I haven't read the entire thread but as a psychiatrist I can tell you that access to firearms is a standard question on all initial evaluations, particularly in patients with current or past suicidal thoughts/violent ideations. I can't speak for general pediatrics but in terms of youth suicide, access to firearms is the most important measure to assess. Most youngsters commit suicide via firearms. It's a question on the board exam every single year. Not only psychiatry but the psychiatry section of general medicine boards.
Serious questions. I have no first hand experience with care of suicidal patients from any perspective, but your comments trigger a number of questions for me. If they come off as combative, I apologize, I do not intend a personal attack, but rather an honest questioning of the science and SOPs in this field.
Isn't it most MALE youngsters who commit suicide by firearms? I believe the total male rate is something like 55% by firearms while for females it is 30% (please forgive me if the numbers are a bit off - I no longer have access to all the journals, much to my dismay, and this is not my area of expertise so I may not be looking at the best sources). So is it standard practice to handle female patients on the basis of male standards of care? Females are not most at risk of suicide via gunshot, so focusing on the presence of guns, as opposed to the means which they, statistically do prefer, is providing substandard care for women by assuming that they function the same as men. I had thought that such things were discredited some time ago as science has realized that different age/gender/ethnic backgrounds are not interchangeable and that biological differences which are critical for providing good care must be considered.
If the presence of a firearm is in fact a RISK FACTOR for suicide, then one would expect to have seen a decrease in suicides in, e.g. the UK and Australia after they instituted gun bans. Can you point me to any such study? All I see are reports of decreases in suicides by gunshot, which is not the same thing. If there is restricted access to firearms, one would logically expect gunshot deaths to decrease. However, logically, I would also expect suicide deaths overall to be unchanged - there are a number of alternative means, and I would expect that you would simply see an increase in suicide by non-gunshot methods. So is the presence of a firearm a risk factor for suicide or just a risk factor for suicide by gunshot? One is important, the other is immaterial. I don't give a fig HOW they die, they're still dead.
I can't speak for general pediatrics but in terms of youth suicide, access to firearms is the most important measure to assess.
I would love to have you clarify this, because as written, i.e. "the most important measure to assess," it would seem that the field believes that access to a firearm is more important than, e.g. existence/strength of a support network, family history of suicide/suicidal thoughts, intensity of suicidal thoughts, presence of depressive triggers (such as a bully, abuser, etc), desire to seek help, etc. Is that really what you mean? If a patient says "I am feeling suicidal", the most important thing to know is whether or not they have access to a firearm?
