(RxWiki News) Talking to parents about their children's risk of suicide can be as difficult as identifying a suicidal teen. A culture of familiarity with guns can complicate the discussion.
A recent study has found that a big part of trying to address suicide risks in children in rural areas needs to be reminding parents that they have guns in the home.
Knowing that easy accessibility to those guns could be dangerous for teens at risk of suicide is paramount.
"Lock up any gun."
Co-authors Jonathan Singer, an assistant professor of social work at Temple University, and Karen Slovak, an associate professor of social work at Ohio University, aimed to find out how therapists and caregivers had helped parents living in rural areas address their suicidal children's mental health needs following a youth suicide assessment.
Singer and Slovak conducted two focus groups with 24 clinicians from the Midwest. The clinicians discussed how they engaged with the parents after a child had been assessed to be at risk for suicide.
As is true with talking to parents of teenagers anywhere about suicide risks, the clinicians in Singer and Slovak's study said they often encountered resistance, shock or a desire to minimize the actual risk of a teen committing suicide when they talked to parents in rural areas.
But the study authors also discovered that many of these clinicians honed in on an aspect of rural families' culture that the families often didn't think about: the commonness and familiarity of guns in the home.
"The clinicians in the study told us that guns were so prevalent in their communities, they were just part of the furniture," Singer said. "So a big part of their job is making the invisible, visible."
Singer said that guns are the most deadly method of attempting suicide. As a case in point, he said boys die four times more often from suicide than girls do even though girls attempt suicide four times more often. Why? Because boys are more likely to use a gun.
Singer said the clinicians needed to discuss guns openly with the parents simply to remind them that they have them, and that just having guns around in the open may make a suicidal teenager more successful at killing themselves in a suicide attempt.
"The conversation needs to focus on keeping guns secure and limiting access to guns," Singer said. "Clinicians need to say, 'Your son could use one of your guns to kill himself.'"
One way clinicians can do this, found Singer and Slovak, is by talking about their own experience with guns so that they gain some credibility when talking with the parents.
As for the parents, it can be tough to watch for signs of suicidal tendencies in their children, according to Glen Elliott, MD, PhD, a clinical professor at the Stanford University Department of Psychiatry and Behavioral Sciences.
Dr. Elliott was not associated with this study but has treated many children as chief psychiatrist and medical director at Children's Health Council, a non-profit mental health facility affiliated with Stanford.
"The difficulty is that many teens (some estimates range as high as 45%) at least passively wish they were dead or think about dying or killing themselves sometime during adolescence," Dr. Elliott said. "Fortunately, the vast majority have no intention of doing anything about such thoughts, and they go away."
He said that suicide, more often than not, follows a specific traumatic or life-changing event in a teen who already has other underlying issues, such as depression, drug use, school difficulties or few friends.
"True suicidal risk usually is a short-lived phenomenon lasting minutes to hours, rarely more than a day or two," Dr. Elliott said. "The risk factors therefore can help point out who might react that way to an acute event, but most don’t have that combination."
He said the best approach for parents is to talk to their teens regularly, in order to have a sense of what is going on in their lives.
"Trying to keep lines of communication open is the best preventative, but really hard to accomplish with many teens," Dr. Elliott said. "Also, basic precautions—not having guns in the home or, if they are there, keeping them securely locked up in a way that even a clever teenager can’t overcome—make sense."
The study was published in the May issue of Child & Family Social Work. No funding or author disclosures were included in the study.