), and 40 leaders (70%). Main outcomes included acceptability (6-point Likert scale, with higher scores indicating better acceptability) and use of the 3 intervention components (4-point Likert scale, with higher scores indicating greater use), as measured by an adapted validated instrument. ResultsAnalyses were conducted in 2017. PCP acceptability of screening (mean = 4.28; standard deviation [SD] = 1.12) and counseling (mean = 4.56; SD = 0.89) were high, but acceptability for firearm lock provision was more neutral (mean = 3.78; SD = 1.16). Most PCPs endorsed sometimes screening (85%) and counseling (80%). Few PCPs offered firearm locks to caregivers (15%). Leaders reported consistent information. ConclusionThe acceptability of screening for firearms and safe storage counseling was high; both components were used commonly but not routinely. The acceptability of providing firearm locks was neutral, and use was rarely endorsed. This study provides important insights about areas of focus for future implementation efforts from policy and research perspectives.

Analysis of pediatric gunshot wounds in Houston, Texas: A social perspective

BackgroundThis study sought to determine the role of social factors in pediatric gunshot wounds (GSW). MethodsWe identified medical records of victims aged 0-15 years who presented to our Level 1 pediatric trauma center from 2001 to 2016. ResultsThree hundred fifty-eight children were treated between 2001 and 2016. Patients ranged from 2.5 months to 15 years old (mean = 10.8 years). Two hundred ninety-two patients (81.6%) were male, and 66 (18.4%) were female. The most common anatomic injury location was the head, face, neck, and/or spine (n = 168; 36.2%). 38.3% of injuries (n = 137) were caused by handguns, 25.1% (n = 90) by BB guns, and 12.6% (n = 45) by shotguns/rifles. 45.5% of incidents (n = 163) were intentional; 17 of these (4.7%) were suicide attempts. 48.9% of incidents (n = 175) were accidental. The majority (n = 229) of incidents (64.0%) occurred in a family residence. An adult supervised the victim in only 26.3% of cases (N = 94). Criminal charges were filed in 36 cases (10.1%). Fifteen victims (4.2%) were placed in CPS custody. 12.0% of charts (N = 43) mentioned gun safety education being provided to the family. ConclusionAnalysis of social factors associated with pediatric GSW suggests that many of these injuries could have been prevented with safe firearm storage, increased community education efforts, and other safety measures. Levels of EvidenceLevel III- Retrospective Comparative Study.

