You are concerned about a patient you are seeing who has recently completed a PHQ9 depression screen during a wellness checkup and scored 13. The adolescent has responded ‘No’ to all questions on the ASK Suicide Risk Screening Tool questions. In addition, the parent has concerns and has shared with you some recent changes in the household and school, including recent separation of parents and the child being bullied at school. Upon further discussion with the father, he shares that he does own a firearm which he reports keeping around for protection in case of an intruder. What would be the best recommendation to give to this father regarding storage of his firearm?
EXPLANATION
The adolescent described has some individual, family, peer/social factors that put them at potential risk for violent behavior. It is important to screen this adolescent for depression and inquire about bullying. Based on this patient’s depression screen, they have moderate depression and should receive outpatient cognitive behavioral therapy, pharmacotherapy should be discussed and considered in addition to close follow-up visits in the office. In this instance it would be important to assist this family with addressing some of the changes they have been adjusting to, offering behavioral supports and linkages; and with consent from the parent, collaborating with the schoolteacher or counselor to discuss any concerns regarding bullying. With regards to recommendations on safe firearm storage, the recommendation should be to advise the firearm be stored unloaded and locked. Additionally, the ammunition should be locked and stored separately from the firearm.
REFERENCES
• Fowler KA., Dahlberg LL, Haileyesus T, Gutierrez C, and Bacon S. Childhood firearm injuries in the United States. Pediatrics. 2017; 140 (1): 1-11. https://doi.org/10.1542/peds2016-3486
• Carter PM. , LJ Cook, M Macy, M. Zonfrillo, et al. Individual and Neighborhood characteristics of children seeking emergency department care for firearm injuries within the PECARN Network. Acad Emerg Med. (2017). 24(7): 803-813. doi.10.1111/acem.13200.
• Lee, L., E. Fleegler, M. Goyal, K. Fraser, et. al. THE COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION. Firearm-Related Injuries and Deaths in Children and Youth: Injury Prevention and Harm Reduction. Pediatrics (2022) 150 (6): e2022060070. https://doi.org/10.1542/peds.2022-060070
