title: Psychiatric comorbidity, suicidality, and in-home firearm access among a nationally representative sample of adolescents.
abstract: OBJECTIVE
  Suicide is the second leading cause of death among US adolescents, and in-home firearm access is an independent risk factor for suicide. Given recommendations to limit firearm access by those with mental health risk factors for suicide, we hypothesized that adolescents with such risk factors would be less likely to report in-home firearm access.
  
  
  OBJECTIVE
  To estimate the prevalence of self-reported in-home firearm access among US adolescents, to quantify the lifetime prevalence of mental illness and suicidality (ie, suicidal ideation, planning, or attempt) among adolescents living with a firearm in the home, and to compare the prevalence of in-home firearm access between adolescents with and without specific mental health risk factors for suicide.
  
  
  METHODS
  Cross-sectional analysis of data from the National Comorbidity Survey-Adolescent Supplement, a nationally representative survey of 10,123 US adolescents (age range, 13-18 years) who were interviewed between February 2001 and January 2004 (response rate 82.9%).
  
  
  METHODS
  Risk factors for suicide, including a history of any mental health disorder, suicidality, or any combination of the 2.
  
  
  METHODS
  Self-reported access to a firearm in the home.
  
  
  RESULTS
  One in three respondents (2778 [29.1%]) of the weighted survey sample reported living in a home with a firearm and responded to a question about firearm access; 1089 (40.9%) of those adolescents reported easy access to and the ability to shoot that firearm. Among adolescents with a firearm in home, those with access were significantly more likely to be older (15.6 vs 15.1 years), male (70.1% vs 50.9%), of non-Hispanic white race/ethnicity (86.6% vs 78.3%), and living in high-income households (40.0% vs 31.8%), and in rural areas (28.1% vs 22.6%) (P < .05 for all). Adolescents with firearm access also had a higher lifetime prevalence of alcohol abuse (10.1% vs 3.8%, P < .001) and drug abuse (11.4% vs 6.9%, P < .01) compared with those without firearm access. In multivariable analyses, adolescents with a history of mental illness without a history of suicidality (prevalence ratio [PR], 1.13; 95% CI, 0.98-1.29) and adolescents with a history of suicidality with or without a history of mental illness (PR, 1.20; 95% CI, 0.96-1.51) were as likely to report in-home firearm access as those without such histories.
  
  
  CONCLUSIONS
  Adolescents with risk factors for suicide were just as likely to report in-home firearm access as those without such risk factors. Given that firearms are the second most common means of suicide among adolescents, further attention to developing and implementing evidence-based strategies to decrease firearm access in this age group is warranted.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle2School of Public Health, Department of Health Services, University of Washington, Seattle3Harborview Injury Prevention and Research Center, University of Wash.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Simonetti
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle5Department of Pediatrics, University of Washington, Seattle.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Mackelprang
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle6Department of Epidemiology, University of Washington, Seattle.
authors.forename: Ali
authors.initials: A
authors.lastname: Rowhani-Rahbar
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle7Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.
authors.forename: Douglas
authors.initials: D
authors.lastname: Zatzick
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle5Department of Pediatrics, University of Washington, Seattle6Department of Epidemiology, University of Washington, Seattle8Editor, JAMA Pediatrics.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000293:Adolescent; D015897:Comorbidity; D005260:Female; D005389:Firearms / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology