Rising Rates of Adolescent Firearm Suicide and the Clinician's Role in Addressing Firearms.

Suicide is a leading cause of death of 10- to 19-year-olds in the United States.1 Firearms were used in 48% of suicides of 15- to 19-year-olds and in 38% of suicides of 10- to 14-year-olds in 2020.1 During the COVID-19 pandemic, gun sales surged, leading to increases in household firearm ownership,2 a known risk factor for suicide.3 There are many ways in which adolescents access firearms. Most commonly, adolescents encounter firearms owned by an adult in the home. One study showed that one-third of adolescents reported they could access a loaded household gun in less than 5 minutes, even in households where parents did not believe that their child could access a household firearm.4 Another study found that 39% of parents who reported that their children did not know the location of household guns, and 22% of parents who reported that their children had never handled a household gun, were contradicted by their children's reports.5Adolescents can legally own rifles or shotguns if gifted to them by a parent. Federal law (18 U.S.C. 922) prohibits possession of handguns by minors less than 18 years of age; however, there are no federal minimum age requirements for possession of long guns (shotguns, rifles).Social media contributes to adolescent gun culture. TikTok users have created and viewed popular videos about guns,6 including videos with instructions on building guns from hardware store materials or via 3D printing. Adolescents can purchase kits online to assemble fully functional handguns. No federal restrictions or background check requirements exist on who can purchase "ghost gun" kits.7Child and adolescent mental health providers often assess suicide risk with a screening tool such as the Columbia-Suicide Severity Rating Scale, with a clinical assessment, or with a combination of both. Either way, the assessment should include asking about access to lethal means, including firearms. Many adolescent suicide attempts are impulsive; completed suicides may be prevented if access to firearms is limited during periods of crisis.8 However, many clinicians do not talk about firearms with patients even when clinically relevant.9 This may be due to assumptions that adolescents do not have access to firearms, or to lack of comfort with this topic. One study surveying medical residents reported the most common barriers to providing firearm counseling were not knowing how to ask about firearm access and not knowing how to respond to patients' answers about firearm access.9Once identifying an adolescent at risk for suicide, clinicians can intervene by providing evidenced-based interventions tailored to each situation. In this article, we present steps adapted from the BulletPoints Project for clinicians to intervene with adolescents at risk for firearm suicide.

Suicide prevention efforts in the United States and their effectiveness.

PURPOSE OF REVIEW: Suicide is a serious public health problem in the United States, and suicide rates have been increasing for more than a decade. Rural areas are more impacted than urban areas, reinforcing that social, cultural, and economic factors contribute to risk. This article reviews recent work about these contributors to suicide and how they may inform prevention efforts. RECENT FINDINGS: Current research has shown that suicide is more than a mental health problem with a psychiatric or medical solution. Universal screening and referral by gatekeepers target a large group with a low baseline risk, and there are few treatments proven to reduce death by suicide, as well as a severe shortage of mental health providers in the United States to provide them. Instead, suicide prevention polices can target various other factors that contribute to elevated suicide risk at the population level, including reducing socioeconomic deprivation and access to firearms, both of which are often higher in rural areas. Internet-based interventions also hold promise as they are highly scalable, accessible almost anywhere, and often anonymous. SUMMARY: Understanding factors that increase suicide risk guide development of evidence-based policies targeted at high-risk groups. Population-level interventions should be developed in collaboration with the target audience for cultural appropriateness.

Concomitant occurrence of FXTAS and clinically defined sporadic inclusion body myositis: report of two cases.

This report describes unique presentations of inclusion body myositis (IBM) in two unrelated patients, one male and one female, with genetically and histologically confirmed fragile X-associated tremor/ataxia syndrome (FXTAS). We summarize overlapping symptoms between two disorders, clinical course, and histopathological analyses of the two patients with FXTAS and sporadic IBM, clinically defined per diagnostic criteria of the European Neuromuscular Centre. In case 1, a post-mortem analysis of available brain and muscle tissues is also described. Histopathological features (rimmed vacuoles) consistent with clinically defined IBM were detected in both presented cases. Postmortem testing in case 1 revealed the presence of an FMR1 premutation allele of 60 CGG repeats in both brain and skeletal muscle samples. Case 2 was a premutation carrier with 71 CGG repeats who had a son with FXS. Given that FXTAS is associated with immune-mediated disorders among premutation carriers, it is likely that the pathogeneses of IBM and FXTAS are linked. This is, to our knowledge, the first report of these two conditions presenting together, which expands our understanding of clinical symptoms and unusual presentations in patients with FXTAS. Following detection of a premutation allele of the FMR1 gene, FXTAS patients with severe muscle pain should be assessed for IBM.