Familial firearm culture among the families of youth who died by firearm suicide in Maryland: a qualitative analysis of psychological autopsy interviews.

backgroundSuicide is a leading cause of death among adolescents in the USA, with firearm-related suicides comprising approximately half of these deaths. This study explores culturally rooted firearm perspectives among the families of youth who died by firearm suicide, including families' perspectives on suicide prevention interventions such as extreme risk protective orders (ERPOs).

methodsWe performed psychological autopsy interviews with the relatives of youth aged 15-21 who died from firearm-related suicide in Maryland between 2013 and 2021. Using an iterative, inductive, analytical approach, two researchers reached consensus on themes.

resultsWe interviewed 17 individuals, including the relatives and friends of 13 decedents. Three themes emerged: (1) multigenerational family histories of engagement with firearm culture, (2) interviewee perceptions of the low risk firearms posed to families and (3) diverse perspectives on the utility of firearm suicide mitigation approaches. Nearly all (92%) interviewees described familial engagement with firearms, with most (77%) decedents using family-owned firearms in their suicide. Though most (85%) decedents were treated for mental illness, many interviewees did not consider or were not told by clinicians that family-owned firearms were sources of danger. Half (46%) would have filed ERPOs had they known the option existed.

conclusionThis study documents familial firearm narratives influencing families' conceptualisation of firearm risk, including during periods when youth exhibited suicide warning signs. It suggests that suicide prevention interventions must help families rescript firearms from tools of familial cohesion and conveyors of intergenerational history to instruments that pose a threat to youth with suicide risk factors.