A Physician’s SMART Week Reminder: Recognizing the Role of Firearms in Suicide Is a Matter of Life and Death

August 26–30, 2024, marks the first annual SMART Week. This week is a time when we come together to spread the word on the critical importance of secure gun storage to prevent gun violence. 

Each day, we’ll be sharing a blog post expanding on each letter of the “SMART” acronym:

• Secure
• Model
• Ask
• Recognize
• Tell

SMART Week is built on the foundation of the Be SMART public education program. Be SMART promotes secure gun storage as a means to prevent kids under 18 and other unauthorized users from accessing guns. 

If you or someone you know is in crisis, please call or text 988, or visit 988lifeline.org/chat to chat with a counselor from the 988 Suicide & Crisis Lifeline, previously known as the National Suicide Prevention Lifeline. The 988 Suicide & Crisis Lifeline provides 24/7, free, and confidential support to people in suicidal crisis or emotional distress anywhere in the U.S.

I am a pediatric surgeon at Rainbow Babies and Children’s Hospital in Cleveland, Ohio. In this role, I have witnessed firsthand the devastating impact of gun violence, particularly among our youth.

The number of gun-related suicides among young people, especially within communities of color, has risen alarmingly in recent years. This surge is not just a statistic; it represents real lives—children and teenagers whose potential has been tragically cut short.

Guns are the leading cause of death for children and teens in America. During the pandemic youth firearm suicide reached its highest rate in more than 20 years—and the presence of unsecured firearms in homes is a significant factor. Nearly 16,000 children under 18 died by suicide in the U.S. between 2013 and 2022—an average of four deaths every day. More than 40 percent of these deaths involved a firearm. In the vast majority of the youth firearm suicides, the gun belonged to a parent or other relative.

This crisis of firearm suicide hits close to home for many families, particularly in historically marginalized communities where access to mental health resources is limited. The grief following people dying by firearm suicide is immeasurable. The ripple effects of these tragedies extend beyond families to friends, schools, and entire communities.

The reality is stark: when a gun is easily accessible, the likelihood of a fatal outcome increases dramatically. Studies show that access to firearms quadruples the risk of suicide in children. In my practice, I have seen too many young lives lost to impulsive decisions made possible by easy access to guns.

Years ago, I admitted a patient for injuries related to a fall. The child was from a prominent suburban family and was somewhat ushered through our care system due to his family background. While treating him, I felt there was something unusual about his demeanor.

I asked him about whether he was experiencing depression, and he said no. However, I had the instinct that he might be in denial about this, as were his parents. I asked the family whether there were guns in the home—there were—but did not go deep into the discussion about the importance of secure storage.

A few months after this interaction, the child died by suicide using a gun. I still think about him and wonder if I could have had a stronger impact on the situation had I asked more questions about the firearms in the home.

Healthcare providers must translate our knowledge to our patients and, through them, their families and communities. Secure firearm storage is an important barrier to the impulsive actions of all individuals, especially children and teens experiencing depression or other mental health struggles.

That is why I co-founded the Antifragility Initiative, a holistic, person-centered, and pediatric hospital-based violence intervention program. It is dedicated to promoting recovery from gun violence in Cleveland, Ohio. Through this program, we strive to increase awareness of and educate the public about responsible gun ownership and secure storage as a means of reducing the scourge of child deaths from guns.

The most heartbreaking aspect of this epidemic is that it is preventable. Research shows that securely storing firearms—unloaded, locked away, and with ammunition stored separately—significantly reduces the risk of youth suicide. Parents and guardians must recognize the gravity of having unsecured firearms in the home. It is a matter of life and death.

To the parents and guardians reading this, I implore you to take immediate action.

• Ensure that all firearms in your home are stored securely: unloaded, locked, and kept separate from ammunition.
• Ask about the presence of firearms in the homes where your children visit.
• Educate your peers on the importance of secure storage.
• Have open and honest conversations with your children about the dangers of guns.
• Talk with your children about their mental health and the stressors they may be experiencing. These stressors can include depression, bullying, or a shift in their sense of identity.

The rise in gun-related suicides among young people is a public health crisis that demands urgent action. As a community, we must come together to protect our children. We need comprehensive education on gun safety and secure storage practices, along with greater access to mental health resources. It is time for us to break the silence and take a stand.

By recognizing the role of firearms in these tragedies, we can work toward a future where fewer families experience the heartbreak of losing a child to suicide.

In memory of every young life taken by gun suicide and in hopes of a safer tomorrow, we must Be SMART.

Find more facts and resources on child firearm suicide.

If you or someone you know is in crisis, please call or text 988, or visit 988lifeline.org/chat to chat with a counselor from the 988 Suicide & Crisis Lifeline, previously known as the National Suicide Prevention Lifeline. The 988 Suicide & Crisis Lifeline provides 24/7, free, and confidential support to people in suicidal crisis or emotional distress anywhere in the U.S.

Edward M. Barksdale, Jr., MD, is Surgeon-In-Chief at Rainbow Babies and Children’s Hospital in Cleveland, Ohio. He is also a Professor of Surgery at Case Western Reserve School of Medicine. Dr. Barksdale is an advocate for gun safety and youth well-being, and is the co-founder of the Antifragility Initiative, a holistic, person-centered pediatric hospital-based violence intervention program.