O3231: Caregiver Perspectives on Firearm Safety Guidance for Children Hospitalized for Suicidal Ideation or Attempt

Background: Firearms are the leading cause of death in United States youth and are utilized in over half of youth suicides. The safe storage of firearms significantly decreases the risk of youth suicide. As hospitalizations for pediatric suicidal ideation or attempt (SI/SA) rise, there is a need to explore caregiver perspectives on in-hospital firearm storage guidance. We aimed to explore caregiver receptiveness to firearm safe storage counseling and free firearm locks while their child is hospitalized for SI/SA.

Methods: Using a cross-sectional study design, we surveyed caregivers of children ages 8-21 admitted to the Pediatric Hospital Medicine service for SI/SA at a quaternary children’s hospital in Houston, Texas from June 2023 - March 2024. We used the electronic medical record to identify caregivers of patients with a primary diagnosis of SI/SA and a primary spoken language of English or Spanish. We excluded caregivers who were not the legal guardian. We developed a 26-item anonymous survey, administered using RedCap either in-person, through email, or over the phone after obtaining informed consent. The survey assessed caregiver demographics, firearm ownership and storage practices, firearm discussions with their child’s healthcare team, and willingness to receive firearm storage guidance and free firearm locks. We used Chi-squared or Fisher’s exact tests to compare responses between firearm owners and non-owners.

Results: Of 120 caregivers approached, 84 (70%) enrolled. 29% were firearm owners, 64% were non-owners, and 7% did not disclose. Of all caregivers, 46% reported being asked about the presence of home firearms by their healthcare team; 96% agreed it was important for their child’s hospital team to ask about firearm ownership; 96% thought safe firearm storage counseling by the healthcare team was important; and 87% felt it was important to distribute firearm locks in the hospital. Of firearm owners, 21% reported their firearms were not securely stored. Compared to firearm owners, more firearm non-owners spoke Spanish and identified as other race and Hispanic ethnicity. Firearm non-owners were more likely to think firearm lock distribution was “very important”, however both groups recognized the importance (74% vs 67%, p-value 0.034).

Conclusion: Caregivers of children hospitalized for SI/SA were not consistently counseled on safe storage by their healthcare team. However, most caregivers, both with and without firearms, acknowledged the importance of firearm counseling and distribution of firearm locks during their child’s hospitalization.