CDC Releases Suicide Prevention Guide for States, Communities

Back to table of contents Previous article Next article Professional NewsFull AccessCDC Releases Suicide Prevention Guide for States, CommunitiesMark MoranMark MoranSearch for more papers by this authorPublished Online:12 Oct 2018https://doi.org/10.1176/appi.pn.2018.10b9AbstractPsychiatrists and mental health clinicians may have an especially important role in counseling patients and family members about safe storage of medications, firearms, and other household items that may be used in suicide.The Centers for Disease Control and Prevention (CDC) has published a “technical package” of suicide-prevention strategies that can be used at the state and community levels as well as by psychiatrists and mental health professionals.Christine Moutier, M.D., urges psychiatrists to seek extra training in suicide risk assessment and treatment.The 67-page document, titled “Preventing Suicide: A Technical Package of Policies, Programs and Practices,” describes a select group of strategies based on the best available evidence. These strategies are described in seven chapters that cover the topics of strengthening economic supports, strengthening access and delivery of suicide prevention care, creating protective environments, promoting connectedness, teaching coping and problem-solving skills, identifying and supporting people at risk, and lessening harms and preventing future risk.“States and communities already engaged in suicide prevention can use this technical package to assess their activities and see if there are areas in which to expand their efforts,” said Deb Stone, Sc.D., M.S.W., M.P.H., in comments to Psychiatric News. She is a behavioral scientist in the Division of Violence Prevention at the CDC’s National Center for Injury Prevention and Control. “For states and communities who have not begun work in the area of suicide prevention, this technical package can help guide decision making and prevention planning.”The strategies in the package include those with a focus on preventing suicide and reducing risk as well as approaches to lessen the immediate and long-term harms of suicidal behavior for individuals, families, communities, and society at large.Although primarily intended for policymakers, the technical package can be used by psychiatrists and mental health clinicians. “Psychiatrists may be able to use the package in several ways—by working with their local community organizations to make sure that evidence-based programs are being implemented and helping to raise awareness about the programs and policies described in the technical package,” Stone said. “The broad range of strategies in the technical package requires collaboration across community sectors. Psychiatrists and other health and mental health professionals are critical to the implementation of evidence-based treatments and practices such as Collaborative Assessment and Management of Suicidality, dialectical behavior therapy, and other forms of cognitive-behavioral therapy.” Among the experts who reviewed the CDC document was APA member Christine Moutier, M.D., chief medical officer of the American Foundation for Suicide Prevention (AFSP).In comments to Psychiatric News, Moutier said the technical package builds on a similar document produced by the AFSP’s Action Alliance, “Transforming Communities: Key Elements for the Implementation of Comprehensive Community-Based Suicide Prevention.” The latter outlined very broad public health strategies—planning, communication with stakeholders in the community, aligning activities to the local culture, and ensuring sustainability for long-lasting change.She said the CDC technical package is a more detailed “toolkit” describing specific strategies that have been shown to reduce suicide.Moutier highlighted the need to reduce access to lethal means among people at risk for suicide. In the chapter titled “Create Protective Environments,” the technical package outlines the importance of safe storage of medications, firearms, and other household products that can be used in suicide.“Such practices may include education and counseling around storing firearms locked in a secure place (e.g., in a gun safe or lock box), unloaded and separate from the ammunition; and keeping medicines in a locked cabinet or other secure location away from people who may be at risk or who have made prior attempts,” according to the technical package.Moutier said psychiatrists and other physicians have a critical role in providing such counseling. “If we educate all gun owners that the presence of a gun in the home increases the risk of suicide and we also teach them basic prevention strategies such as safe storage, we have a logical reason to believe it will reduce suicide in the population,” she said.She urged psychiatrists to seek out extra training in suicide risk assessment and evidence-based treatments and to familiarize themselves with the CDC technical package.“It really represents how far we have advanced in community-based suicide prevention,” Moutier said. ■“Preventing Suicide: A Technical Package of Policies, Programs, and Practices” can be accessed here. “Transforming Communities: Key Elements for the Implementation of Comprehensive Community-Based Suicide Prevention” is available here. ISSUES NewArchived

Prevention of firearm injuries with gun safety devices and safe storage: An Eastern Association for the Surgery of Trauma Systematic Review.

Over 50,000 homicides and suicides occur each year. An estimated half of all US households are believed to have a firearm present, making them one of the most ubiquitous consumer products. Our goal was to determine if the manner of storage of a firearm in a home could potentially make a difference in the outcomes of intentional and unintentional injuries involving a firearm; specifically addressing the use of gun safes and devices that block/disable firearm function (trigger locks, cable locks, etc.). A comprehensive review of the literature was performed. We used Grading of Recommendations Assessment, Development, and Evaluation methodology to assess the breadth and quality of the data specific to our Population, Intervention, Comparator, Outcomes (PICO) questions. A total of 176 studies were initially identified, then, 120 more added after a subsequent literature review, with 97 removed as duplicates. One hundred ninety-one case reports, case series, and reviews were removed because they did not focus on prevention or did not address our comparators of interest. This left a total of two studies which merited inclusion for PICO 1, should gun locks be used to prevent firearm injuries and six studies which merited inclusion for PICO 2, should safe storage for guns be used to prevent firearm injuries. PICO 1: We conditionally recommend that gun locks be used to prevent unintentional firearm injury. PICO 2: Because of the large effect size and the reasonable quality of available evidence with safe storage of firearms, we recommend safe storage prevent firearm-related injuries. Systematic review, level III.

A Gun Neutral Partnership to Promote the Safe Storage of Firearms

Background: Pediatric firearm deaths were the leading cause of injury death to Central Ohio children in 2016. Recent studies have shown that 37% of Ohio households contain a gun, yet those families report only 46% of these weapons are stored safely. Discussion around gun safety has historically been emotional and not productive between organizations and citizens with varying opinions about guns. Objective: To bring together organizations and individuals, with different viewpoints about guns in our society, …