Randomized Clinical Trial of Lethal Means Safety Counseling for Young Adults at Risk for Suicide with Firearm Familiarity

Each year in the United States, over 44,000 individuals die by suicide, and approximately half of these deaths occur from intentional, self-inflicted gunshot wounds. A crucial component of the clinical management of suicide risk is to ask about firearm ownership/access and to provide lethal means counseling on firearm safety. However, few data exist to inform lethal means safety counseling sessions. To address this gap, we randomly assigned 96 young adults to one of four lethal means safety counseling groups that varied on two dimensions demonstrated by past research to potentially influence health behavior change (i.e., fear appeals, emphasis on temporariness). Lethal means safety counseling groups included: (1) low-fear/low-temporary; (2) low-fear/high-temporary; (3) high-fear/low-temporary; and (4) high-fear/high-temporary. All participants reported a lifetime history of suicidal ideation and either owning a firearm, having access to a firearm, and/or a desire/intention to obtain a firearm in the future. We hypothesized that, by one-month follow-up, individuals randomly assigned to the low-fear/high-temporary group compared to the other three groups would (1) report greater intentions to adhere to clinician recommendations to limit access to firearms for safety purposes; (2) report greater intentions to encourage a loved one to adhere to clinician recommendations to limit access to firearms for safety purposes; (3) report greater increases in engagement in firearm safety thoughts/behaviors; and (4) rate the intervention as more acceptable. Results revealed that individuals randomized to the low-fear/high-temporary group reported significantly greater intentions to adhere to clinician recommendations to limit their access to firearms for safety purposes compared to individuals randomized to the other groups. Of note, this effect size was medium in magnitude, highlighting clinical significance. There were no significant intervention group differences regarding encouraging a loved one to adhere to clinician recommendations. Across groups, 35.4% of participants reported an increase in engagement in firearm safety thoughts/behaviors from pre-intervention to one-month follow-up; however, there were no significant group differences. All intervention groups were rated as similarly highly acceptable. Findings underscore the importance of deemphasizing fear and emphasizing temporariness in lethal means counseling for firearm safety. Findings have the potential to inform clinical and public health approaches to limit at-risk individuals’ access to firearms for safety purposes.