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A Case-Control Study

David A. Brent, MD; Joshua A. Perper, MD, LLB, MSc; Christopher J. Allman; Grace M. Moritz, ACSW; Mary E. Wartella, MSW; Janice P. Zelenak, PhD

JAMA. 1991;266(21):2989-2995.

Abstract
Objective.
—The presence of guns in the home, the type of gun, and the method of storage were all hypothesized to be associated with risk for adolescent suicide.

Design.
—Case-control study.

Subjects.
—The case group consisted of 47 adolescent suicide victims. The two psychiatric inpatient control groups were 47 suicide attempters and 47 never-suicidal psychiatric controls, frequency-matched to the suicide victims on age, gender, and county of origin.

Setting.
—The cases were a consecutive community sample, whereas the inpatients were drawn from a university psychiatric hospital.

Main Outcome Measure.
—Odds of the presence of guns in the home of suicide victims (cases) relative to controls.

Results.
—Guns were twice as likely to be found in the homes of suicide victims as in the homes of attempters (adjusted odds ratio, 2.1; 95% confidence interval, 1.2 to 3.7) or psychiatric controls (adjusted odds ratio, 2.2; 95% confidence interval, 1.4 to 3.5). Handguns were not associated with suicide to any statistically significantly greater extent than long guns. There was no difference in the methods of storage of firearms among the three groups, so that even guns stored locked, or separate from ammunition, were associated with suicide by firearms.

Conclusions.
—The availability of guns in the home, independent of firearms type or method of storage, appears to increase the risk for suicide among adolescents. Physicians should make a clear and firm recommendation that firearms be removed from the homes of adolescents judged to be at suicidal risk.

(JAMA. 1991;266:2989-2995)

Author Affiliations
From the Western Psychiatric Institute and Clinic (Dr Brent, Mr Allman, and Mss Moritz and Wartella), Allegheny County Coroner's Office (Dr Perper), and St Francis Medical Center (Dr Zelenak), Pittsburgh, Pa.

Footnotes
Reprint requests to Services for Teens at Risk, Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213-2593 (Dr Brent).

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