Project Safe Guard–Trauma (PSG-T): Protocol for a randomized controlled trial of lethal means safety counseling to promote secure firearm storage among individuals with PTSD

Firearm injury is the most common suicide method. When firearms are stored in a non-secure manner (e.g., unlocked, loaded), risk for suicide may be elevated. Accordingly, clinical, public health, and firearm industry stakeholders recommend efforts to promote secure firearm storage, such as lethal means safety counseling (LMSC). One LMSC intervention, Project Safe Guard (PSG), has demonstrated efficacy in prompting use of firearm locking devices in a sample of military service members; however, subsequent analyses show that PSG has diminished efficacy for individuals with elevated symptoms of posttraumatic stress disorder (PTSD). PTSD, characterized in part by hypervigilance to threat, is associated with elevated suicide risk as well as a greater likelihood of storing firearms using less secure methods. In response, our group developed an adaptation of PSG, termed Project Safe Guard-Trauma (PSG-T). This paper describes the design, methodology, and protocol of a randomized controlled trial comparing PSG-T to PSG among adults who screen positive for PTSD related to a victimization trauma (e.g., physical assault, sexual assault, combat) and who do not currently store all their personally owned firearms in a secure manner. PSG and PSG-T will be delivered by licensed clinical psychologists. Assessments will occur at pre-intervention, post-intervention, and 1-, 3-, and 6-month follow-up. The primary objective is to determine the efficacy of PSG-T in prompting greater beliefs and practices regarding secure storage of personal firearms.