Survey Finds Parents of At-Risk Kids Don’t Safely Store Guns

A child’s history of risk factors for self-harm does not appear to influence caretaker decisions about whether to keep firearms in the home, or whether those firearms are kept unloaded and in locked storage.

That’s the finding from an analysis of data from an online survey published in February in Pediatrics.

“Given the prevalence of household firearms in the United States, our findings suggest that millions of U.S. children are placed at substantially higher risk of fatal firearm injury, especially suicide, than would be the case were parents to follow guidelines first put forward by the AAP [American Academy of Pediatrics] more than a quarter century ago,” wrote John Scott, B.S., Deborah Azrael, Ph.D., and Matthew Miller, M.D., M.Sc., of Northeastern University and Harvard University.

The researchers used data from a web-based survey conducted by the survey firm Growth for Knowledge (GfK) to assess firearm ownership, storage practices, and use among a nationally representative sample of U.S. adults.

Respondents were asked about gun ownership and about various storage practices for their household guns, including the number of guns stored and whether they were locked and unloaded. Participants were also asked if there were children living in the household and, if so, what their relationship was to these children.

Respondents who reported to be the caregiver or health care decision maker (“parent”) of a child under 18 were also asked if this child had attention-deficit/hyperactivity disorder (ADHD), depression, or another mental health condition. Respondents who answered “yes” to any of these were said to have a child with a self-harm risk factor. (Respondents were not asked whether children ever received a formal diagnosis.)

Of 3,949 respondents, approximately 1 in 3 U.S. households contained firearms (34.8 percent), irrespective of whether the household included children. Among the subset of adults who self-identified as parents, approximately 2 in 5 households contained firearms (42.4 percent). Among parents who said they owned guns, 34.9 percent stored all guns locked and unloaded when they had a child with a history of self-harm risk factors, compared with 31.8 percent when none of their children had such a history.

The authors noted that guidelines intended to reduce firearm injury to children, first issued by AAP in 1992 and updated in 2012, “assert that whereas the safest home for a child is one without firearms, risk can be reduced substantially, although not eliminated, by storing all household firearms locked, unloaded, and separate from ammunition.” According to the study authors, the AAP recommendations reflect the following three observations:

• The source of most of the firearms involved in suicide (and unintentional firearm deaths) among children is their home.

• The presence of guns in a child’s home substantially increases the risk of suicide (and unintentional firearm deaths).

• Employees with TRD were absent approximately 35.8 work days per person a year, which was nearly twice as many days as those with non-TRD depression and six times as many days as those without depression.

• The risk of unintentional and self-inflicted firearm injury is lower in homes that store firearms unloaded (compared with loaded) and locked (compared with unlocked).

Child psychiatrist Steven Berkowitz, M.D., who reviewed the report for Psychiatric News, said he believes the study probably underestimates the number of gun owners who are not storing firearms in the manner recommended by AAP.

“I think it’s really important to recognize that the kids in the study counted as ‘at risk’ had been identified as such by their parents,” he said in an interview. “There are probably many more kids who have psychiatric illness but are not recognized by their parents as being at risk. The other piece of this is that younger children in the home who have no understanding about a gun and what it can do may be regarded as at greater risk than older children diagnosed with a disorder.”

Berkowitz said that in his own clinical experience, he has never had a parent refuse to answer questions about gun storage or respond that it was none of his business. “My sense is, however, that there may be many parents who say they don’t have guns in the home when in fact they do,” he told Psychiatric News.

Berkowitz, who is co-chair of the Trauma And Disaster Committee of the American Academy of Child and Adolescent Psychiatry, said Children’s Hospital of Philadelphia is planning a project to deliver lock boxes for guns and trigger locks to gun-owning parents. The project was initiated by Seattle Children’s Hospital.

In an editorial accompanying the Pediatrics survey, David C. Grossman, M.D., M.P.H., of the Kaiser Permanente Washington Health Research Institute, said clinicians caring for teenagers play a critical role in preventing youth suicide, including routine screening of adolescents for depression and ascertaining information about firearms in the household and their storage.

“When screening yields concerns of depression, a natural opportunity arises to ask about access to household firearms and provide intensive behavioral counseling on safe storage,” Grossman wrote. “Ongoing treatment of teenage depression involves systematic monitoring of treatment effectiveness, possibly including message reinforcement about firearm storage. Clinicians may need to engage other family members to ensure that treatment and storage recommendations are followed.” ■