Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States.
Front Public Health. 2024 May 22;12:1352815. doi: 10.3389/fpubh.2024.1352815. eCollection 2024.
Firearm-related suicide is the second leading cause of pediatric firearm death. Lethal means counseling (LMC) can improve firearm safe-storage practices for families with youth at risk of suicide.
This study aims to evaluate the feasibility of pediatric emergency department (ED) behavioral mental health (BMH) specialists providing LMC to caregivers of youth presenting with BMH complaints and to test for changes in firearm safety practices, pre-post ED LMC intervention, as measures of preliminary efficacy.
Prospective pilot feasibility study of caregivers of youth presenting to a pediatric ED with BMH complaints. Caregivers completed an electronic survey regarding demographics and firearm safe-storage knowledge/practices followed by BMH specialist LMC. Firearm owners were offered a free lockbox and/or trigger lock. One-week follow-up surveys gathered self-reported data on firearm safety practices and intervention acceptability. One-month interviews with randomly sampled firearm owners collected additional firearm safety data. Primary outcomes were feasibility measures, including participant accrual/attrition and LMC intervention acceptability. Secondary outcomes included self-reported firearm safety practice changes. Feasibility benchmarks were manually tabulated, and Likert-scale acceptability responses were dichotomized to strongly agree/agree vs. neutral/disagree/strongly disagree. Descriptive statistics were used for univariate and paired data responses.
In total, 81 caregivers were approached; of which, 50 (81%) caregivers enrolled. A total of 44% reported having a firearm at home, 80% completed follow-up at one week. More than 80% affirmed that ED firearm safety education was useful and that the ED is an appropriate place for firearm safety discussions. In total, 58% of participants reported not having prior firearm safety education/counseling. Among firearm owners ( = 22), 18% reported rarely/never previously using a safe-storage device, and 59% of firearm owners requested safe storage devices.At 1-week follow-up ( = 40), a greater proportion of caregivers self-reported asking about firearms before their child visited other homes (+28%). Among firearm owners that completed follow-up ( = 19), 100% reported storing all firearms locked at one week (+23% post-intervention). In total, 10 caregivers reported temporarily/permanently removing firearms from the home.
It is feasible to provide LMC in the pediatric ED via BMH specialists to families of high-risk youth. Caregivers were receptive to LMC and reported finding this intervention useful, acceptable, and appropriate. Additionally, LMC and device distribution led to reported changes in safe storage practices.
与枪支有关的自杀是儿童枪支死亡的第二大主要原因。枪支相关自杀死亡预防咨询（Lethal Means Counseling，LMC）可以改善有自杀风险的儿童家庭的枪支安全储存措施。
本研究旨在评估儿科急诊（ED）行为心理健康（BMH）专家为有 BMH 投诉的青少年的照顾者提供 LMC 的可行性，并测试 ED 内 LMC 干预前后枪支安全措施的变化，作为初步疗效的衡量标准。
前瞻性试点可行性研究，纳入在儿科 ED 就诊有 BMH 投诉的青少年的照顾者。照顾者完成了一份关于人口统计学和枪支安全知识/实践的电子调查，随后由 BMH 专家进行 LMC。为枪支所有者提供免费的保险箱和/或扳机锁。一周后进行随访调查，收集枪支安全实践和干预可接受性的自我报告数据。对随机抽取的枪支所有者进行一个月的访谈，收集更多的枪支安全数据。主要结局是可行性指标，包括参与者的招募/流失和 LMC 干预的可接受性。次要结局包括自我报告的枪支安全实践变化。通过手动制表来衡量可行性基准，Likert 量表的可接受性反应被分为强烈同意/同意与中立/不同意/强烈不同意。使用描述性统计对单变量和配对数据进行响应。
共接触了 81 名照顾者，其中 50 名（81%）同意入组。共有 44%的人报告家中有枪支，80%的人在一周时完成了随访。超过 80%的人认为 ED 枪支安全教育是有用的，ED 是进行枪支安全讨论的合适场所。共有 58%的参与者表示之前没有接受过枪支安全教育/咨询。在枪支所有者中（ = 22），18%的人表示很少/从未使用过安全储存设备，59%的枪支所有者要求提供安全储存设备。在一周随访时（ = 40），更多的照顾者自我报告说在孩子去其他家庭之前询问了枪支情况（增加了 28%）。在完成随访的枪支所有者中（ = 19），100%的人报告在一周内将所有枪支上锁（干预后增加了 23%）。共有 10 名照顾者报告暂时/永久将枪支从家中取出。
通过 BMH 专家在儿科 ED 中提供 LMC 是可行的，适用于高危青少年的家庭。照顾者对 LMC 很接受，并表示发现这种干预措施有用、可接受和合适。此外，LMC 和设备的分发导致安全储存措施的报告发生变化。
