Firearms are the most common cause of suicide in the USA.
- The presence of a gun in the home increases the risk of suicide—5x more likely for teenagers and 3x more likely for adults.
In the USA in 2015, 1 in 3 households with children contained firearms, 21% of which contained at least 1 firearm that was both loaded and unlocked. As a result, approximately 4.6 million children lived in a home with loaded and unlocked firearms.
- Nearly all unintentional firearm injuries in children occur in or around the home
- Nearly two-thirds of the 4,368 children up to age 19yo who were killed by guns in 2020 were homicide victims. Another 30% of firearm-related child fatalities were suicides, 3% were accidental and 2% were of undetermined intent
- From 2019 to 2020, the relative increase in the rate of firearm-related deaths of all types (suicide, homicide, unintentional, and undetermined) among children and adolescents was 29.5% — more than twice as high as the relative increase in the general population
As shown in the figure above, firearm-related injury was the leading cause of death in children in 2020, passing motor vehicle crashes for the first time.
In a study of firearm-related injuries in pediatric patients <15yo in Chicago, African-American children comprised 74.9% of the cohort while only representing 35.9% of local schools.
In a review of disparities in firearm-related injuries, overall death rates from firearm injuries among youth were similar in rural and urban communities (4.45 vs 4.29 per 100,000); however, although youth from rural areas were more likely to die from self-inflicted and unintentional firearm injuries, urban youth were more than 2x as likely to die from firearm homicide.
Risks vs Benefits
Families that keep firearms at home often cite need for personal protection, but a 2014 meta-analysis of 6 observational studies found that the risk of becoming a victim of homicide was greater among adults with access to firearms than those without access (OR 2.0, 95% CI).
Most effective practice is to not keep guns in the home.
If you are to have a gun:
- All guns should be LOCKED and UNLOADED
- Ammunition should be locked SEPARATELY from the gun
When using a gun:
- Keep safety catch in place until ready to fire
- Before setting gun down, always unload it
NEVER let children use a gun.
- Children are not capable or responsible enough to handle a potentially lethal weapon
Safety at others’ homes:
- >1/3 of all unintentional shootings of children take place in homes of their friends, neighbors, or relatives
- Ask about guns/safe storage at other homes that kids may visit
- “Is there an unlocked gun in your house?”
- Normalize the question, just as you’d ask about pets, allergies, supervision, and other safety issues
- Remind kids that if they ever come across a gun, they should stay away from it and tell their parents immediately
Limit exposure to guns:
- Limit toy gun play
- Limit exposure to guns in television, movies, or video games
- Make sure to tell kids that in real life, children can be killed or hurt badly by guns
- Screen for guns in the home at well visits
- Guns should be stored unloaded and locked, with ammunition locked away separately
- For children, educate families:
- Increased risk of suicide, homicide, and unintentional injury when there are guns in the home
- Check whether there are unlocked guns at homes where children are visiting
- Limit exposure to guns in media
Blog post based on Med-Peds Forum talk by Ann Ding, PGY4