{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T11:45:24Z","timestamp":1791632724556,"version":"4.3.4"},"reference-count":40,"publisher":"BMJ","funder":[{"name":"James Wah Fund For Mood Disorders Research"},{"DOI":"10.13039\/100000026","name":"National Institute of Drug Abuse","doi-asserted-by":"crossref","award":["K23DA055693"],"award-info":[{"award-number":["K23DA055693"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"accepted":{"date-parts":[[2025,11,22]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Suicide 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\u2019 perspectives on suicide prevention interventions such as extreme risk protective orders (ERPOs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed psychological autopsy interviews with the relatives of youth aged 15\u201321 who died from firearm-related suicide in Maryland between 2013 and 2021. Using an iterative, inductive, analytical approach, two researchers reached consensus on themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study documents familial firearm narratives influencing families\u2019 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/ip-2024-045490","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T10:35:22Z","timestamp":1765535722000},"page":"ip-2024-045490","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Familial firearm culture among the families of youth who died by firearm suicide in Maryland: a qualitative analysis of psychological autopsy interviews"],"prefix":"10.1136","author":[{"given":"Matthew","family":"Kelly","sequence":"first","affiliation":[{"name":"Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA"},{"name":"Psychiatry, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aubrey","family":"Devinney","sequence":"additional","affiliation":[{"name":"Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Bryant","sequence":"additional","affiliation":[{"name":"Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Dean","sequence":"additional","affiliation":[{"name":"Maryland Office of the Chief Medical Examiner, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Li","sequence":"additional","affiliation":[{"name":"Maryland Office of the Chief Medical Examiner, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3387-2150","authenticated-orcid":false,"given":"Alan Lee","family":"Berman","sequence":"additional","affiliation":[{"name":"Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Wilcox","sequence":"additional","affiliation":[{"name":"Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA"},{"name":"Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2479-703X","authenticated-orcid":false,"given":"Paul","family":"Nestadt","sequence":"additional","affiliation":[{"name":"Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA"},{"name":"Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"2025121202351498000_ip-2024-045490v1.1","unstructured":"CDCa . 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