Adolescent Suicide Risk, Firearm Access, and Family Functioning: Screening in Primary Care

• Published in: Families systems & health 2023-03, Vol.41 (1), p.16-25
• Main Authors: Weissinger, Guy, Myhre, Karoline, Ruan-Iu, Linda, Van Fossen, Catherine, Diamond, Guy
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent Psychology; Adult; Child & adolescent mental health; Family; Family Members; Female; Firearms; Health Screening; Human; Humans; Male; Medical research; Mental Health; Primary care; Primary Health Care; Risk Assessment; Suicidality; Suicide; Suicides & suicide attempts; Teenagers; United States; Violence
• ISSN: 1091-7527; 1939-0602
• DOI: 10.1037/fsh0000680

Introduction: Suicide is a serious mental health concern and the second leading cause of death for adolescents in the United States. Suicide risk is a complex interaction of social, psychological, and physiological factors. Previous research has identified family functioning as being related to adolescent suicide risk, but it is not well studied in clinical settings. This study uses the Behavioral Health Screen-Primary care (BHS-PC) to examine the relationship between current suicide risk in adolescent and a dysfunctional family environment. Method: Adolescents presenting for primary care appointments (n = 6,609; age 14-17) completed the BHS-PC, a broad-based, psychometrically validated screening tool that measures a wide range of adolescent behavioral and mental health concerns. Using data from the BHS-PC, hierarchical logistic regression modeling was used to build and compare models of current suicide risk to determine the effect of including family factors. Fisher's Exact test was utilized to examine the relationship between family functioning and firearm access, a critical factor in youth safety and risk of completing suicide. Results: In the final model, three family functioning related variables were associated with current suicide risk in adolescents: never talking to adult family member about their concerns, witnessing violence in the home, and arguing in the home. In addition, all but one family functioning factor was related to adolescent firearm access. Conclusions: Family functioning and access to firearms are critical to understanding adolescent suicide risk. Utilizing a holistic approach in primary care to screen for adolescent suicide risk may improve clinical response and linkages to care. Public Significance Statement Family functioning factors are important to consider when screening adolescent mental health in the primary care setting. Their inclusion can both improve suicide risk screening and provide contextual information to improve provider response to adolescent suicide risk and mental health concerns.