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Identifying Suicide Risk in Adolescents With Firearm Access: Screening in the Emergency Department

  • Samaa Kemal
    Correspondence
    Address correspondence to Samaa Kemal, MD, MPH, Emergency Department, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave Box 62, Chicago, IL 60611
    Affiliations
    Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago (S Kemal), Chicago, Ill

    Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia (S Kemal, P Krass, and JA Fein), Philadelphia, Pa
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  • Polina Krass
    Affiliations
    Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia (S Kemal, P Krass, and JA Fein), Philadelphia, Pa

    Center for Violence Prevention, Children's Hospital of Philadelphia (P Krass, L Brogan, and JA Fein), Philadelphia, Pa

    PolicyLab, Children's Hospital of Philadelphia (P Krass), Philadelphia, Pa

    National Clinician Scholars Program, University of Pennsylvania (P Krass), Philadelphia, Pa
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  • Leah Brogan
    Affiliations
    Center for Violence Prevention, Children's Hospital of Philadelphia (P Krass, L Brogan, and JA Fein), Philadelphia, Pa

    Stoneleigh Foundation (L Brogan), Philadelphia, Pa

    Department of Psychology, Drexel University (L Brogan), Philadelphia, Pa
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  • Jungwon Min
    Affiliations
    Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia (J Min and WO Quarshie), Philadelphia, Pa
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  • William O. Quarshie
    Affiliations
    Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia (J Min and WO Quarshie), Philadelphia, Pa
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  • Joel A. Fein
    Affiliations
    Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia (S Kemal, P Krass, and JA Fein), Philadelphia, Pa

    Center for Violence Prevention, Children's Hospital of Philadelphia (P Krass, L Brogan, and JA Fein), Philadelphia, Pa
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      Abstract

      Objective

      This study compares current suicidal ideation, prior suicide attempt and associated self-reported risk factors in adolescents with and without access to firearms.

      Methods

      Using data from a clinically applied behavioral health assessment completed by adolescents presenting to a tertiary children's hospital emergency department (ED; N = 15,806), we evaluated the association between firearm access (ie, firearm in the home or ability to obtain one within 24 hours), each of the included suicide risk factors (ie, depressive symptoms, trauma victimization, bullying victimization), and our primary outcomes (ie, current suicidal ideation and prior suicide attempt). We performed regression analyses on 3 groups: 1) The overall population; 2) Only the participants with firearm access; and 3) Only the participants without firearm access.

      Results

      Fourteen percent (2179/15,806) of the sample reported a firearm in the home or ability to access one within 24 hours. Overall, 6.8% of participants reported current suicidal ideation and 9.1% reported prior suicide attempt. Youth with firearm access had 1.52 times higher odds of current suicidal ideation and 1.61 times higher odds of prior suicide attempt compared to youth without firearm access. All included suicide risk factors were found to significantly increase the odds of current suicidal ideation and prior suicide attempt in the overall sample; this increase was similar in the groups with and without firearm access.

      Conclusions

      Adolescents with firearm access have higher odds of suicidal ideation and prior attempt compared to those without firearm access, highlighting the need for universal ED-based screening for suicidality and lethal means.

      Keywords

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