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Research / Funded grants

2016 Focus Grant

An ED-based Randomized Clinical Trial of Lethal Means Counseling for Parents of At-Risk Youth

2 research findings from this AFSP-funded study.

Research finding · May 2024

Receiving lethal means counseling impacted caregivers of adolescents with behavioral health complaints

Suicide attempts in adolescents are often impulsive acts in response to passing and tough-to-predict moments of crisis. Preventative efforts, such as lethal means counseling (LMC), are provided to caregivers in health care settings to reduce access to lethal methods, mainly including firearms and medication. While lethal means counseling has been endorsed by several U.S. medical societies, the application of LMC among clinicians and health care institutions has been limited. To encourage the uptake of LMC in pediatric care, researchers have begun advocating for the use of a shared decision-making model (SDM), which emphasizes a closer collaboration between clinicians and patients.

To examine caregivers' experiences with LMC using the SDM model, Dr. Matthew Miller conducted qualitative interviews with 21 firearm-owning caregivers of adolescents who visited emergency departments in Colorado for behavioral health complaints. Dr. Miller found that caregivers were open to this counseling when clinicians understood their family situation, shared reasons behind the counseling, and discussed safety concerns for their child. However, when counseling was impersonal and didn't consider the family's circumstances, caregivers felt confused and distant. These findings suggest that personalized and sensitive counseling approaches can help caregivers better understand and implement safety measures, potentially reducing suicide risks in adolescents.

Citation: Salhi, C., Beatriz, E., Berrigan, J., Azrael, D., Houston, A., Runyan, C., Barber, C., Betz, M., & Miller, M. (2023). “Your son needs help … and we’re gonna help him”: A qualitative study of the experiences of gun-owning caregivers of adolescents receiving lethal means counseling in the emergency department. Social Science & Medicine, 335. https://doi.org/10.1016/j.socscimed.2023.116218

This finding comes from an AFSP-funded study — see the grant below ↓

Research finding · October 2023

Parents of at-risk youth preferred certain firearm and medication locking devices to others

Suicide is the second leading cause of death among youth ages 10-17, and the methods youth use to attempt suicide typically come from home. Therefore, restricting access to highly lethal methods within the home (e.g., firearms and dangerous medications) provides an immense opportunity for parents and caregivers to protect their children. A central component of lethal means restriction is locking firearms and medication, but a need has been identified for more research to evaluate the effectiveness of the storage devices themselves in order to guide the selection from both safety and consumer preference perspectives.

As part of a large, AFSP-funded, clinical intervention trial (the SAFETY Study) to test the effectiveness of lethal means counseling for parents of youth at risk for suicide, Drs. Matthew Miller, Carol Runyan, and Catherine Barber evaluated feedback on the use and acceptability of different locking devices received from behavioral health clinicians while their children were treated in the emergency department for suicide-related problems. They found a large increase in the use of both medication and firearm locking devices compared to use at the beginning of the study, and that parents preferred some devices (firearm lockboxes vs. cable locks) to others. These results suggest the need for more research on what parents prefer to ensure these vital devices are actually used.

Citation: Barber, C., Azrael, D., Berrigan, J., Betz, M. E., Brandspigel, S., Runyan, C., Salhi, C., Vriniotis, M., & Miller, M. (2022). Selection and Use of Firearm and Medication Locking Devices in a Lethal Means Counseling Intervention. Crisis, 0(0), null, http://dx.doi.org/10.1027/0227-5910/a000855

This finding comes from an AFSP-funded study — see the grant below ↓

The grant behind this work · 2016 Focus Grant

An ED-based Randomized Clinical Trial of Lethal Means Counseling for Parents of At-Risk Youth

Matthew Miller, M.D., MPH, Sc.D.

Matthew Miller, M.D., MPH, Sc.D.

Northeastern University

Carol Runyan, Ph.D.

Carol Runyan, Ph.D.

Harvard University

Cathy Barber, MPA

Cathy Barber, MPA

University of Colorado

Amount awarded
$1,478,266 Focus area
Clinical Treatment

Inside the Research

Question: Does lethal means counseling for parents of adolescents at high risk for suicide positively affect decisions related to access to lethal means in the home?

Strategy: One way for AFSP to reach its goal of reducing suicide 20% by 2025 is to support efforts to reduce the use of lethal means in suicidal acts. One promising strategy — “lethal means counseling” (LMC)— is to counsel patients at risk of suicide, or their families, to store household firearms and medications away from home, or locked inaccessibly, until the patient recovers. This study will be conducted in six Colorado hospitals and will test whether parents of at-risk adolescents who are treated in hospitals that have implemented a LMC protocol are more likely to store household firearms and medications safely relative to before the hospital provided LMC. Factors that affect parents’ willingness and ability to make changes to firearm and medication storage will be explored.

Impact: Increased proactive behaviors to reduce access to lethal means and the potential for reduced rates of suicide.

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